由於醫療服務具高度專業性，故醫療照護市場長期存在資訊不對等的問題。隨著消費者利益保護及病人權利運動的興起、民眾被要求在自己的健康上承擔更多的責任，積極參與健康決策、新資訊科技的發明，使得醫院醫療與服務品質資訊的收集更容易且成本更低廉，因此，歐美各國近年來積極建立健康照護市場的品質資訊，發展醫院品質報告卡，提供民眾就醫選擇所需的資訊，期望能達成保障民眾的醫療權益，同時促使醫院提升醫療與服務品質，及增進醫療照護市場運作效率的目標。
台灣自1995年起實施全民健康保險制度，醫院與中央健康保險局的特約率達90%以上，民眾享有極大的自由選擇就醫地點及醫院，然而到目前為止，仍然欠缺足夠的醫院醫療與服務品質資訊提供給民眾做為選擇醫院的參考。其次，相關研究的結果顯示，台灣民眾對於就醫選擇資訊的提供有高度的興趣，且對民眾就醫選擇決策亦有重大的影響。
目標：本研究旨在由民眾觀點篩選醫院醫療與服務品質報告卡的指標項目，及採用創新擴散理論(innovation diffusion theory)，以結構方程模式(structural equation model)探討住院病人對醫院醫療與服務品質報告卡創新特性的知覺、態度及使用意願。
方法：本研究首先以推動社會福利、關心民眾健康權益及病人團體的30位專家為研究對象，進行二回合的德菲法(Delphi method )問卷調查篩選醫院醫療與服務品質報告卡的指標項目。其次以台北縣市不同層級及權屬別的八家醫院內、外科共500位住院病人為研究對象進行面訪問卷調查，探討住院病人創新接受度、對醫院醫療與服務品質報告卡創新特性的認知、態度及使用意願，並以結構方程模式進行研究假說與架構的驗證。
結果：1.由民眾觀點所選出屬於高適用性且高重視度的指標項目計有院內感染率、手術傷口感染率、住院病人對醫師病情解說內容的滿意度、門診病人對醫師服務態度的滿意度等九項；2.只有17.2%的住院病人在填問卷前有聽過醫院醫療與服務品質報告卡這個名詞；3.有80.2%的住院病人認為醫院醫療與服務品質報告卡對選擇醫院是非常有價值或有價值的；4.住院病人對服務品質指標的瞭解程度相對地高於對醫療品質指標的瞭解程度；5.對呈現方式的瞭解程度由高至而低排序，依序為星號、百分比、長條圖；6.影響「住院病人是否看懂醫院醫療與服務品質資訊」的因素，在控制其他變項的影響後發現，教育程度愈高者、年齡愈輕者、個人平均月收入較高者，較看懂醫院醫療與服務品質報告卡範例中指標資訊；7.創新特性中，「相容性」及「結果展示性」對「對醫院醫療與服務品質報告卡的態度」具有正向的顯著影響；8.「知覺有用性」、「對醫院醫療與服務品質報告卡的態度」及「創新接受度」對「使用醫院醫療與服務品質報告卡的意願」具有正向的顯著影響；9.影響住院病人「對醫院醫療與服務品質報告卡的態度」最主要因素為「相容性」，且達到統計上的顯著水準；10.影響住院病人「使用醫院醫療與服務品質報告卡的意願」的最主要因素為「對醫院醫療與服務品質報告卡的態度」，且達到統計上的顯著水準；11.最後要特別強調的是，本研究的新發現為「知覺有用性」、「知覺易用性」、「相容性」、「結果展示性」、「創新接受度」，兩兩之間具有統計上之顯著相關，這是本研究與以往相關研究結果的最大不同發現。
結論：住院病人認為醫院醫療與服務品質報告卡對選擇醫院是有價值的，因此，建議行政院衛生署可考慮主導，整合醫院評鑑、全民健康保險申報及病人滿意度調查的資料，分區分醫院等級，評比其在高適用性且高重視度的九項指標項目之表現，以星號及百分比的形式呈現，再以小手冊及網際網路查詢的方式對外公佈，並加強對民眾的宣導教育，讓民眾可以將品質資訊運用在就醫選擇決策上，使民眾成為明智的醫療服務消費者及醫療與服務品質的共同監督者，以提升醫療體系的運作效能。 / There exists information asymmetry between providers and consumers in healthcare market due to the highly specialized knowledge in this market. Consumers were asked to bear more responsibility on their own health and to participate in the formulation of healthcare strategies and the inventions of new technology as the uprising in the movement of consumer right protection. These would result in the reduction in costs related to the medical services and information collection. Therefore, western countries have aggressively established the medical information system and developed hospital report cards in order to protect consumers’ right, to improve quality of medical services, and to increase the efficiency of healthcare market by providing service information to consumers.
Taiwan initiated the National Health Insurance since 1995 with the facility contract rate reaching over 90%. This provides consumers great access to healthcare institutions. However, few service data have been provided to consumers as a reference for the choice of providers to date. In addition, previous studies showed that consumers were interested in obtaining available service information and these information have a great influence on consumers’ decision of providers.
Objectives:
The purposes of this study were to select indicators of hospital report cards from public’s perspective and to adopt the innovation diffusion theory and structural equation modeling to explore inpatients’ perception characteristics of innovation, attitudes toward, and willingness to use hospital report card.
Materials and Methods:
Firstly, we selected 30 subjects who were experts in social welfare or consumer right to participate in two rounds of Delphi investigation to select appropriate indicators of hospital report card. Secondly, we purposely ask for the permission from eight hospitals representing different accreditation levels and ownerships to allow us to select 500 medical and surgical inpatients to conduct a face-to-face interview regarding their innovativeness, perception characteristics of innovation, attitudes toward, and willingness to use hospital report cards. Finally, we used structural equation modeling (SEM) to test research hypotheses by way of.
Results:
We found that (1) from publics’ perspective the most applicable and important indicators include nosocomial infection rate, postoperative infection rate, inpatient’s satisfaction toward physician’s explanation, and outpatient’s satisfaction toward physician’s service attitudes; (2) only 17.2% of surveyed sample heard the term “hospital report card” before; (3) a total of 80.2% of inpatients considered hospital report cards to be very valuable or valuable for the selection of providers; (4) inpatients understood more in service indicators than clinic indicators; (5) the order of inpatients’ preference in presentation of hospital report cards was to use stars, percentages, and bar charts; (6) those who had higher education and higher monthly incomes, and were younger were more likely to understand the information provided by hospital report cards after adjusting for other factors; (7) among inpatients’ characteristics of innovation toward hospital report card, ”compatibility” and “result demonstrability” had significant positive influence on ”inpatients’ attitude toward hospital report card”; (8)”perceived usefulness”, “inpatients’ attitude toward hospital report card”, and “inpatients’ innovativeness” had significant positive influence on ”inpatients’ willingness to use hospital report card”；(9)”compatibility” had significant positive influence on “inpatients’ attitude toward hospital report card”；(10)“inpatients’ attitude toward hospital report card” had significant positive influence on ”inpatients’ willingness to use hospital report card”；(11)finally it is worth emphasize that this study had a new finding that ”perceived usefulness”, “perceived ease to use ”, “compatibility”, “result demonstrability ”,and “inpatients’ innovativeness” had significant positive correlation between each other.
Conclusions:
We concluded that inpatients considered hospital report cards to be valuable for the selection of hospitals. Therefore, it is recommended that hospital report cards be initiated by the Department of Health by integrating the information from hospital accreditation, medical claims data from the National Health Insurance, and survey of patient satisfactions. The rankings of hospital shown on report cards can be presented in stars or percentages, and these pieces of information can be released through booklet or Internet. In addition, consumers should be educated to use hospital information in order to monitor hospital performance and improve the efficiency of healthcare delivery system. / 目 錄
誌謝……………………………………………………………… Ⅰ
摘要……………………………………………………………… Ⅲ
Abstract………………………………………………………… Ⅴ
目錄……………………………………………………………… Ⅶ
表目錄……………………………………………………………… Ⅹ
圖目錄……………………………………………………………… Ⅻ
第一章 前言……………………………………………………… 1
第一節 研究背景與動機………………………………… 1
第二節 研究目的與研究問題…………………………… 5
第三節 研究的重要性與預期貢獻……………………… 6
第二章 文獻探討………………………………………………… 8
第一節 醫院品質報告卡的沿革……………………………… 8
第二節 醫院品質報告卡的指標項目………………………… 15
第三節 醫院品質報告卡的影響與推行障礙………………… 27
第四節 醫療品質指標系統及品質報告卡的發展步驟……… 32
第五節 創新擴散理論………………………………………… 37
第六節 結構方程模式………………………………………… 43
第七節 國內外相關實證研究之結果………………………… 48
第八節 綜合討論……………………………………………… 76
第三章 以德菲法篩選醫院醫療與服務品質報告卡之指標項目. 79
壹、研究方法……………………………………………………… 79
第一節 研究設計與流程………………………………………… 79
第二節 研究對象………………………………………………… 79
第三節 研究工具………………………………………………… 81
第四節 資料處理與分析………………………………………… 95
貳、研究結果……………………………………………………… 95
第一節 問卷回收情形…………………………………………… 95
第二節 描述性統計分析………………………………………… 96
第三節 第一回合與第二回合問卷調查結果差異分析…………105
參、討論……………………………………………………………106
第一節 重要研究結果討論………………………………………106
第二節 研究限制…………………………………………………108
第四章 住院病人對醫院醫療與服務品質報告卡的認知、態度
與使用意願……………………………………………… 110
壹、研究方法………………………………………………………110
第一節 研究架構、目的與假說…………………………………110
第二節 研究對象…………………………………………………118
第三節 研究變項之操作型定義…………………………………121
第四節 研究工具…………………………………………………124
第五節 資料處理與分析…………………………………………126
貳、研究結果………………………………………………………128
第一節 問卷信度及效度的檢定…………………………………129
第二節 樣本基本特質與研究變項的統計分析…………………130
第三節 研究假說與架構的驗證…………………………………170
參、討論……………………………………………………………178
第一節 重要研究結果討論………………………………………178
第二節 研究限制…………………………………………………187
第五章 結論與建議………………………………………………188
第一節 結論………………………………………………………188
第二節 建議………………………………………………………191
參考文獻……………………………………………………………194
附錄…………………………………………………………………209
附錄一、德菲法問卷專家效度名單………………………………209
附錄二、德菲法問卷專家名單……………………………………210
附錄三、醫院品質報告卡指標項目適用性及重要性評分問卷 212
附錄四、醫院品質報告卡指標項目適用性及重要性評分問卷
(第二回合) ………………………………………………224
附錄五、住院病人對「醫院醫療與服務品質報告卡」的認知、
態度與使用意願之研究問卷專家效度名單……………246
附錄六、住院病人對「醫院醫療與服務品質報告卡」的認知、
態度與使用意願之研究…………………………………247
附錄七、醫院醫療與服務品質報告卡的範例……………………254
表目錄
表2-1品質報告卡的種類及指標項目…………………………… 20
表2-2台灣有關醫療品質指標的實證研究……………………… 50
表2-3台灣用來評估醫院醫療品質的指標彙總表……………… 56
表2-4有關民眾(病人)選擇醫院(醫師)考量因素的實證研究… 58
表2-5台灣有關醫院品質報告卡及民眾就醫選擇資訊需求的相
關研究 ……………………………………………………… 66
表3-1本研究初步選取醫院醫療與服務品質指標的來源或依據…84
表3-2本研究所採用醫院醫療與服務品質指標的操作型定義……87
表3-3問卷發放及回收情形…………………………………………96
表3-4德菲法專家問卷分析結果……………………………………99
表3-5適用性前十名指標項目及其平均值 ………………………103
表3-6重視度前十名指標項目及其平均值 ………………………104
表3-7適用性與重視度交叉分析矩陣表 …………………………104
表3-8高適用性且高重視度指標項目 ……………………………105
表3-9Wilcoxon Signed Ranks Test 檢定結果………………… 109
表4-1研究對象分配表—依層級別、權屬別及性別分 …………120
表4-2預試問卷各成份信度結果 …………………………………125
表4-3有效樣本分佈情形—依醫院別 ……………………………131
表4-4樣本個人基本特質與就醫選擇資訊搜尋及需求狀況 ……133
表4-5對醫院醫療與服務品質報告卡的認知 ……………………137
表4-6對醫院醫療與服務品質報告卡之指標及呈現方式的瞭解
程度…… ……………………………………………………139
表4-7醫院醫療與服務品質報告卡創新特性之描述性分析 ……140
表4-8醫院醫療與服務品質報告卡的態度及使用意願之描述性
分析………………………………………………………… 144
表4-9創新接受度量表之描述性分析 ……………………………145
表4-10住院病人自覺醫院醫療與服務品質報告卡對選擇醫院有
無價值影響因素的雙變項分析……………………………147
表4-11病人自覺品質報告卡對選擇醫院有無價值影響因素之複
迴歸分析……………………………………………………149
表4-12住院前有無先探聽醫院醫療與服務品質資訊影響因素的
雙變項分析…………………………………………………151
表4-13住院前有無探聽醫院醫療與服務品質資訊影響因素之複
迴歸分析……………………………………………………153
表4-14住院病人是否看懂醫院醫療與服務品質資訊影響因素的
雙變項分析…………………………………………………155
表4-15住院病人是否看懂品質資訊影響因素之複迴歸分析……157
表4-16住院病人是否需要醫院醫療與服務品質報告卡影響因素
的雙變項分析………………………………………………159
表4-17住院病人是否需要醫院品質報告卡影響因素之複迴歸分
析……………………………………………………………161
表4-18住院病人會不會參考醫院醫療與服務品質報告卡影響因
素的雙變項分析 …………………………………………163
表4-19住院病人會不會參考醫院品質報告卡影響因素之複迴歸
分析…………………………………………………………165
表4-20住院病人是否會更換就醫醫院影響因素的雙變項分析…167
表4-21住院病人會不會更換到其他的醫院看病影響因素之複迴
歸分析…… ………………………………………………169
表4-22住院病人創新接受度、對醫院醫療與服務品質報告卡創
新特性之知覺、態度與使用意願理論架構因果模式之配
適度檢定結果………………………………………………171
表4-23整體模式之多元相關平方(SMC) …………………………171
表4-24外因潛在變項與其測量變項關係之標準化係數之檢定…173
表4-25內因潛在變項與其測量變項關係之標準化係數之檢定…174
表4-26潛在變項間之因果關係的標準化係數之檢定……………174
表4-27外因潛在變項間相關係數之檢定…………………………175
表4-28研究模式的間接、直接與整體效果………………………175
表4-29研究假說檢定結果…………………………………………176
圖目錄
圖2-1Rogers的創新--決策過程典範………………………………41
圖3-1德菲法研究流程………………………………………………80
圖4-1研究架構 ……………………………………………………111
圖4-2本研究之結構方程模式關係路徑圖 ………………………177
| Identifer | oai:union.ndltd.org:TW/093NTU05529004 |
| Date | January 1993 |
| Creators | 陳楚杰, Chu-Chieh Chen |
| Contributors | 楊銘欽, Ming-Chin Yang |
| Publisher | 臺灣大學, 醫療機構管理研究所 |
| Source Sets | National Digital Library of Theses and Dissertations in Taiwan |
| Language | 中文 |
| Detected Language | English |
| Type | 博士 |
| Format | 255 |
| Relation | 一、中文部份 中央健康保險局(2004，12月28日)。專業醫療服務品質指標查詢。取自http://www.nhi.gov.tw/15treat/treat_03.htm 中央健康保險局高屏分局(2003，10月8日)。民眾醫療服務品質資訊公開。取自http://www.nhikb.gov.tw/quality/med_quality/quality.asp 中央健康保險局高屏分局(2004，12月28日)。醫療服務品質報告資訊網。取自 http://www.nhikb.gov.tw/quality/quality_92y/92hosp.asp 王乃弘(1995)。民眾對選擇醫院因素及態度之研究--以中部數家醫院為例。未出版之碩士論文。中國醫藥學院，台中，台灣。 王運昌(1996)。全民健康保險第四類被保險人就醫行為相關因素之研究。未出版之碩士論文。國防醫學院，台北，台灣。 王保進(2004)。多變量分析。台北：高等教育。 台灣醫務管理學會(2003)。台灣醫療照護品質指標系列—品質系列手冊（五版）。台北：台灣醫務管理學會 朱永華(1995)。醫院服務知覺品質與病患滿意度之關係研究。未出版之碩士論文。國立成功大學，台南，台灣。 行政院衛生署（2004，12月28日）。醫療院所查詢。取自http://www.doh.gov.tw/newdoh/90-org/org-1/phone.html 何宜真(1999)。住院病人對醫療品質之知覺及其評估能力之初探。未出版之碩士論文。國立台灣大學，台北，台灣。 宋欣怡(2001)。民眾就醫選擇資訊的潛在需求研究。未出版之碩士論文。國立臺灣大學，台北，台灣。 李香瑶(1997)。產婦選擇生產場所之影響因素研究。未出版之碩士論文。國立陽明大學，台北，台灣。 李孟勳(1999)。全民健康保險制度下醫療品質與醫療機構績效關係之研究--以台北醫療區域各級醫院為例。未出版之碩士論文。國立臺灣大學，台北，台灣。 李原任(2002)。影響大高雄地區民眾求醫選擇因素之探討。未出版之碩士論文。義守大學，高雄，台灣。 邱培源(2002)。病患健康資訊需求與尋求行為之研究。未出版之碩士論文。淡江大學，台北，台灣。 邱皓政(2003）。結構方程模式。台北：雙葉。 阮仲炯(1996)。影響血液透析病患選擇醫療機構因素之研究--以行銷觀點。未出版之碩士論文。中國醫藥學院，台中，台灣。 林富滿(2000)。台灣醫療品質指標系統的建立與十家醫療機構可行性測試結果。未出版之碩士論文。台北醫學大學，台北，台灣。 林瑜文(2002)。急診醫療服務人力設置與品質指標之相關性探討。未出版之碩士論文。長庚大學，桃園，台灣。 吳肖琪、李鍾祥(1998)。評估醫院醫療品質指標。台北：行政院研究發展考核委員會。 侯毓昌(1995)。中醫門診病人選擇醫院之因素分析及就醫中醫門診病人選擇醫院之因素分析及就醫滿意度研究。未出版之碩士論文。國立陽明大學，台北，台灣。 周鴻儒(1997)。台北市三家國軍醫院門診病患就醫選擇因素及滿意度調查研究。未出版之碩士論文。國防醫學院，台北，台灣。 許偉信(2001)。血液透析病患選擇醫療機構要素及對現行血液透析機構滿意度之研究－以台南市三家不同類型私立醫療機構為例。未出版之碩士論文。長榮管理學院，台南，台灣。 張苙雲(1998)。醫療與社會—醫療社會學的探索。台北：巨流。 張文瑛(1987)。民眾選擇醫院考慮因素之研究。未出版之碩士論文。國立政治大學，台北，台灣。 張淳茜(2000)。病患健康資訊來源及其相關因素之研究。未出版之碩士論文。中國醫藥學院，台中，台灣。 張紹勳(2001）。研究方法。台中：滄海。 陳佩妮(1995)。醫療品質與經營績效關係之研究--以台北醫療區域各級醫院為例。未出版之碩士論文。國立臺灣大學，台北，台灣。 陳佩妮、鄭守夏、鍾國彪、林王美園(1997)。臺灣地區醫療品質指標適用性之探討。中華衛誌，16(2)，133-142。 陳育達(2001)。由使用者態度探討投資者對網路下單之接受度。未出版之碩士論文。國立中央大學，新竹，台灣。 陳琇玲、鍾國彪、洪幼珊(1999)。臨床品質指標簡介，醫院，32(6)，37-45。 陳楚杰，林恆慶，勞寬(2002)。探討台灣地區醫院品質報告卡之可行指標。台灣衛誌，21(4)，296-304。 陳楚杰、楊銘欽、林恆慶(2004)。門診病人對醫院品質報告卡需求之初探。醫護科技學刊，6(1)，29-42。 陳嘉彌(1996)。中等學校教師接受創新程度之分析。教育研究資訊，4(3)，86-103。 黃俊英(2001)。多變量分析。台北：中國經濟企業研究所。 黃俊英(2002)。企業研究方法。台北：東華書局。 黃嘉勝(1994)。創新觀念接受量表在教學科技上的應用。教學科技與媒體，15，31-36。 黃智強(2000)。影響採用網路購物因素之研究─以網路書店為例。未出版之碩士論文。國立中央大學，新竹，台灣。 黃芳銘(2002）。結構方程模式理論與應用。台北：五南。 黃芳銘(2004）。社會科學統計方法學：結構方程模式。台北：五南。 曾孟蘭(2002）。消費者對行動廣告態度之研究。未出版之碩士論文。國立中山大學，高雄，台灣。 曾倫崇(1997）。顧客選擇醫院就診因素之研究—以行銷觀點。醫院，30(6)，28-37。 勞寬(2002)。醫院品質報告卡可行性研究。未出版之碩士論文。台北醫學大學，台北，台灣。 勞寬，林恆慶，陳楚杰(2002)。探討台灣醫院使用品質報告卡之意願與能力。醫務管理3(4)，61-69。 楊志良(2001)。搶救全民健保—建立健全的健保架構。健康世界，187，121-125。 楊雅惠(2000)。網路上就醫選擇資訊之內容分析與使用者調查。未出版之碩士論文。國立臺灣大學，台北，台灣。 楊哲銘、廖熏香、許志瑋、邱文達(2003)。醫療品質指標之發展經驗。於邱文達主編，醫院品質實務管理(pp123-145)。台北：合記。 蔣宗男(2002)。情境因素、消費者購買涉入與創新接受態度影響網路競標意願之研究。出版之碩士論文。國立政治大學，台北，台灣。 蔡哲宏(1996)。急診病人選擇醫院之考慮因素探討及行銷研究:以臺北市八家醫院為例。未出版之碩士論文。國立陽明大學，台北，台灣。 劉宗憲(2003)。影響精神科門診病患就醫考量因素及就醫醫院類型之相關因素探討。未出版之碩士論文。台北醫學大學，台北，台灣。 劉書蘭(2002）。消費者採用行動商務之行為研究─以行動銀行為例。未出版之碩士論文。雲林科技大學，雲林，台灣。 鄭智仁(2000）。影響我國企業採用成本制度之因素探討以作業基礎成本制為例。未出版之碩士論文。國立台灣大學，台北，台灣。 鄭守夏(2004）。民眾需要的醫療品質資訊。於行政院二代健保規劃小組，行政院二代健保規劃小組第三階段規劃報告。台北：行政院二代健保規劃小組。 盧希鵬、葉乃菁、許晉龍(2002)。探討網路使用者參與虛擬社群意願之影響因素。第十三屆國際資訊管理學術研討會，409-416。 盧瑞芬、謝啟瑞(2000)。醫療經濟學。台北：學富。 謝慧欣(1999)。民眾對健康資訊需要之初探。未出版之碩士論文。國立台灣大學，台北，台灣。 謝慧欣、鄭守夏、丁志音(2000)。住院病患對就醫選擇資訊之需求：初步調查發現。中華公共衛生雜誌，19(6)，437-445。 鍾國彪、徐台玲、謝碧曉、李孟勳(1997)。全民健康保險的整體醫療品質之評估計畫。中央健康保險局八十六年度委託研究計畫報告（計畫編號DOH -86-NH-019）。 鍾國彪、藍忠孚、郭乃文、胡煒明、石崇良、鄭鴻鈞、謝碧晴、薛亞聖(2000)。全民健康保險整體醫療品質之研究—以建立指標之基本資料為主。行政院衛生署八十八年下半年及八十九年度委託研究計畫報告（計畫編號DOH -89 -NH-004）。 戴蘭祺(2003)。參與台灣醫療照護品質指標系列(THIS)醫院對其門診指標知覺一致性評估。未出版之碩士論文。國防醫學院，台北，台灣。 蘇斌光(1989)。醫院行銷研究的應用：病患選擇醫院的因素分析。未出版之碩士論文。中國醫藥學院，台中，台灣。 二、英文部份 Agarwal, R., & Prasad, J. (1997). The role of innovation characteristics and perceived voluntariness in the acceptance of information technologies. Decision Sciences, 28(3), 557-582 Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, New Jersey: prentice-Hall. Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. action-control: From cognition to behavior, Heidelberg: Springer. Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: Areview and recommended two-step approach. Psychological Bulletin, 103, 411-423. Arnold, M. E. (2000). Public Release of Performance Data: A progress report from the Front. The Journal of the American Medical Association, 283(14), 1884 -1886. Anderson, P. (1999). England publishes first tables of hospital performance. British Medical Journal, 318(7200), 1715. Anell, A., Rosen, P., & Hjortsberg. (1997). Choice and participation in the health services: A survey of preferences among swedish residents. Health Policy, 40, 157-168. Anonymous. (1994). How will employees use report cards? Business and Health, 12(6), 24. Anonymous. (1995). Nursing indicators in hospital report cards can be feasible? Health Care Strategic Management, 13(4), 17-18. Anonymous. (2002). Should consumers trust hospital quality report cards? The Journal of the American Medical Association, 287(24), 3206-3208. Bajaj, A. & Nidumolu, S. R. (1998). A feedback model to understand information system usage. Information & Management, 33(4), 213-224. Baker, D. W., Einstadter, D., Thomas, C., Husal, S., Gordon, N. H., & Cebul, R. D. (2003). The effect of publicly reporting hospital performance on market share and risk-adjusted mortality at high-mortality hospitals. Medical Care, 41(6), 729-740. Beaulieu, N. D. (2002). Quality information and consumer health plan choices. Journal of Health Economics, 21(1), 43-63. Bell, P. F., Daly, J., & Chang, E. M. L. (1997). A study of the educational and research priorities of registered nurses in rural Australia. Journal of Advanced Nursing, 25(4), 794-800. Bentler, P. M., & Chou, C. P. (1987). Practical issues in structural modeling. Sociological Methods and Research, 16, 78-117. Bernstein, A. B., & Gauthier, A. K. (1999). Choices in health care: What are they and what are they worth? Medical Care Research and Review, 56(suppl 1), 5-23. Bentley, J. M., & Nash, D. B. (1998). How Pennsylvania hospitals have responded to publicly released reports on coronary artery bypass graft surgery. The Joint Commission Journal on Quality Improvement, 24, 40-49. Berwick, D. M., & Wald, D. L. (1990). Hospital leaders’ opinions of the HCFA mortality data. The Journal of the American Medical Association, 263(2), 247 -249. Bodenheimer, T. (1999). The American health care system-- Physicians and the changing medical marketplace. The New England Journal of Medicine, 340(7), 584-588. Boscarino, J., & Steiber, S. R. (1982). Hospital shopping and consumer choice. Journal of Health Care Marketing, 2(2), 15-23. Burnette, D., Morrow-Howell, N., & Chen, L. M. (2003). Setting priorities for gerontological social work research: A national Delphi study. The Gerontologist, 43(6), 828-838. Busselle, R., Reagan, J., Pinkleton, B., & Jackson, K. (1999). Factors affecting iternet use in a saturated-access population. Telematics and Informatics, 16(1-2), 45-58. Canadian Institute for Health Information. (2002, November 7). Hospital report 2001: Acute care. http://secure.cihi.ca/hreports/toc.shtml. Chen, L., Gillenson, M. L., & Sherrell, D. L. (2002). Enticing online consumers: an extended technology acceptance perspective. Information & Management, 39, 705-709. Cheng, S. H., Ho, Y. C., & Chung, K. P. (2002). Hospital quality informationfor patients in Taiwan: Can they understand it ? International Journal for quality in Heallth Care, 14(2), 155-160. Cheng, S. H., Yang, M. C., & Chiang, T. L. (1999). Patient satisfaction with and recommendation of a hospital: Effects of interpersonal and technical aspects of hospital care. International Journal for quality in Heallth Care, 15(4), 345-355. Chin, W. W., & Gopal, A. (1995). Adoption intention in GSS: Relative importance of beliefs. DATABASE Advances, 26(2), 42-63. Chen, J., Radford, M. J., Wang, Y., Marciniak, T. A., & Krumholz, H. M. (1999). Performance of the ‘100 top hospitals’: What does a report card report? Health Affairs, 189(4 ), 53-68. Cheng, S. H., Ho, Y. C., & Chung, K. P. (2002). Hospital quality information for patients in Taiwan: Can they understand it? International Journal for Quality in Health Care, 14(2), 155-160. Collopy, B. T., Ansari, M. Z., Booth. J. L., & Brosi, J. A. (1995). The Australian council on healthcare standards care evaluation program. The Medical Journal of Australia, 163(9), 477-480. Cooper, D. R., & Schindler, P. S. (2003). 企業研究方法（古永嘉譯）。台北：華泰。（原書發行於2003） Crane, F. G.., & Lynch, J. E. (1988). Consumer selection of physicians and dentists: A examination of choice criteria and cue usage. Journal of Health Care Marketing, 8(3), 16-19. Davis, F. D. (1989). Perceived usefulness, perceived ease of use , and user acceptance of information technology. MIS Quarterly, 13(3), 318-339. Deering, M. J., & Harris, J. (1996). Consumer health information demand and delivery: Implications for libraries. Bulletin of the Medical Library Association, 84(2), 209-216. Donabedian, A. (1980). Explorations in quality assessment and monitoring: The definition of quality and approaches to its assessment. Ann Arbor, Michigan: Health Administration Press. Donabedian, A. (1988). The quality of care. How can it be assessed? The Journal of the American Medical Association, 260(12), 1743-1748. Dziuban, S. W., Mcllduff, J. B., Miller, S. J., & Dal Col, R. H. (1994). How a New York cardiac surgery program uses outcomes date. Annals of Thoracic and Cardiovascular Surgery, 58, 1871-1876. Edgman-Levitan, S., & Cleary, P. D. (1996). What information do consumers want and need? Health Affairs, 15(4), 42-56. Egunjobi, L. (1983). Factors influencing choice hospitals: A case study of the northern part of Oyo State, nigeria. Social Science & Medicine, 17(9), 585-589. Ellen, A. B., & Chere, C. G. (1998). Fishbein and Ajzen''s theory of reasoned action: Accurate prediction of behavioral intentions for enrolling in distance education courses. Adult Education Quarterly; 49(1), 43-56. Entwistle, V. A., & Watt, I. S. (1998). Disseminating information about healthcare effectiveness: a survey of consumer information services. Quality in Health Care, 7, 124-129. Epstein, A. (1995). Performance reports on quality--prototypes, problems, and prospects. The New England Journal of Medicine, 333(1), 57-61. Epstein, A. (1998). Rolling down the runway: The challenges ahead for quality report cards. The Journal of the American Medical Association, 279(21), 1691-1696. Fitzgerald, J. F., Fagan, L. F., Tierney, W. M., & Dittus, R. S. (1987). Changing patterns of hip fracture care before and after implementation of the prospective payment system. Journal of American Medical Association, 258(2), 218-221. Fitzgerald, J. F., Moore, P. S., & Dittus, R. S. (1988). The care of elderly patients with hip fracture: Changes since implementation of the prospective payment system. New England Journal of Medicine, 319(24), 1392-1397. Fletcher, R. H., O’Malley, M. S., Erap, J. A., Littleton, T. A., Fletcher, S.W., Greganti, M. A., Davidon, R. A., & Taylor, J. (1983). Patients’ priorities for medical care. Medical Care, 21(2), 234-242. Frist, B. (1998). Patients'' bill of rights. Journal of the Tennessee Medical Association, 91(12), 472-474. Fogg, D. M. (1998). Health care report cards. AORN Journal, 67(3), 669-672. Gabel, J. R., Hunt, K. A., Hurst, K., & Peat Marwick, K. P. (1998). When employers choose health plans. New York, NY: Commonwealth Fund, Report 293. Gemignani, J. (1999). Hospitals abandon report card initiative. Business and Health, 17(3), 12. Gormley, W. T. (1998). Assessing health care report cards. Journal of Public Administration Research and Theory, 8(3), 325-353. Hanna, N., Schoenbachler, D. D., & Gordon, G. L. (1994). Physician choice criteria: Factors influencing patient selection of generalists versus specialists. Health Marketing Quarterly, 12(2), 29-42. Hannan, E. L., Kiburn, H., Racz, M., Shields, E., & Chassin, M. R. (1994). Improving the outcomes of coronary artery bypass surgery in New York State. The Journal of the American Medical Association, 271(10), 761-766. Hannan, E. L., Stone, C. C., Biddle, T. L., & DeBuono, B. A. (1997). Public release of cardiac surgery outcomes data in New York. American heart journal, 134, 55-61. Hair, J. F., Anderson, R. E., Taham, R. L., & Black, W. C. (1998). Multivariate data analysis(5th ed.). Prentoce Hall international: UK. Harris, N. (1994). Report cards, Part 2: How hospitals measure up. Business Health, 12(8), 20-24. HCIA, Inc. & William M. Mercer, Inc. ( 2003, October 24). 100 Top Hospitals : Benchmarks for Success-2002. Available http: //www.100tophospitals. com/ Studies/national02/methology.asp. HealthGrades (2002, Oct 17). How to choose a hospital 2002. Available http:// www.healthgrades.com/public/. Heischmidt, K. A., Hekmat, F., & Gordon, P. (1993). A multivariate analysis of choice criteria for hospital, Journal of Health Care Maarketing, 8(1),41-54. Hibbard, J. H. (1998). Use of outcome data by purchasers and consumers: New strategies and new dilemmas. International Journal of Quality in Health Care, 10(6), 503-508. Hibbard, J. H., & Jewett, J. J. (1996). What type of quality information do consumers want in a health care report card? Medical Care Research Review, 53(1), 28-47. Hibbard, J. H., & Jewett, J. J. (1997). Will quality report cards help consumers? Health Affairs (Millwood), 16(3), 218-228. Hibbard, J. H., Jewett, J. J., Engelmann, S., & Tusler, M. (1998). Can Medicare beneficiaries make informed choices? Health Affairs (Millwood), 17, 181-193. Hibbard, J. H. (1998). Use of outcome data by purchasers and consumers: New strategies and new dilemmas. Internationa Journal of Quality in Health Care, 10(6), 503-508. Hibbard, J. H. (2002). The impact of a CAHPS report on employee knowledge, beliefs, and decisions. Medical Care Research Review, 59(1), 104-116. Hill, C. J., Garner, S. J. (1991). Factors influencing physician choice. Hospital & Health Services Administration, 33(4), 491-503. Hochhauser, M. (1998). Why patients have little patience for report cards. Managed Care, 7(3), 31-32, 34. Hoerger, T. J., & Howard, L. Z. (1995). Search Behavior and choice of physician in the market for prenatal care, Medical Care, 33(4), 332-349. Hoffer, J. A., & Alexander, M. B. (1992). The diffusion of database machines. Data Base, 23(2), 13-19. Hsia, D. C., Ahern, C. A., Ritchie, B. P., Moscoe, L. M., & Krushat, W. M. (1992). Medicare reimbursement accuracy under the prospective payment system, 1985 to 1988. Journal of American Medical Association, 268(7), 896-899. Hu, P. J., Chau, P. Y. K., Sheng, O. R. L., & Tam, K. Y. (1999).Examining the technology acceptance model using physician acceptance of telemedicine technology. Journal of Management Information Systems, 29, 227-238. Hurt, H. T., Joseph, K., ＆ Cook, C. D. (1977). Scales for the measurement of innovativeness. Human Communication Research, 4(1), 58-65. Iezzoni, L. I. (1997). The risks of risk adjustment. The Journal of the American Medical Association, 278(19), 1600-1607. Inguanzo, J. M., & Harju, M. (1985). What makes consumers select a hospital. Hospital, 59(5), 90-94. Isaacs, S. L. (1996). Consumer''s information needs: Results of a national survey. HealthAffairs, 15(5), 31-41. Javalgi, R. G., Rao, S. R., & Thomas, R. G. (1991).Choosing a hospital: analysis of consumer tradeoffs. Journal of Health Care Marketing, 11(1), 2-22. Jaklevic, M. C. (1999). Hospital report-card model in peril. Modern Healthcare, 29(3), 14-5. Jewett, J. J., & Hibbard, J. H. (1996). Comprehension of quality care indicators: differences among privately insured, publicly insured, and uninsured. Health Care Financing Review, 18(1), 75-94. Joint Commission on Accreditation of Healthcare Organizations. (2002, October 17). About performance reports. Available http://www.jcaho.org/lwapps/perfrep/pdshowto.htm. Joreskog, K. G.., & Sorbom, D. (1993). LISREL8: Structrual equation modeling with the SIMPLIS command language. Chicago: International Educational Services. Kaiser, H. F., & Rice, J. (1974). Little Jiffy Mark IV. Educational andPsychological Measurement, 34, 111-117. Karahanna, E., Straub, D., & Chervany, N. (1999). Information technology adoption across time: A cross-sectional comparison of pre-adoption and post- adoption beliefs. MIS Quarterly, 23(2), 183-213. Kazandjian, V. A., Lawthers, J., Cernak, C. M., & Pipesh, F. C. (1993). Relating outcomes to processes of care: The Maryland Hospital Association’s Quality Indictor Project(QI Project). The Joint Commission Journal on Quality Improvement, 19(11), 530-538. Kenkel, P. (1995). Report cards: A cautionary tale. Business Health, 13, 23. Kotler, P. (2000). Marketing Management(10th). New Jersey: Prentice Hall. Lamb, C. W., Hoverstad, J. R., & Lancaster, W. (1988). Consumer perceptions about doctors of osteopathy and medical doctors. Journal of Health Care Marketing, 8(4), 53-57. Lane, P. M., & Lindquist, J. D. (1988). Hospital choice : A summary of the key empirical and hypothetical finding of the 1980s. Journal of Health Care Marketing, 8(4), 5-20. Liao, S., Shao, Y. P., Wang, H., & Chen, A. (1999). The adoption of virtual banking: An empirical study. International Journal of Information Management, 19, 63-74. Lin, J. C. C., & Lu, H. (2000). Towards an understanding of the behavioral intention to use a web site. International Journal of Information Management, 20, 197-208. Longo, D. R., Land, G., Schramm, W., Fraas, J., Hoskins, B., & Howell, V. (1997). Consumer reports in health care: Do they make a difference in patient care? The Journal of the American Medical Association, 278(19), 1579-1584. Luce, J. M., Thiel, G.. D., Holland, M. R., Swig, L., Currin, S. A., & Luft, H. S. (1996). Use of risk-adjusted outcome data for quality improvement by public hospitals. The Western journal of medicine, 164(5), 410-414. MacStravic, S. (1999). Hospital rating systems. Quality indicators and specious inferences. Health Care Strategy Management, 17(6), 15-18. Marshall, M. N. (2001). Accountability and quality improvement: The role of report cards. Quality of Health Care, 10(2), 67-68. Marshall, M. N., Shekelle, P. G., Davies, H. T. O., & Smith, P. C. (2003). Public reporting on quality in the United States and the United Kingdom. Health Affairs, 22(3), 134-148. Marshall, M. N., Shekelle, P. G., Leatherman, S., & Brook, R. H. (2000). The public release of performance data: What do we expect to gain? A review of the evidence. The Journal of the American Medical Association, 283(14), 1866-1874. Mathieson, K. (1991). Predicting user intention: Comparing the technology acceptance model with theory of planned behavior. Information Systems Research, 2(3), 173-191 Mathieson, K., Peacock, E., & Chin, W. W. (2001). Extending the technology acceptance model: The influence of perceived user resources. Database for Advances in Information Systems, 32(3). 86-112. Mayer-Oakes, S. A., & Barnes, C. (1997). Developing indicators for the Medicare Quality Indicator System(MQIS): Challenges and Lessons learned. The Joint Commission Journal on Quality Improvement, 23(7), 381-390. McCormack, L. A., Garfinkel, S. A., Schnauer, J. A., & Lee, A. J. (1996). Consumer information development and use. Health Care Financing Review, 18(1), 15-30. McDonald, R. P., & Ho, M. R. (2002). Principles and practice in reporting structural equation analysis. Psychological Methods, 7, 64-82. Methieson, K., Peacock, E. & Chin. W. (2001). Extending the Technology Acceptance Model: The Influence of Perceived User Resources. DATA BASE for Advances in Information Systems, 32(3), 86-112. Minnesota Health Data Institute. (1996). 1995 Consumer Curvey, “You and Your Health plan”. Minneapolis, : MN: Author. Moore , G. C., & Benbasat, I. (1991).Development of an instrument to measure the perception of adopting an information technology innovation. Information Systems Research, 2(3),192-222 Mukamel, D. B., & Mushlin, A. I. (1998). Quality of care information makes a difference: An analysis of market share and price changes after publication of the New York State Cardiac Surgery Mortality Reports. Medical Care, 36(7 ), 945-954. Nadzam, D. M. (1991). Development of medication-use indicators by the Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission Journal on Quality Improvement,19(5 ),1925-1928. Nadzam, D. M., Turpin, R., Hanold, L. S., White, R. E. (1993). Data-Driven performance improvement in health care: The Joint Commission’s Indicator Measurement System(IMSystem). The Joint Commission Journal on Quality Improvement, 19 (11 ), 493-500. National Committee for Quality Assurance. (1998). Ten steps to a successful report card project: producing comparative health plan reports for consumers. National Committee for Quality Assurance. ( 2002, November 6). NCQA report cards. NCQA Website. Available http://hprc.ncqa.org/menu.asp. Nowak, L. I., & Washburn, J. H. (1998). Patient sources of information and decision factors in selecting cosmetic surgeons. Health Marketing Quarterly, 15(4), 45-54. Ontario Hospital Association. (2003, November 6). Hospital Report 2002: Acute Care. OHA Website. Available http://caohat03.oha.com/oha/reprt5.nsf/48ee32adfb17199c85256c980064f6e5/3a0eee202d95413f85256ca9005542b8/$FILE/INSIDEoha2002v4.pdf Ovretveit, J. (1996). Informed choice? Health service quality and outcome information for patients. Health Policy, 37, 75-90. Peterson, E. D., Delong, E. R., Jollis, J. G., Muhlbaier, L. H., & Mark, D. B. (1998). The effects of New York’s bypass surgery provider profiling on access to care and patient outcomes in the elderly. Journal of the American College of Cardiology, 32, 993-999. Rainwater, J. A., Romano, P. S., & Antonius, D. M. (1998). The California hospital outcomes project. The Joint Commission Journal on Quality Improvement, 24, 31-39. Robertson, T. S. (1967). The Process of innovation and the Diffusion of Innovation. Journal of Marketing, 31, 14-19. Robinson, S., & Brodie, M. (1997). Understanding the Quality Challenge for Health Consumers: The Kaiser /AHCPR Survey. Joint Commission Journal on Quality Improvement, 23(5), 239-244. Rogers, E. M. (1962). Diffusion of Innovations. New York: Free Press of Glencoe. Rogers, E. M., & Shoemaker, F. F. (1971). Communication of Innovations(2nd). New York: The Free Press. Rogers, E. M. (1983). Diffusion of Innovations(3rd ed). New York: Free Press. Rogers, E. M. (1995). Diffusion of Innovations(4th ed). New York: Free Press Romano, P. S., Rainwater, J. A., & Antonius, D. (1999). Grading the graders: How hospitals in California and New York perceive and interpret their report cards. Medical Care, 37(3), 295-305. Romano, P. S., Zach, A., Luft, H. S., Rainwater, J., Remy, L. L., & Campa, D. (1995). The California hospital outcomes project: Using administrative data to compare hospital performance. Joint Commission Journal of Quality Improvement, 21(12), 668-682. Rose, C. (1989). Patient dumping: The physician’s dilemma. Chest, 95(3), 490-491. Rosenthal, G. E., Quinn, L., & Harper, D. L. (1997). Declines in hospital mortality associated with a regional initiative to measure hospital performance. American journal of medical quality, 12(2), 103-112. Royal Women’s Hospital. (2000). Review of existing models of reporting to consumers on health service quality. Melbourne: Royal Women’s Hospital. Rubenstein, L.V., Kahn, K. L., Reinisch, E. J., Sherwood, M. J., Rogers, W. H., Kamberg, C., Draper, D., & Brook, R. H. (1990). Changes in quality of care for five diseases measured by implicit review, 1981 to 1986. Journal of American Medical Association, 264(15), 1974-1979. Sangl, J. A., & Wolf, L. F. (1996). Role of consumer information in today’s health care system. Health Care Financing Review, 18(1), 1-8. Scanlon, D., Chernew, M., McLaughlin, C., Solon, G. (2002). The impact of health plan report cards on managed care enrollment, Journal of Health Economics, 21(1), 19-41. Schauffler, H. H., & Mordavsky, J. K. (2001). Consumer reports in health care: Do they make a difference? Annual Review of Public Health, 22, 69-89. Schiff, R. L., Ansell, D. A., Schlosser, J. E., Idris, A. H., Morrison, A., & Whitman, S. (1986). Transfers to a public hospital: A prospective study of 467 patients. New England Journal of Medicine, 314(9), 552-557. Schiffman, L. G., & Kanuk, L. L. (1994). Consumer Behavior (5rd). New Jersey: Prentice –Hall. Schneider, E. C., & Epstein, A. M. (1996). Influence of cardiac surgery performance reports on referral practices and access to care. New England Journal of Medicine, 335(4 ), 251-256. Schneider, E. C., & Epstein, A. M. (1998). Use of public performance reports: A survey of patients undergoing cardiac surgery. The Journal of the American Medical Association, 279(20), 1638-1642. Schneider, E. C., & Lieberman, T. (2001). Publicly disclosed information about the quality of health care: Response of the US public. Quality of Health Care, 10(2), 96-103. Schumacker, R. E., & Lomax, R. G.. (1996). Abeginner’s guide to structural equation modeling, Mahwah, NJ: Lawrence Erlbaum Associates. Schwartz, M. P. (1994). Survey: "Report cards" not yet having an impact. National Underwriter, 98(3), 50-52. Simborg, D. W. (1981). DRG creep: A new hospital-acquired disease. New England Journal of Medicine, 304(26), 1602-1604. Shepperd, S., Charnock, D., & Gann, B. (1999). Helping patients assess high quality health information. British Medical Journal, 319(18), 764-766. Shmuel, E., & Shaul, A. (1999). Predicting intentions to report administrative and disciplinary infractions: Applying the reasoned action model. Human Relations, 52(7), 947-967 Slovensky, D. J., Fottler, M. D., & Houser, H. W. (1998). Developing an outcomes report card for hospitals: A case study and implementation guidelines. Journal of Healthcare Management, 43(1), 15-35. Stewart, D. W., Hickson, G.. B., & Pechmann C. (1989). Informaytion search and decision making in the selection f family health care. Journal of Health Care Marketing, 9(2), 29-39. Taylor, S., & Todd, P. A. (1982). Understanding information technology usage: A test of competing models. Information System Research, 6(2), 145-176. Taylor, S., & Todd, P. A. (1995a). Decomposition and crossover effects in the theory of planned behavior: A study of consumer adoption intentions. International Journal of Research in Marketing, 12, 137-155. Taylor, S., & Todd, P. A. ( |
Page generated in 0.005 seconds