高估或低估？自我評核與評鑑委員評核結果的一致性探討：以2009年護理之家評鑑資料庫為例

Higher or Lower? Agreement between Self-evaluation and External Evaluation Regarding the Outcome of Nursing Home Accreditation: An Analysis of the 2009 Nursing Home Accreditation Survey

梁亞文(Yia-Wun Liang) ； 蔡淑鳳(Shwu-Feng Tsay) ； 鄭瑛琳(Ying-Lin Cheng) ； 林育秀(Yu-Hsiu Lin)

《台灣公共衛生雜誌》 31卷6期 (2012/12) Pp. 545-555

https://doi.org/10.6288/TJPH2012-31-06-06

摘要

目標：本研究旨在瞭解首次台灣一般護理之家評鑑自評結果及委評結果之一致性，並探討影響一致性之相關因素，做為主管機關未來修訂評鑑實施方式及內容與經營管理者準備評鑑工作參考。方法：本研究為一橫斷式研究，以2009年「台灣護理之家評鑑資訊網資料庫」中之351家一般護理之家為研究對象，進行次級資料分析。採一致性百分比與Kappa檢定分析受評護理之家自評與委評於評鑑結果之一致性，並以邏輯斯迴歸探討影響自評結果與委評結果一致性之因素。結果：評鑑基準五大面向與總評結果之自評結果與委評結果Kappa值介於0.086-0.291，一致性百分比介於40.17%-65.53%。護理之家開業年數、負責人角色為合夥股東型態者顯著增加自評結果與委評結果的一致性；所在區域為南區及高屏區的護理之家其自評結果與委評結果一致性顯著低於東區的護理之家。結論：整體而言，kappa值介於輕微至尚可之間，顯示護理之家自評者與評鑑委員對於評鑑項目達成認知的一致性不高。建議主管機關未來修訂評鑑指標應力求清晰明確，並舉辦評鑑後論壇，探討當年度評鑑自評結果與委評結果不一致之可能原因及改善方案；機構自評者應多參加評鑑前說明會與評鑑後論壇，透過標竿學習，提昇自評結果與委評結果的一致性。

關鍵字

護理之家 ； 評鑑 ； 一致性 ； Kappa檢定

並列摘要

Objectives: This study examined the agreement between self-evaluation and external evaluation regarding the outcome of nursing home accreditation and factors related to that agreement. Methods: This was a cross-sectional study using data from the 2009 Taiwan Nursing Home Accreditation Survey. A total of 351 nursing homes were included. Percentage agreement and Kappa tests were used to measure the agreement between self-evaluation and external evaluation. Multivariate logistic regression was used to identify factors associated with agreement. Results: The Kappa ranged from 0.086 to 0.291, and the percentage of agreement from 40.17% to 65.53%. After controlling for other variables, multivariate logistic regression showed that years of nursing home operation (OR=1.078, 95% C.I.=1.006-1.156), the owner's role (OR=2.540, 95% C.I.=1.062-6.077), and region of the nursing home's location (OR=0.262, 95% C.I.=0.075-0.913; OR=0.197, 95% C.I.=0.055-0.705) were significantly associated with agreement. Conclusions: As a whole, agreement between self-evaluation and external-evaluation regarding the outcome of nursing home accreditation was only slight to fair. A clear and specific accreditation index and the use of benchmarks to encourage nursing home employees to identify best practices are suggested as ways to promote agreement between self-evaluation and external-evaluation. Additional training of self-evaluators and external-evaluators may be useful in increasing the rates of agreement between these groups.

並列關鍵字

Nursing home ； accreditation ； agreement ； Kappa test