住院病人就醫經驗測量工具之驗證與應用

背景：自1990年代起，病人權益與病人為中心的健康照護逐漸受到醫療照護提供者重視，醫療品質的測量從過去採取照護提供者的觀點，逐漸走向從需求者-病人的觀點來設計，也因此國外學者開始發展病人經驗的測量工具。但相對於歐美國家，亞洲國家用來測量住院病人就醫經驗的工具相對較少。本研究共分三個子題來驗證一個具有信效度的住院病人就醫經驗的測量工具，並探討個人與組織因素會影響住院病人就醫經驗。研究目的：1.檢測鄭守夏(2019)發展的住院病人就醫經驗調查問卷(Patient Experience of Hospital Care, PEHC)之信度與效度。2.探討個人與組織因素會影響住院病人的就醫經驗。3檢視病人經驗是否為醫院規模與病人推薦之間的中介變項。研究方法：研究資料主要來自鄭守夏(2019)執行之「住院病人就醫經驗調查運作模式之先驅研究」回收之郵寄問卷，其中郵寄問卷(無給予禮卷)共回收3,182份問卷，郵寄問卷(有給予禮卷)共回收536份問卷，兩者共3718份問卷資料，扣除無效問卷後，最後分析之資料共3118筆研究資料。資料分析使用IBM SPSS 22.0版與AMOS 24.0版統計分析軟體進行描述性統計分析與解釋性統計分析。研究結果：本研究利用項目分析、信度分析、以及探索性因素分析等技術，挑選合適的量表項目，建構PEHC量表。第一個研究子題，獲得整體量表的信度Cronbach’s α值大於0.7，各構面(包含醫師、護理人員、醫病互動、尊重與心理支持、出院準備服務、醫院環境)的Cronbach’s α值也大於0.7。各構面的組成信度都大於0.7，收斂效度都高於0.5。模型配適度GFI>0.9，RMSEA<0.08，CFI>0.9，IFI>0.9。第二個研究子題分析結果發現：病人個人因素(包含個人特質：有偶/無偶、個人平均月所得、教育程度；住院特質：住院管道、是否有手術或侵入性治療、住院日數)與病人整體就醫經驗呈現正相關。醫院特質(包含健保業務區域、醫院層級、醫師人數、護理人數、急性病床數)與病人整體就醫經驗呈現正相關。第三個研究子題發現：醫院層級與病人整體就醫經驗呈現正相關，醫院規模與病人推薦醫院的意願呈現正相關，當病人就醫的醫院層級愈高，病人推薦醫院的意願也會愈高，而病人就醫經驗是醫院規模與病人推薦醫院意願的部分中介變項。結論:本研究發現PEHC是一份具有進度與效度的病人經驗量表，醫院特質與病人個人因素會影響病人經驗的評分，而病人經驗好壞可以部分解釋醫院規模與病人推薦的相關性。

關鍵字

住院服務；病人經驗；醫療品質；推薦

並列摘要

Background: Since 1990s, patient rights and patient-entered care have been gradually valued by health care providers, and the measurement of health care quality has shifted from the perspective of health care providers to the viewpoint of patients. Scholars have begun to develop measurement tools for patient experience. However, the measurement tool developments were much fewer in Asian countries compared with that in European and American countries. This study aimed to verify a measurement tool for inpatient care experience, and to explore the applications of the measurement tool. Objectives: This study aimed: 1. To validate the reliability and validity of the Patient Experience of Hospital Care (PEHC) questionnaire developed by Cheng (2019); 2. To explore individual and organizational factors that affect patients’ experience; and 3. To examine the mediation effect of patient experience for the relationship between hospital scale and patient’s recommendation. Methods: The research materials were mainly derived from the 3,718 questionnaires completed by mail from Cheng (2019); 3,182 questionnaires were collected by mailing without incentive, and 536 questionnaires were collected by mailing questionnaires with incentive. A total of 3,118 questionnaires were used in the final analyses. The study used IBM SPSS version 22.0 and AMOS version 24.0 statistical analysis software for descriptive and analytic statistical analysis. Results: First, we followed item analysis, reliability tests and exploratory factor analysis to select appropriate items for the PEHC. When validating the reliability and validity of the PEHC, we found good fit with Cronbach’s α greater than 0.7 among the six dimensions and model fits from results of confirmative factors analyses. Second, we found individual-level patient factors such as marital status, education level, and length of stay etc., were positively associated with inpatient experience and the willingness to recommend a hospital. Hospital-level characteristics such as accreditation level and bed size etc. were also positively correlated with the inpatient experience. Third, we found that hospitals with bigger scale were more likely to be recommended by patients, and we found that patient experience was a partial mediator between the scale of the hospital and the patient's recommendation of a hospital. Conclusion: This study found that PECH is a valid and reliable tool for measuring patient experience of hospital care. Hospital and patient characteristics were associated with the scores of PEHC. Patient reported experience can partially account for the association between hospital scale and patient recommendation in Taiwan.