應用PMMM開發以TAI分類法為基礎的護理之家照護成本模式之研究

Applying PMMM to Develop a Cost Model of Tai-based Nursing Home

江嘉凱(Jia Kai Chaing)

指導教授 ： 呂克明

亞洲大學/資訊學院/資訊工程學系碩士班/碩士(2006年)

摘要

21 世紀的現代，由於醫學科技的進步以及出生率日趨下降的影響，台灣漸漸邁入一個高齡化的社會，社會上老年人口日漸增加因此老人的醫療問題開始受到重視，並且也引發護理之家的產業起飛；但隨著護理之家產業的日漸茂盛，卻沒有一套良好的成本制度作為收費標準；目前護理之家的收費方式，缺乏特定標準並且合理性也相當受到質疑，因為大部分的收費方式都是沿用醫院本身的成本制度，因此本研究的最主要目的為建立一套標準又合理的成本制度以提供醫療業者作為收費之標準，也可以提供病人家屬作為挑選護理之家的參考。
本研究將利用高橋 泰高齡者評估法(TAI1)、專案管理成熟度模型(PMMM2)及作業基礎成本制度(ABC3)；三種方法來建立照護成本模式，對於評估住民的方法沒有選用另ㄧ套較為普及的MDS4系統的原因，是因為此系統還有下列幾項缺點，例如：利用MDS 評估住民沒辦法像TAI 方法清楚地掌握住民的整體狀況、不容易了解住民在護理之家中的整體狀況變化、MDS 評估項目太過複雜且施行起來耗人、耗事、耗時容易造成評估者的問題。
本研究的第一個步驟是選用台北地區某一間護理之家之全體住民為研究對象，首先經由TAI 評估法評估住民的研究前狀態，再來利用專案管理中PMMM的模式來改進某些照護工作上的缺失，以幫助住民們有正向的狀態改變，之後在將各項的護理工作分類定義出來作為成本動因；最後再利用這些定義出來的成本動因經由ABC 的制度來評估所需的成本；研究的過程中會增減護理工作的次數來實驗，哪幾項護理工作對於住民的狀態改變最有幫助，而住民狀態改變分析就要經由TAI 來做判斷。
探討哪幾項工作對於住民的狀態改變最有幫助的原因，是為了建立三種不同階級的護理服務來提高護理工作效能；這三種階級的護理服務分為：高、中、低；高階級服務將提高住民狀態改變最有幫助的那幾項護理工作的次數，然而中、低階級在依服務水平來遞減工作次數，雖然高階的服務會令住民有較正向的狀況改變，可是相對的工作次數增加成本也必須增加，而中、低階服務的成本也會因服務水平的降低而降低成本。

關鍵字

專案管理成熟度模型 ； 高橋泰 ； 作業基礎成本制度 ； 護理之家

並列摘要

In the 21st century, due to the influence of improvement of medical science and technology and the declining birth rate, the Taiwanese Society has experienced the problem of aging population, which increases the demands of elderly care and the retirement home services. Once the demands goes up and the prices goes up as well; however, lack of enforceable government regulations to monitor and the standards for the industry to follow in terms of pricing, has created many discrepancies and services charged related problems. Therefore, my thesis will be focusing on designing and developing a well-established and reasonable service charging standards that suitable to Taiwanese Medical System.
“TAKAHASI TAI” Typology of Aged with Illustration (TAI), Project Manage Maturity Model (PMMM) and Activity-Based Costing (ABC) are the three major recourse for assisting in developing the standard. However, there are some drawbacks in this system, for example: Utilize MDS to assess the people and have no way to grasp the people's whole state clearly as TAI method, it is not apt to understand the people's whole state change in home that is attended to, the thing, question consuming time and apt to cause the persons who assess that it is too complicated and implement and consume people, dawdle that MDS assesses the project.
The first step is choosing City of Taipei as an experimental area and some of households were selected as sample of this project. Assessing the state before research that France assesses the people via TAI at first, the way of PMMM improved some and looked after the disappearance at work while coming to utilize the special project to manage, in order to helping it live it have the peoples to state change, later come out cost factor defining nursing job classification every ; Utilize the cost factor that these definitions come out to assess the necessary cost via the system of ABC afterwards; The experiment comes in the number of times that will increase and decrease the nursery work in the course studied, it is most helpful that which nursery work the people's state for living changes, live the people state is it is it judge via TAI soon to analyses to change.
It is discussed that which jobs the people's state for living change the most helpful reason, improve nursery work efficiency for the care of setting up three kinds of different classes; The care of these three kinds of classes is divided into: High , middle and low; The high class serves and improves the number of times that the people's state changes most helpful several items of nursery work, but in, it is low class it is in accordance with service level come decrease progressively number of times not working, though can make not having in the people service of high-order to state change, it is but relative working number of times increase too lasting cost, and in lower costs cost serving steps not low because of reducing of the service level too.

並列關鍵字

pmmm ； abc ； tai

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