醫師人力配置評比量表的建立：效度、信度與均等度分析

目的：對於醫院間醫師人力之評估與比較，建立一個常模參照的評估平台，以迎合醫院評鑑第8.1.2.2項確保院內必要職系人力配置之足量評估與說明。方法：本研究擷取衛生署網站的醫事機構開業登記查詢資料，分析全國19家醫學中心及60家區域醫院的醫師人力，利用探索性因素分析及試題反應理論的Rasch模式，分析24個專科醫師的人力供給，建構成一個單向度的測量。結果：研究發現：(1)國內19家醫學中心及60家區域醫院的內、外、婦、兒科醫師人力佔醫師總數的50%；(2)醫師人力評估量表鑑別醫院相異性的均等度達0.97；(3)有三分之一的區域醫院在醫師人力配置上的表現，達到表現達醫學中心的水準。結論：醫師人力的評比量表，藉由各醫院登錄在衛生主管機關的資料，轉換成測量值而可以比較醫院間人力的供給水準、配適度Fit統計及均等度指標可以瞭解各項醫事人力供給的形態及趨勢、各醫院在各專科醫師人力供給下的標準化殘差Z分數，可以得知該醫院在該專科醫師供給上的足與不足。

關鍵字

Rasch分析；探索性因素分析；醫師人力；醫學中心；區域醫院

並列摘要

Objectives: To set up a reference norm that compares physician manpower among hospitals, so that each hospital can keep accreditation and maintain sufficient professionals. Methods: We downloaded data from a government website of the physician supply at 79 Taiwanese medical centers and regional hospitals. Then, we used exploratory factor analysis and the Rasch model to examine the underlying unidimensionality of physician manpower characteristics and whether we can establish an appropriate scale that measures individual hospital performance and physician supply. Results: We found that: (1) four classes of physicians (internal, surgery, obstetrics and gynecology, and pediatrics) accounted for 50% of the total number of physicians; (2) the Ferguson discrimination delta for physician supply was 0.97; (3) more than one third of Taiwanese regional hospitals met the criterion of medical centers in terms of physician supply. Conclusions: The 16-item Rasch model can be used to: (1) determine the physician supply among hospitals; (2) determine the distribution and changes of different classes of physicians over time by use of Rasch residual fit statistics and the Ferguson delta coefficient; and (3) investigate the number of specified professionals in each hospital, to determine whether the supply is sufficient, by use of Z-residual score analysis.

並列關鍵字

Rasch analysis ； exploratory factor analysis ； clinical manpower ； medical center ； regional hospital

參考文獻

Cooper RA.(2009).States with more physicians have better-quality health care.Health Affairs.28(1),91-102.

Google Scholar

Baker TD,Perlman M.(1968).Health Manpower in a Developing Economy: Taiwan, A Case Study in Planning.Am J Public Health Nations Health.58(6),1125-1126.