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題名:以資源基礎觀點探討影響醫療照護機構遠距照護系統的能力和績效
作者:陳俊勲
作者(外文):Chun-Hsun Chen
校院名稱:國立東華大學
系所名稱:企業管理學系
指導教授:楊維邦
許芳銘
學位類別:博士
出版日期:2020
主題關鍵詞:資源基礎觀點科技-組織-環境遠距照護系統組織資源科技資源遠距照護採用組織能力組織績效resource-based viewT-O-Etelehealth care systemadoption of telehealthIT resourcesorganizational resourcesorganizational capabilitiesorganizational performance
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本研究是探討醫療照護機構遠距照護系統採用的前置影響因素及使用後整合能力對績效的影響。研究參考資源基礎理論及科技-組織-環境之研究架構,整理出遠距照護系統採用的四個影響因素:科技、組織、環境與風險,從不同層級及地理位置照護機構之觀點,探討醫療照護機構採用遠距照護系統的前置影響因素,及使用過程形成的內部及外部整合能力對績效的影響。
研究結果顯示,機構遠距照護系統採用同時受到科技、組織、環境及風險特性影響,績效受到科技、環境及採用特性影響。其中,社區照護機構同時受到科技、組織、環境及風險特性影響,醫院受到科技及組織特性影響,顯示不同層級遠距照護系統採用存在差異。研究建議照護機構應採用先進的資通訊科技發展適合本身之遠距照護模式,整合社區資源及網絡,強化照護能力,快速回應民眾照護需求,創造具有可近性、低成本及較高品質的顧客價值。組織及科技資源對績效直接模式顯示,遠距照護系統的組織資源對財務績效沒有影響,必須透過服務中介才能對財務績效產生正向影響。在整合能力中介模式研究顯示,機構的組織及科技資源可以形成內部及外部能力,並同時產生服務績效,但是只有外部能力對財務產生正向績效,內部能力無法產生正向績效。研究證實透過科技整合能力的操作和利用方式,遠距照護系統可以促成醫療照護機構獲得超過其對手的競爭優勢。遠距照護系統採用本身無法提高財務績效,需要通過資訊科技及組織資源整合促進照護知識及服務品質等內部能力,進而改善醫療照護可近性並建立病人忠誠發展外部能力,最終提升服務及財務績效。
隨著社會經濟生活水平的提高,導致消費者對包括醫療照護在內的各種產業中個人服務的需求增加,卻面臨醫療照護的城鄉不均。儘管健康科技具有巨大的潛力,但醫療照護產業在使用健康資訊科技有效地提供創新服務方面仍然落後。本研究建議政府應鼓勵資通訊業者發展以雲端運算為基礎的遠距照護系統,協助中小型照護機構提供行動裝置發展個人化的照護服務,並透過大數據發展人工智慧提供智慧及精準醫療,整合資通訊跟醫療照護產業,創造新的價值應用服務,研究結果可以做為政府及資通訊業者推動及發展遠距照護的政策依據。
This research takes a quantitative approach by developing and validating a resource-based view theory-based conceptual model. Among the theories commonly applied in telehealth care system adoption research, the authors found that the Technology-Organization-Environment framework can encapsulate the relevant factors. This study explored the effects of information technology (IT) resources—in conjunction with IT infrastructure and organizational resources—on organizational capabilities and performance. The study further analyzed the mediating effect of organizational capabilities on the relationship between IT resources and organizational performance. A cross-sectional research design was adopted, and questionnaire copies were administered to senior care supervisors of Taiwanese day care centers, care institutions, and hospitals. In total, 328 valid questionnaire responses were obtained.
The results indicate the following: (1) care institutions’ adoption of telehealth is concurrently affected by the factors of technology, organization, environment, and risk; (2) for the factors affecting the adoption of telehealth by care institutions of different levels, the results showed that, community institutions are affected by environmental factors, and hospitals are affected by technological and organizational factors; (3) for the factors affecting the performance of institutions of different levels, the results showed that, community institutions are affected by technological and environment factors, while hospitals are affected by technological and environmental factors.
This study found that, the different scales of institutions have different influences on the adoption of telehealth. The resources of community care institutions are relatively insufficient. rural areas need telehealth; however, such areas also face the predicaments of lacking technological and organizational resources, and the economic ability of residents is poorer. The government should use policies to provide care institutions in remote areas with more incentives and improve the public’s willingness to adopt telehealth. This study provided clearer perspectives and decision-making bases for practical planning and adoption of telehealth for care institutions of different levels. Moreover, this study provided the results as reference for future studies to perform in-depth investigations on the adoption of telehealth or other innovative applications of care institutions with different levels or characteristics.
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盧瑞芬、謝啟瑞(2003) ,臺灣醫院產業的市場結構與發展趨勢分析,經濟論文叢刊,31卷1期,p 107-153。

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三、網路資料
1.衛生福利部(2018),通訊診察治療辦法,Retrieved March 21, 2020, from, https://www.mohw.gov.tw/cp-16-41136-1.html
2.Arthur D. Little(2016), Impact of Digital Health on the Pharmaceutical Industry, Retrieved June 13, 2019, from, https://www.adlittle.com/sites/default/files/viewpoints/ADL_HC_2016_Digital-Health_01.pdf
3.WHO(2010), Retrieved November 8, 2014, from, https://www.who.int/goe/publications/goe_telemedicine_2010.pdf
4.Verma, S. (2020), Early Impact of CMS Expansion of Medicare Telehealth During COVID-19, Retrieved July 23, 2020, from, https://www.healthaffairs.org/do/10.1377/hblog20200715.454789/full/
 
 
 
 
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