目標：本論文旨在瞭解目前醫院結核病個案管理模式的內涵，並進一步探討「結核病醫療給付改善方案」試辦計畫等因素對於醫院採取的個案管理模式內涵之影響。方法：本研究的研究母群體為衛生署90-93年度醫院評鑑結果屬於地區（含）以上之醫院，共有462家，問卷填答對象則為上述醫院中負責執行結核病個案管理工作之人員。研究人員於民國95年3月初開始寄發問卷，最後的實際有效研究樣本數為234家醫院。結果：樣本醫院所採行之結核病個案管理模式的內涵可歸類為人力配置、收案管理、資料建立、治療管理、護理指導、回診管理及轉介管理等七項。統計分析結果顯示，除了轉介管理此要項外，加入「結核病醫療給付改善方案」試辦計畫的醫院在人力配置等要項均優於未加入該試辦計畫的醫院。結論：研究結果顯示「結核病醫療給付改善方案」試辦計畫對醫院有正面的影響力，本研究對於衛生主管機關並提出「有計畫性地培育醫院結核病防治人才」等六項建議。

Objectives: The purpose of this study was to investigate the current management of tuberculosis patients in Taiwan's hospitals and to analyze the impact of hospital characteristics on the inclusion of various components of the model for tuberculosis case management. Methods: Using the 2001-2004 hospital accreditation data, the study population comprised more than 462 district hospitals in Taiwan. The survey was conducted in early March 2006 by mailing self-administered questionnaires to the individuals in charge of managing tuberculosis patients in those hospitals. The final effective sample size was 234. Results: The results showed that, except for the referral management aspect, hospitals that were participating in the pay-for-quality demonstration program performed better in terms of manpower allocation, admission management, and the like. Conclusions: This study demonstrated that the pay-for-quality demonstration program did exert a positive influence on management of tuberculosis patients in these hospitals. Six policy recommendations, such as increasing the training of tuberculosis case managers, were proposed on the basis of these research findings.

個案管理模式 ； 醫療給付改善方案試辦計畫 ； 結核病 ； 醫院

Case management model, Pay-for-quality demonstration program, Tuberculosis, Hospital