依據美國腎臟資料庫系統(USRDS) 2011年度報告中，台灣透析(洗腎)病患之盛行率與發生率分別高居世界第一及二位，目前全國已突破六萬人(65883) 的透析(洗腎)人口。可以提供透析(洗腎)醫療服務的機構稱之為血液透析中心。根據行政院衛生署醫療機構設置標準規定，血液透析中心可以由各級醫院(醫學中心，區域教學醫院，地區醫院)所屬的腎臟內科來設置，亦可以由專科診所來設置，因此血液透析中心會附屬於醫院也可以是診所。目前臺灣可以提供透析(洗腎)醫療服務的血液透析中心數量為571所，其中附屬於醫院有262所，附屬於診所有309所。我們想要研究這兩個中心類別所提供的醫療服務品質是否不同？病患滿意度與病患行為意圖是否不同？是否各有所長，可以各自發揮？本研究是以Zineldin（2006）所提出的5Qs model為基礎，針對不同的血液透析中心類別病患，我們選擇對象品質、過程品質、溝通品質與氣氛品質等四個品質構面來檢視哪些醫療服務品質會影響他們的滿意度與行為意圖，並期望此一研究結果能對不同的血液透析中心類別在未來關於提升醫療服務品質，加強競爭力與永續經營上，提供有效的策略方向。
本研究的研究對象為三家血液透析中心的病患，每家各發放100份問卷(一家是附屬於區域教學醫院，一家是附屬於地區醫院，一家是附屬於腎臟專科診所)。經篩選後的有效問卷為240份，有效回收率為80%。本研究的醫療服務品質是以四大品質構面作為分析單位，分別對病患滿意度、病患行為意圖進行分析，另外加上病患滿意度對病患行為意圖進行分析。
本研究所得到的結果歸納如下: 1.醫療服務品質中「對象品質」、「過程品質」、「氣氛品質」對病患滿意度有正向相關顯著影響，尤其以「過程品質」對病患滿意度影響度最高，「溝通品質」則沒有顯著關係。2.醫療服務品質中，「過程品質」對病患行為意圖有正向相關顯著影響，但「對象品質」，「過程品質」與「溝通品質」則沒有顯著關係。3.病患滿意度與行為意圖互相有正向顯著影響。4.血液透析中心不同類別則對於「對象品質」、「過程品質」、「溝通品質」、「氣氛品質」、「病患滿意度」與「病患行為意圖」皆具有顯著性的不同。

Based on the 2011 annual report of the United States Renal Data Library System (the USRDS), the prevalence and incidence of dialysis patient in Taiwan were the first and second in the world and the population of dialysis patient has exceeded six million (65883). Where can provide dialysis
medical services called the hemodialysis center. According to the setting standards of medical institutions,provisions of the Department of Health, hemodialysis center can be set by the hospitals under the division of of Nephrology (Medical Center, regional teaching hospital, district hospital) and also set by the specialised clinics, hemodialysis centers will attached to the hospital or the clinic. Taiwan have 571 hemodialysis centers where can provide dialysis medical services , separated to 262 hospitals and 309 clinics.
We want to study the difference of quality of health care services provided by these two center categories ? Is it different from their patient satisfaction and patient behavioral intention ? Whether their own merits, can each play? This study is based by the 5Qs the model proposed by Zineldin (2006) upon the hemodialysis patients, we have chosen four quality dimensions including the quality of object, quality of process, quality of communication and the quality of atmosphere to see which quality of health care services will affect their satisfaction and behavioral intentions, and look forward to the results of a study on the different category of hemodialysis centers in the future to improve the quality ofhealth care services, strengthening the competitiveness and sustainable management, to provide effective strategic direction.The study included patients from the three hemodialysis centers, each centers have received 100 questionnaires (one is regional teaching hospital, one is district hospitals and the rest is nephrologist clinics ). Effective returned questionnaires is 240 and the rate is 80%. In this study, the quality of healthcare services is based on four quality dimensions as the unit of analysis, the patient`s satisfaction, patient`s behavior intension.
The results of this study are summarized as follows: 1. Quality of healthcare services " quality of object " and " quality of process ", "quality of atmosphere " has a positive significant impact on patient`s satisfaction, particularly in the " quality of process ",but " quality of interaction " has no significant relationship. The quality of healthcare services, " quality of process " has a positive significant impact on patient behavior intentions, but the " quality of object " ," quality of process " and " quality of interaction " have no significant relationship. 3 Patient`s satisfaction has positive and significant impact to behavioral intentions each other. 4.Different category of hemodialysis centers all have significant correlation for the " quality of object ", " quality of process ", " quality of interaction ", "quality of atmosphere ", patient`s satisfaction and patient`s behavior intention".

論文審定書 ……i
論文提要……… ii
誌謝…………… iii
中文摘要………iv
英文摘要 ……v
目錄………… vii
圖次 …………ix
表次 …………x
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 3
第三節 研究流程 5
第二章 文獻探討 7
第一節 血液透析(洗腎)醫療服務 7
第二節 血液透析治療的照護品質指標 17
第三節 醫療服務品質 19
第四節 病患滿意度 25
第五節 病患行為意圖 29
第六節 不同中心類別病患的醫療服務品質評價，病患滿意度與病患行為意圖 …31
第三章 研究方法 32
第一節 研究架構 32
第二節 研究變數與問卷設計 33
第三節 研究工具 37
第四節 研究樣本與資料蒐集方式 38
第五節 資料分析方法 38
第四章 統計結果與分析 41
第一節 樣本結構 41
第二節 敘述性統計分析 44
第三節 問卷信度與效度分析 46
第四節 多元迴歸分析 49
第五節 ANOVA分析 56
第五章 結論與建議 66
第一節 研究結果 66
第二節 研究建議 68
第三節 研究限制與未來研究方向 69
參考文獻……………… 70
附錄：問卷 ……………76

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三、網站部分
美國品質學會（ASQ）「Why Quality?」(http://asq.org/index.aspx)
Institute of Occupational Medicine (IOM,1990)( http://www.iom-world.org/)