當民眾產生病痛而需尋求醫療服務時，通常需到醫療院所接受服務。然而，對於一些需長期看病之年邁老人而言，頻繁至醫療院所就醫將增加出外之危險性，如能改由醫師至其居住的地方提供診療服務，不僅增加就醫之可近性，也可免去許多老人可能面臨的危險。有鑑於此，本研究之復健模式以復健醫師外診、復健師駐診的方式，與安養中心簽約，在安養中心設置一與復健診所同規模之復健診療室。醫師每週一次至安養中心為老人看診，而復健師則依醫囑每日為安養中心病患復健。對照之復健科的門診病患，新的復健模式最大的不同在於這些有復健需求的老人不用勞碌奔波至醫院復健，免去有可能遭遇跌倒、醫院內病菌的感染等等之危險。加上復健門診已設置在安養中心內，病患較能按時就診，可提高復健的成效。
由於沒有研究探討此模式與一般的就醫模式有何不同，故本研究就以環境與結構因素的觀點，利用成本效果分析來探討傳統就醫模式與醫師外診復健模式之間的差異。
研究方法：
本研究為長期研究，在2002年11月至2003年11月間，收集醫師外診模式與一般就醫模式病人從開始復健日至研究結束時之巴氏量表分數以及復健所花費之醫療成本，共收集四次。統計方法除描述性統計與t檢定、卡方檢定外，利用廣義估計方程式分析環境因素與結構因素對病患復健效果、復健成本與復健成本效果(cost-effectiveness)的影響。
結論：
環境因素包括復健模式與病患—復健師比，結構因素包括鏈結與否、設備多寡與設備新舊，環境與結構因素皆會影響復健單位的績效，復健模式與病患—復健師比皆會負向的影響復健單位的復健成效，但在效率方面，其對復健成本與復健成本效果的影響是正向的。結構因素中，鏈結與否、設備多寡與設備新舊皆會正向的影響復健的效果，但在效率方面，其對復健成本與復健成本效果的影響是負向的。

Study objectives and significance
Generally, patients go to hospitals or clinical offices for seeking health care service. However, some studies reveal that old patient or those who have disability would get hurt and expose in some dangerous situation, such as falls and infection. As the reasons, the rehabilitation delivery model, which sends the service to patients’ community, is needed. The community delivering-rehabilitation model that this study focuses on integrates hospital center and retirement home. This study is to compare the community delivering-rehabilitation model and general delivery model that patients go to hospital for rehabilitation service.
Data and methods
In one-year study duration from Nov. 1, 2002 to Oct. 31, 2003, the Barthel Index score from two delivery models were collected every 3 months. On the other hand, patients’ rehabilitation costs were collected once 3 months, too. The study unit is individual unit. Cost-effectiveness analysis (CEA) was used here to be a standard comparing tool. CEA was computed by dividing the cost that patient spent in 3 months into the Barthel Index score which patient improved his functional status. Independent variables include environmental factors and structural factors The Environment factors include rehabilitation delivery model and the patient-therapist ratio. Structural factors include chain-affiliation status, instrumental volume and status. The General Estimating Equation was used here for comparing longitudinal dependent data.
Results
The study reveals that environmental factors and structural factors affect the performance of rehabilitation units. Environmental factors positively affect the rehabilitation effect. Structural factors negatively affect the rehabilitation effect. On the other hand, Environmental factors positively affect the rehabilitation efficiency. Structural factors negatively affect the rehabilitation efficiency.
Conclusion and the project’s relevance to public health
The community delivering-rehabilitation model has better rehabilitation effect, but on the aspect of efficiency, is not as good as general delivery model. However, the community delivering-rehabilitation model has good accessibility to patient. It also concerns patient safety. If the model can improve its efficiency, the promotion of health can be further implied in community delivering-rehabilitation model.

中文摘要 II
Abstract IV
目錄 VI
圖目錄 VII
表目錄 VIII
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與研究問題 3
第二章 文獻探討 4
第一節 法源依據 4
第二節 環境與結構因素對組織績效之影響 7
第三節 成本效果與影響成本效果的因素 9
第四節 巴氏量表簡介 12
第三章 研究方法 13
第一節 研究架構 13
第二節 研究假設 15
第三節 研究方法 16
第四節 分析方法 20
第四章 研究結果 22
第一節 基本資料分析 22
第二節 復健效果分析 24
第三節 成本分析 34
第四節 成本效果分析 38
第五章 結論與建議 41
第一節 討論 41
第二節 結論與建議 46
第三節 研究限制 47
參考文獻 48

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