研究背景與目的:衛生福利部於2015年為了解決急診壅塞及住院醫師人力不足的問題，參考了來自美國醫療體制下的駐院主治醫師制度，希望能善用醫院現有的資源做最佳運用，以期提升醫療品質，落實建構「全人健康照護醫療體系」之目的。後續醫療團隊與資訊人員合作整合醫療資訊系統，將各種不同職類的病歷資料整合在同一個畫面，醫院將此稱為「全人醫療照護平台」，而目前鮮少研究聚焦此平台之效益分析。因此本研究以南部某公立醫學中心之病人及醫師為對象，分析跨領域團隊全人照護對於疾病照護之影響。同時以質性研究設計，探討醫師對於跨領域團隊全人照護的看法及相關經驗。並依據量性分析與質性訪談結果討論跨領域團隊全人照護成效。
材料與方法: 量性研究部分，以傾向分數配對實驗組(接受跨領域團隊全人照護之住院病人)對照組背景變項，以配對後結果進行相關分析。質性研究部分，以啟動過全人會議之主治醫師為研究對象進行訪談。訪談對象選取以願意受訪為原則，採用主題分析法分析。
結果:接受跨領域團隊全人照護之病人住院天數較多。有其他職類介入會顯著增加啟動跨領域團隊全人照護的機率。跨領域團隊全人照護有助於減少病人再返急診率、再住院率及住院死亡率。質性研究分析受訪醫師對於跨領域團隊之看法，可歸類為運作方式、困難與挑戰、與其他職類溝通方式、帶來的改變及安排計畫。
結論:跨領域團隊全人照護模式對於病人疾病照護結果有正向影響，而跨領域團隊是以醫師為主導者，與不同領域專業人員共同擬定照護方式，給予病人以需求為主的全人照護。

Backgrounds and Objectives:In 2015, to solve the problems of emergency congestion and shortage of resident physicians, the Ministry of Health and Welfare referred to the resident physician (Hospitalist) system from the American medical system. This system hopes to make the best use of the existing resources of the hospital. To improve the quality of medical care and implement the purpose of building a "whole person health care medical system". The follow-up medical team cooperates with information personnel to integrate medical information systems and integrate medical records of various categories on the same screen. The hospital calls this a "comprehensive medical care platform". Few studies are focusing on the benefit analysis of this platform to date.Therefore, this study aimed to analyze the outcomes of a multidisciplinary team with comprehensive care for inpatients and physicians in a public Medical Center located in Southern Taiwan.While a qualitative research design was used to explore physicians' perceptions and related experiences of a multidisciplinary team with comprehensive care. Then discussed the effectiveness of comprehensive care in multidisciplinary teams based on the results of quantitative analysis and qualitative interviews. Materials and Methods:In the quantitative part, the inpatients who received comprehensive care from a multidisciplinary team were used as the experimental group, and used the propensity score matching was to complete the controlled-experiment pairing of patients’ sociodemographic variable and the correlated analysis. In the qualitative part,interviews were conducted with the physicians who had initiated the meeting as the subjects. The selection of interviewees is based on the principle of willingness to be interviewed, and thematic analysis was used. Results:The experimental group had a longer length of stay. Multidisciplinary comprehensive care can help reduce patient readmission rate, inpatient rate and mortality rate. The physicians' views on multidisciplinary comprehensive care can be categorized into operation mode, difficulties, and challenges, communication with other occupations, changes brought about and arrangements planned. Conclusion:Multidisciplinary comprehensive care had a positive impact on the outcome of disease care. The team is led by physicians. They work together with professionals in different fields to provide patients with comprehensive care based on their needs.

論文審定書 i
致謝 ii
摘要 iii
Abstract iv
圖次 viii
表次 ix
第一章緒論 1
1.1 研究背景與動機 1
1.2 研究目的 3
第二章文獻查證 4
2.1 綜合性照護相關研究 4
2.2 名詞解釋 5
2.2.1 整合性照護(Integrated Care) 5
2.2.2 綜合性照護(Comprehensive Care) 6
2.2.3 以病人為中心的全人照護（Patient-Centered Holistic-Care） 7
2.2.4 跨領域團隊照護(Multidisciplinary Care) 7
2.2.5 跨領域團隊全人照護 8
2.3 跨領域團隊全人照護的成效量測 9
2.4 以跨領域團隊全人照護為主題之相關質性研究 16
第三章研究方法 29
3.1 研究架構 29
3.1.1 量性分析研究架構 29
3.1.2 質性分析研究架構 29
3.2 量化成效分析 30
3.2.1 資料庫的取得 30
3.2.2 受試者資料選取 32
3.2.3 統計方法 34
3.3 質性研究設計 36
3.3.1 訪談對象招募及受試地點 36
3.3.2 資料收集及記錄方式 36
3.3.3 樣本數取得與飽和性分析 37
3.3.4 訪談大綱 38
3.3.5 資料處理及分析 39
3.4 倫理考量 40
3.5 研究流程與時程規劃 40
第四章研究結果 41
4.1 量性研究結果 41
4.1.1 住院病人基本資料分析 41
4.1.2 評估相關變項於兩組間之差異性 43
4.1.3 評估經濟、憂鬱與失眠等因素於兩組間之差異 46
4.1.4 其他職類介入相關因素於兩組間之差異 50
4.2 質性研究結果 54
4.2.1 受訪者基本資料說明 54
4.2.2 受訪醫師對於「跨領域團隊全人照護模式」之看法 56
4.2.3 關於團隊運作方式 58
4.2.4 關於職類間溝通 60
4.2.5 關於困難與挑戰 62
4.2.6 關於帶來的改變 66
4.2.7 對於跨領域團隊全人照護安排 70
4.2.8 比較執行不同醫療模式醫師的看法 71
第五章研究討論 74
5.1 量性研究分析 74
5.1.1 兩組病人住院天數顯著差異之原因分析 74
5.1.2 兩組病人於出院後相關評估指標上差異之原因分析 75
5.1.3 職類介入成為啟動跨領域團隊全人照護判斷依據 78
5.2 質性研究探討 79
5.2.1 跨領域團隊照護運作模式受醫師個人特質影響 79
5.2.2 採用不同照護模式之醫師與其他職類溝通方式相似 80
5.2.3 以疾病為導向的照護 81
5.2.4 跨領域團隊全人照護帶來的改變不侷限於醫病之間 82
5.3 研究限制 83
第六章結論與建議 85
參考文獻 87
附錄 94

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