隨著人口老齡化及疾病慢性化得趨勢加劇，身心障礙者對於醫療和支援需求日益增加，需要更加全面化和個性化的醫療和支持。因此針對身心障礙者的需求整合醫療模式來提供更全面有效的服務。
本研究主要探究醫學中心在提供身心障礙整合門診對身心障礙患者整體就醫滿意度，並以身心障礙患者整體滿意度為基礎，探討醫院環境設施、就醫過程中的專業照護、患者在就醫中所感受到的服務以及個案管理師在提供專業照護及服務態度相互間的影響關係。問卷調查對象針對在2022年身心障礙整合門診已收案對象採不計名方式進行一對一進行訪談，研究問卷調查採用量性研究進行取樣收集分析。問卷發放及回收共計202份，有效回收率為100％。研究結果採SPSS/25.0統計軟體進行資料分析。其中問卷填答對象以本人填答有47%，以男性居多佔了57.4%，且多為重度肢體障礙且需要親友陪同就醫為對多。
分析結果顯示，身心障礙患者在醫院環境設施、就醫過程中的專業照護及感受到的服務態度，與當次整體就醫經驗的滿意度與推薦他人至本院就醫正相關聯性。在身心障礙人口特徵中的差異性分析中，有人陪同就醫及年齡越高的患者對就醫中所感受到的服務及環境友善設施有較高的評價。而個案管理師所提供的專業照護與服務態度會提高身心障礙患者整體就醫滿意度，讓他們更願意推薦其他患者至本院就醫。然而在控制了其他變項後，身心障礙類別與嚴重程度對整體就醫滿意度與推薦醫院與否並無顯著差異。
身心障礙整合計畫裡多為需協助的身心障礙患者，在身心障礙患者抵達醫院後各項環境設施、就醫過程中的專業照護及感受到的服務態度以及個案管理師整體的專業照護及服務與身心障礙患者整體就醫滿意度是有顯著相關的。而醫院可藉由流程的改善來提升身心障礙患者的整體滿意度，個案管理師針對身心障礙者的特殊需求提供相關就醫幫助及服務，使其提高對醫院整體就醫的滿意度。且讓身心障礙患者或家屬對整體就整經驗得滿意度提高，且更願意推薦其他身心障礙者來本院就醫。另本研究最後提供相關研究應用、研究貢獻與建議，以供後續研究者進行參考。

As the aging population and the chronicity of diseases continue to worsen, the increasing number of individuals with disabilities has led to a growing demand for comprehensive and personalized medical care and support. There is a need to integrate healthcare models specifically tailored to the needs of individuals with disabilities in order to provide more comprehensive and effective services.
This study aims to investigate the overall satisfaction of individuals with disabilities with the integrated outpatient services provided by a medical center. Based on the overall satisfaction of individuals with disabilities, the study examined the relationships between hospital environmental facilities, professional care during the medical process, the perceived quality of services experienced by patients, and the impact of case managers on professional care and service attitudes. The survey targeted individuals who received case management services in the integrated outpatient clinic for individuals with disabilities in 2022, and one-on-one interviews were conducted anonymously. The research adopted a quantitative research approach for sampling, data collection, and analysis. A total of 202 questionnaires were distributed and collected, resulting in a 100% response rate. The research findings were analyzed using SPSS/25.0 statistical software. Among the respondents, 47% completed the questionnaire by themselves, with the majority being male (57.4%), and most had severe physical disabilities and required the accompaniment of family members or friends during medical visits.
The analysis results indicate that there is a correlation between the satisfaction with hospital environmental facilities, professional care during the treatment process, perceived service attitude, and the overall satisfaction of individuals with disabilities during their medical visits, as well as their likelihood of recommending the hospital to others. In terms of differences in the characteristics of individuals with disabilities, it was found that patients who are accompanied by someone during their medical visits and older patients place greater importance on the perceived services and friendly environmental facilities during their visits. Additionally, the professional care and service attitude provided by case managers contribute to higher overall satisfaction among individuals with disabilities, making them more likely to recommend the hospital to other patients.
Based on the research findings, it is evident that within the integrated care plan for individuals with disabilities, most participants are those who require assistance. The study demonstrates a positive correlation between various environmental facilities, professional care during the medical process, perceived service attitudes, overall professional care and service provided by case managers, and the overall satisfaction of individuals with disabilities during their medical visits. Hospitals can enhance the overall satisfaction of individuals with disabilities by improving their processes, while case managers can address the specific needs of individuals with disabilities and provide relevant medical services and assistance, thereby increasing their satisfaction with the hospital visit experience. This, in turn, leads to a higher likelihood of recommending the hospital to other individuals with disabilities and their families seeking medical care. Lastly, the study provides recommendations and contributions for future research applications in this field.

論文審定書 i
中文摘要 ii
Abstract iv
圖次 viii
表次 ix
第一章 緒論 1
第一節研究背景 1
第二節研究動機 2
第三節研究目的 2
第二章 文獻探討 4
第一節流程改善模型 4
第二節身心障礙者就診時所遇困境 6
第三節個案管理師角色與定義 7
第四節醫療機構對身心障礙者的需求服務 8
第五節文獻探討與總結 9
第三章 研究方法 11
第一節研究架構 11
第二節研究假說 14
第三節研究設計 15
第四節問卷發放與回收 21
第五節資料統計分析方法 23
第四章 研究結果與資料分析 27
第一節敘述性統計資料分析 27
第二節身心障礙患者整體感受與三大構面相互影響分析 32
第三節個案管理師整體服務態度的感受相關性分析 37
第四節身心障礙類別及其嚴重程度在計畫實施下的差異性及迴歸分析41
第五章 討論46
第一節研究結果彙整與討論46
第二節研究應用49
第三節研究限制50
第六章 研究結論與建議52
第一節研究結論與研究貢獻52
第二節未來研究建議53
參考文獻54
一、英文文獻54
二、中文文獻56
附錄58
一、專家效度58
二、人體研究倫理審查委員會人體研究計畫同意函60
三、正式問卷61

一、 英文文獻
Brown, C. (2019). Why and how to employ the SIPOC model. Journal of business continuity & emergency planning, 12(3), 198-210.
Carr, D. D. (2006). Implications for case management: Ensuring access and delivery of quality health care to undocumented immigrant populations. Professional case management, 11(4), 195-204.
Carr, D. D. (2007). Case managers optimize patient safety by facilitating effective care transitions. Professional case management, 12(2), 70-80.
Donabedian, A. (1988). The quality of care: How can it be assessed? Jama, 260(12), 1743-1748.
Donabedian, A. (2005). Evaluating the quality of medical care. 1966. The Milbank quarterly, 84(4), 691-729.
Health, B. U. (2016). Boston University School. Retrieved 06/10/2023 from https://sphweb.bumc.bu.edu/otlt/MPH-Modules/HPM/AmericanHealthCare_Quality-Cost-Outcomes/AmericanHealthCare_Quality-Cost-Outcomes3.html#headingtaglink
Hwang, B., Chun, S. M., Park, J. H., & Shin, H. I. (2011). Unmet healthcare needs in people with disabilities: comparison with the general population in Korea. Annals of rehabilitation medicine, 35(5), 627-635.
Maier, D., Sven-Joachim, I., Fortmuller, A., & Maier, A. (2017). Development and operationalization of a model of innovation management system as part of an integrated quality-environment-safety system. Amfiteatru Economic, 19(44), 302-314.
McCormick, F., Marsh, L., Taggart, L., & Brown, M. (2021). Experiences of adults with intellectual disabilities accessing acute hospital services: A systematic review of the international evidence. Health & social care in the community, 29(5), 1222-1232.
Nunnally, J. C. (1978). An overview of psychological measurement. Clinical diagnosis of mental disorders: A handbook, 97-146.
Parkash, S.,& Kaushik, V. K. (2011). Supplier performance monitoring and
Improvement (SPMI) through SIPOC analysis and PDCA model to the ISO 9001 QMS in sports goods manufacturing industry. LogForum, 7(4), 1–15.
Schuetze, K.,& Cunningham, B. (2007). The case manager connection: Taking a leadership role to improve patient outcomes. Nurse Leader, 5(1), 48-50.
Sobiś, A., Olesków-Szłapka, J., & Fertsch, M. Analysis of capability of Lean
Manufacturing implementation in manufacturing enterprise from sector of electromechanical industry-case study.
Thomas, P. L. (2008). Case manager role definitions: do they make an organizational impact? Professional Case Management, 13(2), 61-71.
Yeung, S. M. (2009). Using Six Sigma–SIPOC for customer satisfaction. International Journal of Six Sigma and Competitive Advantage, 5(4), 312-324.
Zhang, H., Fan, L., Chen, M., & Qiu, C. (2022). The impact of SIPOC on process reengineering and sustainability of enterprise procurement management in e-commerce environments using deep learning. Journal of Organizational and End User Computing (JOEUC), 34(8), 1-17.

二、 中文文獻
田蒙潔、劉王賓(2010)。《新版無障礙環境設計與施工實務》。臺北：詹氏書局。
石又敏、陳玉敏、曾月霞(2010)。家屬陪伴失智症患者門診就醫之生活經驗。
長期照護雜誌，14(1)，43-57。
石曜堂(1978)。醫療品質評估。醫院雜誌，11(2)，106-109。
全國法規資料庫。身心障礙者權益保障法。2023年6月10日 取自
http://law.moj.gov.tw/LawClass/LawAll.aspx?PCode=D0050046
吳明隆(2009)。SPSS操作與應用:問卷統計分析實務。五南圖書出版社。
林金定、嚴嘉楓、李志偉、吳佳玲(2002) 。智能障礙者醫療需求與就醫障礙: 以
專家面向分析。台灣家庭醫學雜誌，12(3)，111-120。
林昭吟、鄭雅之、張恒豪(2018)。當「不標準的病人」遇到醫療專業體制：身
心障礙者就醫經驗的質化分析。臺大社會工作學刊，38，99-145。
國家人權委員會(2021)。國家人權委員會就身心障礙者權利公約第二次國家
報告之獨立評估意見。
張正二（1995）。全民健保實施下如何提升醫療服務品質。醫院，28(4)，12-16。
游政諺、陳孝平(2015)。就醫路關卡多:成年聽覺障礙者就醫經之研究。
趙曉芳、黃詩淳、陳怡伃、李會珍、陳筠靜、傅從喜(2021年6月)。被看見
與不被看見：失智者服務使用與權益保障的困境與挑戰。臺灣社會福利學刊，17(1)，51-84。
蔡文正、龔佩珍(2006)。運用重要性與績效分析法探討身心障礙者對醫療服務品
質之重要性認知與滿意度。2023年6月10日 取自http://ir.cmu.edu.tw/ir/handle/310903500/11231
蔡文正、龔佩珍(2002)。身心障礙者就醫環境品質指標之建立、評估與滿意度
調查。2023年6月10日 取自http://ir.cmu.edu.tw/ir/handle/310903500/11201
衛生福利部(2016)。身心障礙者生活狀況調查。2023年6月10日 取自
https://dep.mohw.gov.tw/DOS/lp-5096-113-xCat-y105.html
韓揆(1994)。醫療品質管理及門診服務品質定性指標。中華公共衛生雜誌，
13(1)，35-53。
CRPD身心障礙者權利公約。2023年6月10日 取自
https://crpd.sfaa.gov.tw/BulletinCtrl?func=getBulletinList&p=b_1&page=1&rows=15&c=C&t=C