24卷2期

• Link 綜論 Review Article
• 預防老人跌倒之運動訓練研究趨勢探討Trends of Exercise Training Research in Fall Prevention Programs among the Elderly
• 陳怡如、黃璉華、鄭舜平
  I-Ju Chen, Lian-Hua Huang, Shun-Ping Cheng
• 老人；跌倒；運動訓練
  elderly?;?fall?;?exercise training
• 目標：了解自1990年來預防老人跌倒的運動訓練發展走向，並提出預防老人跌倒之運動訓練之相關建議。方法：回顧1990到2002年預防老人跌倒之相關文獻，主要字彙包括臨床研究、老人、跌倒、運動，方法包括電子資料庫與參考資料搜尋，主要收集文章中有描述運動訓練的預防老人跌倒計畫。結果：共尋獲20篇相關文獻。文中依照研究設計與架構、參與人數與對象、訓練地點、運動訓練之內容與模式、所需之設備、中期指標、結果測量、與遵從性之監測等方面，描述自1990年代以來預防老人跌倒之運動訓練研究概況。結論：運動訓練是以積極的方式，來促進老人生理與心理健康，並提高獨立生活的能力與信心。對未來研究提出之建議：l．需跨學門人員共同參與合作，設計以運動訓練為主要部分之預防老人跌倒計畫。2．計畫中需設計評值，以評估長期與短期之成效。3．要用實驗法或隨機控制試驗等研究設計，嚴謹的控制會影響結果解釋的變項。4．需要客觀之評估工具，以提供科學實證。
  Objectives: To evaluate the trend of exercise research in exercise programs on fall prevention programs among the elderly and propose suggestions for future studies. Methods: Following a systematic literature search using the key word: clinical research, old adults (elderly), fall, and exercise, articles published from 1990 to 2002 describing exercise programs on fall were reviewed. Result: Twenty articles were reviewed. Research design, participants, setting, exercise program, equipments, intermediate indicator, outcome measure, and compliance were identified and discussed in the article. Conclusions: Exercise appeared to be an effective intervention in promoting physical and psychological well-being among the elderly. Suggestions for future studies include 1. A multi-disciplinary team working together to pool their knowledge and findings. 2. Evaluation being a part of exercise programs in order to assess its short term and long term effects. 3. Experimental or randomized controlled design being preferred in order to control for confounding factors. 4. Objective tools for fall assessment being required to provide scientific evidence.
• 93 - 102
• 10.6288/TJPH2005-24-02-01

• Link 綜論 Review Article
• 急性醫院入院適當性工具AEP於國內應用之初探An Exploratory Study of AEP on Acute Hospital Admission Appropriateness in Taiwan
• 溫信財、陳傑峰、 季瑋珠、高森永
  Hsyien-Chia Wen, Chieh-Feng Chen, Wei-Chu Chie, Sen-Yeong Kao
• 入院適當性；住院適當性評估表；總額支付制度
  Admission appropriateness ; Appropriateness Evaluation Protocol (AEP) ; Global budget
• 健保局為持續改善醫療品質，在民國85-92年間，針對不同層級醫院之一般病床給付，逐漸調漲34.4-40.5%，可是醫療機構在醫療審查執行是否適當上，與保險人間仍有相當大的爭議，醫界對未建立共同審查指標迭有抱怨，認為事後醫療審查在無明確基準下，嚴重損害醫院權益，故建議應制訂入院審核標準。 國內有關醫療適當性之研究或報導，多數集中在醫療服務上，但有關醫療場所適當性的研究則不多見。由於Appropriateness Evaluation Protocol(AEP)的信度、效度受到肯定，且具有允許公用(public domain)，不受智慧財產困擾之特性，故常被國際研究做為入院適當性判定工具，因此本文除將之與其他工具比較外，並針對其特性做較詳細的介紹。雖然國際間對AEP多所肯定，但各國之實證研究亦發現：不同國家在採用AEP時均會考慮原基準是否適用於國內，而無論以前瞻或回溯性方式執行住院適當性判定、病歷是否做為審查之唯一依據等問題，均為影響住院適當性判定之相關變項。 全民健保現在雖改變以總額方式來支付醫院，但若無客觀明確之基準做為病人應否住院的依據，在醫院間無一協調機制運作下，醫院為維持原有之醫療收入，仍將多提供醫療服務，今人擔憂其結果將與論量計酬制度相同，因此本文相信發展適用國內之判定工具，將有助於醫療資源的有效運用並減少醫院及保險人間之爭議。
  The Bureau of NHI (BNHI) raised acute bed reimbursement by 34.4-40.5% during 1996-2003 at different levels of hospitals in order to improve quality of care. However, many hospitals were still unsatisfied with the results of the medical review, they complained that the retrospective review which did not include explicit criteria damaged their rights. Therefore, developing admission criteria is of urgent importanct in Taiwan. Articles or reports regarding medical care appropriateness have focused on medical services. Few have focused on medical setting of Taiwan. An international review criteria ”Appropriateness Evaluation Protocol (AEP)”, which is a reliable, valid and public-domain tool will be introduced in more detail in this paper and compared with other admission instruments. Although AEP has been endorsed by the studies of many other countries, the criteria of the admission is adjusted in the different countries because of physician differing practice styles and available resources. It also needs a further study to find out those variables that will influence the admission decision, such as whether medical records are the only information source, the difference between reviewed by the retrospective and prospective method etc. Although the global budget payment system was recently adopted by BNHI, there are still no explicit criteria to assess the appropriateness of admission now. If there is no effective mechanism to negotiate between hospitals, over-utilization will be occured in the same way as with previous fee-for-service payment. Therefore, a Taiwanese- version admission criteria needs to be developed in order to provide more efficiently care and resolve the disputes between hospitals and BNHI.
• 103 - 113
• 10.6288/TJPH2005-24-02-02

• Link 原著 Original Article
• 運用“核心組織充能” 於社區糖尿病防治介入研究－以台北都會某小型社區為例Intervention Effectiveness of Diabetes Prevention Using an Urban Mini-Community in Taipei as an Example
• 劉潔心、楊智琳、陳合如、林怡君
  Chieh-Hsing Liu, Ju-Lin Yang, Ho-Ju Chen, I-Chiung Lin
• 社區 ； 糖尿病防治 ； 社區介入
  community ; diabetes ; community intervention
• 目標：探討如何運用有效的社區介入策略，提升社區居民對糖尿病防治之行動力。本研究為期兩年，第一年研究結果已另文發表，本文將繼續呈現第二年社區糖尿病防治計畫之發展與執行結果。方法：選擇以社區核心組織為切入點，運用充能介入原則，與社區核心組織共同發展符合居民需求之糖尿病防治計畫。結果：l.社區核心組識充能介入成效方面：充能介入能促進社區發現問題、凝聚社區共識，並有效改變成員溝通、組織氣候、成員參與與成員滿意度等運作型態；但對於促進資源動員、強化組織結構、計畫執行有效性等，未能有顯著的效果。2.社區居民對社區營造中心計畫執行成效評價方面：受訪之居民有85%未聽過當地有社區健康營造中心，而聽過社區健康營造中心的居民有將近半數不清楚其地點及服務內容，此結果突顯出在推動全面性社區糖尿病防治介入工作時，需加強推廣居民對營造中心的認識，方能有效推動社區介入。結論：未來推動糖尿病防治社區介入時，可運用社區充能原則強化社區組織的力量，當社區核心組織獲得足夠的能力時，方是推動社區全面性教育介入計畫之成熟時機。而當社區組織未產生有效的運作機制，社區間結盟合作模式時，選擇從社區中的學校組織切入，是快速而有效的方法。
  Objectives: This study aimed to explore the manipulation of effective community intervention strategies for action-taking ability of community members in diabetes prevention . This is a two-year study. The results of the first year study have been published. In the second year, the study focuses on developing and implementing the community diabetes prevention program. This article presents the process and achievements of the second year of the study. Methods: For the development of a diabetes prevention program, the researcher selected a core community organization as the intervention point of a partnership, and then collectively developed a diabetes prevention program that met the needs of the community members. Results: l. For the intervention results of empowerment of the core community organization, it was that it was difficult to host a comprehensive community activity. This indicates that volunteers have a better sense of belonging towards the basic unit of city administration than that of the community health building center. 2. In the evaluation of other community members, nearly 85% of the interviewed community members indicated that they have never heard of the community health building center, for the half of the community members who had heard about the center, they indicated that they didn't know the location or anything about the services of the community health building center . This result indicates that there is still great room for the community health building center to progress in promoting total community diabetes prevention tasks. Conclusions: In regard to further promoting the diabetes prevention intervention in the community, emphasis should be placed on strengthening the community organization alliances using the community empowerment principle. When the core community organization has developed the adequate competence, it will then be the right time to promote a comprehensive intervention in the community. Also, when the community organizations are not ready for demonstrating effective mechanisms of leadership, communication, organizational climate, and member participation, it is more efficient and effective to choose a school settings as the intervention point of building a partnership.
• 114 - 124
• 10.6288/TJPH2005-24-02-03

• Link 原著 Original Article
• 高雄市和臺北市居民平均餘命差距之分析Analysis of the Life Expectancy Gap between Taipei and Kaohsiung
• 溫啓邦、蔡善璞、鍾文慎
  Chi-Pang Wen, Shan-Pou Tsai, Isabella Wen-Shen Chung
• 生命表 ； 平均餘命 ； 標準化死亡比 ； 分因式
  life table ; life expectancy ; Standardized Mortality Ratio ; decomposition
• 目標：探討不同死因對高雄市和臺北市兩地居民平均餘命差距之量化分析，提供不同人口健康差異之研究方法。方法：利用衛生署及內政部提供之1981年至2001年之死因資料，以及分年齡、性別之人口資料，計算高雄市人口各類死因之標準化死亡比，並應用Chiang生命表方法計算高雄市與臺北市人口出生時之平均餘命，以及Tsai et al. (1982)的方法計算重大死因對兩地平均餘命差距之影響。結果：自從1981年以來，高雄市人口幾乎所有死因之死亡率均比臺北市高。2001年，高雄市男、女性人口出生時之平均餘命為73.8年和78.7年，臺北市則為77.6年和82.0年，高雄市人口的平均餘命，無論男女，均與15年前臺北市相似，亦即高雄居民平均餘命較臺北落後了15年，兩地20年來保持著 3至4歲之差距。癌症、糖尿病、呼吸系統疾病、消化系統疾病及事故傷害為造成2001年兩地平均餘命差距之主要因素。結論：1981年至2001年間高雄市和臺北市市民平均餘命之差距穩定維持在3至4年，其中62%-65%是由癌症、糖尿病、呼吸系統疾病、消化系統疾病以及事故傷害之死亡率之差別所構成。經由減少機車、吸菸、嚼檳榔、肥胖、增加運動等一級預防工作來降低這些疾病之危險因子，對於縮短兩地平均餘命之差距較會有快速之效應。
  Objectives: To quantify the effect of major causes of death on the life expectancy gap between Kaohsiung City and Taipei City and provide a research method for the comparison of life expectancy between two populations. Methods: Mortality data from 1981 to 2001 were acquired from the Department of Health. The population census data for the same period were obtained from the Ministry of the Interior. These two data sets were used to calculate the standardized mortality ratios (SMRs) and life expectancy of the residents of Taipei and Kaohsiung. Life expectancy was calculated using Chiang's life table method. The life expectancy gap between Kaohsiung and Taipei was decomposed using a method proposed by Tsai et al. (1982) Results: The mortality rates for virtually all leading causes of death in Kaohsiung were higher than those in Taipei in the past 20 years. In 2001, the life expectancies among males and females in Kaohsiung were 73.8 years and 78.7 years, respectively, which were similar to those in Taipei residents in 1986. The corresponding figures for Taipei residents in 2001 were 77.6 years and 82.0 years, respectively. The gap in life expectancy gaps between the two cities remained at three to four years from the period 1981-2001, of which cancer, diabetes, respiratory system disease, digestive system disease, and injuries accounted for 65% of the gaps for males and 62% for females in 2001. Conclusion: The gap in life expectancy for both males and females between Kaohsiung and Taipei remained relatively stable (3-4 years) from 1981-2001. The differential mortality from the diseases of cancer, diabetes, respiratory system disease, digestive system disease, and fatal injuries accounted for more than 60% of the gaps. Reducing risk factors for these diseases through primary prevention could have long-term effects in closing the life expectancy gaps between the two cities.
• 125 - 135
• 10.6288/TJPH2005-24-02-04

• Link 原著 Original Article
• 石牌地區老年人跌倒累積發生率及其相關因素之探討Cumulative Incident Rate and Associated Factors of Falls among the Elderly in Shih-Pai, Taiwan
• 黃少君、陳曾基、周碧瑟
  Shao-Chun Huang, Tzeng-Ji Chen, Pesus Chou
• 跌倒 ； 相關因素 ； 累積發生率 ； 老人 ； fall
  associated factor ; cumulative incident rate ; the elderly
• 目標：探討石牌地區老人跌倒之累積發生率與相關因素。方法：本研究以社區為基礎的族群調查研究法，探討臺北市石牌地區 65歲以上老人的跌倒累積發生率及其相關因素。訪員根據問卷面對面訪談石牌地區65歲以上老人，問卷內容包括基本人口學資料、飲食習慣、個人疾病史等。統計分析方法包括單變項分析（卡方檢定、單因子變異數分析）及邏輯斯多變項回歸分析，以建立跌倒的預測模式。結果：總共2,045人完成問卷調查，完訪率為54.6%，在過去一年曾經跌倒者有303位，其累積發生率為14.8%。在單變項分析中，與過去一年曾跌倒者有顯著相關因素包括性別、婚姻狀況、教育程度、服用鈣片、糖尿病、痛風性關節炎、失眠、憂鬱、姿態性低血壓箏。在邏輯斯多變項?歸分析中，與過去一年曾經跌倒者有顯著相關因素包括性別、痛風性關節炎、憂鬱、姿態性低血壓等。結論：本研究發現跌倒的相關因素為性別、痛風性關節炎、憂鬱、姿態性低血壓。除了性別與個人疾病史外，姿態性低血壓是社區老人跌倒的重要相關因素。
  Objectives: To determine the cumulative incident rate and associated factors for falls among the elderly in Shih-Pai, Taipei. Methods: This study was a community-based survey to determine the cumulative incident rate and associated factors for falls among the elderly above 65 years old in Shih-Pai, Taipei. The elderly were interviewed using a structured questionnaire. The data collected included socio-demographic factors, dietary habits, and self-reported medical history. The statistical methods included univariate analyses (chi-square, one way ANOVA), and logistic regression to construct a fall-risk model for the elderly. Results: Totally, 2,045 subjects answered the questionnaire (response rate, 54.6%). In the past year, 303 persons fell one or more times; the one-year cumulative incident rate of falls was 14.8%. Univariate analyses showed that the significant associated factors were gender, marital status, level of education, dietary calcium intake, diabetes, gout, insomnia, depression, and orthostatic hypotension. The multiple logistic regression analysis showed that the significant associated factors were gender, gout, depression, and orthostatic hypotension. Conclusions: This study found that the associated factors for falls were gender, gout, depression and orthostatic hypotension. In addition to gender and self-reported medical history, orthostatic hypotension was an important associated factor for falls among community-dwelling elderly.
• 136 - 145
• 10.6288/TJPH2005-24-02-05

• Link 原著 Original Article
• 嬰幼兒腹瀉和輪狀病毒感染的特徵Characteristics of Gastroenteritis and Rotavirus Infection in Young Children
• 黃鈴雅、陳國東、陳豪勇、宋鴻樟
  Ling-Ya Huang, Kow-Tong Chen, Hour-Yong Chen, Fung-Chang Sung
• 輪狀病毒 ； 腸胃炎 ； 幼兒
  rotavirus ; gastroenteritis ; young children
• 目標：本文陳述5歲以下幼兒急性腸胃炎的感染原及輪狀病毒感染的臨床現象。方法：本研究利用2001年4月到2002年10月之間，四家醫學中心向衛生署疾病管制局通報的幼兒急性腸胃炎資料，區分住院、急診和門診病人，觀察輪狀病毒感染之性別、年齡及臨床症狀分布。結果：在通報的2477位急性腸胃炎病童中，以住院病人最多(74.8%)，急診病人其次(22.3%)，門診病患很少(2.9%)。不同來源病患的年齡分布主要集中在6~36個月大的小孩(65.2%)，高峰出現在6~11個月大(20.6%)。實驗室檢驗結果顯示輪狀病毒為幼兒急性腸胃炎主要病原(43.6%)，檢體中輪狀病毒的陽性率以住院病人最高47.1%，其次為急診病患和門診病人，分別為33.9%和28.8%。細菌及腺病毒的陽性率相對較低，合計分別為10.0%和2.4%，亦以住院病人為高。檢體中檢驗出2種以上病原的分率也以住院病人較高(4.5%)。輪狀病毒感染住院病童出現發燒、嘔吐及脫水症狀的機會明顯較其他病童高。結論：由醫學中心通報的幼兒急性腸胃炎超過四成和輪狀病毒感染有關，或許不能反映在診所診視的個案，但由住院、急診和門診病人陽性率的差異，推測社區診所病人的感染率可能較低。
  Objectives: This report described the prevalence and clinical characteristics of rotavirus infection among children aged 5 years and younger with acute gastroenteritis receiving cares at four medical centers in Taiwan. Methods: The surveillance data from April 2001 and October 2002 for childhood gastroenteritis, obtained from the Center for Disease Control, Department of Health, Executive Yuan were used to calculate counts and rates among inpatients, emergency patients, and outpatients. Results: Among 2477 gastroenteritis cases, there were more inpatients (74.8%) than emergency patients (22.3%) and outpatients (2.9%). Most reported children (65.2%) were between 6 to 36 months of age with a peak shown between 6 to 11 months of age (20.6%). Rotavirus was the predominant pathogen (43.6%) with the prevalence rate being higher for inpatients (47.1%) than for emergency patients (33.9%) and outpatients (28.8%). Inpatients were also more likely than others to have infections of bacteria (11.7%), adenovirus (2.9%), or dual types of pathogen (4.5%). Patients with rotavirus infection were likely to have diarrhea (93.7%), fever (63.9%), and dehydration (54.8%). These symptoms were also more prevalent in inpatients than in other patients. Conclusion: In infants and young children with acute gastroenteritis receiving care at medical centers are more likely to have the rotavirus infection, particularly for inpatients. We also speculate that the rotavirus infection is relatively low among gastroenteritis patients being cared for by community physicians.
• 146 - 153
• 10.6288/TJPH2005-24-02-06

• Link 原著 Original Article
• 從台灣盒餐業員工工作內容探討肌肉骨骼不適之危險因子Risk Factors Associated with Work-Related Musculoskeletal Discomfort among Commissary Foodservice Workers
• 全中妤、何汝惠、宋鴻樟
  Jong-Yu A. Chyuan, Ju-Hui Ho, Fung-Chang Sung
• 盒餐業 ； 工作有關之肌肉骨骼不適或傷病 ； 危險因子 ； 盛行率 ； 勝算比
  Commissary foodservice factory ; Work-related musculoskeletal discomfort (WMSD) ; Prevalence rate ; Odds ratio ; Risk factors
• 無
  Objectives: To investigate work-related musculoskeletal discomfort (WMSD) and its association with tasks carried out by commissary foodservice employees in northern Taiwan. Methods: A cross-sectional survey of a convenient sample of 309 commissary employees was conducted at 20 factories from 2002-2003 to collect information on individual’s demographic characteristics, work characteristics, and perceived discomfort from work. Results: The study participants frequently used both hands (55.0%) while working. The tasks for most study participants included moving objects (61.2%), packing lunch boxes (56.3%), and cleaning dishes (52.1%). Most study participants used trolleys (62.5%) and spent a lot of time standing (88.7%). Results showed significant WMSD was found from the tasks of packing lunch boxes using the upper arm or the ankle/feet, moving objects using the forearm, and washing materials using the lower back and waist. Carrying heavy objects for more than 1 minute for each task was associated with an increased risk of 12 body site-specific WMSD, especially for the upper back (OR=16.9) and feet (OR=14.4). Shoulder pain was significantly associated with awkward postures including lifting the hand over the shoulder, twisting the body trunk, and carrying heavy objects for more than 1 minute. Conclusion: Different postures at work may lead to different body site-specific WMSD. Carrying heavy materials was found to be associated with an elevated risk of discomfort in the upper back and feet.
• 154 - 161
• 10.6288/TJPH2005-24-02-07

• Link 原著 Original Article
• 醫院擴增不同型態精神醫療資源之影響因素探討The Factors Associated with the Willingness of Hospitals to Expand Different Types of Mental Health Services
• 彭英傑、陳端容
  Ying-Chieh Peng, Duan-Rung Chen
• 精神醫療資源 ； 醫院 ； 擴增意願 ； 承載能量
  mental health ; hospitals ; willingness to expand ; investment plans
• 目標：精神醫療資源長期存在資源不足、分布不均與低度發展之問題，既使在政策鼓勵與經費補助下，其成長仍相當有限。本研究旨在探討影響醫院擴增不同型態精神醫療服務之影響因素，藉以瞭解影響精神醫療資源成長之機制。方法：以郵寄問卷方式進行，對台灣地區136家提供精神醫療服務之醫院進行普查。結果：寄出問卷136份，回收82份，問卷回收率60.3%，回收個案與未回收個案在權屬別、評鑑別、型態別、地區別上無差異。教學醫院擴增急性精神病床意願較高，擴增慢性精神病床意願較低；住院個案經他院轉介比例高於20%之醫院，在擴增急性精神病床意願較高；而精神科專科醫院在擴增康復之家、社區復健中心意願會較高；中部地區的醫院擴增社區復健中心之意願較高。位居都會區周邊縣市之醫院擴增急性精神病床之意願較高，而鄉村地區醫院擴增慢性精神病床意願較高，工業地區醫院擴增社區復健中心意願較高。機構所在地縣市每萬人口急性精神病床數多者擴增急性精神病床之意願較低，擴增慢性精神病床、康復之家及社區復健中心之意願較高；機構所在地縣市每萬人口日間留院床數少者擴增擴增慢性精神病床及康復之家之意願較高。結論：醫療機構持續有擴增精神醫療資源之計畫，規模有擴大趨勢；影響醫院擴增不同型態之精神醫療服務的因素不同；醫療機構特性、機構所在地社經條件、機構所在地精神醫療資源等因素對不同型態之精神醫療服務有不同之影響，營運層面考量未有顯著影響力。
  Objectives: To examine the factors associated with the investment of hospitals in five different types of mental health services and explore mechanisms of mental health resources growth in Taiwan. Method: A cross-sectional study was conducted, and mailed questionnaires were used to collected data from the managers of all (136) hospitals. Logistic regressions were employed to examine whether institutional linkages, socio-economic levels, and the mental health resources capacity surrounding hospitals, and the profit consideration were associated with the future investment of hospitals in mental health services. Results: 82 of 136 hospitals responded to the questionnaires, resulting in a response rate of 60.3%. The respondents were not different from the non-respondents across the variables examined. Institutional linkages are significantly statistically associated with future investment in different mental health services. Various variables were differently associated with the future investment of hospitals in different types of mental health service. Being a teaching hospital or a hospitals that has more than 20% of inpatients transferred from other hospitals were significant factors associated with investment in acute psychiatric inpatient service. Conclusions: Different variables are associated with different types of mental health services. The results indicate that more work should be done to look into the different mechanisms for the growth of mental health services.
• 162 - 172
• 10.6288/TJPH2005-24-02-08

• Link 原著 Original Article
• 團體觀點：醫院品管圈之結構與效能Group Perspective: Group Structure and Effectiveness of Quality Control Circles in Hospitals
• 洪素英、謝碧晴、蘇慧芳
  Su-Ying Hung, Pi-Ching Hsieh, Hui-Fang Su
• 團體層級分析 ； 團體規模 ； 團體規範 ； 團體任務凝聚力 ； 團體效能
  group-level analysis ; group size ; group norms ; group task cohesion ; group effectiveness
• 目標：探討台北地區區域級以上醫院之品管圈團體結構（團體規模、團體合作規範、團體任務規範及團體任務凝聚力）與團體效能之相關性。方法：採橫斷式問卷調查法，台北地區已推行品管圈之醫院共19家，有16家醫院品管圈圈員同意接受調查，共收集263個有效品管圈樣本，包括1,914位品管圈圈員，團體回收率達86.80%。以團體為分析單位，每個團體內的個人層級之資料將聚合代表該團體的分數，以內部相關係數(Intraclass correlation coefficients, ICCs), eta squared (η^2)，及單因子變異數分析(one-way analysis of variance)檢定，確定個人層級資料可聚合後代表團體層級之資料，再以迴歸模式進行四個與團體相關之研究假說檢定。結果：團體合作規範、團體任務規範、團體任務凝聚力與團體效能呈正相關之三個假說獲得支持，共解釋51%團體效能的變異量，但團體規模與團體效能則無顯著的正相關，該假說未獲支持。結論：品管圈具有較高的團體合作規範、團體任務規範及團體任務凝聚力的特質時，會有較好的績效表現，因此建議未來可積極建立團體合作規範、團體任務規範及團體任務凝聚力來促進良好的團體互動，以提昇團體效能。
  Objectives: This study aimed to investigate the relationship between group structures (group size, cooperation norms, task norms, and task cohesion) and group effectiveness of the quality circles of hospitals in Taipei area. Methods: A cross-sectional research design was adopted for data collection. Two hundred and sixty-three quality circle groups with 1,914 individuals from the 16 of the 19 hospitals in the Taipei area were enrolled for analysis. The groups' response rate was 86.8%. Because the unit for analysis was the quality circle group, the aggregated individual-level data in a single group were used as the representative values for the group. Results of intraclass correlation coefficients (ICCs), Eta-squared (?^2), and one-way analysis of variance showed that aggregated individual-level data were capable of representing the group level data. Multiple regression analysis was adopted to test four hypotheses. Results: Groups with higher levels of cooperation norms, task norms, and task cohesion had greater feeling of group effectiveness as perceived by the members. In spite of this group size was not considerably associated with group effectiveness. The cooperation norms, task norms, and task cohesion accounted for 51% of the variance in group effectiveness. Conclusions: It was concluded that the group members having better feeling of cooperation norms, task norms, and task cohesion demonstrated higher group effectiveness. To improve the performance of group, the strategies for building group norms and creating a cohesive culture should be taken by the organization.
• 173 - 183
• 10.6288/TJPH2005-24-02-09