38卷2期

• Link 政策論壇 Policy Forum
• 從公衛觀點談病人自主權利法與「死亡識能」的增能From public heath perspective to discuss the Patient Autonomy Right Act and death literacy enhancement
• 陳端容、吳丕玉
  Duan-Rung Chen, Pi-Yu Wu
• 無
  none
• 無
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• 111 - 114
• 10.6288/TJPH.201904_38(2).PF02

• Link 公衛論壇 Public Health Forum
• 台灣全面禁用石綿了嗎？從石綿產品的進口量看可能的管制漏洞Is a total asbestos ban achieved in Taiwan? Probable regulatory flaws are found based on the import data of asbestos-containing materials
• 施聿芃、李俊賢、鄭雅文
  Yu-Peng Shih, Lukas Jyuhn-Hsiarn Lee, Yawen Cheng
• 無
  none
• 無
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• 115 - 117
• 10.6288/TJPH.201904_38(2).108008

• Link 公衛論壇 Public Health Forum
• 生命早期經驗與非傳染性疾病防治：歷史備忘錄Early life experience and the prevention and control of non-communicable diseases: a historical note
• 江宛霖、江東亮
  Wan-Lin Chiang, Tung-liang Chiang
• 無
  none
• 無
  none
• 118 - 123
• 10.6288/TJPH.201904_38(2).107131

• Link 綜論 Review Article
• 青少年電子煙使用與吸菸意圖或吸菸行為之關聯性：系統性文獻回顧Association of e-cigarette use with smoking intentions and behaviors among adolescents: a systematic review
• 賴鼎富、林倩宇、廖邕
  Ting-Fu Lai, Chien-Yu Lin, Yung Liao
• 青少年；理性行動論；電子煙；吸菸意圖；吸菸行為
  adolescent?;?Theory of Reasoned Action?;?e-cigarette?;?smoking intention?;?smoking behavior
• 世界衛生組織指出，吸菸為全球主要的健康危險因子。近年來電子煙在青少年族群中的使用率逐漸提升，而青少年電子煙使用與其未來吸菸意圖及行為的關聯仍有爭論。本文以PubMed、PsycINFO、CINAHL資料庫、與華藝線上圖書館，系統性回顧2014年1月至2018年2月，以中、英文發表的青少年電子煙使用與其未來吸菸意圖及行為相關研究，共納入18篇符合納入規範的文獻。現有研究多來自於美國，且多為橫斷性設計，僅有少數追蹤不超過一年的縱貫性研究。我們依循部分理性行動論的架構，將研究結果歸納成「電子煙使用與吸菸意圖之關聯」與「電子煙使用與吸菸行為之關聯」兩大主軸。結果指出，青少年的電子煙使用與其吸菸意圖、吸菸行為及吸菸的數量與頻率均呈正相關。建議未來研究採用長期的縱貫性設計，以利於確認其因果關聯，作為公共衛生研究與實務之參考。
  The World Health Organization reported that smoking is a primary health risk factor. The prevalence of e-cigarette use in adolescents has increased recently. However, the association of e-cigarette use with smoking intentions and behaviors is unconfirmed. Through PubMed, PsycINFO, CINAHL, and Airiti Library, this study systematically reviewed studies published in English or Chinese language that have examined the association of adolescent's e-cigarette use with smoking intentions and behaviors from January 2014 to February 2018. We identified 18 empirical studies satisfying the respective criteria. Most of the studies had cross-sectional designs and were from the United States; only a few longitudinal studies had follow-up periods of less than 1 year. Based on the Theory of Reasoned Action, this systematic review provided some evidence of positive associations between e-cigarette use and smoking intentions, smoking behavior, and smoking frequency among adolescents. Future research must investigate the association of e-cigarette use with smoking-related behaviors by using longitudinal designs with long-term follow-ups to determine the respective causality for informing subsequent policymaking and research.
• 124 - 138
• 10.6288/TJPH.201904_38(2).107136

• Link 綜論 Review Article
• 以條件性收載管理協議加速癌症創新藥品的可近性Managed entry agreement to improve access to innovative cancer medicines
• 施廷芳、王正旭
  Sophy TF Shih, Cheng-Hsu Wang
• 藥品給付政策；風險分攤；癌症
  managed entry agreement(MEA) ; pharmaceutical benefits policy ; risk-sharing arrangement ; cancer ; managed entry agreement (MEA)
• 癌症創新藥的開發為治療帶來新契機，但高治療費用使得受惠病患侷限於少數，如何解決高價癌症新藥的普及是全球各國面臨的難題。本綜論以官方重點文件分析加上敘述型文獻回顧，重點探討澳洲與英國於其歷史背景下的變革為出發點，針對昂貴的創新藥所引進的加速審查與條件性收載給付辦法進行討論。為了有效管理醫療給付決策的風險，加速審查及以療效表現為基礎的之條件性收載給付為近年來發展的策略。澳洲政府實施的條件性藥品收載管理辦法與目前英國癌症藥品基金，都是透過藥品收載管理（Managed Entry Agreement，MEA）的方式，讓有希望前景的新治療，在進一步收集療效證據的同時，透過暫時性的過渡給付讓病人提早受惠癌症新治療。MEA雖然立意良好但也不是萬靈丹，其潛在問題例如資料收集、藥物安全性疑慮、終止給付的反彈等也需慎重考量。透過參考英澳兩國的條件性給付辦法，可以提供醫界與健保當局在討論高價藥給付困境時，以加速台灣癌症創新藥品普及的可行性。
  Innovative medicines bring a promising future for cancer treatment. However, the benefit to patients is limited by its high cost. Access to these innovative cancer medicines through reimbursement is a pressing issue for government authorities around the globe to resolve. Analyses of key policy documents with a narrative literature review were conducted to provide suggestions for policy consideration. This review focused on the financial risk-sharing programs of pharmaceutical benefits in Australia and United Kingdom (UK) that have had extensive experience. Various risk-sharing arrangements for pharmaceutical benefits have been implemented to contain the risk related to reimbursement decision-making. Accelerated appraisal process and performance-based arrangement are two tactics undertaken by the developed countries to deal with the high costs of innovative medicines. The Australian Pharmaceutical Benefit Scheme and UK Cancer Drug Fund are two exemplary schemes using managed entry agreement (MEA). MEA allows conditional reimbursement to new medicines subject to its development of clinical evidence. It allows early access to new medications while new evidence are being collected. However, several barriers, such as collection of high-quality data, safety of new medicines and issues around de-listing, have been identified for a successful MEA to be implemented. Overseas experience is valuable to the Taiwanese government authorities in the context of pharmaceutical benefits policy discussion.
• 139 - 149
• 10.6288/TJPH.201904_38(2).107122

• Link 原著 Original Article
• 台北市成年酒駕初犯者的酒精使用型態、酒癮及酒駕行為之相關性Alcohol use pattern, alcohol dependence, and their correlation with driving under the influence in adult first-time DUI offenders in Taipei City
• 張祜銘、陳亮妤、范瓊月、郭彥君、楊添圍、鄭婉汝、黃名琪
  Hu-Ming Chang, Lian-Yu Chen, Chiung-Yueh Fan, Yen-Chun Kuo, Tien-Wei Yang, Wan-Ju Cheng, Ming-Chyi Huang
• 酒後駕駛；酒精使用疾患；酒精依賴（酒癮）
  ?driving under the influence (DUI)?;?alcohol use disorder?;?alcohol dependence
• 目標：本研究旨於探討台北市酒駕初犯者之飲酒問題及其與酒駕行為之相關性。方法：針對參與台北地方檢察署舉辦「酒害衛教之團體課程」的酒駕初犯者進行匿名自填問卷調查，包括以酒精使用疾患辨識問卷來篩檢酒精使用疾患、華人飲酒問題篩檢問卷篩檢酒精依賴（酒癮）、簡式健康量表評估情緒困擾，並收集飲酒與酒駕行為參數。本研究定義高頻率酒駕為自陳每個月酒駕兩次以上，並利用邏輯迴歸分析找出高頻率酒駕的相關因子。結果：在597位酒駕初犯中，酒精使用疾患佔52.3%，酒癮佔34.4%。具酒精使用疾患和酒癮者有較高的比例具狂飲行為、飲用烈酒、情緒和睡眠困擾。酒精使用疾患、酒癮、在工作地點飲酒都是預測高頻率酒駕的相關因子。酒精使用疾患和酒癮個案出現高頻率酒駕行為的比例，分別為非酒精使用疾患和非酒癮患者的5倍及2倍。結論：酒精使用疾患和酒癮與高頻率酒駕呈現顯著相關。我們建議針對酒駕初犯進行飲酒問題的篩檢及介入，以期減少酒駕行為以及酒精相關危害。
  Objectives: This study investigated alcohol use problems in first-time offenders of driving under the influence (DUI) in Taipei City and the risk factors for a high frequency of DUI. Methods: We conducted an anonymous survey for first-time DUI offenders who attended the mandatory educational program held by Taiwan Taipei District Prosecutors Office. Participants completed the following self-rated questionnaires: the Alcohol Use Disorder Identification Test for screening alcohol use disorder (AUD); the C-CAGE questionnaire for screening alcohol dependence (AD); and the Brief Symptom Rating Scale for screening psychological symptoms, alcohol drinking, and DUI variables. We defined a high frequency of DUI as occurrence of 2 or more DUI behaviors per month. Results: Among 597 participants, 52.3% and 34.4% had AUD and AD, respectively. Offenders with AUD or AD had higher risks of binge-drinking behavior, consuming a high alcohol concentration, and psychological and sleep problems. AUD, AD, and drinking at the workplace were potential risk factors for a high frequency of DUI. Notably, compared with offenders without AUD and AD, offenders with AUD and AD respectively had 5 and 2 times higher likelihoods of having a high frequency of DUI. Conclusions: AUD or its more severe form, AD, is relatively common in first-time DUI offenders. In particular, having AUD or AD is associated with an increased risk of a high frequency of DUI. Routine screening for alcohol use problems and ensuing intervention programs or referral to treatment are warranted for all DUI offenders to reduce the recidivism rate and alcohol-related harm.
• 150 - 162
• 10.6288/TJPH.201904_38(2).107134

• Link 評論 Commentary
• 評論：酒駕－凝視冰山的視角與距離評論：酒駕－凝視冰山的視角與距離
• 陳娟瑜
  Chuan-Yu Chen
• 無
  none
• 無
  none
• 163 - 164
• 10.6288/TJPH.201904_38(2).10713401

• Link 評論 Commentary
• 評論：台北市成年酒駕初犯者的酒精使用型態、酒癮及酒駕行為之相關性評論：台北市成年酒駕初犯者的酒精使用型態、酒癮及酒駕行為之相關性
• 孫亦君
  Yi-Chun Sun
• 無
  none
• 無
  none
• 165 - 165
• 10.6288/TJPH.201904_38(2).10713402

• Link 評論 Commentary
• 作者回覆：台北市成年酒駕初犯者的酒精使用型態、酒癮及酒駕行為之相關性作者回覆：台北市成年酒駕初犯者的酒精使用型態、酒癮及酒駕行為之相關性
• 張祜銘 、 陳亮妤、 范瓊月 、 郭彥君 、 楊添圍 、 鄭婉汝、 黃名琪
  張祜銘 、 陳亮妤、 范瓊月 、 郭彥君 、 楊添圍 、 鄭婉汝、 黃名琪
• 無
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• 無
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• 166 - 166
• 10.6288/TJPH.201904_38(2).10713403

• Link 原著 Original Article
• 醫院保健志工代謝症候群培訓課程成效之研究：應用Natural Helper概念A study of effectiveness on the metabolic syndrome training program to hospital health volunteer: applied Natural Helper concept
• 莊瑋芷、陳富莉
  WEI-CHIH CHUANG, Fu-Li Chen
• 醫院保健志工 ； 態度 ； 自我效能
  hospital health volunteer?;?Natural Helper?;?attitude?;?self-efficacy
• 目標：本研究旨在設計Natural Helper概念融入醫院保健志工培訓課程，探討培訓課程對於醫院保健志工的專業知能、態度與自我效能之成效。方法：採類實驗設計，研究工具包括：1.自填式問卷，內容包含代謝症候群相關知能、擔任社區保健志工態度與自我效能等；2.訓練課程教材包含：Natural Helper概念與應用、自信心訓練、代謝症候群、營養與運動認知等。實驗組進行約六小時培訓課程及面對面諮詢介入、對照組無介入課程，共分前、後、後後測三次進行問卷施測，資料採描述性統計、重複測量變異數分析與廣義估計方程式（Generalized Estimating Equation，GEE）等統計分析。結果：經GEE分析組別與時間交互作用結果顯示，代謝症候群知能部分，實驗組在後測、後後測均顯著高於對照組；擔任社區保健志工態度與自我效能部份：實驗組後測顯著高於對照組，但後後測，兩組則無顯著差異。結論：醫院保健志工培訓課程後測對於代謝症候群知能、營養知能、運動知能、態度與自我效能有立即顯著成效。但後後測僅知能部份有持續效果，擔任社區保健志工態度與自我效能部份則沒有持續成效。建議未來在教育訓練課程應強化Natural Helper自信心技能訓練及實作經驗。
  Objectives: The study purpose is to design the Natural Helper concept into the hospital health volunteer training course to explore the effectiveness of the training and consultation on the professional literacy, attitude, and self-efficacy of hospital health volunteers. Methods: A quasi-experimental design was adopted in conjunction with a self-administered questionnaire and self-developed curriculum. The questionnaire incorporated of professional literacy, attitude, and self-efficacy. The curriculum content included topics on the concept and application of Natural Helpers, training on self-confidence, and concepts related to metabolic syndromes, nutrition, and exercise. The experimental group participated in an intervention program that involved a training curriculum 6 hours and consultation, whereas the control group did not participate in the program. The questionnaire was administered in a pretest, posttest, and post-posttest. The collected data were analyzed using statistical methods. Results: A GEE was adopted to analyze the interaction effect of grouping and time. The results revealed that the literacy scores of the experimental and control groups were significantly correlated in both the posttest and post-posttest. In the posttest, significant correlations were also observed between the two groups in terms of their attitude and self-efficacy scores, but no significant correlation was observed in the post-posttest. Conclusions: The training curriculum and consultation exerted an immediate and significant effect on hospital health volunteers' attitude, self-efficacy, and literacy in metabolic syndromes, nutrition, and exercise. However, the post-posttest verified that the retention effect of the intervention program was only observable in the volunteers' professional literacy. The hospital health volunteers' attitude, self-efficacy had no sustained maintenance. Subsequent about training curricula are recommended to focus on enhancing Natural Helpers' skills in maintaining self-confidence as well as increasing their practical experience.
• 167 - 177
• 10.6288/TJPH.201904_38(2).107078

• Link 原著 Original Article
• 從醫師經驗探討醫院的醫療糾紛處理制度Preliminary study of hospital systems for malpractice dispute management based on physicians' experiences
• 蔡依倫、董鈺琪、鄭雅文
  Yi-Lun Tsai, Yu-Chi Tung, Yawen Cheng
• 醫療糾紛；醫院制度；醫師工作環境
  malpractice disputes?;?hospital systems?;?physicians' working environment
• 目標：醫療糾紛是重要的社會議題，但目前探討醫師經驗的研究不多，也缺乏醫院態度與做法的相關資訊。本研究從醫師經驗探討醫院的醫療糾紛處理制度，並針對相關政策提出具體建議。方法：本研究採用深度訪談法，對象為18位在過去十年內曾有醫療糾紛經驗的受僱醫師。結果：目前院內制度對醫師當事人多提供法律方面和賠償金的協助，卻缺乏同事或主管關懷等實質的心理支持，並普遍存在羞恥與究責文化。對糾紛事件的回應則是大致了解事件經過，卻鮮少深入探究根本原因或提出預防措施。大多數的醫院態度相對被動，僅少數落實醫療糾紛的預防制度。結論：衛生主管機關應要求醫院定期舉辨醫療糾紛的教育訓練，加強醫護人員對於醫療糾紛的知識態度，並針對每個醫療糾紛進行根本原因分析，提出預防措施，且留存檔案作為相關政策依據。此外應要求醫院落實預防制度，主動介入協助通報的不良結果或病人抱怨，及早消弭潛在的醫療糾紛。
  Objectives: This study explored the characteristics of hospitals' systems for malpractice dispute management. Suggestions are proposed for improving hospitals' policies in this field. Methods: Eighteen physicians who had experienced malpractice disputes in the past 10 years were interviewed. Results: Most physicians received legal and financial support from hospital systems for malpractice disputes, but emotional support from colleagues and supervisors was inadequate due to a prevalent culture of shame and liability in malpractice dispute contexts. Hospital systems were reported to examine dispute events to assure monetary compensation but not to discover root causes of events or to devise preventive strategies. Most hospitals were determined to be reactive, with few implementing policies to proactively prevent malpractice disputes. Conclusions: Government authorities handling health affairs should request that hospitals organize educational activities regularly to improve medical staff members' knowledge and attitudes regarding malpractice disputes. Each malpractice dispute requires root cause analysis and recording of results to guide future policies. For resolution of potential malpractice disputes, hospitals should implement preventive policies to enable early assistance when adverse outcomes or patient complaints occur.
• 178 - 188
• 10.6288/TJPH.201904_38(2).107107

• Link 原著 Original Article
• 運用文字探勘分析全民健保與五項總額支付制度之民眾知覺感受Application of text mining in the public perception analysis of global budget payment and National Health Insurance systems
• 江婉琪、林應龍、禹良治、張鈺旋、 陳俞安、王復中、黃珮珊、林寬佳
  Wan-Chi Chiang, Ying-Lung Lin, Liang-Chih Yu, Yu-Hsuan Chang, Yu-An Chen, Fu-Chung Wang, Pei-Shan Huang, Kuan-Chia Lin
• 全民健保與五項總額支付制度；情感分析；文字探勘；公眾感受
  National Health Insurance (NHI) and five global budget payment system?;?text mining?;?sentiment analysis?;?public perception
• 目標：本研究為發展與評估一套健保文字探勘技術以彌補傳統量性監測工具的不足並克服質性資料分析與解讀上的困難。方法：以106年度全民健保與五項總額支付制度之全國民意調查為基礎。運用文字採礦技術探討民眾對於健保意見感受之語意結構。進一步將上述語意結構進行情感分類，評估其做為輔助監測民意之適切性。結果：六大文本的詞頻統計皆近似齊夫經驗法則，少數高頻詞彙影響多數的文本內容。透過文字雲得到共有語意特徵為「很好」、「滿意」和「不錯」等對健保正向的評價。於因素分析皆呈現多元的潛在語意結構，整體解釋變異達70％以上。情感標記圖之分布皆呈反拋物線，點座落位置與色彩間的對比差異說明質、量性資料彼此具互補效益。結論：本研究具體實證如何從公眾的自由評論中，提取出輿情感受與意向，同時藉由情感標記，偵測文字評論背後的情感與情緒，將可作為探討民眾對於健康政策感知的另一項調查方法依據。
  Objectives: The aim of this study was to facilitate text mining for overcoming the limitations of traditional questionnaire-based surveys and the challenges of analyzing textual data for monitoring public perceptions regarding the different fields of the National Health Insurance (NHI) system. Methods: The study data consisted of the 2017 national survey and public polls regarding people's satisfaction with NHI and five global budget payment systems in Taiwan. We derived the structure and information from the text of responses through text mining and further applied sentiment analysis by using lexical signifiers and classifying emotions to determine whether the data lean toward positive or negative emotions. Results: (1) The rank-frequency distribution for all texts of the six major fields of medical care followed Zipf's law. This means that a few high-frequency words affected most of the textual content. (2) The results in word cloud visualizations could reflect public perceptions regarding various topics. The most common semantic features were ”very well,” ”satisfied,” and ”good.” Most participants, especially dialysis patients, provided positive comments on different types of medical care in the NHI system, which shows that the health care offered by the NHI system meets peoples' needs. (3) Factor analysis further indicated that our semantic results explained more than 70% of the variance for the six major texts. For the majority of the dialysis patients, the semantic structure of responses consisted of positive words and was significantly different from those of other texts. (4) The reverse para-curve and color differences in valence-arousal space further produced qualitative and quantitative results indicating the subjects' positive perceptions and opinions. Conclusions: Public perceptions and opinions are essential for policy evaluation and implementation. They play a critical role in policy innovations. This study outlines the potential benefits of text mining and sentiment analysis techniques for developing an NHI sentiment analysis system that can aid in the assessment of public perceptions and opinions regarding the health care system. Police surveillance can benefit by incorporating such a systematic approach into the visualization and standardization of data content.
• 189 - 202
• 10.6288/TJPH.201904_38(2).107137

• Link 原著 Original Article
• 探討慢性腎臟病患者衛教介入措施對其自我管理、生活品質及生理數值控制之長期追蹤Effect of a prevention program on the self-management, quality of life, and disease control of patients with chronic kidney disease
• 唐敏華、李文欽、丘周萍
  Min-Hua Tang, Wen-Chin Lee, Chou-Ping Chiou
• 慢性腎臟病；生活品質；自我管理
  chronic kidney disease?;?quality of life?;?self-management
• 目標：慢性腎臟病指腎功能逐漸且難以逆轉的衰退，為避免提早進入透析階段，目前醫療團隊提供慢性腎臟病患者疾病控制、飲食治療及日常保健等相關衛教，但病人是否能確實了解衛教內容及落實自我管理，最後得到良好的控制進而提升生活品質，實值得研究探討。方法：本研究採縱貫性研究設計，於南部某醫學中心腎臟科門診進行收案，共收集150位慢性腎臟病患者。以結構性問卷進行資料收集，於收案時、三個月及六個月時進行三次問卷填寫。資料以廣義估計函數式模式（GEE）進行相關資料分析。結果：腎臟病患者之照護與衛教計畫的實施後，隨著時間的增加，病人的自我管理、整體生活品質及eGFR皆有顯著改善情形。另每日規則運動、隨時間增加及eGFR的改善，與生活品質呈正相關。結論：本研究有助於瞭解腎臟病照護與衛教計畫的實施後，腎臟病患者自我管理、生活品質及eGFR的長期變化，建議醫療團隊可介入多元及適才的照護模式，運用衛教計畫的介入及良好的生理控制以提升慢性腎臟病患者之整體生活品質，延緩病人腎功能的惡化，避免提前進入透析階段。
  Objectives: Chronic kidney disease (CKD) is a long-term disease, and to prevent it from developing from the early stage to the dialysis stage, patients follow the advice of their medical team. However, whether patients thoroughly understand the content of the health education that they are provided with and implement self-management to enhance their quality of life is worthy of research and investigation. Methods: This study employed a longitudinal research design and recruited 150 patients with CKD from a medical center in southern Taiwan. Structured questionnaires were used to collect their data a total of three times, and the data were analyzed using GEE. Results: The patients' average score on the short-form Mandarin Health Literacy Scale for CKD was 9.06 ± 3.205, and their self-management, overall quality of life, and eGFR demonstrated significant improvements over time. Conclusions: This study clarified long-term changes in the self-management and quality of life of patients with CKD. Medical teams are advised to provide diverse and proper care models to delay the deterioration of kidney function as well as prevent the need for dialysis in patients with CKD.
• 203 - 214
• 10.6288/TJPH.201904_38(2).107114

• Link 實務 Public Health Practice
• 從醫院到社區的四種照顧轉銜模式觀察與討論：以台灣某縣長期照顧管理中心為例An observation and discussion of four care transfer models from hospital to community: an example of a county government long-term care management center in Taiwan
• 李佩芳
  Pei-Fang Lee
• 長期照顧；服務轉銜模式；照顧管理專員（照專）
  ?long-term care?;?transfer service model?;?care manager
• 目標：本研究觀察台灣某縣長期照顧管理中心為因應從醫院到社區的服務轉銜，而逐步嘗試的四種轉銜服務模式。希望藉由訪談參與其中的照顧管理專員，檢視並分析其發展歷程的問題。方法：本研究將X縣的轉銜服務發展歸納、區分為四種轉銜模式，以質性研究訪談方式，立意取樣訪談六位歷經不同階段的照顧管理專員，探究模式發展歷程中的問題。結果：本研究將X縣的發展歷程區分為傳統模式、照專入院、駐院照專與準照專模式。結果發現，傳統模式與準照專模式相對具有轉銜服務效益，但四種模式皆無法單獨因應家屬照顧安排決策過程的多變性。同時，醫院、服務提供單位與照管中心間仍缺乏足夠的溝通與協調。結論：政策的規劃與執行宜更加重視使用者的立場與需求，同時也應持續強化不同服務單位間的溝通與協調，同時中央政府或可多增加跨縣市的經驗交流並提供必要的實務指引、支持或財務支援。
  Objectives: This paper reports on four transfer service models trialed by a long-term care management center run by a county in Taiwan. These models were developed to transfer care services from the hospital to the community. Reviews and analyses from the care managers were obtained during the development of the models. Methods: The transfer services of X county were classified into four models. To identify problems in the model development process, qualitative research methods and purposive sampling were employed to analyze data obtained from six care managers who experienced various stages of development process. Results: The development stages of X county's transfer service can be classified as the traditional model, visit care manager model, resident care manager model, and the quasi-care management manager models. The traditional and license-specific models are relatively service-effective. However, the four transfer models cannot manage the variability of the family carer's decision-making process, and communication and coordination between the hospitals, service providers, and long-term care manager center are inadequate. Conclusions: Policy planning and practice should focus on the position and requirements of users and continue to strengthen communication and coordination between different service units. The central government can also simultaneously increase information exchange among local governments and provide the required practical guidance and financial support.
• 215 - 222
• 10.6288/TJPH.201904_38(2).107123