23卷2期

• Link 綜論 Review Article
• 風險校正因子：論人計酬醫療費用預測之基礎Risk Adjuster: The Basis for Capitation Payment
• 張睿詒、賴秋伶
  Ray-E Chang, Chiu-Ling Lai
• 風險校正因子 ； 風險校正 ； 論人計酬 ； 健康保險
  risk adjuster ; risk adjustment ; capitation ; health insurance
• 為了有效控制醫療費用成長與強化社會公平，前瞻式預算支付設計已被許多先進國家的健康照護制度採用，在避免無效率及缺乏公平性存在於此預算額度的決定，近年來風險校正機制已逐漸導入。而多年來國際研究持續投入此一領域，提供許多政策制訂上之依據，其中發展風險校正因子，提升對未來醫療費用預測的研究，為數甚多。鑑於全民健康保險支付制度已全面採行前瞻式總額支付方式，而多項健保改革制度倡議均提及風險校正之必要性，而國內之風險校正相關研究仍處於萌芽階段，然初步結果顯示，我國風險校正因子預測力相較國際研究結果並不遜色，甚或有較佳之跡象。在檢視國內外文獻提出對台灣風險計價發展之下列建議：（１）風險計價與校正因子的發展，應考量本土保險制度與社會習性，方可提供有效訊息予政策規劃使用；（２）短期內，國內風險計價研究可利用完整診斷資訊，發展具預測力的風險因子並從事國際比較，中、長期而言，可藉由處方資訊的改善，發展用藥處方因子，全面與國際發展趨勢銜接。
  In order to contain the escalation in health care expenditure and strengthen social equity ,most developed countries ,at least to a certain degree ,have introduced prospective budget mecha-nism into their health care systems. To avoid the carrying over of inefficiencies and any resulting unfairness into the current system, in recent years the determination of the prospective budget has been calculated more cautiously by employing risk adjustment. Many studies have been dedicated to this area and have provided a sound basis for policy making. Among these studies, a large number are related to the development of risk adjusters to increase the predictability of risk assessment. Taiwan’s NHI has fully implemented a prospective budget payment system, and many reform proposals have urged the necessity of risk adjustment. Although the research into risk adjustment is at an early stage, some risk assessment studies have reported promising results. After reviewing both Taiwan’s and international risk assessment studies, we recommend: (1) to provide valuable information to policy makers, the development of a risk assessment model must take Taiwan’s health care system and social characteristics into account; and (2) in the short term, a risk assessment model incorporating fully diagnostic information should be developed immediately, and in the long term, the prescription information in the claim data should be improved, which can be used in developing indigenous prescription drug adjusters. In this way, the research into risk assessment in Taiwan will be able to be used for cross-country comparisons and be compatible with the global trend.
• 91 - 99
• 10.6288/TJPH2004-23-02-01

• Link 原著 Original Article
• 全民健保中醫門診利用率及其影響因素Utilization of Ambulatory Chinese Medical Services under the National Health Insurance in Taiwan
• 李丞華、周穎政、陳龍生、張鴻仁
  Cheng-Hua Lee, Ying-Jenq Chou, Long-Shen Chen, Hong-Jen Chang
• 中醫醫療 ； 門診 ； 醫療利用
  chinese medical services ; ambulatory care ; health care utilization
• 目標：本研究目的有兩項，第一為描述全民健保保險對象的中醫門診利用率及其在年齡、性別及地區之間的變異；第二為探討個人特質、疾病狀態及地區醫療資源對中醫門診利用率的影響。方法：本研究運用次級資料分析，採用國家衛生研究院提供2000年具有全國代表性之全民健康保險對象個人歸戶資料檔，並透過中央健康保險局數據中心協助，進行門住診明細檔、重大傷病檔及戶籍資料檔等檔案串聯，共完成88,101名2000年在保且存活之我國國民為研究對象。本研究分析中醫門診利用率的影響因素，採用二部模型(two-part model)的迴歸分析。結果：１）2000年健保保險對象每人每年中醫平均利用率為1.264次，女性利用1.477次高於男性利用1.051次，而年齡別利用率呈現“ㄇ”型，35到65歲間呈現高峰，迥異於西醫門診年齡別利用率呈現“J”曲線。２）中醫門診在健保局六個分局轄屬民眾之年齡性別標準化利用率，由高而低分別為中區分局1.922次，南區分局1.302次，高屏分局1.246次，北區分局1.016次，台北分局0.990次，及東區分局0.877次。３）中醫門診在十七個醫療區轄屬民眾之年齡性別標準化利用率差距頗大，最高的前五名分別是台中醫療區2.134次、彰化醫療區1.665次、南投醫療區1.483次、台南醫療區1.347次及雲林醫療區1.309次；最低的後三名分別是台東醫療區0.679次、宜蘭醫療區0.923次、及桃園醫療區的0.954次。最高與最低相差3.14倍。４）二部模型複迴歸分析顯示女性、40歲到70歲、非原住民、居住在中度都市化之市鎮者、慢性病患者、居住於中醫師資源豐富及西醫師資源較少之地區者，其中醫門診利用率顯著較高。結論：研究結果顯示中醫門診利用率的地域性差異甚大，且個人特質、疾病狀態及地區中醫資源均會影響中醫門診利用率。
  Objective: The objectives of this study were: first to describe the utilization of ambulatory Chinese medical services of the NHI enrollees and how it varied according to the insured’s age, sex and geographical location; second to discuss the influences of the characteristics of patients, attributes of the diseases, and local medical resources on the Chinese medical services utilization. Method: This study applied secondary data analysis to representative NHI enrollees sample files in the year 2000 provided by the National Health Research Institute. And with the assistance of the Bureau of National Health Insurance, the sample files were linked with the Family Registration File. A total of 88,101 enrollees alive in 2000 were retrieved as the study subjects. This study used two-part model regression analysis to analyze the factors affecting the utilization of ambulatory Chinese medical services. Result: 1) On average, the utilization rate of ambulatory Chinese medical services was 1.264 visits per person per year in 2000. Female had a higher utilization rate than male (1.477 visits vs. 1.051 visits). However, age-specific utilization rate presented a “reverse U” curve, with a peak occurred among 35 to 65 years of age, in contrast to the ”J” curve of the utilization of ambulatory western medical services. 2) The age-and sex- adjusted utilization rates by the six BNHI branches were (from high to low) : 1.922 visits for the Central Branch, 1.302 visits for the Southern Branch, 1.246 visits for the Kao-Ping Branch, 1.016 visits of the Northern Branch, 0.990 visits for the Taipei Branch, and 0.877 visits for the Eastern Branch. 3) The age- and sex- adjusted utilization rates differed significantly among 17 medical care regions. The five regions with the highest rates were: 2.134 visits for the Taichung medical region, 1.665 visits for the Changhua medical region, 1.483 visits for the Nantou medical region, 1.347 visits for the Tainan medical region, and 1.309 visits for the Yunlin medical region. Three regions with the lowest rates were: 0.679 visits for the Taitung medical region, 0.923 visits for the I-Lan medical region, and 0.954 visits of the Taoyuan medical region. 4)Two-part regression model showed that people retaining the following characteristics were more likely to have higher utilization rates of ambulatory Chinese medical services: female, people aged between 40 to 70, non- aboriginal, sub-urban citizens, patients with chronic disease, and living at areas with more sufficient manpower resources in Chinese medicine but less sufficient manpower in western medicine. Conclusion: The results show that Chinese medical services utilization rates varies significantly among different geographical regions. Besides, patient characteristics, the attributes of diseases and the adequacy of Chinese medical resources, all have an important impact on the Chinese medical utilization rates.
• 100 - 107
• 10.6288/TJPH2004-23-02-02

• Link 原著 Original Article
• 醫院員工工作壓力與健康相關生活品質之探討-以台中某醫學中心為例Job Strain and Health-Related Quality of Life of Hospital Employees: Case of a Medical Center in Tai-Chung
• 林雅雯、張雅雯、蔡佳珍
  Yea-Wen Lin, Ya-Wen Chang, Chia-Chen Tsai
• 工作壓力 ； 健康相關生活品質 ； 醫院員工
  Job stress ; Health-related quality of life ; Hospital employee
• 目標：本研究目的旨在探討某醫學中心員工之工作壓力與健康相關生活品質。方法：採橫斷式調查研究並利用自填式問卷調查法蒐集相關資料，以中文版工作特質量表及台灣版世界衛生組織生活品質問卷分別測量工作壓力與健康相關生活品質。研究母群為台中某醫學中心之員工，採分層抽樣方法選取樣本500人進行問卷拖測。結果：有關工作壓力部分，將近10％的員工屬於高壓力族群。而整體健康相關生活品質量表之得分為51.56，各分量表之得分以生理健康範疇最高，環境範疇最低。將工作壓力與健康相關生活品質進行相關分析，結果顯示各分量表間大多數有顯著相關，且發現高壓力群之心理層面生活品質較低壓力群為差。再分析健康相關生活品質之預測因子，發現工作控制度、社會支持度、工作年資，以及職務之虛擬變項中護理人員與醫師等變項的影響達顯著水準，可以解釋48.2%的變異量。結論：衛生主管機關及醫務管理者應重視醫院員工之壓力問題，並提出有效的壓力管理策略，以預防壓力對醫院員工身心健康的傷害，並增進其身心健康與福祉。
  Objectives: The purpose of this study was to explore job stain and health related quality of life (HRQOL) for hospital employees in a medical center. Methods: A cross-sectional survey by self-administered questionnaires using the Chinese Version of the Job Content Questionnaire (C-JCQ) and the World Health Organization Quality of Life (WHOQOL) Taiwan version to measure job strain and HRQOL, respectively. Using stratified random sampling procedure, the survey data was collected from 500 employees working in a medical center located in Tai-Chung. Results: Slightly less than 10% of the employees in the sample had high-strain jobs. The overall score of HRQOL was 51.56, among four subscales, these employees scored highest on the physical health subscale and lowest on the environment subscale. The C-JCQ subscales and WHOQOL subscales were found to have a significantly highly correlation, and the high strain group was as likely to report a lack of quality of life on the psychological scale than the low strain group. In examining the predictors of HRQOL, it was found seniority, job control, work-related social support, physician dummy variable, and nurse dummy variable explained 48.2% of the variance in HRQOL. Conclusions: the findings in this study can help management executives and cabinet policy-makers to pinpoint the problem of job strain. They should build effective stress management strategies to avoid the stress hazards affect on the mental and physical health of employees, and to thereby improve employees’ health and well-being.
• 108 - 120
• 10.6288/TJPH2004-23-02-03

• Link 原著 Original Article
• 探討術前合拼症指標與醫療利用及手術相關結果之關聯性-以全股(髖)關節置換健保申報資料為例Using the Comorbidity Index to Evaluate the Medical Utilization and Outcomes of Total Hip Replacement through Analyzing National Insurance Claimed Data
• 吳肖琪、簡麗年、吳義勇
  Shiao-Chi Wu, Li-Nien Chien, Yee-Yung Ng
• 合拼症嚴重度指標(CCI) ； 死亡率 ； 申報資料 ； 全股(髖)關節置換術
  Charlson comorbidity index ; mortality rate ; claimed data ; total hip replacement
• 目標：應用察爾森合拼症嚴重度指標(Charlson comorbidity index，以下簡稱CCI)，探討全股(髖)關節置換術病患之手術前合拼症嚴重度與術後醫療利用及手術結果之關聯性。方法：利用全國健保申報次級資料，以民國89年1至12月進行單側全股(髖)關節置換手術者為研究對象，控制病患特質（年齡、性別、手術原因）、醫院特質（地區別、公私立與評鑑等級別）與住院期間復健次數與住院期間拼發症等，評估以當次住院及當次拼前一年住院診斷，計算合拼症嚴重度之CCI值大小與住院日、住院費用，出院後３０日及一年內死亡與再住院之關聯性。結果：以當次住院診斷計算CCI值，發現CCI值「2」分以上之病患住院日、費用、出院後３０日及一年內之死亡與再住院顯著高於「0」分的病患（住院日分別為11.9日與9.4日，費用為14.9萬與12.5萬，３０日內死亡率為2.8%與0.4%，30日再住院率為31.4%與7.2%，一年內死亡率為15.3%與1.8%，一年內再住院率為147.5%與40.0%）；控制其他干擾因子後，CCI值高低仍顯著影響住院日、費用，出院後30日及一年內死亡及再住院。當次拼前一年住院診斷之CCI值也顯著影響病患醫療利用與手術結果，但以當次住院CCI值校正合拼症嚴重度較具便利性。結論：術前合拼症嚴重度CCI值的高低與病患之住院期間醫療利用與出院後手術結果有關，除非計算一年內住院，否則以當次住院診斷計算CCI值即可。建議未來研究者可利用CCI值校正病患術前合併症嚴重度，健保局可進一步利用CCI值評估支付金額之合理性，醫院管理者可利用CCI值追蹤病患的預後。
  Objective: To evaluate the correlation between the pre-operative Charlson comorbidity index (CCI) and post-operative medical utilization and quality for patients who underwent a total hip replacement (THR). Methods: The claimed data from the National Health Insurance for patients who underwent elective primary THR in 2000 was used in this study. The correlation between CCI and the parameters including length of stay, medical fee rate of mortality, and readmission within thirty days and one year were analyzed after adjustment of patients’ characters (age, gender, major diagnosis), characters of hospitals (area, owner and size), times of in hospital rehabilitations and complications. Result: The THR patients with a present pre-operative CCI score of more than 2 had a higher medical fee (NT $14,900 versus NT $12,500), thirty-day mortality (2.8% versus 0.4%), thirty-day readmission rate (31.4% versus 7.2%), one-year mortality (15.3% versus 1.8%), one-year readmission rate (147.5% versus 40.0%) and longer length of stay (11.9 days versus 9.4 days) than those with a zero score. After adjustment of the confounding factors, the pre-operative CCI score was still significantly positively related to the above parameters. Even the CCI score within one year was also positively related to the above parameters. The present score CCI was more efficient than the CCI score within one year for the response to the medical utilization and quality. Conclusion: The CCI score was highly correlated with the utilization of medical care during hospitalization and medical quality after discharge. The present CCI was more efficient than the CCI within one year, except for in respect to the one-year readmission rate. The CCI score could be used for the correction of severity of THR patients. NHI could use CCI to evaluate the rationality of reimbursements. The CCI score could also be applied to the hospital for prediction of the prognosis of THR.
• 121 - 129
• 10.6288/TJPH2004-23-02-04

• Link 原著 Original Article
• 醫院權屬別與醫療收費Hospital Ownership and Medical Service Pricing
• 張樂心、鄭守夏、楊銘欽、 江東亮
  Le-Hsin Chang, Shou-Hsia Cheng, Ming-Chin Yang, Tung-Liang Chiang
• 醫院權屬別 ； 醫療費用 ； 自付費用 ； 住院天數 ； 支付制度
  Ownership ; medical expense ; out-of-pocket ; length of stay ; payment system
• 目標：我國私人醫院比例高於美國三倍以上，不同權屬別醫院收取醫療費用是否不同，本研究提供台灣實證資料。方法：以糖尿病、中風、剖腹產與闌尾切除四種常見疾病病人為研究對象，共4945名，分析不同權屬別醫院之醫療費用；包括醫院向病人收取之自付費用、向健保局申報之醫療費用，以及住院天數。並以同病再入院與術後傷口發炎率作為品質指標。結果：論病例計酬的剖腹產與闌尾切除病人，私人醫院的申報費用最低，但收取最高的自付費用與醫療總費用；論量計酬的糖尿病與中風患者，私人醫院的申報費用、自付費用與總費用皆顯著高於公立醫院。無論哪種支付方式，公立醫院的平均住院天數皆較長。結論：私人醫院論病例計酬的申報費用低於公立醫院，論量計酬類則較高，其因應健保支付制度之費用策略可能較公立醫院明顯。公立醫院可能因公務預算補助等因素，收取最低的自付費用，但住院天數偏長。
  Objective: The proportion of private hospitals in Taiwan is 3 times higher than that in the United States. This study addresses the question as to whether private hospitals charge higher prices by providing empirical evidence from Taiwan. Method: There were 4945 patients with one of common diagnoses/procedures of diabetes, stroke, Cesarean section, or appendicitis included in the analysis. The between-hospital comparisons were measured by patients’ out-of-pocket payment, NHI claimed expenses, and patients’ length of stay. We also adopted the readmission rate and post-operation infection rate as quality indicators for comparison. Results: Multiple regression models showed that private hospitals had the lowest level of claimed expenses, but higher out-of pocket and total expenses than their counterparts for procedures under the case payment method. Moreover, both their claimed reimbursements and out-of-pocket charges were both higher than that of public hospitals for diseases under the Fee-for-Service system. On average, public hospitals had the longest length of stay. Conclusion: Private hospitals seem more flexible in response to the NHI payment policy than public hospitals. Owing to the governmental subsidy, public hospitals charge lower out-of-pocket prices but have a longer length of stay.
• 130 - 140
• 10.6288/TJPH2004-23-02-05

• Link 原著 Original Article
• 從健保申報資料探討中耳炎抗生素療程之合理性Analyses of Antibiotic Treatment Duration on Otits Media Using NHI Claims
• 龐一嗚、黃文鴻、謝曉菱、游素香、吳欣蓉、陳蕙玲、鍾進蘭、馬貴蘭、李惠珠
  I-Ming Parnn, Weng F. Huang, Hsiao-Ling Hsieh, Su-Hsiang Yu, Hsin-Jung Wu, Huei-Ling Chen, Chin-Lan Chung, Kuei-Lan Ma, Hui-Chu Lee
• 中耳炎 ； 抗生素 ； 合理療程
  Otitis media ; antibiotic treatment ; rational therapy
• 目標：瞭解健保特約醫療機構申報資料，在中耳炎使用抗生素的療程是否合理，分析可能影響用藥品質的指標值。方法：從民國九十年五月至十月之中央健康保險局台北分局門診申報資料，篩選ICD-9-CM代碼為3810、3814、3820、3824、3829等五碼之中耳炎案件共計119,773件，以統計分析軟體SPSS及SAS等，進行中耳炎病患的整體描述性統計及療程歸戶分析。結果：中耳炎案件以“3829未明示之中耳炎”申報最多，病患年齡以5歲以下最多，主要看診科別為耳鼻喉科及小兒科，近七成的中耳炎病患選擇在基層診所就醫。藥物療程經歸戶後，僅醫學中心之每療程平均給藥日份10.73天符合中耳炎標準療程10-14天用藥，療程平均給藥日份差異在各層級間有顯著差異。符合合理中耳炎療程給藥日份之案件比率，醫學中心佔15.86%最高、基層佔3.04%最低。個別醫療院所中耳炎療程平均給藥日份僅不到二成符合臨床規範；給藥療程合理案件佔中耳炎總案件之比率亦僅有22.18％；小兒科和耳鼻喉科的療程給藥日份合理之件數比率較高。在醫院層級以耳鼻喉科的合理比率最高；在基層則為小兒科合理比率最高。結論：本研究所探討的合理中耳炎療程，符合研究所界定的標準僅約二成左右。如對應院所個別分析資料，可加強院內自我管理，達到合理用藥之目標。
  Objectives: This study analyzes the rational duration of antibiotic treatment on otitis media among NHI contract institutions. It explores potential indicators that may affect rational drug therapy in order to improve the quality of drug treatment. Method: The material for this study was based on the claimed data files dating May 1st ~October 31st, 2001 from the Northern Branch Office of NHI Bureau. A total of 119,773 cases diagnosed with otitis media by ICD-9-CM codes 3810,3814,3820,3824 and 3829 were screened for analysis using software programs of SPSS and SAS. Descriptive and analytical analyses were performed for selected otitis cases. Results: The number of otitis media by ICD-9-CM 3829 “unclassified otitis” ranked the highest among five ICD-9-CM codes. The patient group? 5 years old was the largest group, and ENT and the pedestrian departments were two most utilized specialties. There were nearly 70% of otitis patients choosing primary clinics. After the data files were classified by individual ID number, only medical centers with an average drug regiment of 10.73 days met the rational therapy criterion. There were significant differences among different levels of institution in terms of the average number of drug regimen days. The medical centers had the highest percentage (15.86%) meeting the rational antibiotic therapy criterion, the primary clinics the lowest (3.04%). There were less than 20% of institutions meeting rational antibiotic therapy criterion. The figure for physicians was 22.18%, while a higher percentage of rational antibiotic therapy was found in pedestrian and ENT departments. The ENT department ranked as the highest percentage for rational antibiotic therapy in the hospital segment, and pedestrian department the highest of the primary clinics. Conclusion: There were only around 20% of cases receiving rational antibiotic therapy regardless of the type of institution, physician, or clinical department. The results may be compared to the profile of an individual institution for better drug therapy management.
• 141 - 149
• 10.6288/TJPH2004-23-02-06

• Link 原著 Original Article
• 醫院因應總額支付制度之策略方案及其相關因素探討Factors Associated with Strategic Choices of Hospitals in Response to the Global Budget System
• 莊念慈、黃國哲、許怡欣、郭乃文、魏中仁
  Nien-Tzu Chuang, Kuo-Chearh Huang, Yi-Hsin Elsa Hsu, Nai-Wen Kuo, Zhong-Ren Wei
• 總額支付制度 ； 策略方案
  global budget payment system ; strategic choices
• 目標；有鑒於健保支付制度之改變，對醫院經營管理之影響甚鉅，因此各醫院莫不積極採取因應策略。本研究及探討醫院對於總額支付制度之實施，所採取因應策略之類型，並分析影響其策略選擇的相關因素。方法；本研究依據Shortell的理論架構，將醫院的策略類型氛圍機構層面、管理層面、及技術層面等三類。研究設計採橫斷性研究，使用結構式問卷，於總額支付制度實施九個月後，針對我國地區教學醫院(含)以上的127家醫院進行郵寄問券調查，最後回收之有效問卷共計75分，回收率為59.7%。結果：為了因應醫院總額支付制度的實施，樣本醫院在機構層面上採用最多的策略為教育院內同仁瞭解高制度之情形及其影響；在管理層面上採用最多的策略為加強內部財務管理，及建立完善成本會計制度；在技術層面上，採用最多的策略則為建立院際間轉診或轉檢之機制。研究結果亦顯示，醫院權屬別及醫院在總額支付制度實施後住院服務量的變化情形兩個變項，對於樣本醫院在機構層面所採取的策略有險著性的影響力。而醫院評鑑等級、醫院所處市場的競爭程度、及醫院在總額支付制度實施後總營運收入的變化情形等三個變項，則會影響樣本醫院在管理層面所採取的策略。結論；本研究發現醫院特性、醫院所處市場之競爭程度對於醫院因應總額支付制度所採取之策略有影響力。本研究的研究發現對於醫院經營管理者採取適當的策略，以因應環境的變動壓力當有所助益。
  Objectives: Due to the continuous revolutions in the national health insurance payment system the management of hospitals have been seeking a better strategy to cope with these changes. The purpose of this study was to explore the factors associated with strategic choices of hospitals in response to the global budget payment system. Methods: This study employed Shortell’s model by dividing strategies into three types; institutional-level response managerial-level response, and technical-level response. This cross-sectional study investigated 127 hospitals in Taiwan (including district teaching hospitals and higher levels) by sending them structured questionnaires. The response rate was 59.1% with 75 hospitals returning the questionnaires. Results: The results of the study indicated that in respect to institutional-level response to the global budget payment system, most hospitals adopted the strategy of further educating their staff about the major changes in the global budget payment system. In regard to managerial-level response, the majority of hospitals adopted the strategy of enhancing their financial management and constructing a better cost accounting system. Finally, for the technical-level response, most hospitals employed the strategy of establishing a referral system. The results of the study also showed that strategies at the institutional-level were influenced by hospital ownership and service volume following the implementation of the global budget payment system. Hospital level, degree of market competition, and change in operating income after the after the implementation of global budget payment system were significant indicators of the strategies at the managerial-level that the hospitals would adopt. Conclusions: The results demonstrated that the characteristics of the hospital and degree of market competition were significant indicators of strategies that hospitals would adopt in response to the global budget payment system.
• 150 - 158
• 10.6288/TJPH2004-23-02-07

• Link 原著 Original Article
• 社區老人之生命意義及其相關因素－以雲林縣為例Meaning of Life and Related Factors Among Community-Dwelling Elders in Yunlin County
• 黃子庭、林柳吟
  Tzu-Ting Huang, Liu-Yin Lin
• 老人 ； 生命意義 ； 社會支持
  elder ; meaning of life ; social support
• 目標：確認社區老人之生命意義及其預測因子。方法：使用橫斷式相關性研究設計，以雲林縣65歲以上的社區老人為研究對象，以隨機化成比例之機率方式抽出樣本數360人，有效樣本共計308人。結果：1.老人的生命意義以子孫成就得分較高；2.迴歸分析顯示，社會支持、心理功能、教育、生活事件及性別等變項為老人生命意義總得分的預測因子，共可解釋66.7%變異量，其中又以社會支持具有最大的解釋力，可以解釋46.5%變異量。結論：本研究結果可以提供社區老人服務的相關人員對其生命意義的瞭解，並且可以依此發展出合宜的措拖，以提昇社區老人的生命意義及其生活品質。
  Objectives: To identify the meaning of life as perceived by the community-dwelling elders and their predictors. Methods: A cross- sectional, correlational design was used to a 308 randomized (probabilities proportional to size measure) community-dwelling elders in Yunlin County to assess their physical and mental health status, social support, life events and meaning of life. Results: 1. The scores of “descendant of accomplishment” were higher than “personal value” of meaning of life among subjects. 2. The results from the regression analyses indicate that a combination of “social support”, “psychological function”, “educational level”, “life changing event”, and “gender” explained 66.7% of the variability of the meaning of life among the elders. Among these variables, “social support” was the most powerful predictor that explained 46.5% of the variability. Conclusions: The results of this study improve the understanding of meaning of life from the elders’ perspective for service providers. Thus, appropriate programs to promote the meaning of life and quality of life for elders can be developed.
• 159 - 167
• 10.6288/TJPH2004-23-02-08