臺灣博碩士論文加值系統

目前急診X光醫囑系統的設計多為文數字輸入介面，但面對急診高負荷的工作特性，與普遍醫護人力吃緊，此種以文數字代碼來完成X光檢查的開立，容易發生開單錯誤，並使得後續流程產生連環性的錯誤。根據實務觀察，開立檢查醫囑的錯誤以『左右相反、部位開立錯誤、醫囑重複開立』最常發生，有鑑於此，個案醫院急診部希望進行X光醫囑系統介面優化，採用圖形化介面取代過去輸入代碼的方式完成開單，藉此降低X光檢查開單的錯誤率，但推動成果不彰。
本研究協助個案醫院進行急診X光醫囑系統的成效分析，並試圖找出系統推行受阻的原因。以認知適配理論為基礎，採用實驗室實驗法分析新介面導入後對於決策時間和品質的改善與否；以科技任務適配理論為基礎，納入優使性變數並發展問卷以收集急診醫師對於標的系統的評價資料。此外，也收集個案醫院品管資料與系統導入前後X光開單錯誤率資料。
實驗結果顯示，使用圖形化介面開立X光檢查醫囑兩者具有認知適配性，反應的開單績效結果較好。問卷資料分析顯示整體模型解釋力達73%，其中，科技特性正向影響任務科技適配度，且任務科技適配度正向影響工作績效，與過去研究以及實驗結果一致。此外，科技適配度也正向影響系統使用與優使性、促成條件正向影響系統使用、優使性正向影響工作績效。本研究建議個案醫院應當採納使用者的建議，後續修改介面，提高介面優使性，此外，適時介入管理措施並輔以獎賞制度，以利扭轉情勢與提高醫師接受與採用新介面。

The current order entry system for X-rays is based on the input of characters and numbers. In a fast-paced, stressful and often short-staffed workplace like the emergency department, this input method is prone to errors, leading to incorrect or unnecessary X-ray scans that could cause a chain reaction in the resultant processes of medical treatment. Clinical observations showed that right-left reversal, incorrect targets and unnecessary repeats to be the three most commonplace mistakes. To tackle these, the case hospital introduced a graphical input interface to the X-ray order entry system at its emergency department to replace the previous method of keying in reference codes. With the aim to improve the accuracy rate of X-ray ordering, this system optimization was somehow met with limited successes.
To find out the reasons, this research helped the case hospital assess the efficacy of the X-ray order entry system. Experimental methods and questionnaire survey were used to explore emergency practitioners’ evaluation of the system. Based on the cognitive fit theory and task-technology fit theory, the experiments collected data of system users’ objective opinions, which offers the basis of the survey’s questionnaire design. The survey then asked subjective feedback from the users. Combination of an objective evaluation via experiments and subjective one via questionnaire helped improve the completeness of results and the study’s impact factor.
The cognitive fit analysis revealed that the graphical interface for X-ray order entry was perceived as suitable with users recognizing its higher efficiency. Questionnaire data analyses confirmed the overall explanatory power up to 73%. Technology characteristics have an effect on the task-technology fit, which subsequently influences work efficiency. Task-technology fit have significant positively effect on utilization and usability. Facilitating conditions have significant positively effect on utilization. Usability have significant positively effect on performance. The research advises hospital managers to learn from user feedback about the effectiveness of the system and use such knowledge as the reference for the system’s wider applications, function modification and future updates.

摘要 i
ABSTRACT ii
目錄 iv
表目錄 vii
圖目錄 ix
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 8
第三節 研究流程 10
第二章 文獻探討 11
第一節 關於醫療業 11
2.1.1 急診醫療 12
2.1.2 病人安全 15
2.1.3 醫療品質 17
第二節 醫囑系統 18
2.2.1 系統介紹 18
2.2.2 系統應用與相關研究 19
第三節 適配理論 20
2.3.1 認知適配理論 20
2.3.2 任務科技適配理論 24
第三章 研究方法 27
第一節 研究架構 27
第二節 研究假說 28
第三節 研究變數定義 29
3.3.1 自變數 29
3.3.2 依變數 30
第四節 實驗設計 30
3.4.1 實驗分組與對象 30
3.4.2 實驗任務與系統介紹 31
3.4.3 實驗流程 36
第五節 研究工具 38
3.5.1 系統成效問卷 39
第六節 資料分析方法 41
第七節 研究倫理 41
第八節 個案醫院 41
第四章 資料分析 43
第一節 樣本基本資料與問項之描述性統計 43
第二節 信度與效度分析 48
4.2.1 信度 48
4.2.2 效度 49
第三節 實驗數據分析 53
4.3.1 獨立樣本t檢定 55
4.3.2 單因子變異數分析 55
第四節 結構方程模型 57
4.4.1 測量模型分析 58
4.4.2 結構模型分析 67
第五節 假說檢定 71
第五章 討論 74
第一節 實驗設計 74
第二節 系統成效問卷 76
第六章 結論與建議 81
第一節 結論 81
第二節 研究建議 82
第三節 研究限制 83
第四節 未來研究方向 84
參考文獻 86
附錄一、個案醫院急診部之檢查醫囑開立錯誤事件 96
附錄二、各構面之操作型定義與問項 98
附錄三、系統成效問卷 104

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