臺灣博碩士論文加值系統

目前國內大部分門診掛號系統是採行預約和現掛並存的，因為不確定的時間(包括服務時間及現掛病人的到時間)，而常常造成病人等候和醫師閒置的情況發生。因此本研究主要的目標是安排一最佳的預約排程法則，以降低醫院門診的平均總成本，其中總成本定義為病人的等候時間和醫師的閒置時間的線性關係。
我們所建議的預約排程法則是根據Ho和Lau所提出的變化間隔時間的排程方法。他們經由不斷的執行模擬來決定法則的相關合理參數值。但是相對地，本研究則是應用模擬最佳化方法尋找上述參數的最佳值；具有相關參數值的變化間隔時間的排程法則稱之為最佳的預約排程法則。模擬最佳化方法主要分成兩步驟：首先，利用模擬來產生隨機的服務時間及現掛的到時間；再者，以模擬產生的值為輸入常數，使用非線規劃搜尋最佳的參數值；重覆執行上述二步驟直到符合收斂標準。
經由上述的研究方法，本研究分別找出在不同環境參數組合下的最佳預約法則，再進行模擬實驗以驗證本研究的優越性。研究結果顯示，在大部份情況下，使用我們的方法搜尋出的法則都可優於文獻上的法則。

Most of hospitals in Taiwan allow appointment patients and walk-in patients simultaneously. Due to the uncertainties of both the service times and walk-in patients’ arrival times, it is often the case that the patients have to wait and the doctor has to idle. The main goal of this research is to arrange the best appointment scheduling rule to reduce the average total cost, which is defined as the linear combination of the waiting time of all patients and the idle time of the doctor.
The rule proposed here is based on the variable-interval scheduling rule designed by Ho and Lau. In their method, a series of continuous simulation experiments are performed to find the reasonable values of the associated parameters. Contrast to theirs, the simulated-based optimization methodology is utilized to determine the optimal values of the same parameters; the variable-interval rule with the optimal values of the corresponding parameters is what we call the optimal scheuduling rule. There two main steps in the simulation optimization method: first of all, the random service times and walk-in’s arrival times are produced by the simulation; secondly, the non-linear programming method is used to search the best values of the corresponding parameters, as the random times generated in the first step are treated fixed. These two steps are repeatedly executed until the convergent criterion is satisfied.
Different environments are designed to test our method. For each case, the above simulation-based optimization method is utilized to find its best appointment scheduling rules. To verify superiority of each optimal scheduling rule, its simulation model is developed and then performed. The results show most of the rules proposed in this research outperform those in the literature.

目 錄
中文摘要…………………………………………………………… i
英文摘要…………………………………………………………… ii
誌謝………………………………………………………………… iv
目錄………………………………………………………………… v
表目錄……………………………………………………………… vii
圖目錄……………………………………………………………… viii
第一章、緒論……………………………………………………… 1
1.1前言…………………………………………………………… 1
1.2研究動機與目的……………………………………………… 2
1.3研究流程……………………………………………………… 2
1.4論文架構……………………………………………………… 4
第二章、文獻探討………………………………………………… 5
2.1醫療預約排程系統…………………………………………… 5
2.1.1預約系統…………………………………………………… 5
2.1.2預約排程法則……………………………………………… 9
2.1.2.1國外文獻探討…………………………………………… 9
2.1.2.2國內文獻探討…………………………………………… 11
2.2非線性規劃及系統模擬……………………………………… 13
2.2.1非線性規劃………………………………………………… 13
2.2.2系統模擬…………………………………………………… 16
第三章、研究方法………………………………………………… 22
3.1問題描述與符號定義………………………………………… 22
3.1.1問題描述…………………………………………………… 22
3.1.2符號定義及模擬參數組合………………………………… 23
3.2研究方法發展………………………………………………… 25
3.2.1模擬技術…………………………………………………… 26
3.2.2非線性規劃之參數搜尋法………………………………… 30
3.2.3模擬最佳化………………………………………………… 33
3.3建立預約法則的模擬模型…………………………………… 38
第四章、實驗設計與驗證………………………………………… 42
4.1驗證原始方案………………………………………………… 42
4.2改善方案建立及實驗結果分析……………………………… 44
4.3最佳方案之討論分析………………………………………… 53
第五章、結論……………………………………………………… 69
5.1結論及論文貢獻……………………………………………… 69
5.2未來研究方向………………………………………………… 70
參考文獻 ………………………………………………………… 71

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