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研究生:徐瑜敏
研究生(外文):Yu-Min Hsu
論文名稱:臨床實驗室高危險值警示系統之初步評估
論文名稱(外文):Preliminary Evaluation of High Risk Reminder SystemConcerning Clinical Laboratory Critical Value Alerts
指導教授:黃崇謙黃崇謙引用關係
指導教授(外文):Chung-Chien Huang
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫務管理學系
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:73
中文關鍵詞:PZB服務品質量表高危險值警示系統
外文關鍵詞:PZBSERQUALHigh Risk Reminder System
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本研究旨在使用PZB (1985) SERVQUAL之五大構面設計臨床實驗室高危險值警示(High Risk Reminder, 以下簡稱HRR)系統的服務品質問卷,以此問卷衡量臨床醫療人員對HRR系統服務品質期望程度及知覺程度,以求得臨床醫療人員認知的HRR系統服務品質(滿意度),藉以提供醫院作為提昇HRR系統服務品質的參考。
並且利用實驗室資訊系統(Laboratory Information System)之資料庫,統計每月檢驗危急值通報數量,以及常發生在門診、急診及住院病人之危急值檢驗項目,常發生危急值之臨床科別。
研究結果發現,臨床實驗室HRR系統的服務品質皆受到臨床醫療人員的肯定,平均滿意度為3.84。臨床醫師平均每月接獲通報的數量為857次,其中血色素(Hb)1298次(13.75%)、血液酸鹼值(pH)947次(10.03%)、血液二氧化碳濃度(blood gas pCO2)918次(9.73%)之檢驗,不論是在急診、住院或是門診病人中被通報的次數最多。通報檢驗高危急值給臨床醫師最高頻率的前三名科別:急診醫學科2417次(25.61%)、胸腔內科1179次(12.49%)、小兒科1026次(10.87%)。
The study is using PZB model to design Clinical Laboratory High Risk Reminder (HRR) System service quality questionnaires, to measurement clinical medical staffs their expection and perception of HRR, for understanding their satisfaction, and provide the outcome to the information technology department for improving the service of HRR.
Otherwise, using Laboratory Information System (LIS) database to calculate HRR amounts per month, which test items are high frequencies occurred in OPD, ward and ER department, and which department doctors were received the most frequencies reminding messages.
The study found that clinical medical staffs all approve HRR system, the average score is 3.84. There were average 857 HRR amounts per month, Hb 1298 times(13.75%)、pH 947 times(10.03%)and blood gas pCO2 918 times(9.73%)are the most frequencies reminding test items whatever in OPD, ward or ER department. ER 2417 times(25.61%), thoracic department 1179 times(12.49%) and pediatrics department 1026 times(10.87%) were the most high frequencies reminding department.
致謝……………………………………………………………………….…I
中文摘要……………………………………………………………….…...II
英文摘要……………………………………………………………….......III
目錄……………………………………………………………………...…IV
表目次……………………………………………………………………...VI
圖目次………………………………………………………………….….VII
附件目次…………………………………………………………….……VIII

第壹章 緒論
第一節 研究背景與動機……………………………………….…..1
第二節 研究重要性…………………………………………….…..3
第三節 研究目的……………………………………………….…..4
第四節 研究流程…………………………………………………...5
第五節 研究架構…………………………………………………...6
第貳章 文獻探討
第一節 使用資訊系統增進醫療品質……………………………...7
第二節 資訊系統之時效性………………………………………...8
第三節 醫護人員對資訊系統之滿意度…………………………...9
第四節 資訊超載與資訊焦慮…………………………………….12
第五節 服務品質評估(SERVQUAL)…………………………….13
第六節 高危險值警示系統……………………………………….18

第參章 研究方法
第一節 研究架構與研究假設…………………………………….19
第二節 問卷設計………………………………………………….21
第三節 抽樣設計與方法………………………………………….23
第四節 資料處理與統計分析方法……………………………….24
第肆章 結果
第一節 問卷信度與效度分析…………………………………….25
第二節 描述性統計資料結果…………………………………….27
第三節 推論性統計資料結果…………………………………….50
第伍章 結論與建議
第一節 研究結論………………………………………………….62
第二節 研究建議………………………………………………….67
第三節 研究限制…………………………………….……………68

參考文獻
中文部分…………………………………………………………….69
英文部分…………………………………………………………….69
書本………………………………………………………………….72
一、中文文獻
吳清賢(1997)。從強化醫院資訊系統促進醫療品質與效率─淺談國外先進醫院之概況。經營決策論壇。
孫漣(1997)。臨床即時警示系統--以腎臟科為例。國立陽明醫學大學。碩士論文。
薛亞聖、石崇良、廖熏香、羅恆廉、曾慧萍、張穎貞(2003)。建立安全的醫療環境。病人安全架構之規劃研究成果報告。
楊秀儀(2001)。醫療糾紛與醫療過失制度 - 美國經驗四十年來之探討。政大法學評論,(86)。
楊秀儀(2002)。論醫療糾紛之定義、成因及歸責原則,台灣本土法學(39),121-123。
蘇映云(1999)。高科技研發人員的網路使用、資訊焦慮與工作表現之研究—以工研院為例。國立交通大學傳播研究所。碩士論文,未出版。
傅振瑞 (1996)。資訊負荷、情緒對消費者決策效果的實驗室研究。國立中央大學資訊管理研究所。碩士論文。

二、英文部分
Bates DW, Cohen MC, Leape LL, Overhage JM, Shabot MM, Sheridan T. (2001). Reducing the frequency of errors in medicine using information technology. J of the American Medical Informatics Association, 8(4), 299-308.
Bates DW, Gawande AA. (2003). Improving safety with information techonology. The New England Journal of Medicine, 348(25), 2526-2534.
Bates DW, Kuperman G, Teich JM. (1994). Computerized physician order entry and quality of care. Qual Manag Health Care, 2(4), 18-27.
Bates DW, Leape LL, Cullen DJ. (1998). Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA, 280, 1311-6.
Bates DW. (2000). Using information technology to reduce rates of medication errors in hospitals. BMJ, 320, 788-91.
Bawden, David ; Holtham, Clive ; and Courtney, Nigel.(1999). Perspectives on Information Overload. Aslib Proceedings 51(8), 249-255.
Cardozo, Richard N. (1965). An Experimental Study of Consumer Effort, Expectation, and Satisfaction. Journal of Marketing Research, 2 (Aug), 244-249.
Chertow GM, Lee J, Kuperman GJ. (2001). Guided medication dosing for inpatients with renal insufficiency. JAMA, 286, 2839-44.
Emancipator K. (1997). Critical values: ASCP practice parameter. Am J Clin Pathol, 108, 147-153.
Erratum, Johnston ME, Langton KB, Haynes RB, Mathieu A. (1994). Effects of computer-based clinical decision support systems on clinician performance and patient outcome: a critical appraisal of research. Ann Intern Med, 120, 135-42.
Fornell, C. and B. Wernerfelt (1988).A Model for Customer Complaint Management. Marketing Science, 7(Summer), 271-286.
Hobbs GA, Jortani SA, Valdes R. (1997). Implementation of a successful on-call system in clinical chemistry. Clin Chem, 108, 556-563.
Hortin GL, Csako G. Critical values, panic values or alert values? (1990). [letter]. Am J Clin PathoL,109, 496-497.
Howanitz PJ, Steindel SJ, Heard NV. (2002). Laboratory critical values policies and procedures: A college of American Pathologists Q-probes study in 623 institutions. Archives of Pathology & Laboratory Medicine, 126(6), 663-670.
Hunt DL, Haynes RB, Hanna SE, Smith K. (1998). Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA, 280, 1339-46.
Hunt, H. K. (1977). CS/D-Overview and Future Research Directions, Conceptualization and Measurement of Consumer Satisfaction and Dissatisfaction in H.K. Hunt (ed.), Cambridge, MA: Marketing Science Institute.
Iselin, E. R. (1988). The Effects of Information Load and Information Diversity on Decision Quality in a Structured Decision Task. Accounting, Organizations and Society, 13(2), 147-165.
Kuperman GJ, Boyle D, Jha A. (1998). How promptly are inpatients treated for critical laboratory results? J Am Med Inform Assoc, 5, 112-9.
Kuperman GJ, Teich JM, Bates DW. (1996). Detecting alerts, notifying the physician, and offering action items: a comprehensive alerting system. Proc AMIA Annu Fall Symp, 704-8.
Kuperman GJ, Teich JM, Tanasijevic MJ. (1999). Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc, 6, 512-22.
Leape LL. (1994). Error in medicine. JAMA,272(23), 1851-7.
Leape LL. (2000). Institute of Medicine medical error figures are not exaggerated. JAMA, 284, 95–7.
Lum G. (1998). Critical limits (alert values) for physician notification: universal or medical center specific limits? Ann Clin Lab Sci,28, 261-271.
Lundberg GD. (1990). Critical (panic) value notification: an established laboratory practice policy (parameter).JAMA, 2; 263(5), 709.
Macklis RM, Meier T, Weinhous MS. (1998). Error rates in clinical radiotherapy. J Clin Oncol, 16, 551–6.
McDonald CJ, Weiner M, Hui SL. (2000). Deaths due to medical errors are exaggerated in Institute of Medicine report. JAMA, 284, 93–5.
Miller, G. A. (1956). The Magic Number Seven, Plus or Minus Two: Some Limits on Our Capacity for Processing Information. Psychological Review, 81-97.
Oliver, Richard L.(1980). A Cognitive Model of the Antecedents and Consequences of Satisfaction Decisions. Journal of Marketing, 17, 460-469.
Paul Effler, Myra Ching-Lee, April bogard, Man-Cheng leong. (1999). Statewise system of electronic notifiable disease reporting from clinical laboratories: Comparing automated reporting with conventional methods. JAMA, 282(19), 1845-1850.
Parasuraman, A., Zeithaml, V. A., and Berry, L. L. (1988). Communication and Control Processes in the Delivery of Service Quality. Journal of Marketing, 52, 35-48.
Parasuraman A., Valarie A. Zeithaml, and Leonard L. Berry. (1996). The Behavioral Consequences of Service Quality. Journal of Marketing,.60, 31-46.
Rind DM, Safran C, Phillips RS. (1994). Effect of computer-based alerts on the treatment and outcomes of hospitalized patients. Arch Intern Med,154, 1511-7.
Shabot MM, Lobue M, Leyerle BJ, Dubin SB. (1990). Decision support alerts for clinical laboratory and blood gas data. Int J Clin Monit Comput, 7(1), 27-31.
Shea S, DuMouchel W, Bahamonde L. (1996). A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc,3, 399-409.
Sorin DI, David O, Julian Z.(2001). A Comprehensive Computerized Critical Laboratory Results Alerting System for Ambulatory and Hospitalized Patients. Medinfo, 469-473.
Tate KE, Gardner RM, Scherting K. (1995). Nurses, pagers, and patient-specific criteria: three keys to improved critical value reporting. Proc Annu Symp Comput Appl Med Care, 19, 164-8.
Tate KE, Gardner RM, Weaver LK. (1990). A computerized laboratory alerting system. MD Comput,7(5), 296-301.
Tate KE, Gardner RM. (1993). Computers, quality and the clinical laboratory: a look at critical value reporting. Ann Symp Comp Appi Med Care, 193-197.
Thomas C Bailey. (2000). Real-time notification of medication errors. Health management Techonology, 21(6), 24-25.

三、書本
盧瑞芬、謝啟瑞(2000)。醫療經濟學,220-221。學富文化事業。
吳明隆(2000)。SPSS 統計應用實務。松崗圖書股份有限公司。
吳明隆(2004)。SPSS 統計應用學習實務—問卷分析與應用統計。知城數位科技。
Ball MJ, Garets DE, Handler TJ. (2003). Leveraging IT to improve patient safety. Yearbook of Medical Informatics, 153-158.
Commission on Laboratory Accreditation. (2004) Inspection Checklist. Northfield, Ill: College of American Pathologists.
Institute of Medicine. (2001) Crossing the quality chasm: a new health system for the 21st century. Washington, D.C. National Academy Press.
Kohn LT, Corrigan JM, Donaldson MS, eds. (2000). To err is human: building a safer health system. Washington, D.C. National Academy Press.
Kotler, P. (1997). Marketing Management: Analysis, Planning, Implementation and Control,” 9th Edition, Prentice-Hall, Upper Saddle River, NJ.
Schroder, H. M, Driver M.J., and Streufert, S. (1967). Human Information Processing, Holt, Rinehart and Winston.
Shenk, D. (1997). Data smog: Surviving the information glut. Harper Collins Publishers, Inc.
Rabinovitch A. (2000)The College of American Pathologists (CAP) LaboratoryAccreditation Checklists. Northfield, III: College of American Pathologists.
Wurman, R. S.(1990). Information Anxiety. Bantam, Ind.
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