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研究生:黃筱芸
研究生(外文):Hsiao-yun Huang
論文名稱:應用決策樹於民眾參與家庭醫師照護制度之可能因素研究
論文名稱(外文):An Application of Decision Tree to Investigate Affecting Factors of Patients'' Participation in the Family Physician Program
指導教授:陳咻�林為森林為森引用關係
指導教授(外文):Yu-cheng ChenWeir-sen Lin
學位類別:碩士
校院名稱:嘉南藥理科技大學
系所名稱:醫療資訊管理研究所
學門:教育學門
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:85
中文關鍵詞:決策樹家庭醫師制度
外文關鍵詞:family physician systemdecision tree
相關次數:
  • 被引用被引用:10
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  • 下載下載:139
  • 收藏至我的研究室書目清單書目收藏:0
中央健保局於92年開始推行「家庭醫師整合性照護制度」試辦計畫,其主要弁酮偌ㄗ悒螻釧P全性、協調性與持續性的初級醫療與預防保健服務,並以民眾健康為導向,建立以病人為中心的醫療觀念,提升醫療服務品質。不過,由於民眾長久養成的就醫習慣以及對基層診所看病的疑慮與不信任,使得家庭醫師制度的參與一直到現在都還不普及。為了找出影響民眾參與家醫計劃的重要因素,本研究利用94年「南區區域家庭醫師整合照護計劃管理及探討」之病人問卷調查資料,以資料探勘技術之決策樹演算法進行分析,找出影響民眾參與家庭醫師整合照護制度之行為規則模式。研究結果發現:是否知道家庭醫師整合試辦計劃、教育程度、知道計劃的消息來源等因素,為造成影響民眾參與計劃的重要因素;知道家庭醫師試辦計劃之民眾和得知該計劃是透過診所醫師的民眾,較易加入家醫會員。教育程度為初中以上之民眾和透過傳播媒體(報紙、雜誌、電視、廣播)得知計劃的民眾,較不會加入家醫會員。建議應促進醫病雙方互信的關係,使民眾與基層醫師產生相互依賴與信任,加強家庭醫師制度方面的教育宣導,使其瞭解實施家庭醫師制度的重要性,才能有效導正病人的就醫行為。
The trial plan of family physician integrated care system has implemented by Bureau of National Health Insurance in 2003. Purposes of this plan are providing comprehensive, coherent and continuing primary health care and preventive services, and to establish a patient-orientated concept to enhance service quality of health care. The participative rate is low because of patients’ medical seeking behaviors and patients’ doubt and distrust in the primary health care.
In order to find out the significant factors which influence patients’ participation in this plan, this research used decision tree of data miming techniques to develop a behavior model by analyzing a database on patient''s questionnaire survey of southern district regional family physician planned management in 2005. Results of study found, that whether knowing the family physician integration trial plan or not, education, and information sources are important factors to influence people participating in this plan. Members participated in the family physician intergraded trial plan knew this program well and got the information from primary physicians. Subjects educated above junior high school and got the plan information from mass media would not join to be members. Results suggested the relationship between physicians and patients should be promoted to build patients faith in primary care physicians, education of the family physicians’ system should be emphasized to improve patients’ understanding of importance of the family physician to guide patients’ medical behavior effectively.
中文摘要------------------------------------------------------------------Ⅰ
英文摘要------------------------------------------------------------------Ⅱ
目錄----------------------------------------------------------------------Ⅲ
圖目錄--------------------------------------------------------------------Ⅵ
表目錄--------------------------------------------------------------------Ⅶ

第壹章 緖論--------------------1
第一節 研究背景--------------------1
第二節 研究動機--------------------3
第三節 研究目的--------------------4
第二章 文獻探討--------------------5
第一節 我國健康照護體系發展--------------------5
第二節 家庭醫師角色--------------------12
第三節 整合性照護系統與家庭醫師的運用--------------------15
第四節 民眾就醫選擇之探討-------------------- 25
第五節 決策樹之應用--------------------31
第三章 研究方法--------------------37
第一節 研究架構--------------------37
第二節 研究流程--------------------38
第三節 研究問題--------------------40
第四節 資料收集與變項--------------------40
第五節 研究分析方法與工具--------------------42
第四章 研究結果--------------------44
第一節 民眾特質之描述性分析--------------------44
第二節 量表之因素分析--------------------54
第三節 參與及未參與計畫之求診民眾差異性分析--------------------58
第四節 民眾參與家庭醫師制度之邏輯斯迴歸分析--------------------60
第五節 民眾參與家庭醫師制度之決策樹分析--------------------63
第六節 邏輯斯迴歸與決策樹建立之預測模式比較--------------------69
第五章 討論與建議--------------------71
第一節 民眾特質分析--------------------71
第二節 民眾參與家庭醫師制度之因素--------------------75
第三節 研究限制--------------------78
第四節 建議--------------------79
參考文獻--------------------80

圖目錄
圖2-1 台灣各醫院之家庭醫學科87-94年之總診數--------------------10
圖2-2 計劃基本架構--------------------21
圖2-3 計劃費用支付方式--------------------23
圖2-4 綜合健康行為模式--------------------26
圖3-1 本研究架構圖--------------------37
圖4-1 停止條件--------------------64
圖4-2 CART決策樹--------------------68

表目錄
表2-1 歷年醫療健保支出統計--------------------7
表2-2 87-94年家庭醫學師之增加數比較表、變化率-------------------- 11
表2-3 顧客選擇醫院主要考慮因素之國內外文獻整理--------------------29
表2-4 國內外決策樹應用於醫療領域上之相關研究文獻--------------------35
表4-1 受訪者之基本資料--------------------45
表4-2 受訪者之健康情況--------------------46
表4-3 受訪者之就診行為--------------------47
表4-4 受訪者對家庭醫師整合試計劃的瞭解--------------------50
表4-5 受訪者對家庭醫師的認知--------------------50
表4-6 受訪者對家庭醫師的態度--------------------51
表4-7 受訪者對家庭醫師整合照護計畫提供之健康照護期�--------------------52
表4-8 就診民眾滿意度--------------------53
表4-9 對診所醫師期望服務因素分析--------------------56
表4-10 診所服務滿意因素分析--------------------57
表4-11 受訪者對各因素構面分析表--------------------59
表4-12 民眾參與家庭醫師制度之邏輯斯迴歸分析--------------------62
表4-13 邏輯斯迴歸與決策樹之預測比率------------------- 69
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