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研究生:陳柏達
研究生(外文):Po-Ta Chen
論文名稱:醫師採用電腦化臨床指引之關鍵因素:使用者接受觀點
論文名稱(外文):The Critical Factors Affecting the Intention of Using Computerized Clinical Practice Guidelines: Acceptance Aspects
指導教授:蕭如玲蕭如玲引用關係
指導教授(外文):Dr. Ju-Ling Hsiao
口試委員:蕭如玲黃興進陳瑞甫
口試委員(外文):Hsiao, Ju-LingHwang, Hsin-GinnChen, Rai-Fu
口試日期:2013-06-27
學位類別:碩士
校院名稱:嘉南藥理科技大學
系所名稱:醫務管理系
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:2013
畢業學年度:101
語文別:中文
論文頁數:97
中文關鍵詞:實證醫學臨床指引電腦化臨床指引活動理論
外文關鍵詞:Evidence-based medicineClinical practices guidelinesComputerized clinical practices guidelinesActivity Theory
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二十一世紀是知識經濟時代,國人對健康知識的重視,也讓一般民眾對於醫療照護之品質意識與日俱增,因此醫療機構與專業人員對提供良好之醫療服務品質,已成為當今醫療管理之重要議題。而如何因應環境的衝擊,以病人為中心的照護模式為考量,來提升醫療品質更成為醫療機構努力方向,其中若要提供完善的醫療照護與優良的醫療品質,必與走在時代尖端的醫學知識結合。而以實證醫學(Evidence-based medicine)為基礎的臨床指引(Clinical Practice Guideline, CPG),正與上述論點相符,而隨著醫療資訊之廣泛應用,透過資訊化之臨床指引所產生的臨床指引系統(Computerized Clinical Practice Guideline, CCPG)是相當多學者認為能有效達到前述目標的方法。
在醫療機構中,醫師是醫療團隊之主要領導者更是臨床指引系統主要使用者,因此若要成功採用臨床指引系統,必需了解其採用的關鍵因素,然而目前國內之臨床指引推展才剛起步,發展「以實證為基礎的電腦化臨床指引」並不容易,系統發展與採用需要配合使用者之臨床診療活動之需求與支持,然而過去研究大多是屬於系統建置面,對影響採用臨床指引系統之研究相對欠缺;因此為彌補此一領域相關研究之不足,並滿足醫療實務上的需求,本研究將以活動理論(Activity Theory)為研究之理論基礎,透過問卷調查法,針對已實施電腦化臨床指引之某區域醫院之臨床醫師進行資料蒐集。從使用者的角度來探討「醫師採用電腦化臨床指引的關鍵因素」。本研究共發放130份問卷,回收有效問卷75份,有效收回率57.7%。所蒐集資料採用Smart PLS 2.0 M3進行資料分析,資料分析方法包括:敘述性統計分析與部分最小平方法(Partial Least Square, PLS)分析,透過PLS 的方法,檢定研究之測量模型,以及研究構念所組成之結構模型,整體R2為0.728,對醫師採用電腦化臨床指引可達72.8%的預測力。其中臨床指引特性之完整性(γ=-0.201,p<0.05)、專業人員之態度(γ=0.257,p<0.05)、社群關係(γ=0.194,p<0.05)、組織資源(γ=0.384,p<0.001)達顯著的正向影響。由統計結果可知,臨床醫師採用電腦化臨床指引之關鍵因素包括:臨床指引完整性、專業人員之態度、組織之社群關係、組織資源提供。
透過了解醫師採用電腦化臨床指引之關鍵因素,建構改善臨床指引之應用性以滿足醫師需求,將有利於提升醫師採用電腦化臨床指引。同時可依此研究結果做為改進依據,使醫院能針對醫師需求,投入資源改善,進一步提升照護品質,落實病人安全。

The twenty-first century is an epoch of knowledge economy. People pay more and more attention to health knowledge, and their consciousness of the quality of medical care is ever increasing. Therefore, it has become an important issue in healthcare management for medical institutions and professionals to provide high-quality medical service. To respond to the impact from the environment and to improve the quality of medical care based on the patient-oriented care has become a direction for the efforts of medical institutions. For the purpose of providing perfect medical care and high quality of medical service, up-to-date medical knowledge must be applied. The clinical practice guideline supported by evidence-based medicine conforms to the aforesaid argument. With the wide application of medical information, several studies have argued that Computerized Clinical Practice Guideline (CCPG) is a method that can effectively realize the aforesaid goal.
In a medical institution, physicians are the major leader of medical teams and the main users of CCPG. Therefore, to apply the system successfully we must understand the key factors influencing its application. However, the use of clinical practice guideline is just in the primary stage in Taiwan, and so it is not easy to develop evidence-based CCPG and the development and employment of such system requires users’ requirements and support in clinical diagnosis and treatment. Most preceding studies focus on the building of system, but neglect the factors influencing its application. To make up for the shortage in this field and satisfy the demand in medical practice, this study employs activity theory as the theoretical foundation for research, collects data through questionnaire survey from physicians in case hospital in a certain area where CCPG have been applied, and discusses from the user’s perspective the key factors influencing physicians applying CCPG. A total of 130 questionnaires were sent out, with 75 completed copies returned, indicating a valid response rate of 57.7%. We used Smart PLS 2.0 M3 to analyze the data. The PLS method is used to test the measurement model and the structure model composed of research concepts. The overall R2 is 0.728, showing a predictability of 72.8% on physicians’ applying computerized clinical practice guideline. The completeness of CCPG (γ=0.201,p<0.05), the attitude of professionals (γ=0.257,p<0.05), community relationship (γ=0.194,p<0.05) and organizational resource (γ=0.384,p<0.001) have significant impact on the acceptance of the CCPG. From the statistic results finds that the key factors influencing doctors’ acceptance of CCPG include: the completeness of guideline, attitude of professionals, community relationship, and organizational resource.
Through understanding the key factors influencing physicians’ acceptance of CCPG, we can improve its characteristics to satisfy physicians’ demands and help increase physicians’ use of CCPG. Meanwhile, the research result may be regarded as a reference for improvement and stimulate hospitals to input resources according to users requirements and further improve care quality to protect patients’ safety.

摘 要 III
Abstract V
誌謝 VII
表目錄 X
圖目錄 XI
第一章 緒論 1
1.1 研究背景與動機 1
1.1.1研究背景 1
1.1.2研究動機 2
1.2 研究目的與問題 3
1.2.1研究目的 3
1.2.2研究問題 4
1.3 研究步驟與流程 5
第二章 文獻探討 6
2.1 臨床指引 6
2.1.1臨床指引定義 6
2.2 電腦化臨床指引 12
2.2.1電腦化臨床引定義: 12
2.2.2電腦化臨床指引研究 12
2.2.3電腦化臨床指引與臨床診療照護活動之相關性 17
2.3 活動理論 17
2.3.1活動理論源起與應用 18
2.3.2活動理論基本分析單位 19
2.3.3目的導向: 19
2.3.4活動的基本架構: 20
2.3.5活動的階層結構 22
2.4 影響電腦化臨床指引採用關鍵因素相關研究 24
2.4.1影響電腦化臨床指引採用關鍵因素 24
第三章 研究方法 29
3.1 研究架構 29
3.2 研究假說 31
3.3 問卷設計 36
3.4 研究對象及研究工具 40
3.5 資料分析方法 40
第四章 資料分析結果 42
4.1 資料分析 42
4.2 問卷回收狀況與基本資料變異數分析 43
4.2.1問卷回收狀況: 43
4.2.2基本資料變異數分析 44
4.3 衡量模式分析 47
4.4 結構模式分析 52
第五章 討論與建議 55
5.1 討論 55
5.2 研究貢獻 62
5.2.1在學術研究方面 62
5.2.2在實務貢獻方面 63
5.3 研究限制 63
5.4 未來研究 64
第六章 結論 65
附錄一:大腸癌治療指引 75
附錄二:研究問卷 79

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