臺灣博碩士論文加值系統

背景: 過去醫院管理者引入資訊系統主要都運用於內部相關的營運面、作業面和管理面，其目的多以效率為考量，主要對象都是以員工為主。隨著”以病人中心”的理念的落實，和資訊科技的長足發展，使醫院管理者大量將資訊科技引入病人的照護，目的在於契合病人的需要及提升服務品質。
近年來，因為網際網路和智慧型手機的技術發達，更貼近病人的資訊科技產品更進一步深入照護領域，例如病人可以掛號和繳款免排隊的自動掛號繳款機(kiosk)、直接從手機或電腦就可以輕鬆掛號的網路掛號系統，與藉著網路連結雙向傳輸，使病人在家裡仍能夠將生理數據上傳醫院伺服器，醫院可以密切追蹤病人慢性疾病的控制，跨越時間和空間障礙的持續照護-「遠端照護(telecare)系統」，並獲致一些成果，但是應用在持續照護層面，仍面臨著民眾利用擴大與強化的難題。本研究的目的在於建構科技接受模式的結構式問卷，用以探討影響病人使用遠端照護裝置的因子。

方法: 本研究以Davis等於1989年依理性行為理論(TRA)為基礎，所發展的科技接受模型(TAM)為架構，來探討可能影響使用者對使用遠端照護系統之意向(intentions)的影響因子。問卷調查之結果運用統計軟體進行結構方程模式(SEM)的分析與研究。

結果: 本問卷調查研究的結果，除本研究所建構中文化醫療照護版的科技接受模式(TAM)的標準問卷與用語具有信度和效度外，發現知覺易用性、知覺有用性等內部因素和電腦自我效能、主觀規範等外部因素，可能直接或間接影響使用者的使用意向，且具統計上的顯著意義。

結論: 要能操作遠端照護系統需有其基本的電腦能力，一般而言，年齡、性別、教育程度等對電腦自我效能可能有不同程度的影響，內部因素如知覺易用性、知覺有用性則直接或間接影響病人的使用意向。未來若要進一步推廣遠端照護系統，必須降低病人使用的障礙，提升對病人健康照護的價值。

Background: The administrators of the hospitals used to apply information technology in the operational, financial and administrative aspects, and the main targets were internal customers. As the realization of the concept of patient- centered medicine and rapid progression of information technology in recent years, the administrators start to apply information technology more and more on the patient care. The main idea is to fit the demand of patients and improve the quality of care.
The prosperity of internet and smart mobile industry provide further penetration of patient- friendly information technology into the patient care. For example, the kiosk could reduce the waiting time of registration and billing; the internet registration system provides an easy and efficient way to make appointments with desired physicians than before; the telecare system enables the patients to upload physiological data to the server of the hospital, and the medical personnel could analyze the data and provide continuum of care beyond the boundary of time and distance. However, there are still a long way to achieve the wide application and successful implementation for the telecare system. The specific aim of this study is to find the influencing factors of utilizing telecare system.

Methods: Based on the technology acceptance model (TAM) proposed by Davis et al. and theory of reasoned action (TRA), we developed a structured model and questionnaire to measure the measureable and latent variables and constructs. The data analysis is performed by the statistic software based on the structural equation modeling (SEM).

Results: The reliability and validity of questionnaire and model are supported by the factor analysis. The results reveal the endogenous constructs such as perceived easy of use (PEOU) and perceived usefulness (POU), and the exogenous variables such as computer literacy and subjective norms influence the patient’s intention to use (ITU) the telecare system.

Conclusion: The telecare system requires the basic ability and passion of computer literacy which may be influenced by age, gender and education level. If we want to implement the telecare system successfully, to reduce the entering barrier and provide the health promotion are major issues.

口試委員會審定書..........................................i
謝辭…………………………iii
中英文摘要…………………………………………v
表目錄……………………………………………………………ix
圖目錄………………………………………………………………………...………xi
第一章 導論…………………………………………………………………………..1
第一節 實習單位特色與簡介……………………………………………………......1
第二節 文獻回顧………………………………………………………………...…...9
第三節 研究目的與研究問題………………………………………………………17
第二章 方法…………….…………………………………………………………...18
第一節 研究架構與假說……………………………………………………………18
第二節 研究設計……………………………………………………………………28
第三節 研究對象與分析分法………………………………………………………29
第四節 研究限制……………………………………………………………………43
第三章 結果…………………………………………………………………………44
第一節 問卷回收之結果……………………………………………………………44
第二節 問卷之信效度檢定…………………………………………………………46
第三節 病人對智能醫學照護系統之看法…………………………………………52
第四節 病人對智能醫學照護系統之使用意向及可能影響因素…………………65
第四章 討論…………………………………………………………………………84
第一節 結果討論……………………………………………………………………84
第二節 結論…………………………………………………………………………88
第三節 是否達成實習目的…………………………………………………………92
第四節 對於實務實習單位的建議與回饋…………………………………………93
第五節 相關政策上的意涵或政策建議……………………………………………94
參考文獻……………………………………………………………………………..95
中文部分………………………………………………………………………95
英文部分………………………………………………………………………97
附錄一: 本研究調查之問卷內容……………………………………………….…110
附錄二: 敏盛綜合醫院人體試驗委員會研究計畫通過函…………………….....115
附錄三 敏盛綜合醫院人體試驗委員會研究計畫變更通過函…………………..116

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