臺灣博碩士論文加值系統

實證醫學是一種有系統的資料搜尋、評估與使用，透過網際網路與電子資料庫的運用，醫師們可以快速的獲得大量的醫療資訊，並將其應用在日常診療工作中。
本研究主要在探討所在實證醫學在台灣的區域級醫院導入狀況的研究，探討預期成效，接受度及導入策略之關鍵成功因素。由於各區域級醫院均為近8年內開始導入實證醫學，且各醫院實證醫學實施之普及度均不同，因此本研究之探討內容上，包括：區域醫院實證醫學責任單位之組織架構，各醫院實證醫學導入及推廣之現況，辨識針對各院實施實證醫學之障礙，提出未來實施實證醫學之策略。
本研究以質化研究方式，深入訪談四家北部區域級教學醫院，主要研究目的在探討各不同性質區域醫院對於實證醫學之導入動機、導入過程及導入成效，藉此找出其關鍵成功因素，以供決策者制定導入及持續應用之策略。研究過程對為各區域級醫院實證醫學單位負責人進行深入訪談，驗證出之導入關鍵成功因素對實證醫學實施成功因素，經由分析後，歸納出下列研究結論：個案醫院認為導入實證醫學之關鍵成功要素為個人與組織對於實證醫學學習的動機。其他相關內外環境機制與此因素互動以持續產生動能運作實證臨床環境，達成最佳健康照護結果並兼顧品質與成本優勢。導入實證醫學的成效則在於醫療品質之提升顯著，而對於成本控制的效應較難評估。最後依研究結果歸納出本研究之發現及區域等級醫院導入實證醫學的成功模式。
本研究並提出具體建議供各區域醫院持續改善實證醫學實行之參考。由於受限於研究時的受訪樣本數，此差異仍有賴於後續研究證明。

The major issue of this study is the identification of critical success factors for implementation and the integration of evidence-based medicine to typical regional hospitals in TAIWAN. The idea of the Evidence Based Medicine (EBM) is changing the traditional clinical practice paradigm. Medical professionals improve their knowledge and skills by applying EBM to their researches and practices， which promote the clinical decision and the quality of health service。
This research discusses the study of implementation of EBM to four midsized regional hospital in Taiwan. The clinicians in these four different hospitals awared of the importance of evidence-based medicine and related guidelines. However, the leaders in charge of EBM are frustrated by implementational processes that are enormously time comsuming, skill and resource intensive. Through qualitative research with extensive investigation and discussion to those team leaders; the most important critical success factors were identified. Among these factors, motivation of learner and learning groups stands the first place. According to above conclusion, developing strategy of EBM in regional hospitals of Taiwan was revealed.

目錄
誌謝 1
摘要 2
Abstract 3
目錄 4
圖目錄 8
表目錄 9
第一章 緒論 10
第一節 研究背景 10
1.1.1實證醫學的發展 11
1.1.2實施實證醫學的目的 12
1.1.3推行實證醫學的成效 13
第二節 研究動機 14
第三節 研究目的 15
第四節 研究範圍與流程 16
第五節 論文架構 18
第二章 相關文獻探討 19
第一節 實證醫學導入概況 19
2.1.1實證醫學的定義 19
2.1.2臨床實施實證醫學 23
2.1.3實證醫學與管理 25
2.1.4實證醫學在台灣的發展 26
2.1.5區域醫院導入實證醫學現況 27
2.1.6實證醫學對醫療品質的影響 28
2.1.7臨床指引的概念 29
第二節 實證醫學之運作背景 31
2.2.1實證醫學的實施要素 31
2.2.2醫學的知識轉譯 36
2.2.3資訊科技的實證應用 38
2.2.4實證醫學的資源與運作機制 39
2.2.5實證競賽性與團隊學習 40
2.2.6實證醫學環境設置 41
2.2.7跨專業實證醫學運作機制 43
第三節 導入新知識科技之相關理論 43
2.3.1實證醫學與組織變革 44
2.3.2變革策略與實證醫學整合 45
2.3.3醫療成本的控制與經濟分析 48
2.3.4關鍵成功因素 48
2.3.5創新擴散 52
2.3.6文獻總結 54
第三章 研究架構與方法 55
第一節 研究架構 55
3.1.1研究範圍與變數說明 56
3.1.2研究架構圖說 57
第二節 研究命題 59
第三節 分析方法 60
3.3.1研究設計 61
3.3.2個案深度訪談法 63
3.3.3簡單敘述統計法 63
第四章 研究結果與分析 64
第一節 各醫院訪談分析 64
4.1.1個案醫院簡介 64
4.1.2個案醫院綜合分析 66
4.1.3個案醫院實證醫學傳遞過程分析 67
4.1.4依訪談內容分析各構面之命題 68
第二節 實證醫學實施之關鍵成功因素 76
4.2.1實證醫學導入的理想狀態 77
4.2.2實證醫學組織結構 78
4.2.3實證醫學資源投入程度 78
4.2.4實證醫學教學 79
4.2.5實證醫學導入之關鍵成功因素 81
第三節 實證醫學之導入策略 83
4.3.1醫療工作者的態度與文化 83
4.3.1組織結構調適策略 84
4.3.2資源配置策略分析 85
第五章 研究結論與建議 86
第一節 結論與建議 86
5.1.1研究分析與結論 86
5.1.2 管理意涵 87
5.1.3面對外在環境的實證醫學因應策略 88
5.1.4 區域醫院導入實證醫學的創新方式 89
5.1.5 區域等級醫院導入實證醫學的成功模式 89
第二節 研究貢獻 90
第三節 研究限制 91
第四節 後續研究建議 91
參考文獻 93
英文文獻 93
【附錄一】訪談問卷表 99
【附錄二】訪談內容 102
個案醫院A 102
個案醫院B 108
個案醫院C 114
個案醫院D 119

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