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    Title: 醫師對影響醫療檢驗資源有效使用因素之看法-以桃園縣執業醫師為例
    A study of influencing factors related to efficient use of medical exanimation resources: the perspective of certified medical doctors in Taoyuan County, Taiwan
    Authors: 劉麗文
    Contributors: 陳敦源
    劉麗文
    Keywords: 全民健保
    醫療檢驗
    醫療資源
    適當醫療服務
    National Health Insurance
    Medical Examination
    Medical Resources
    Appropriate Health Care.
    Date: 2008
    Issue Date: 2009-09-19 13:53:54 (UTC+8)
    Abstract: 研究動機與問題:本研究最主要的目的希望能夠將最易被大家忽略的健保醫療檢驗資源使用問題,從實務面上探討,並指認出有效使用醫療檢驗資源的關鍵因素,針對這些因素與措施進行評估,歸納出具體明確可行的方向,提供主管機關做為費用管控的參考,為我國健保永續經營貢獻一份力量。
    本研究根據研究動機與目的,設定三個研究問題:1.影響醫師有效的使用醫療檢驗資源的因素有哪些?2.藉由桃園縣執業醫師的看法了解有效使用醫療檢驗資源關鍵因素為何?3.不同執業院所、服務科別、職別的醫師對有效的使用醫療檢驗資源看法是否有差異?
    研究資料與方法:以文獻回顧法、問卷調查法、深度訪談法蒐集資料及驗證資料;研究過程分三個階段進行,第一階段為背景資料與文獻資料的蒐集,瞭解醫療檢驗資源使用現況與問題,並透過訪談實務界菁英驗證文獻與補充資料不足;第二階段依文獻分析與彙整內容設計問卷與訪談大綱;第三階段將回收的問卷編碼、整理後以Excel/2003版與SPSS for window12.0版套裝軟體進行資料分析;深度訪談資料透過內容分析法予以歸納整理分析。獲得研究答案,達成研究目的。
    研究結果與建議:量化研究部分,本研究共分送488份問卷,回收318份,回收率為65.1%。並以卡方檢定樣本與母群體並無差異,可代表母群體。質化研究部分,深度訪談三位年資10年以上實務界菁英,建構本研究實務上的概念。歸納研究結果:醫療檢驗資源有效使用的關鍵影響因素有「醫療風險」、「病人就醫行為」與「照護之連續性」3項。根據研究結果,為有效使用醫療檢驗資源,必需減少醫療風險、規範病人就醫行為與進行照護流程改造。
    Background:The purpose of this research is to find out the influencing factors related to the usage of resources for medical examinations under the Taiwanese National Health Insurance (NHI). From the practical point of view, this research focuses on, the first, defining the efficient use of medical test and then finding out the critical factors effecting the efficient usage from medial practitioners’ viewpoints in Taoyuan County, Taiwan. It is expected to provide advisory values to improve the global budget system of NHI.
    Research Questions:
    1.What are the factors influencing doctors to utilize medical examination efficiently?
    2.What are the certified medical doctors of Taoyuan County thinking about these factors?
    3.Concerning the above factors, do there exist systematic differences among medical doctors from different hospitals, rank of medical doctors and fields of profession?
    Methods: In this study, author utilizes literature review, questionnaires, and in-depth interview. The survey was divided into three stages. First, related information was collected to clarify the problems of medical examination usage in present situation from both interviewing medical practitioners and literature review. In the 2nd stage, a general questionnaire was designed to administrate to selected medical doctors in Taoyuan County in mid-2008. The last stage was data coding and analyzing by using Excel/2003 and SPSS for Windows. The return rate was 65% (318/488) and there is no difference between population and sample after consistency test.
    Results and Suggestions The results show that the key factors of efficient medical examination usage are medical risk-aversion of doctors, clinical shopping of patients, and the need to medical care continuity. These exist a greater viewpoint differences between different level of hospital than different ranks or specialties of doctors. These results will lead the author to suggest that the Bureau of NHI needs to promote adequate mediation mechanism to reduce medical risk, to promote inter-hospital patient information sharing system, and to improve the logistic of continuity care.
    Reference: 中文部份
    王文科(1995)。教育研究法。台北:五南圖書出版公司。
    王石番,(1991)。傳播內容分析法:理論與實踐。台北:幼獅。
    江琇琴(2000)。論病例計酬醫師績效模式之建立及其在臨床路徑變異控制之應用。台北醫學院醫學研究所碩士學位論文,未出版,台北。
    何清松(2003)。知識經濟時代醫療資訊系統之整合與規劃-利用e化資訊系統節制不必要的醫療浪費。臺中健康暨管理學院。
    林恆慶、趙儷靜(2002)。整合性健康照護系統。臺灣公共衛生雜誌,第21卷1期,頁1-8。
    林震岩(2007)。多變量分析:SPSS的操作與應用。台北:智勝。
    吳就君(1983)。從醫護人員工作行為分析看醫院病人衛生教育實況。公共衛生,第10卷第2期,頁14-136。
    吳孟芬(1997)。服務情境中之溝通問題分析:以醫療服務為例。國立中正大學企業管理研究所碩士論文,未出版,嘉義。
    紀駿輝(2001)。一分錢一分貨?永續性的醫療品質提升措施。健保局演講稿。
    陳端容、鍾國彪、吳麗竹、曾靜瑤、張金堅(2006)。同儕資訊回饋與內科醫師開立TG檢驗次數之關係:一個探索性研究。臺灣公共衛生雜誌,第25卷第1期,頁26-36。
    陳琇玲、溫信財、揚志良、黃文駿、黃意婷、徐慧娟(2002)。健保支付標準與醫師執業耗用資源對牙科服務量之影響。中華公共衛生雜誌,第25卷第1期,頁17-26。
    張鈺、張菊惠、胡幼慧(1997)某醫學中心子宮切除婦女自述醫病溝通之探討。臺灣公共衛生雜誌,第16卷第1期,頁1-12。
    黃秀雅(2000)。醫病溝通中第三者角色、影響與因應分析。國立中正大學企業管理研究所碩士論文,未出版,嘉義。
    喻小珠、趙坤郁、黃凱琳、王世叡、張玉君、黃靜宜、賴叔芬、莊惠真、黃昭聲(2002),同儕比較回饋對醫師開立檢驗行為的影響,四個月的觀察。臺灣公共衛生雜誌,第21卷第2期,頁107-114。
    楊國樞等(1989),社會及行為科學研究法。台北:東華書局社。
    葉君宇(2003),總額支付制度下同儕制約不當運用對牙醫師行為模式影響之探討。高雄醫學大學口腔衛生科學研究所碩士論文,未出版,高雄。
    鄭麗寶(1990),醫療過程中人際互動的社會學分析。台灣大學社會學研究所碩士論文,未出版,台北。
    盧瑞芬、謝啟瑞(2000),醫療經濟學。台北:學富文化。
    鍾國彪(1988),公保門診醫師與病人互動之研究。陽明大學公共衛生研究所碩士論文,未出版,台北。
    報紙
    郭正典(2002年11月8日)。「為何有醫師濫用健保資源?」。自由時報。
    英文部份
    Ament,A.(1989).Optimaal gebruik van diagnostische tests.Maastricht:Thesis.
    Annemiek MA Bugter-Maessen,Ron AG Winkens, Richard PTMGrol,J Andre Knottnerus,Arnold DM Kester,George HMI Beusmans and Peter Pop.(1996).Factors predicting differences among general practitioners in test ordering behaviour and in the response to feedback on test requests.Family Practice Oxford University Press, Vol.13,No.3,Pp.254-258.
    Balas EA, Boren SA, Brown GD, Ewigman BG, Mitchell JA, Perkoff GT.(1996).Effect of physician profiling on utilization. Meta-analysis of randomized clinical trials.J Gen Intern Med.11:584–590.
    Beck JR.(1993).Does feedback reduce inappropriate test ordering?.Arch Pathol Lab Med,117:33–34.
    Carl van Walraven, MD, MSc, FRCPC; C. David Naylor, MD, DPhil, FRCPC.(1998).Do We Know What Inappropriate Laboratory Utilization Is?:A Systematic Review of Laboratory Clinical Audits.JAMA,.280:550-558.
    Coyte,P.C.(1993).Providers,Perceptions,Geographic Variation,and the Cost-Effective Provision of Health Care Service in Blomqvist and Brown(eds.),Limits to Care:Reforming. Canada,s Health System in an Age of Restraint. Toronto:CD.Howe Institute.
    Eisenberg JM, Nicklin D.(1981).Use of diagnostic services by general
    practitioners in community practice. Med Care;19:297-309.
    Epstein AM, Begg CB, McNeill BJ.(1984). The effects of physicians`training and personality on test ordering for ambulatory patients. AmJ Publ Health;74:1271-1273.
    Epstein AM,McNeil BJ.(1986).Relationship of beliefs and behavior in test ordering.Am J Med;80:865.
    Epstein AM, McNeil! BJ.(1985). Physician characteristics and organizational factors influencing use of ambulatory tests.Med Decision Making; 5: 401-414.
    Fuch,V.R.(1986).The Health Economics.Cambridge:Harvard University Press.
    Feldstein,P.J.(1988).Health Care Economics.(3rd ed.).New York,NY:John Wiley and Sons Inc..
    Griner PF,Liptzin B.(1971).Use of laboratory in a teaching hospital:implications for patient care,education,and hospital costs.Ann Intern Med.;75:157-163.
    Grol R, Whitfield M, de Maeseneer J, Mokkink H.(1990). Attitudes to risk taking in medical decision malring among British,Dutch and Belgian general practitioners. Br J Gen Pract;40: 134-136.
    Hirsch EO.(1974).Utilization review as a means of continuing education.Med Care;12:358.
    Hughes RA,Gertman PM,Anderson JJ,et al.(1984). The ancillary services review program in Massachusetts:experience of the 1982 pilot project.JAMA.;252:1727.
    Jaggers,L.D.(1996).Differentiation of Critical Pathways From Other Health Care Management Tools.American Journal of Health-System Pharmacy,53(3):311-313.
    James Studnicki,ScD;Douglas D.Bradham,DrPH;Jan Marshburn,MPH MT(ASCP);Philip R.Foulis,MD,PhD(1993).A Feedback System for Reducing Excessive Laboratory Tests. Archpathol Lab Med, Vol.251,January;35-39.
    Jane S.Spiegel,MD,MSPH;Martin F.Shapiro,MD,PhD;Barbara Berman,PhD;Sheldon Greenfield,MD(1989).Changing Physician Test Ordering in a University Hospital-An Intervention of Physician Participation,Explicit Criteria,and Feedback.Arch Intern Med, Vol.149,March.;549-553.
    Karl E,Weick(1976).Educational Organizations as Loosely Coupled Systems, Administrative Science Quarterly,21,1:19
    Kleinman,A.(1980).Patient and Healers in the Context of Culture.Berkeley:University of California press.
    Lundberg GD.(1983).Perseveration of laboratory test ordering:a syndrome affecting clinicians.JAMA.;249:639.
    Martin AR,Wolf MA,Thibodeau LA,et al.(1980).Atrial of two strategies to modify the test-ordering beof medical residents.N Engl J Med;303:1330.
    Michell JM,Hadley J,Gaskin DJ.(2000).Physicians’Responses to Medicare Fee Schedule Reduction.Med Care;38:1029-1039.
    McConnell TS,Berger PR,Dayton HH,et al.(1982).Professional review of laboratory utilization.Hum Pathol;13:403.
    Omstein SM, Markert GP, Johnson AH, Rust PF, Afrin LB.(1988).The effect of physician personality on laboratory test ordering for hypertensive patients.Med Care;26:536-543.
    Peter S. Bunting,Carl van Walraven(2004).Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians Clinical Chemistry.;50:321-326.
    Petra Axt-Adam,MD,Johannes C.Van Der Wouden,MA, and Emiel Van Der Does,MD,PHD(1993).influencing behavior of physicians ordering Laboratory Test:A Literature Study Medical Care,Vol.31,No.9,784-794.
    Pop P, Winkens RA.(1989).A diagnostic centre for general practitioners:results of individual feedback on diagnostic actions.J R Coll Gen Pract;39:507–8.
    ReidMC,LachsMS,FeinsteinAR.(1995).Use of methodological standards in diagnostic test research:getting better but still not good. JAMA.;274:645-651.
    Ron Winkens,Geert­Jan Dinant(2002).Evidence base of diagnostic research Rational,cost effective use of investigations in clinical practice.BMJ;324.7340.783.
    Schifman RB.(1989).Comprehensive and concurrent surveillance of test utilization.Am J Clin Pathol.;92:539.Abstract.
    Schroeder SA,Kenders K,Cooper JK.(1973).Use of laboratory tests and pharmaceuticals:Variation among physicians and effect of cost audit on subsequent use.JAMA;225:969.
    Shortell,S.M.et al.(1996).Remarking Health Care:Creating Organized Delivery Systems.Health Affairs,13(5):46-64.
    Spiegel JS, Shapiro MF, Berman B, Greenfield S.(1989). Changing physician test ordering in a university hospital. An intervention of physician participation, explicit criteria, and feedback. Arch Intern Med;149:549–53.
    Stenven L.,PHD,Arthur F.Bickford,MD,Herbert O.Mathewson,MD,Karin Dumbaugh,scd,and Peter C.Tirrell,BS(1988).A Successful Experiment to Unnecessary Laboratory Use in a Community Hospital.Medical Care June,Vol.26,No.6.Pp.631-641.
    Terry W.Crowson,MD,Eugene C.Rich,MD,Bert F.Woolfrey,MD,Phd,Donald P.Connely,MD,phd(1984).Overutilization of Cultures of CSF for Mycobacteria.JAMA,Jan 6,Vol.251,No.1.Pp.70-72.
    Tydeman JT,Morrison JL,Cassidy PA,Hardwick DF.(1983).Analyzing the factors contributing to rising laboratory codts.Arch Pathol Lab Med.;107:7-12.
    Ulrich Ronellenfitsch,Eric Rössner,Jens Jakob,Stefan Post,Peter Hohenberger,Matthias Schwarzbach.(2008).Clinical Pathways in surgery—should we introduce them into clinical routine? A review article. Langenbecks Arch Surg;393:449–457
    VHA.Integration(1994).Market Forces and Critical Success Factors-An Executive Report for VHA Health Care Organization.
    Wachtel TJ,O,Sullivan P.(1990).Practice guidelines to reduce testing in hospital.Gen Inter Med.;5:335-341.
    Wennerberg,J.E.,Barnes B.A.(1982).Proessional uncertainty and the problem of supplier-induced demand.Social science&Medicine,16(7),811-824
    Winickoff RN, Coltin KL, Morgan MM, Buxbaum RC, Barnett GO.(1984). Improving physician performance through peer comparison feedback. Med Care;22:527–34.
    Winkens RA, Pop P, Grol RP, Kester AD, Knottnerus JA.(1992).Effect of feedback on test-ordering behaviour of general practitioners. BMJ;304:1093–6.
    Winkens RA, Pop P, Bugter-Maessen AM, Grol RP, Kester AD,Beusmands GH, et al.(1995). Randomized controlled trial of routine individual feedback to improve rationality and reduce numbers of test requests. Lancet;345:498–502.
    Zaat JOM,van Eijck JThM.(1992). General practitioners` uncertainty,risk preference and use of laboratory tests. Med Care;30: 846-854.
    Description: 碩士
    國立政治大學
    行政管理碩士學程
    95921067
    97
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0095921067
    Data Type: thesis
    Appears in Collections:[行政管理碩士學程(MEPA)] 學位論文

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