臨床醫師採用「電腦化臨床指引」不但能降低醫療照護成本，也能提升醫療品質；而透過此臨床決策支援系統的使用，對於醫院之照護品質與經營可帶來顯著的效益。本計畫為兩年計畫，分別從正向(採用)及反向影響因素(抗拒)的角度，來探討醫師採用與抗拒電腦化臨床指引意圖的影響因素。第一年以活動理論為基礎，從正面來探討影響醫師使用之關鍵因素；第二年則以使用者抗拒理論為基礎，從反面來探討影響醫師抗拒使用電腦化臨床指引意圖。兩年之研究流程均以文獻探討與理論為基礎，建立初始之研究架構、假說與問卷後，再經專家會議修訂與先導研究確認問卷。採用調查法蒐集資料，對象為國內教學醫院已設置實證醫學中心及台灣實證醫學會之醫師。採用結構方程式進行資料分析，提出醫師採用與抗拒電腦化臨床指引意圖之關鍵因素。針對前述每年之結果，將進行後續數家醫院深度訪談，以提高研究成果之效度。最後，本研究將整合第一年與第二年不同面向之結果，提出整合性之研究模式，再依據此模式至醫院訪談以驗證本研究之發現及管理意涵，來針對醫院、衛生主管機構及後續研究提出相關建議。 The purpose of this project is to investigate the factors affecting the intention of physicians to use computerized clinical practice guidelines (CCPG). This study will be divided into two stages and one year for each stage. The first stage is based on the Activity Theory (from the positive aspect) to identify the critical factors affecting the intention of physician to accept CCPG. The second stage, however, is based on the Resistance Theory (from the negative aspect) to identify the critical factors affecting the intention of physicians to resist using CCPG. First of all, based on literature review and expert panel sessions, an initial research framework, hypotheses, and related questionnaire will be proposed. Then, a pilot study will be conducted to ensure the above framework, hypotheses, and questionnaire meet required conditions for this study. The survey methodology will be utilized and subjects are physicians of teaching hospitals with evidence-based medicine centers and members of the Taiwan Evidence-based Medicine Association. Factor Analysis and Structural Equation Modeling (SEM) techniques will be utilized to analyze the collected data. Following up case studies will be conducted to validate the results of this study. Finally, an integrated model of affecting the intention of physicians to use CCPG will be presented. In addition, managerial implications of the results of this study will be also discussed in details.
