會診諮詢資訊系統實施成效分析－－以中部不同屬性醫學中心為例

Performance Analysis of Consultation Information Systems Employed in Medical Centers in Central Taiwan

目的：為了解台灣偏遠社區老年婦女骨質疏鬆症盛行率及其相關危險因子。方法：本研究於2009年7月，針對高雄縣田寮鄉65歲以上婦女進行隨機抽樣。每位受訪者均接受專門訓練之固定人員以結構式問卷作面對面訪談，及身高、體重、兩臂伸展距離等理學檢查；並由行動骨質密度檢測車做腰椎及髖骨之骨質密度檢查。骨質疏鬆症的診斷則依據世界衛生組織於1994年所訂之標準，包括低能量骨折病史。共取得有效樣本368位，完成率為75.9%。結果：在368位65歲以上之受訪者中，平均年齡為74.3±6.0歲，骨質疏鬆症之盛行率為60.6%，經年齡調整後盛行率為60.4%。在單變項分析中，年齡、身體質量指數、兩臂伸展距離、及喝茶習慣為罹患骨質疏鬆症相關之危險因子。經邏輯複迴歸分析後顯示，身體質量指數、兩臂伸展距離、喝茶習慣為獨立負相關危險因子，而年齡為骨質疏鬆症之獨立正相關危險因子。結論：本研究顯示，田寮鄉老年婦女骨質疏鬆症之盛行率較之前文獻為高。年齡較老、兩臂伸展距離較小、身體質量指數較低、無喝茶習慣，為罹患骨質疏鬆症之獨立危險因子。

Background: A consultation system is one of the mechanisms that provide better medical services in hospitals. Through this system, the physician can obtain proper and timely information in order to improve the quality of patient management. This study analyzed the relationship between performance and factors affecting the consultation information systems, and compared the different consultation information systems in various hospitals. Method: Users of the consultation system, including physicians, computer technicians and nursing staff in three hospitals in central Taiwan (one public, one private and one incorporated hospital) were surveyed with a structured questionnaire after stratified sampling. System quality, user satisfaction, impact on individuals and impact on hospitals were investigated. Results: The results indicated that all three hospitals were large enough to develop their own computerized consultation systems. There were significant differences in the quality of the consultation systems, user satisfaction, and their effect on users and on hospitals. The time period of use of the computerized system in various hospitals was related to the software system that they used. The public hospital that first implemented the consultation system used a less friendly DOS. This resulted in less satisfaction when compared to the private hospital that used Windows as the system environment. The incorporated hospital had the worst satisfaction level due to the short implementation period while users were still learning and adjusting to the new system. Significant differences between hospitals in factors affecting the performance of the systems were observed in users' understanding of the computers, the development of the computerized system, the training in using the consultation system, and the timing of the hospital in developing the consultation system. Individuals with higher education or in management positions had better levels of satisfaction with the system. Conclusions: The system environment affects performance and user satisfaction. A communication channel that allows users to make comments and point out problems regarding use of the system is essential so that the designers and maintenance personnel can promptly improve system performance. This will increase the efficiency of the consultation system, enhance user satisfaction, and ultimately benefit patients.