網際網路的快速興起，根據資策會ACI-FIND最新調查數據顯示，截至2004年9月底止，網際網路連網應用普及率為40%，我國目前家庭連網普及率已經超過六成。網路世界的熱絡，造就了各式各樣的網站成立，醫療資訊網也不例外的迅速成長。然而相關的醫療資訊系統網站大都只提供初淺之健康資訊和醫療相關資訊，深度明顯不足，對於就醫科別選擇資訊上顯得少之又少，因此如何協助民眾精確的選擇適合的就醫科別是醫療資訊網站所必須致力的，藉由提供就醫選擇的輔助決策功能可增加網站系統的附加價值。
決策活動是決策者就其對某問題的瞭解，並據以產生方案的過程。病患選擇就醫科別就是一個標準的決策活動。在台灣，病患自由選擇就診科別是台灣醫療很重要的特色。在現今的醫療習慣以及制度之下，病患對於就醫選科的決策常常產生困難與困擾。目前對於病患在選擇科別的決策分析以及選擇之後的就醫行為研究的論文皆付之闕如，對於病患就醫決策與行為模式也缺乏了解。目前針對就醫選擇因素的研究主要是以醫療機構的角度出發，探討醫療院所行銷面策略的制定，缺乏針對民眾就醫選擇門診科別時的輔助，協助病患解決就醫選科時所面臨到的困難。因此，本研究將以病人為中心，來探討病患就醫的決策模式並實際發展就醫決策輔助系統。

The activities in the Internet grow rapidly, according to the recent study from Institute for Information Industry, until September 2004, there are more than nine million people using the Internet in Taiwan. The ratio of prevalence for individual users is 40 %, and the ratio of prevalence for the households is 61%. Obviously, the Internet has influenced our daily lives deeply. Millions of web sites appear and more are generated everyday, and the situation is the same for medical or health information web-sites. However, most of the medical/health information web-sites haven’t provided patients oriented in-depth information, not to mention a tailored healthcare provider choice support system. It will be a great opportunity to develop this kind of decision support system for the patients.
Decision-making is a process to identify, define problems and to generate the alternatives. To decide which department, which hospital or which doctors to visit is a typical decision-making process. In Taiwan, the patients can choose the department or doctors they want to visit freely. Most of the patients and their family will have difficulty in the choice of medical department, especially when the symptoms are complicated. On the other hand, there still lacks of academic study regarding the healthcare provider seeking decision and behavior, which may provide an important references for health insurance policy. Until now, there are many researches address the issues of medical marketing. However, there’s few study to aim to study the patient’s healthcare providers seeking decision and behaviors. This proposal will focus on 1). Understand the factors influencing the patient’s healthcare providers seeking decision 2). Development and evaluation of a web-based healthcare providers seeking decision support system.

目 錄
目 錄 iv
表目錄 vi
圖目錄 viii
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機 1
1.3 研究目的 2
1.4 研究流程 3
1.5 論文架構 3
1.5 論文架構 4
第二章 文獻探討 5
2.1 台灣醫療就診輔助現況相關研究 5
2.2 就醫選擇的關鍵因素 7
2.3 醫學診斷專家系統相關研究 9
2.3.1 MDDS系統介紹 10
2.3.2 利用資訊科技輔助就醫決策制定 12
2.3.3 成功的電腦化決策支援系統的特徵 14
2.4 網際網路對醫病關係的影響相關研究 15
2.5 貝氏分類法之相關研究 16
第三章 研究方法與設計 18
3.1 研究架構 18
3.2 研究方法 18
3.2.1 問卷設計與說明 18
3.2.2 模式建立架構 26
3.2.3 模式推導 27
3.2.4 建置雛型系統 30
第四章 研究結果 32
4.1節門診病患就醫選科行為分析問卷的分析結果 32
4.1.1 樣本回收情形 32
4.2節利用專家群組填寫的權重建立概似機率實施與結果 58
4.2.1 專家權重問卷實施結果 58
4.2.2 模式建立 64
4.2.3 系統滿意度建立 66
4.3節 模式驗證與系統評估 68
4.3.1 模式驗證 68
4.3.2 系統評估 70
第五章 結論與建議 73
5.1 研究結論 74
5.2 研究貢獻 75
5.3 研究限制與後續研究之建議 76
參考文獻............................................................78
附錄一 門診病患就醫選科之尋求行為...................................84
附錄二 專家群組對各科症狀填寫權重...................................87
附錄三 科別代碼說明.................................................90
附錄四 症狀代碼說明.................................................91
附錄五 外科權重回收.................................................93
附錄六、外科 、 概似機率.............................98
附錄七、外科 、 概似機率.............................103

參考資料
中文文獻
藍中賢，結合模糊集合理論與貝氏分類法之資料探勘技術 應用於健保局醫療費用審查作業，元智大學資訊管理研究所，碩士論文，2000年。
謝秀芳，以貝氏模式建構之軟體開發品質評估指標，元智大學資訊管理研究所，碩士論文，1999年。
楊捷名，住宅更新決策模式之研究，國立成功大學建築學研究所碩士論文，2000。
孫漢屏，類神經網路為基礎之智慧型醫院網路掛號系統，中國醫藥學院衣物管理學研究所碩士論文，2002。
黃俊英，行銷研究管理與技術，華泰書局，台北，1999。
李友專，http://li.tmu.edu.tw/slide/Diag_Dec_Supp/mdss.htm，1998
行政院衛生署疾病管制局，http://203.65.72.83/ch/dqia/ShowPublication.ASP?RecNo=895，2001
台灣e院，http://sp1.cto.doh.gov.tw/doctor/Index1.php
台灣歷年上網人口統計，資策會ACI-FIND，http://www.find.org.tw/0105/howmany/usage_1.asp
我國家庭上網調查，資策會ACI-FIND，http://www.find.org.tw/0105/howmany/howmany_disp.asp?id=91
醫管資訊，http://www.uhealthy.com/chinese/uhealthy-network/medical-management/news-003.htm，1999


英文文獻
Anell A, Rosen P, Hjortsberg C. Choice and participation in the health services：a survey of preferences among Swedish residents. Health Policy 1997;40: 157- 168
Barness, LA, Tunnessen WW Jr, Worley WE, et al. Computer-assisted diagnosis in pediatrics. AJDC. 1974;127:852-858
Barnett, GO. Computers in medicine. JAMA 1990;263:2631-2633
Brennan, P., S. Ripich, and S. Moore,1991. “ComputerLink: Electronic Support for the Home Caregiver” Advances in Nursing Science,13(4)
Celler, B.G., Earnshaw, W., Ilsar, E.D., Betbeder-Matibet, L., Harris, M.F., Clark, R., Hesketh, T., Lowell, N.H., 1995. “Remote monitoring of health status of the elderly at home. A multidisciplinary project on aging at the University of New South Wales,” International Journal of Biomedical Computing
Chan, C.L., Chung-Hsien Lan, 2001, June, “A Data Mining Technique Combining Fuzzy Sets Theory and Bayesian Classifier- An Application of Auding the Health Insurance Fee”, Proceedings of the International Conference on Artificial Intelligence, IC-AI’2001, Las Vegas, U.S.A., pp402-408
Chan, C.L., 1995.”Self-efficacy, Social Support & Emotional Wellbeing---Using a Health Support System to Cope with AIDS”, Ph.D. Dissertation, University of Wisconsin-Madison
Chien, C., Gustafson, D.H., Bricker, E., Chan, C., 1996. “Development and Pilot Evaluation of a Health Support System on the World Wide Web,” paper accepted for 12th International Conference on Advanced Science and Technology, Chicago, April 6-7
Coiera , E. (1998) http://www.coiera.com.
Deber, R.B., Physicians in health care management: 7. The patient-physician partnership: changing roles and the desire for information, Canadian Medical Association Journal. 1994;151:171-176.
Deber, R.B., Physicians in health care management: 8. The patient-physician partnership: decision making, problem solving and the desire to participate, Canadian Medical Association Journal. 1994;151:423-7
Ebell, M., Gaspar, D., Khurana, S. Family physicians’ preferences for computerised decision-support hardware and software. J Fam Pract 1997; 45: 137-41.
Elson, R., Connelly, D. Computerised decision support systems in primary care. Prim Care 1995; 22: 365-84.

Fitzmaurice, D., Hobbs, F., Murray, E., Bradley, C., Holder, R. Evaluation of computerised decision support for oral anticoagulation management based in primary care. Br J Gen Pract1996; 46: 533-5.
Gustafson, D.H. Hawkins, R.P., Boberg, E.W., Pingree, S., Serlin R.E., Graziano, F., Chan C.L.,1999, “Impact of a patient-centered, computer-based health information/support system”, American Journal of Preventive Medicine, Vol.16,No.1
Gustafson, D.H., Hawkins, R.P., Boberg, E.W., Pingree, S., Chan C.L.,1995.”The Use and Impact of a computer-Based Support System for People living with AIDS and HIV Infection”, Journal of the American Medical Informatics Association
Gustafson, D. H., F. Sainfort, S. W. Johnson, and M. Sateia. Measuring Quality of Care in Psychiatric Energencies: Construction and Evaluation of a Bayesian Index.. Health Services Research 28 1993; 2:131-158.
Hebda, T., Czar, P., Mascava, C. Handbook of informatics for nurses and health care professionals. Menlo Park, CA: Addison-Wesley 1998.
Hjortdahl P, Laerum E. Continuity of care in general practice: effect on patient satisfaction. British Medical Journal 1992;304:1287-1290
Hunt, D., Haynes, R., Hanna, S., Smith, K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 1998; 280: 1339-46.
Johnson, Kevin B.; Feldman, Mitchell J.Medical Informatics and Pediatrics: Decision-Support Systems. JAMA 1995;149:1371-1380
Kenneth A. Heischmidt. Firooz Hekmat and Peter Gordon. A Multivariate
Analysis of Choice Criteria for Hospitals. Journal of Hospital Marketing 1993;8:41-55
Kersnik J. Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country. Health Policy 2001;57:155-164
Kononenko, I. Inductive and Bayesian Learning in Medical Diagnosis. Applied Artificial Intellifence 1993; 7:317-337
Kravitz RL, Bell RA, Azari R, Kelly-Reif S, Krupat E, Thom DH. Direct observation of requests for clinical services in office practice: what do patients want and do they get it? Archives of Internal Medicine 2003;163:1673-1681
Lavrac, N. Selected techniques for data mining in medicine. Artificial Intelligence in Medicine 1999;16:3-23
Lemaire, Jane B. MD; Schaefer, Jeffrey P. MD; Martin, Lee Ann MD; Faris, Peter MSc; Ainslie, Martha D. MD; Hull, Russell D. MB, MSc. Effectiveness of the Quick Medical Reference as a diagnostic tool. CMAJ-JAMC 1999;161:725-728
Luge CF, Assal JP.1993.”Designing Computer Assisted Instruction Programs for Diabetic Patient: How Can We Make Them Really Useful?” SCAMC Procesding
Masarie FE, Miller RA. QMR: a diagnostic decision-support program for internal medicine. Group Pract J. 1990;39:16-25
Mctavish F.M., Gustafson D.H., Owens B.H., Wise M., Taylor O., Apantaku F.M., Berhe J., and Thorson B.,1994.”CHESS: An Interactive Computer System for Women with Breast Cancer Piloted with an Under-Served Population”, JAMIA Symposium Supplement, SCAMC Proceeding
Michaud, G., McGowan, J., van der Jagt, R., Wells, G., Tugwell, P. Are therapeutic decisions supported by evidence from health care research? Arch Int Med 1998; 158: 1665-8.
Murray, Elizabeth MRCGP, PhD; Lo, Bernard MD; Pollack, Lance PhD; Donelan, Karen ScD; Catania, Joe PhD; White, Martha BA; Zapert, Kinga PhD; Turner, Rachel. The Impact of Health Information on the Internet on the Physician-Patient Relationship: Patient Perceptions. Archives of Internal Medicine.2003;163:1727-1734
Payne, Thomas H. MD. Computer Decision Support Systems. Chest 2000; 118: 47-52
Peleska, J., Svejda, D., Zvarova, J. Computer supported decision making in therapy of arterial hypertension. Int J Med Inf 1997; 45: 25-9.
Purves, I. PRODIGY: implementing clinical guidance using computers. Br J Gen Pract 1998; 48: 1552-3.
Rajamohanan K Pillai, Sankey V. Williams, Henry A. Glick, Daniel Polsky, Jesse A. Berlin, Robert A. Lowe, Factors affecting decisions to seek treatment for sick children in Kerala, India, Social Science & Medicine 2003;57:783–790
Reuben Granich, Michael F. Cantwell, Kurt Long, Yvonne Maldonado, Julie Parsonnet, Patterns of health seeking behavior during episodes of childhood diarrhea: a study of Tzotzil-speaking Mayans in the highlands of Chiapas, Mexico, Social Science & Medicine 1999; 48:489-495
R. Kalda, K. Po lluste , M. Lemb. Patient satisfaction with care is associated with personal choice of physician. Health Policy 2003; 64:55-62.
Ronald Andersen, Nancy Harada, Vicki Chiu, Takashi Makinodan. Application of the Behavioral Model to Health Studies of Asian and Pacific Islander Americans. Asian American and Pacific Islander Journal of Health 1995;129-141.
Saltman, R.B., Patient Choice and Patient Empowerment: A Conceptual Analysis. Occasional Paper 40, SNS Fiirlag, Stockholm, 1992
Schmittdiel J, Selby J, Grumbach K, Quesenberry C. Choice of a personal physician and patient satisfaction in a Health Maintenance Organisation. Journal of American Medical Association 1997;278:1596-1599
Sheldon Ross. A first course in probability. Prentice Hall International Editions 1994.
Shortliffe, E. Medical informatics: computer applications in health care. Reading, MA: Addison-Welsley 1990.
Simon HA. The New Science of Management Decision, Harper and Brothers, 1960.
St James Hospital (1998) http://www.stjames.ie/nmic/warfarin/warfint.html.
Susan L. Taylor and Louis M. Capella Hospital Outshopping: Determinant
Attributes and Hospital Choice. Health Care Manage Rev 1996;21:33-44
Vadher, B., Patterson, D., Leaning, M. Evaluation of a decision support system for initiation and control of oral anticoagulation in a randomised trial. BMJ 1997; 314: 1252-6.
Van Bemmel, J., Musen, M. Handbook of medical informatics. Houten / Diagem,1997.