第六章 結論與討論
6.2 未來研究方向
根據本研究之結果,已完成整個看診流程之前半段,圖6-1 之模式則作 為未來推展至整各看診時間預測之流程,其最後結果將以病患就診之屬性,
加上等候理論以決定病患之就診序號及預估看診時間。
圖6-1 病患就診預約時間預測模式 候線,在此根據等候管制規則(queue discipline),先後接受服務設施(service facility)所提供的服務,服務完畢後即離開等候系統(作業研究,2001)。以一
HIS Database
N N-1
參考資料
中文文獻
中華民國台灣醫學會,高血壓研究小組,「本土醫學資料庫之建立及衛生政策 上之應用」,行政院衛生署八十一年度委託研究計畫研究報告,1992。
古政元,「門診等候時間縮短之研究—運用行動通訊技術」,國立中正大學資訊 管理學系,2001。
行政院國軍退除役官兵輔導委員會-統計出版品,「榮民總醫院就醫病患狀況調 查報告」,資料時間: 88 年 出版時間: 89.12。
吳永順,「門診藥局等候時間最佳化之研究---以成大醫院為例」,國立成功大 學工業館理學系,1998。
吳佩璟,「全民健保實施下影響門診病患選擇就醫層級之因素探討」,台北大學 財政學系碩士班碩士論文,2000。
吳國禎,「資料探索在醫學資料庫之應用」,私立中原大學醫學工程學系碩士論 文,2000。
侯幸雨,「應用模擬技術探討台灣醫院門診預約掛號系統」,國立中正大學企業 管理研究所,1998。
胡國岱,「醫院門診掛號時間之研究」,國立中正大學企業管理學系碩士論文,
1996。
張櫻淳,「醫院形象定位-以台北市六家醫學中心的家醫科就診民眾為例」,台 灣大學公共衛生研究所碩士論文,1996。
陳怡潔,「醫療服務品質與顧客滿意之相關研究-彰化基督教醫院為例」,東海 大學管理研究所碩士論文,1996。
黃俊智,「應用模擬技術探討某專科診所之門診預約掛號制度」,國立台灣大學 醫療機構管理研究所碩士論文,1996。
楊朝欽,「醫院掛號作業效率之決策研究--等候理論之應用」,大葉工學院事業 經營研究所碩士論文,1996。
廖慶榮,「作業研究」,第二版三刷,三民書局,台北市2001。
劉敏玲,「急診病患對就醫之感受等候時間、實際等候時間與滿意度之相關研 究」,國立臺灣大學醫療機構管理研究所碩士論文,2001。
劉偉文,「醫療行銷對病患滿意度之實證研究」,中正大學企業管理研究所碩士 論文,1999。
盧昭文,「門診等候時間報告-壢新醫院為例」,2000。
謝崇耀 譯,「Oracle 資料庫設計」,初版,美商歐萊禮台灣分公司,台北市2000。
DB2 資訊月刊譯,Peter Gwynne 「用資料挖採技術 讓廢紙轉變成寶藏(1)」,
DB2 資訊月刊 第五期 九月號,相關軟體學術合作計劃,交通大學計算 機中心,1996。
英文文獻
Anil. K. Jain. and Dubes Richard, Algorithms for Clustering Data. , Prentice-Hall Advanced reference series. Prentice-Hall, Inc., Upper Saddle River, NJ. 1988.
Berry J. A. Michael & Gordon Linoff , Data Mining Techniques . , New York: John Wiley & Sons, Inc. 1997.
Blanco White MJ, Pike MC. , Appointment systems in out-patients clinics and the effect of patients unpunctuality., Med Care, 2: 133–45, 1964.
Connolly M.Thomas & Begg E. Carolyn, , Database System – A practical approach to design implementation and management , 2nd Edition, Addison Wesley, 1998.
Dexter, Franklin MD, PhD. , Design of Appointment Systems for Preanesthesia Evaluation Clinics to Minimize Patient Waiting Times: A Review of Computer Simulation and Patient Survey Studies , International Anesthesia Research Society 1999.
Dubes, R.C. , How many clusters are best? An experiment. Pattern Recognition. , pp.645-663, Nov.1.1987.
Fitzsimmons A. James,Service Management: Operations Strategy and Information Technology, Part Three Managing Service Operations, 3nd Edition.
Boston:Irwin/McGraw Hill. 2002.
Golfarelli, M., and Rizzi, S. , Designing the data warehouse: key steps and crucial issues. , Journal of Computer Science and Information Management, vol. 2, n. 3, 1999.
Lan H. Witten, Eibe Frank , Data Mining-Practical Machine Leaning Tools and Techniques with Java Implementations. , Chapter 6 Clustering pp.210-224 Morgan Kaufmann Publishers. 1999.
Larson, Richard C.,Perspectives on Queues: Social Justice and the Psychology of
Queuing, Operations Research, pp. 895-905 vol. 35, no. 6, November-December 1987.
Maister David, The Psychology of Waiting in Lines, Harvard Business Review, 1984.
Mitchell M.Tom., Machine Learning. , Chapter 6 The EM Algorithm pp.191-198. The McGraw-Hill Companies,Inc. 1997.
Rockhart JF, Herzog EL. , A predictive model for ambulatory patient service time. , Medical Care, 12: 512–9, 1974.
Tsai Yuh-Show, Paul H. King, Michael S. Higgins, Nonald Pierce, and Nimesh , An expert-guided decision tree construction strategy:An application in knowledge discovery with medical database , AMIA Annual fall symposium, pp.121-280, AMIA Nashville TN,1997.
Vissers J. , Selecting a suitable appointment system in an outpatient setting. , Medical Care, 17: 1207–20, 1979.
附 錄
附錄一
D63 醫師以 Index Mining 軟體所得到 EM 之結果以下為取D63 醫師以 Index Mining 軟體所得到 EM 之結果。
=== Run information ===
Scheme: EM -I 100 -N 5 -S 100 -M 1.0E-6 Relation: QueryResult
Instances: 1179 Attributes: 7 pt_type date shift dr_v_time age sex
disease_code
Test mode: evaluate on training data
=== Clustering model (full training set) ===
EM
==
Number of clusters: 5
Cluster: 0 Prior probability: 0.3387 Attribute: pt_type
Discrete Estimator. Counts = | 3: 207.73 | 2: 178.73 | 1: 11.86 (Total = 398.31) Attribute: date
Discrete Estimator. Counts = | 6: 0 | 3: 0 | 5: 0 | 1: 0 | 4: 175.38 | 2: 222.92 | 7: 0 (Total = 398.31)
Attribute: shift
Discrete Estimator. Counts = | 1: 0.01 | 2: 0.01 | 3: 398.3 (Total = 398.31) Attribute: dr_v_time
Normal Distribution. Mean = 3.3477 StdDev = 1.7989 Attribute: age
Normal Distribution. Mean = 30.1084 StdDev = 17.4799 Attribute: sex
Discrete Estimator. Counts = | 1: 211.39 | 0: 186.93 (Total = 398.31) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 32.99 | 6809: 15.45 | 87340: 26.37 | 6819:
Cluster: 1 Prior probability: 0.2901 Attribute: pt_type
Discrete Estimator. Counts = | 3: 162.59 | 2: 154.18 | 1: 24.93 (Total = 341.7) Attribute: date
Discrete Estimator. Counts = | 6: 152.19 | 3: 139.13 | 5: 9.73 | 1: 0 | 4: 0 | 2: 0 | 7:
40.66 (Total = 341.7) Attribute: shift
Discrete Estimator. Counts = | 1: 341.67 | 2: 0.03 | 3: 0.01 (Total = 341.7) Attribute: dr_v_time
Normal Distribution. Mean = 3.6181 StdDev = 1.8787 Attribute: age
Normal Distribution. Mean = 36.0586 StdDev = 20.1089
Attribute: sex
Discrete Estimator. Counts = | 1: 159.64 | 0: 182.07 (Total = 341.7) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 22.97 | 6809: 14.94 | 87340: 16.85 | 6819: 7 | Cluster: 2 Prior probability: 0.0381 Attribute: pt_type
Discrete Estimator. Counts = | 3: 21.77 | 2: 23.29 | 1: 1.74 (Total = 46.8) Attribute: date
Discrete Estimator. Counts = | 6: 0.19 | 3: 0.25 | 5: 28.21 | 1: 17.86 | 4: 0.02 | 2: 0.03
| 7: 0.24 (Total = 46.8) Attribute: shift
Discrete Estimator. Counts = | 1: 5.05 | 2: 41.7 | 3: 0.05 (Total = 46.8) Attribute: dr_v_time
Normal Distribution. Mean = 11.865 StdDev = 4.0115 Attribute: age
Normal Distribution. Mean = 35.4439 StdDev = 17.8517
Attribute: sex
Discrete Estimator. Counts = | 1: 29.63 | 0: 17.17 (Total = 46.8) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 2.78 | 6809: 1.08 | 87340: 0.11 | 6819: 0.32 |
Cluster: 3 Prior probability: 0.271 Attribute: pt_type
Discrete Estimator. Counts = | 3: 146.53 | 2: 155.03 | 1: 16.27 (Total = 317.83) Attribute: date
Discrete Estimator. Counts = | 6: 0 | 3: 0 | 5: 126.69 | 1: 191.12 | 4: 0 | 2: 0 | 7: 0 (Total = 317.83)
Attribute: shift
Discrete Estimator. Counts = | 1: 0.59 | 2: 317.24 | 3: 0.01 (Total = 317.83) Attribute: dr_v_time
Normal Distribution. Mean = 3.8263 StdDev = 2.1145 Attribute: age
Normal Distribution. Mean = 33.0233 StdDev = 20.4843 Attribute: sex
Discrete Estimator. Counts = | 1: 163.96 | 0: 153.87 (Total = 317.83) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 28.2 | 6809: 10.93 | 87340: 21.91 | 6819: 3.68 |
Cluster: 4 Prior probability: 0.0621 Attribute: pt_type
Discrete Estimator. Counts = | 3: 48.38 | 2: 23.77 | 1: 2.19 (Total = 74.35) Attribute: date
Discrete Estimator. Counts = | 6: 14.62 | 3: 18.61 | 5: 0.37 | 1: 0.01 | 4: 20.59 | 2:
18.05 | 7: 2.09 (Total = 74.35) Attribute: shift
Discrete Estimator. Counts = | 1: 35.68 | 2: 0.02 | 3: 38.64 (Total = 74.35) Attribute: dr_v_time
Normal Distribution. Mean = 11.4713 StdDev = 3.2281
Attribute: age
Normal Distribution. Mean = 41.66 StdDev = 21.1914 Attribute: sex
Discrete Estimator. Counts = | 1: 49.38 | 0: 24.96 (Total = 74.35) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 1.06 | 6809: 3.61 | 87340: 3.76 | 6819: 0.06 |
=== Evaluation on training set ===
EM
==
Number of clusters: 5
Cluster: 0 Prior probability: 0.3387 Attribute: pt_type
Discrete Estimator. Counts = | 3: 207.73 | 2: 178.73 | 1: 11.86 (Total = 398.31) Attribute: date
Discrete Estimator. Counts = | 6: 0 | 3: 0 | 5: 0 | 1: 0 | 4: 175.38 | 2: 222.92 | 7: 0
(Total = 398.31) Attribute: shift
Discrete Estimator. Counts = | 1: 0.01 | 2: 0.01 | 3: 398.3 (Total = 398.31) Attribute: dr_v_time
Normal Distribution. Mean = 3.3477 StdDev = 1.7989 Attribute: age
Normal Distribution. Mean = 30.1084 StdDev = 17.4799 Attribute: sex
Discrete Estimator. Counts = | 1: 211.39 | 0: 186.93 (Total = 398.31) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 32.99 | 6809: 15.45 | 87340: 26.37 | 6819:
Cluster: 1 Prior probability: 0.2901 Attribute: pt_type
Discrete Estimator. Counts = | 3: 162.59 | 2: 154.18 | 1: 24.93 (Total = 341.7) Attribute: date
Discrete Estimator. Counts = | 6: 152.19 | 3: 139.13 | 5: 9.73 | 1: 0 | 4: 0 | 2: 0 | 7:
40.66 (Total = 341.7)
Attribute: shift
Discrete Estimator. Counts = | 1: 341.67 | 2: 0.03 | 3: 0.01 (Total = 341.7) Attribute: dr_v_time
Normal Distribution. Mean = 3.6181 StdDev = 1.8787 Attribute: age
Normal Distribution. Mean = 36.0586 StdDev = 20.1089 Attribute: sex
Discrete Estimator. Counts = | 1: 159.64 | 0: 182.07 (Total = 341.7) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 22.97 | 6809: 14.94 | 87340: 16.85 | 6819: 7 | Cluster: 2 Prior probability: 0.0381 Attribute: pt_type
Discrete Estimator. Counts = | 3: 21.77 | 2: 23.29 | 1: 1.74 (Total = 46.8) Attribute: date
Discrete Estimator. Counts = | 6: 0.19 | 3: 0.25 | 5: 28.21 | 1: 17.86 | 4: 0.02 | 2: 0.03
| 7: 0.24 (Total = 46.8)
Attribute: shift
Discrete Estimator. Counts = | 1: 5.05 | 2: 41.7 | 3: 0.05 (Total = 46.8) Attribute: dr_v_time
Normal Distribution. Mean = 11.865 StdDev = 4.0115 Attribute: age
Normal Distribution. Mean = 35.4439 StdDev = 17.8517 Attribute: sex
Discrete Estimator. Counts = | 1: 29.63 | 0: 17.17 (Total = 46.8) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 2.78 | 6809: 1.08 | 87340: 0.11 | 6819: 0.32 |
Cluster: 3 Prior probability: 0.271 Attribute: pt_type
Discrete Estimator. Counts = | 3: 146.53 | 2: 155.03 | 1: 16.27 (Total = 317.83) Attribute: date
Discrete Estimator. Counts = | 6: 0 | 3: 0 | 5: 126.69 | 1: 191.12 | 4: 0 | 2: 0 | 7: 0
(Total = 317.83) Attribute: shift
Discrete Estimator. Counts = | 1: 0.59 | 2: 317.24 | 3: 0.01 (Total = 317.83) Attribute: dr_v_time
Normal Distribution. Mean = 3.8263 StdDev = 2.1145 Attribute: age
Normal Distribution. Mean = 33.0233 StdDev = 20.4843 Attribute: sex
Discrete Estimator. Counts = | 1: 163.96 | 0: 153.87 (Total = 317.83) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 28.2 | 6809: 10.93 | 87340: 21.91 | 6819: 3.68 |
Cluster: 4 Prior probability: 0.0621 Attribute: pt_type
Discrete Estimator. Counts = | 3: 48.38 | 2: 23.77 | 1: 2.19 (Total = 74.35) Attribute: date
Discrete Estimator. Counts = | 6: 14.62 | 3: 18.61 | 5: 0.37 | 1: 0.01 | 4: 20.59 | 2:
18.05 | 7: 2.09 (Total = 74.35)
Attribute: shift
Discrete Estimator. Counts = | 1: 35.68 | 2: 0.02 | 3: 38.64 (Total = 74.35) Attribute: dr_v_time
Normal Distribution. Mean = 11.4713 StdDev = 3.2281 Attribute: age
Normal Distribution. Mean = 41.66 StdDev = 21.1914 Attribute: sex
Discrete Estimator. Counts = | 1: 49.38 | 0: 24.96 (Total = 74.35) Attribute: disease_code
Discrete Estimator. Counts = | 8730: 1.06 | 6809: 3.61 | 87340: 3.76 | 6819: 0.06 | Clustered Instances
0 437 ( 37%) 1 382 ( 32%) 2 360 ( 31%) Log likelihood: -8.44279