預測病患到診時間之研究-以心臟內科為例

The Study on the Prediction of OPD Patient's Arriving Time for Internal Heart Department

林惠淳(Hui-Chun Lin)

指導教授 ： 白佳原

中山醫學大學/醫學院/醫學研究所/碩士(2010年)

摘要

摘要

由於台灣封閉式之醫院醫師制度，造成了目前醫院的門診病患必須大排長籠等候看醫生。太多的病患在等候區不只會浪費病人的時間，而且還可能增加醫院的成本，另外，病患可能會因過長的等候時間而取消看診，更會造成後續病患更長的等候時間。雖然樣本醫院超過50%的病患已有預約掛號，但醫院之資訊系統仍無法告知病患何時應該到達醫院。尤其本研究之樣本醫院以心臟內科的病患等候時間最久，許多研究已指出病患認為合理的門診時間約莫在16分鐘至30分鐘，如何有效的縮短目前心臟內科病患的等候時間從108分鐘至合理的等候時間是目前急切的目標。因此，為了預估醫師之看診速度，以通知病患到達醫院之時間，以減少門診病患之等候時間，本研究依據每位醫師看診風格與習慣，監測門診病患等候時間與到診時間，作出適合的預測模式。樣本醫院在2007年11月至2009年2月推動實施ISO，改善心臟內科門診病患到診時間為ISO之品質指標之一。

研究方法
大型教學醫院被選為樣本醫院由於願意提供必要之數據，1927筆病患的到達及等候時間被收集，統計檢定力分析顯示本研究的總樣本數說明接受錯誤虛無假設的機率遠低於0.00001，足可見本研究結果之解釋力，而後本研究進行複迴歸分析以作為預測病患等候時間之模型。開診至病患進診間看診的時間為非獨立變數，獨立變數為診號、醫師編號、初複診、VIP號、看診時段，以上變數進入複迴歸模型。本研究使用STATISTICA® Version 7.1進行統計，例如F檢定和複迴歸分析。

研究結果
根據複迴歸分析的結果，顯示診號及醫師編號對於病患等候時間的解釋力有顯著性，為求預測模型的簡約性與準確性，僅診號及醫師編號進入迴歸模型，以作為病患等候時間的預測變數。最適當之複迴歸模型為：Y=a0+a1X1+a2X2，Y為開診至病患看診的時間，a0為截距項，X1為診號，X2為六位心臟內科醫師之編號，R= 45.5%，adjusted R2 = 20.7%，F檢定顯示此模型為適當的。

結論與建議
研究結果顯示樣本病患的等候時間平均長達108分鐘，此數據結果遠高於其它等候時間研究的結果，亦顯示該樣本醫療機構必須縮短等候時間至病患合理接受的範圍。樣本醫院的MIS (Management Information System)系統結合本研究之複迴歸模型，可預測出更有效的病患等候時間，同時可以增加即時通知病人到診時間：例如透過醫院網頁公告、電話通知，鼓勵門診病患利用電話或網路預約掛號。透過本研究所提出的病患等候時間預測模型，病患可在預測的等候時間等十至二十分鐘通知到院等候看診，可有效節省病患的等候成本及降低病患臨時取消看診的可能，對於醫院在門診營運的效率是可有顯著的改善。

關鍵字

預測 ； 等候時間 ； 複迴歸模型 ； 醫院

並列摘要

Due to the closed staff system of Taiwan’s hospitals, patients always have to waiting in line to see doctors in the outpatient department (OPD). Too much patients in the waiting area not only waste patients’ time, but also increase hospitals cost. In addition, patients may suddenly cancel the health care service due to the prolonged waiting time. Nonattendance may bring about more long waiting time for the following patients. Although more than 50 % of patients already make a reservation, the system could not tell the patients when to come to the hospital. This research, estimated the time when patients should come to OPD according to each doctor’s style and pattern to reduce patients’ waiting time. Many studies have suggested that the reasonable waiting time for patients is 16 min to 30 min. Therefore, it is the most important for OPD that change the waiting time from 108 min to reasonable waiting time.

Methods A large teaching hospital was chosen as sample hospital due to the willingness to provide the necessary data. In this study, 1927 patients arrive time and waiting time were collected. First of all, power analysis results show that the probability of accepting typeⅡ error for this study was below 0.000001, which provides evidence that the results have significant power of explanation in the regression model. Sequentially, multiple regression model was been conducted to predict the waiting time of outpatient which include the time patients waiting to see doctor as impendent variable and the independent variables such as the patient attendance number, physicians, newly diagnosed patients, patients with special condition (VIP), and the doctor’s office shift were put inside the regression model. The STATISTICA® Version 7.1 was used for statistics such as F test and multiple regressions.

Results According to the regression model, the findings show that patient attendance number and physician number are significant related to the time patients waiting to see doctor. The proper multiple model are Y=a0+a1X1+a2X2

並列關鍵字

waiting time ； Multiple regression ； predict ； hospital.

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