醫療機構慢性病門診之過號病患再入診法則

Abstract

近年來各國慢性病患者數逐漸增加，同時也產生成本高昂的醫療費用，而現今醫療門診在設計預約系統時，大多未把門診預約系統設計將影響病人到診行為的因素納入考量，因此本研究運用兩階段決策模型（two-stage decision model），探討慢性病門診的預約系統設計問題，其中醫療機構為先行決策者，決定門診中給予各病患的建議報到時間以及發生病患過號情況時的過號處理法則；門診中病患則為後決策者，根據醫療機構給予的建議報到時間、過號處理法則以及候診的歷史經驗，決策其到診的時間。 本研究假設門診病患在有限的資訊下，運用適應性預期（adaptive expectations）來決策每次看診所偏好的到診時間。藉由模擬（simulation）門診實際看診情況，得到病患的候診時間與過號情形，以作為病患運用適應性預期時，所需的輸入值相關資訊，藉此比較不同的建議報到時間及過號法則設計下，門診病患到診行為的差異。最後將個案教學醫院數據運用於本研究模型上，探討預約系統設計對病患到診行為的影響，本研究結果分析得知，當醫療機構管理者設計預約系統時，將病患到診行為納入考量，能夠降低認知誤差並改善預約系統設計，進而減少門診病患候診時間與醫師產能閒置時間。

Recently a large increase in the number of outpatients with chronic diseases accompanies with a high health care cost. The current clinic appointment system typically neglects how it affects the behavior of outpatient arrivals. We apply a two-stage decision model where a health care institute first proposes a suggested arrival time and designs a late arrival policy for outpatients. After knowing the suggested arrival time estimated by the health care institute, outpatients determine their arrival time according to their experience of waiting times and the late arrival policy. We assume that outpatients apply adaptive expectations to adaptively forecast their preferable arrival time based on limited information regarding possible alternatives and consequences. Under different late arrival policies and suggested arrival times, the simulation is the tool to describe the behavior of outpatient arrivals, which is the input information to adaptive expectations. Our case study shows that the proposed model helps improving the performances of actual waiting times of outpatients and idle times of physicians in a health care institute.