隨著醫療知識與技術的進步，關於醫療處置之最新文獻與證據已被大量發表。實證醫學強調整合最佳研究證據、臨床專業知識與病患價值，以應用於病患照顧之實務工作中；因此，為改善醫療品質與提升醫院競爭優勢，有關實證醫學的議題越加普遍與重要。現今關於探討醫院導入實證醫學的文獻，大多聚焦於組織層級的活動；然而，假如我們無法了解實證醫學系統使用者的認知，則系統的績效將會因而折損。台大醫院雲林分院與彰化基督教醫院為本計畫的兩個實證個案，其中台大醫院雲林分院的一位高階主管與彰化基督教醫院實證醫學中心主任，已受邀為本計畫之協同主持人。為發掘使用者與系統互動時其內心之深層意義，參與式觀察法與深度訪談法，將被用來收集受訪醫師之系統使用經驗；受訪之個案醫院的次級資料亦將是另ㄧ資料來源，而分析資料將會運用紮根理論之技巧。在本計畫中，我們欲探索實證醫學系統實現時的符號環境，藉由詮釋醫師與系統互動經驗，預期將能提升系統之績效。我們規劃兩年期的時程以完成本計畫，各年度目標如下所述：
一、在第一年中，將建構醫師與系統間之符號互動模式，關於實證醫學系統實現之多重符號將會被歸納，並進一步詮釋醫師在使用系統時，其感受與思想傾向的深層意義。因此，系統之實現也許將會被更有效率與有效地被管理。
二、在第二年中，我們將從醫師與病人的觀點探索病患價值為何。基於所得到的結論，我們將進一步探索如何在實務上整合最佳研究證據、臨床專業知識與病患價值，以應用於病患照顧之實務工作中。此探索的過程於結果也許將有助於精進實證醫學系統之實現，並因而使得系統能發揮其最大之效能。
With the progress of medical knowledge and technology around the world, a great deal of new literature and other evidences about medical treatments are being published. Evidence-based medicine (EBM) highlights the integration of the best research evidence, clinical expertise and patient values into the practice of patient care. Therefore, issues about EBM become more common and critical in order to improve medical quality and promote competitive advantage in the hospital industry. There were some studies concerning on the implementation of EBM in hospitals. The considerations of those researches are mostly focused on organization-level actions. However, if we fail to understand what users think, the EBM system performance will be undermined. National Taiwan University Hospital Yunlin Branch (NTUH Yunlin Branch) and Changhua Christian Hospital are our two research cases. The top manager in NTUH Yunlin Branch and the leader of EBM Center in Changhua Christian Hospital are invited to be the co-leaders of the project. To discover the deeper meaning of members’experiences with an EBM system, the participant observation and in-depth interview methods will be used to gather the physicians’ meaningful experiences. The secondary data of the hospitals will be an additional source. Then the collected data will be analyzed using the techniques of grounded theory. In the project, we intend to explore the symbolic environment of EBM realization. By interpreting the interaction between physicians and EBM system, the performance of EBM system is expected to be promoted. We plan a 2-year schedule to complete the project and the objectives in the each year are shown as follows.
1. In the first year, we will establish a symbolic interaction model between physicians and an EBM system. The multiple symbols associated with EBM realization are induced and reflect the feeling and mindset of physicians towards interacting with an EBM system. Thus the EBM realization maybe managed more efficiently and effectively.
2. In the second year, we will explore what patient value is from viewpoints of both physicians and patients in advance. Based on the derived results, we further explore how to practically integrate best evidences, patient value and clinical expertise of physicians into patient care. The exploring process and conclusions in the year are possible to be contributory to refine the EBM realization and hence make the EBM system reach its fullest potential.
