有效提升院內異常事件自願性通報率一直是醫療機構增進病人安全所面臨的重要議題之一。本論文分兩個階段進行。第一階段，基於解構式計畫行為理論，探討哪些重要的信念足以影響醫療從業人員採用線上通報系統進行通報的意圖，再據此建置院內疑似醫療相關感染通報系統並推動上線。上線後，針對該系統388位實際使用者進行問卷調查，採PLS驗証所提出理論架構的測量與結構模式。第二階段，根據第一階段的研究結果，將整個研究重點移到通報後的回應流程之改善，針對全院性病人安全異常事件通報系統進行回應流程再生工程，並新增工作流程為基礎的回應系統到既有的通報系統之中。此階段比較新回應系統介入前(2006-2007)、後(2008-2009)各兩年的全院性異常事件通報率與事件嚴重程度分佈情形。研究結果顯示在第一階段的313份有效問卷中，根據解構式計畫行為理論所建構的行為意圖模式得以有效說明潛在通報者的通報意圖(R2 = 0.767)；屬於計畫行為理論本身的態度、主觀規範與認知行為控制會影響通報意圖；除了保密性外，即時性與回應性對於態度、規範影響與比較影響對於主觀規範、自我效能與資源配合情況對於認知行為控制皆有正面的影響。其中以回應性的間接效果最大。而第二階段的回應流程改善介入後，有效提升全院性的異常事件通報率(RR:3.0, 95% CI: 2.7-3.2, p<0.001)；事件實際或潛在傷害程度更加平均分佈到5個不同的嚴重程度，特別是非常嚴重(RR: 20.6, 95% CI: 9.7-43.8, p<0.001)與沒有傷害(RR:8.1, 95% CI: 5.7-11.6, p<0.001)增加最為顯著。本文以嚴謹的理論模式為基礎，作為建置與導入一個通報系統的參考依據，並驗證一組足以影響通報意圖的重要信念，該方法與結果可供醫療機構未來建置通報系統的重要參考；而通報系統強調回應性可以有效改善通報率的論述，也在本文中得到進一步的驗證。

A fundamental and important way of improving patient safety in a hospital is to develop an internal voluntary reporting system to report incident events so that causes of these events can be identified and future events be prevented. Although it is believed that the reporting of incidents can be increased by creating and installing information systems that can be used to efficiently report of incidents, there remains far fewer voluntary reports of incidents than actual number of incidents.
This dissertation has the first aim to draw on the decomposed theory of planned behavior to understand which beliefs would most impact nurses’ intentions to use a nosocomial infection reporting system (Phase 1 Research). It then aims to apply results to the improvement of a hospital-wide web-based voluntary incident reporting system and test its effect incident reporting rates of incidents being reported (Phase 2 Research).
The first study found intention to use the nosocomial infection reporting system was significantly influenced by attitude, subjective normal and perceived behavior control. These three factors were influenced by timeliness, normative influence, comparative influence, self-efficacy, facilitating conditions, and particularly responsiveness.
The second study found a significant increase in inpatient and emergency department reports of incidents made by doctors in inpatient areas, emergency department nurses, and allied health professionals in inpatient areas. Post-system reported incidents were more evenly distributed over five severity levels than pre-system incidents, moving more toward the very severe level and no harm level.
Together, these findings suggest that the responsiveness of an incident reporting system may have a stronger effect than efficient incident reporting alone in increasing incident report rates and that the addition of the workflow-based response system to the hospital incident reporting system significantly increased hospital-wide voluntary incident report rates at all incident injury levels.

ABSTRACT II
CHAPTER 1 INTRODUTION 1
1.1 BACKGROUND 1
1.2 MOTIVATION 2
1.3 OBJECTIVES OF DISSERTATION 3
CHAPTER 2 LITERATURE REVIEW 5
2.1. A THEORETICAL APPROACH TOWARD INCIDENT REPORTING SYSTEM USE 5
2.2. DECOMPOSED THEORY OF PLANNED BEHAVIOR (DTPB) 8
2.3. IMPROVING REPORTING RATES BY USING INFORMATION TECHNOLOGY 11
2.4. IMPROVING REPORTING RATES BY REVERTING TO PAPER-BASED REPORTING FORMXX 13
2.5. IMPROVING REPORTING RATES BY FOCUSING ON FEEDBACK 14
CHAPTER 3 RESEARCH METHODS 19
3.1 STUDY SETTING 20
3.2 PHASE 1 RESEARCH: A THEORETICAL APPROACH TO DETERMINE NURSES’ ACCEPTANCE OF INCIDENT REPORTING SYSTEM FOR SUSPECTED INCIDENT OF NOSOCOMIAL INFECTION 21
3.2.1 Theoretical model and hypotheses 21
3.2.2 Nosocomial Infection Reporting System 29
3.2.3 Questionnaire Development 30
3.2.4 Participants 30
3.2.5 Statistical Analyses 31
3.3 PHASE 2 RESEARCH: THE EFFECT OF A WORKFLOW-BASED RESPONSE SYSTEM ON HOSPITAL-WIDE VOLUNTARY INCIDENT REPORTING RATES 31
3.3.1 Workflow-Based Response System Intervention 32
3.3.2 Study Outcomes and Variables 37
3.3.3 Statistical Analysis 37
CHAPTER 4 A THEORETICAL APPROACH TO DETERMINE NURSES’ ACCEPTANCE OF INCIDENT REPORTING SYSTEM FOR SUSPECTED INCIDENT OF INFECTION 39
4.1 RESULTS OF PHASE 1 RESEARCH 39
4.1.1 Demographic Characteristics 39
4.1.2 Data Screening 39
4.1.3 Measurement Model 40
4.1.4 The Structural Model 44
4.2 DISCUSSION 45
CHPATER 5 THE EFFECT OF A WORKFLOW-BASED RESPONSE SYSTEM ON HOSPITAL-WIDE VOLUNTARY INCIDENT REPORTING RATES 50
5.1 RESULTS OF PHASE 2 RESEARCH 50
5.2 DISCUSSION 52
CHAPTER 6 CONCLUSION 57
REFERENCES 60
APPENDIX A QUESTIONNAIRE ITEMS 69

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