目的：
近年來，各國對醫療品質逐漸重視，在醫療資源有限的環境中，醫療浪費是影響醫療品質的因素之一，2012年美國內科醫學會(ABIM) 創議明智選擇運動(Choosing Wisely Campaign)，目的為減少非必要醫療的行為，而目前尚不清楚台灣急診科醫師對於智選擇的了解程度，本研究旨在探討台灣急診醫師對明智選擇的知識、態度與行為及其相關因素，以促進將來在台灣推廣明智選擇運動。

方法：
本研究為橫斷面研究，以台灣急診醫師作為研究對象，採線上問卷方式進行收案，施測時間為2020年08月24日至10月14日，共回收162份有效問卷。利用描述性分析、卡方檢定、獨立樣本T檢定、單因子變異數分析、皮爾森相關分析及多元線性迴歸分析進行問卷分析。

結果：
本研究發現僅38.9%的急診醫師有聽過明智選擇，急診醫師在知識得分平均答對率為70.1%，顯示台灣急診醫師對以實證為基礎的建議指南有一定程度的了解。在明智選擇的態度與行為之間有正向影響關係，表示對明智選擇態度越正向，其對明智選擇的行為也越積極。經多元線性迴歸分析，曾擔任主管、健保分區及聽過明智選擇（p<0.05）正向影響明智選擇之知識，而年齡則為負向的影響關係。

結論：
透過本研究結果，希望可以作為台灣醫療體系推動明智選擇的基礎，建議在未來除了訂定更明確的明智選擇的實踐指南外，也應該將明智選擇加入院內政策，改變醫師執行醫療的習慣，並透過相關的教育訓練及臨床決策工具，以改善醫療浪費，藉此提高醫療品質。

Objective:
In recent years, countries have gradually paid attention to the quality of healthcare. In an environment with limited medical resources, the waste caused by unnecessary care is one of the factors affecting the quality of healthcare. In 2012, the American Board of Internal Medicine (ABIM) launched the Choosing Wisely Campaign to reduce unnecessary care. It is not yet clear how much emergency physicians in Taiwan understand about choosing wisely. The purpose of this study was to explore the knowledge, attitude and behavior of emergency physicians in Taiwan regarding choosing wisely and its related factors, so as to promote choosing wisely in Taiwan in the future.

Method:
This study is a cross-sectional study. Emergency physicians in Taiwan were selected as the research subjects and adopting online questionnaires to collect. The test period was from August 24 to October 14, 2020, and a total of 162 valid questionnaires were collected. Descriptive analysis, chi-square test, independent sample t-test, ANOVA, Pearson correlation analysis and multiple linear regression analysis were used for questionnaire analysis.

Result:
This study found that only 38.9% of emergency physicians had heard a choosing wisely, and the average answer rate of emergency physicians in the knowledge score was 70.1%, indicating that emergency physicians in Taiwan have a certain degree of understanding of evidence-based recommendations. There is a positive relationship between the attitude and behavior of choosing wisely, which means that the more positive the attitude towards choosing wisely, the more positive the behavior towards choosing wisely. After multiple linear regression analysis, ever served as a supervisor, divisions of health insurance service, and ever heard that choosing wisely (p<0.05) positively affects the knowledge of choosing wisely, while age has a negative influence.

Conclusion:
Through the results of this study, it is hoped that it can be used as the basis for Taiwan's health care system to promote choosing wisely. It is recommended that in the future, in addition to formulating clearer practice guidelines for choosing wisely, choosing wisely should also be incorporated into hospital policies to change the practice of physicians in performing medical treatment. Improve medical waste through relevant education training and clinical decision-making tools, thereby improving the quality of healthcare.

論文審定書 i
中文摘要 ii
Abstract iii
目錄 iv
圖次 vi
表次 vii
第壹章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究流程 3
第貳章 文獻探討 5
第一節 知識、態度與行為文獻回顧 5
第二節 知識態度行為理論 6
第三節 明智選擇(Choosing Wisely)的概念 8
第四節 明智選擇之全球現況 11
第五節 重要文獻整理 12
第六節 文獻探討小結 13
第參章 研究方法 14
第一節 研究架構與假說 14
第二節 研究對象與資料來源 16
第三節 研究變項與操作定義 17
第四節 問卷設計 19
第五節 問卷前測結果分析與問卷信效度 24
第六節 資料處理與統計分析 27
第肆章 研究結果 29
第一節 受訪者基本資料分析結果 29
第二節 明智選擇的知識、態度與行為分析 32
第三節 個人基本資料與明智選擇知識、態度與行為之差異性 43
第四節 明智選擇知識、態度與行為之相關情形 52
第五節 明智選擇知識、態度與行為之多元線性迴歸分析 53
第六節 研究架構與假設檢驗 59
第伍章 討論與建議 61
第一節 受訪者樣本特徵 61
第二節 研究結果討論 62
第三節 研究建議 67
第四節 研究限制 68
第五節 結論 69
附錄一 專家效度問卷 74
附錄二 專家效度審查意見整理 79
附錄三 正式問卷 84

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