在台灣兒童氣喘為醫療花費最高的慢性肺疾病，兒童氣喘防治照護成為不容忽視的公共健康議題，落實主要照顧者之氣喘教育與提昇自我處理行為進而改善病童健康則是氣喘防治的重要關鍵。因應台灣醫療保健體系轉型，基於成本效益提昇照護品質考量，兒童氣喘個案管理照護模式的確有其推展之可行性，而個案管理師應用網際網路不受時空限制使用的特性，提供多元化的醫療照護服務，更能發揮「個案管理」照護模式的功效。本研究目的包括：一、發展、執行與驗證「以網路為輔助之個案管理」對於氣喘病童照顧者於氣喘知識、技能、自我處理行為與病童健康狀況改變之成效；二、比較「以網路為輔助之個案管理」與「單純個案管理」對於氣喘病童照顧者於氣喘知識、技能、自我處理行為與病童健康狀況改變之成效差異。
本研究採實驗性設計，以立意取樣方式，隨機分派為實驗組與對照組。自95 年8 月至96 年9 月於台南市某醫學中心之小兒過敏免疫門診收案，總共收案54 名氣喘病童照顧者，其中41 位（含實驗組19 位與對照組22 位）完成研究過程。完成前測評量後，實驗組接受「以網路為輔助之個案管理」；對照組接受「單純個案管理」，照護計畫執行三個月後，於門診或利用郵寄方式回收追蹤問卷，並進行組內與組間之成效比較。
研究結果顯示兩組之氣喘病童照顧者在接受氣喘照護計畫前，對於使用氣喘吸入劑技巧、了解氣喘藥物種類與使用目的、判斷氣喘嚴重程度之概念仍不足，對於居家治療處理行為與評估性自我處理行為只做到「偶爾」程度，且病童氣喘控制測驗前測得分低於20 分，顯示兩組病童氣喘症狀處於不穩定控制中。當不同方式照護措施介入後，兩組照顧者之照護成效皆有明顯進步，其前後測比較，在實驗組病童照顧者氣喘知識與使用吸入性藥物技能平均值爲9.42 分對11.84 分，p＜.001；自我處理行為平均值爲89.84 分對99.63 分，p＜.002；病童氣喘控制測驗平均值爲20.32分對23.00 分，p＜.02；病童平均每月就醫次數由5 次降低為2 次，p＜.01。在對照
組病童照顧者之氣喘知識與使用吸入性藥物技能平均值爲9.73 分對12.27 分，p＜.000；自我處理行為平均值爲83.64 分對94.77 分，p＜.009；病童氣喘控制測驗平均值爲19.32 分對22.27 分，p＜.002；病童平均每月就醫次數由5 次降低爲2 次，p＜.06。然而，由兩組間照護成效比較，則未呈現顯著性差異。
此研究結果反映出個案管理師運用不同之管理工具進行氣喘個案管理，均能發揮個案管理模式角色功能，能增加氣喘病童照顧者氣喘知識與使用吸入性藥物技能，提升照顧者自我處理行為之成效，使病童氣喘症狀達到穩定控制。雖研究結果呈現有或無應用網路輔助個案管理之成效相近，然而，以網路輔助個案管理卻有即時性掌控病情、提醒警覺症狀變化與提供處置決策等優點，在未來，可以嘗試推展運用不同輔助工具之兒童氣喘個案管理模式，以提供更有效率氣喘照護管理。

Because asthma is the most common and costly chronic disease of childhood in Taiwan, manage and control asthma in childhood has become a major public health problem. An efficient, continuous and cost–effective asthma managing model can be designed to improve the quality of asthma care in childhood. The purpose of this study were to：1. assess the effectiveness of internet-based case management program on caregiver’s asthma knowledge, skill, self-management behavior and children’s health condition; 2. evaluate the comparative effect of two different asthma case management program which was based on the PRECEDE/PROCEED model. Forty-one caregivers of children with asthma visiting pediatric allergy-immunology clinic were randomly assigned to experimental and comparison group (19 participants were in experimental group and 22 participants were in comparison group). Both group received an asthma education and experimental group participants received additional internet-based case management program in which researcher provided instant and closer care through an interactive internet device. The comparison group also received a case management program in which researcher provided a traditional case management care. The outcomes measurement including: Pediatric asthma caregiver’s knowledge and skill questionnaire, Pediatric asthma caregiver’s self-management behavior, Childhood Asthma Control Test (ACAT), and the visiting number in previous three months collected on the time before intervention and 12 weeks later.
Results showed that the scores of caregiver’s asthma knowledge and skill in experimental group was significant increased (9.40 vs. 11.84, p＜.001), caregiver’s self-management behavior significant improved (89.84 vs. 99.63, p＜.002). Also, the scores of CACT increased (20.32 vs. 23.00, p＜.02) and the visiting number decreased (1.74 vs. 0.74, p＜.01) in experimental group. Besides, the similar effect were shown in comparison group, which were the significant increased in caregiver’s asthma knowledge and skill (9.73 vs. 12.27, p＜.001), caregiver’s self-management behavior (83.64 vs. 94.77, p＜.09), scores of CACT (19.32 vs. 22.27, p＜.002), and slightly decreased on the number of visiting (1.00 vs. 0.45).
Compare to the differences in caregiver’s asthma knowledge and skill, self-management behavior and children’s health condition in both group after receiving different case management program, results indicated that there was no significant difference in scores of caregiver’s asthma knowledge and skill, caregiver’s self-management behavior, CACT and the number of visiting in both of experimental group and comparison group.
In conclusion, both traditional case management and internet-based case management program can provide the effective outcome to asthmatic children and their caregivers, however,internet-based case management demonstrated more advantages, which included immediate monitoring, alert reporting and advises for symptom management. Further study would focus on the applications for pediatric asthma control and managed care.

中文部分
王保進（2004）‧視窗版SPSS與行為科學研究‧台北：心理出版社。
王資惠（1996）‧探討護理指導