对保健科患者病案管理实施临床路径管理的效果观察

目的 探讨对保健科患者病案管理实施临床路径管理的效果观察.方法 通过对临床路径与病案记录关系的分析,制定保健科患者病案管理临床路径管理的实施措施与配套措施.结果 实施临床路径后,保健科病人的对于医院的医疗环境、服务质量、服务态度、医疗信息等满意度都有了明显提高,实施前后对比差异有统计学意义(P＜0.05).结论 根据临床路径对保健科患者制定病案管理质量的监控标准是可行的与有效的,值得临床推广.     

膝关节镜手术患者实施临床路径管理的满意度研究

[目的]评价膝关节镜手术患者实施临床路径后的满意度情况。[方法]采用问卷调查法对实施临床路径管理的患者进行问卷调查;整理资料,对比分析实施临床路径前后两组患者的满意度评分。[结果]临床路径治疗组的总体满意程度显著高于对照组;临床路径治疗组与满意度对照组除入院过程、医疗环境设施外,医疗/护理/辅助科室服务、医疗费用、诊疗结果和知情同意满意度得分均显著提高。[结论]临床路径在膝关节镜手术中是一种有效的管理工具,临床路径的实施可以提高患者对医院所提供医疗服务的满意程度。     

急性缺血性脑卒中临床路径管理模式的优化及实践

目的 评价优化后急性缺血性脑卒中临床路径管理模式的优越性.方法 随机选取医院实施急性缺血性脑卒中治疗临床路径管理优化前后收治的急性脑梗塞患者各200例,采用回顾性分析比较各组患者的相关指标.结果 路径优化管理后.患者诊疗等待时间缩短,疾病规范诊疗比率进一步提高,医护工作量大大减少,患者满意度进一步提高.结论 实施临床路径能够改善医疗质量,更好地利用医疗资源.临床路径优化后医疗质量进一步提高.     

临床路径在下肢静脉曲张患者护理中的应用体会

目的:探讨临床路径在下肢静脉曲张患者中的应用效果.方法:采用不同病例进行对照研究,对照组36例实施传统治疗和护理,观察组36例实施临床路径,比较两组患者的平均住院日、住院费用、满意度指标的差异.结果:实施临床路径后,观察组病人的平均住院天数、医疗费用下降明显,患者的满意度大幅度提高.结论:下肢静脉曲张患者实施临床路径能明显提高工作效率及护理质量,减少医疗费用,缩短住院时间.     

临床路径在神经根型颈椎病保守治疗中的应用与变异管理

目的 评价临床路径在神经根型颈椎病保守治疗中的应用效果。方法 通过制订临床路径,将实施临床路径前后病人的住院天数、医疗费用、健康知识评分、满意度进行比较并对出现的变异进行管理。结果 实施临床路径提高了医务人员工作的主动性,加强了医患沟通,使患者住院天数、医疗费用有所下降,健康知识掌握情况、满意度有所提高。统计学分析差异有显著性。结论 临床路径作为一种新型的医疗质量管理模式,值得在临床推广应用。临床执行过程中应注意对变异的管理。     

临床路径实施前后医疗费用对比分析

目的 对比分析临床路径实施前后各项医疗费用变化情况,评价临床路径的实施效果,为实施单病种付费提供研究基础.方法 采用病历回顾调查的方法,抽取我院临床路径实施前后大肠息肉、结节性甲状腺肿、腰椎间盘突出症住院病人的住院病历,采用t检验、秩和检验等统计方法对比分析其各项住院费用.结果 Wilcoxon秩和检验显示大肠息肉及腰椎间盘突出症住院病人临床路径实施前后的住院天数有统计学差异;大肠息肉临床路径实施前后人均住院总费用分别为5 758.60元、5 118.68元,差异具有统计学意义,临床路径实施后床位费、检查费、药费也显著低于实施前;结节性甲状腺肿临床路径实施后人均住院总费用10 509.91元,低于实施前的11 284.93元,差异具有统计学意义,检查费、药费及护理费在临床路径实施前后同样具有显著性差异,实施后费用显著低于实施前;腰椎间盘突出症临床路径实施前后人均住院总费用差异同样具有统计学意义,实施后为6 860.99元,较实施前有显著降低,临床路径实施后床位费、药费、手术费及其他费用低于实施前,差异具有统计学意义.结论 临床路径的实施有助于减少无效、低效住院日,控制住院天数,降低住院费用.     

某院腰椎间盘突出症临床路径的实施效果分析

[目的]研究某院腰椎间盘突出症临床路径的实施效果。[方法]采用文献查阅、专家访谈及专家论证等方法设计腰椎间盘突出症MED术临床路径文本,并采用历史对照法对比分析实施前后的效果。[结果]经t检验,临束路径组与对照组的平均住院天数、术后住院天数差异有统计学意义（P〈0．05）,路径组与对照组的平均住院费用、床位费及检查费差异有统计学意义（P〈0．05）,两组患者满意度差异有统计学意义（P〈0．05）。[结论]实施临床路径后在保证医疗质量的基础上,缩短了患者的平均住院时间、降低了平均住院费用、提高了患者的满意度。但在实施过程中仍存在一些问题,有待在以后的研究中不断改进并逐步完善。     

胆石症和慢性肾炎临床路径应用的初步评价

目的探讨手术病种慢性胆囊炎胆石症和非手术病种慢性。肾炎实施临床路径的可行性及意义。方法以实施临床路径的患者为研究组、随机选择未实施临床路径的患者为对照组进行对照研究;采用电话回访和发放调查表对患者及医护人员进行满意度调查研究,并对各组数据进行相关的统计学分析。结果实施临床路径患者的平均住院日、医疗总费用、药费、检查费均有不同程度的下降,手术费无明显差异,患者的满意度及医护人员的满意度均有不同程度的上升。结论实施临床路径对患者的医疗费用控制良好,患者及医护人员的满意度得到增加,对其他病种临床路径的实施也有一定的借鉴作用。     

临床路径在慢性阻塞性肺病患者护理中的应用评估

目的 评估临床路径在慢性阻塞性肺病患者护理中应用效果.方法 采用随机抽样的研究方法,将患者分成两组,每组60例.对照组实施整体护理,实验组在肺功能检测的基础上实施临床路径.将两组患者的平均住院天数、平均医疗费用及患者满意度进行比较.结果 肺功能应用于临床路径后,实验组病人的平均住院天数医疗费用下降明显,而患者的满意度有较大幅度的提高.两组患者比较有统计学差异.结论 肺功能应用于临床路径可合理使用有限的卫生资源,提高工作效率,保证护理质量.     

白内障进入临床路径后住院费用变化的研究

目的研究白内障病种进入临床路径后住院费用的变化。方法采用SPSS13.0统计软件中的t检验进行分析。结果缩短了平均住院日,降低了医疗费用。结论临床路径的实施规范了医疗行为,提高了患者满意度,降低了医疗成本,缓解了紧张的医患关系,为实现医疗预付费制度提供了理论依据。     

Patient satisfaction with hospital services: determinants and level in a hospital in Kuwait.

The present study used a well-tested patient satisfaction measuring instrument to identify the determinants of the level of overall satisfaction with hospital services, and to examine the level of satisfaction with attributes of 7 specific dimensions of hospital services. Using multiple regression analysis, it was found that out of 12 patient characteristics, age was the most important determinant of overall satisfaction, followed by gender. Perceived health status, clinical department, and expectations about the quality of services before admission were also significant but less important determinants of overall satisfaction. Marital status, level of education, nationality, and previous hospitalization in the study hospital, in Kuwait, or in a western country hospital, all had no significant effect on overall satisfaction. Concerning the effect of satisfaction with specific dimensions of hospital services on overall satisfaction, it was found that satisfaction with physicians was the most important determinant of overall satisfaction, followed by satisfaction with housekeeping and with nurses. Satisfaction with hospital environment and facilities and with admission process were also significant but less important determinants of overall satisfaction, while satisfaction with food and radiology services did not affect overall satisfaction. The level of overall satisfaction as well as satisfaction with specific dimensions of hospital services were quite high. Physicians' care was the most favorably rated dimension, followed by admission process and housekeeping, while nursing care was the least favorably rated dimension. Among the attributes of physicians' and nurses' care, technical care and courtesy were the most favorably rated items; while communication, particularly imparting of information, was the least favorably rated aspect. Several attributes of the hospital environment and facilities and of the food services were found to be dissatisfying to patients.     

护理组长在创优护理服务中的作用

目的探讨临床护理组长在耳鼻喉科创优护理服务中发挥的作用。方法选取具有主管护师以上职称、在科室工作年满10年以上者担任护理组长,实施病床分组责任制、护理床边工作制的护理模式,明确其岗位职责,强化创优意识,推进优质护理服务;比较实施前后1年病区综合护理质量、患者的满意度。结果通过护理组长在创优护理服务中参与制定预见性护理措施、加强护理风险管理、指导并解决护理业务技术难题、督导健康教育及质控工作,与相关的专业团队进行有效的沟通与协调,使住院患者满意度、护理服务质量有了明显提高,p<0.05,差异具有统计学意义。结论护理组长职能的良好发挥可激发各级护理人员的潜能,以减少医疗安全隐患,有效地提高患者满意度和护理质量,从而促进创优护理服务的实施。     

慢性病患者忠诚度现状及影响因素研究

目的了解慢性病患者忠诚度现状,并分析患者忠诚度的影响因素,为提高患者忠诚提供参考。方法选取2014年4月－2015年12月北京市20家市属医院住院患者满意度调查数据库中共计10 774例慢性病患者数据进行统计学描述并采用多元线性回归进行影响因素分析。结果北京市属医院慢性病患者忠诚度处于较高水平。年龄、户籍地址、总体满意度和感知服务质量中的治疗效果、医务人员态度、是否讲解出院后康复和服药方法、办理入院和出院手续便捷、病区环境安静整洁、签署知情同意书、注意保护隐私、膳食服务是患者忠诚度的影响因素。结论管理者和医疗服务提供者应针对性提高慢性病患者感知服务质量和总体满意度,从而培养患者忠诚。     

护理延伸服务在儿科出院保健中的应用

目的：探讨儿科出院保健中应用护理延伸服务的效果。方法：选取本院2012年8月-2014年8月正常出院的患儿160例作为研究对象,所有患儿家属皆签署知情同意书愿意配合本次研究,随机均分为研究组与对照组,各80例。对照组患儿出院后未予以护理延伸服务,而研究组患儿出院后则予以护理延伸服务,皆于出院后2个月进行电话随访,调查家属健康宣教知识掌握情况与满意度情况,并对比分析。结果：研究组出院后2个月随访结果显示,家属健康宣教知识掌握优良率与满意率皆明显高于对照组,组间比较差异有统计学意义（P〈0.05）。结论：将护理延伸服务应用在儿科出院保健中,可以帮助患儿家长出院后予以患儿更好的照料,同时能提高患儿家属对健康宣教知识的掌握率,并提高满意度,值得借鉴。     

优质护理服务在产科的实施与成效

目的探讨优质护理服务在产科的实施效果。方法自2010年3月起在产科实施优质护理服务,于实施前后对患者、医生、护士的满意度进行问卷调查,对科室护理工作质量进行考核,并将实施前后调查考核的结果进行比较。结果开展优质护理服务后,医生、患者、护士满意度及护理工作质量明显提高。结论在产科开展优质护理服务,有利于提高护理质量和医、护、患满意度。     

Factors determining inpatient satisfaction with care

The objective of the study was to identify factors associated with satisfaction among inpatients receiving medical and surgical care for cardiovascular, respiratory, urinary and locomotor system diseases. Two weeks after discharge, 533 patients completed a Patient Judgments Hospital Quality questionnaire covering seven dimensions of satisfaction (admission, nursing and daily care, medical care, information, hospital environment and ancillary staff, overall quality of care and services, recommendations/intentions). Patient satisfaction and complaints were treated as dependent variables in multivariate ordinal polychotomous and dichotomous logistic stepwise regressions, respectively. Patient sociodemographic, health and stay characteristics as well as organization/ activity of service were used as independent variables. The two strongest predictors of satisfaction for all dimensions were older age and better self-perceived health status at admission. Men tended to be more satisfied than women. Other predictors specific for certain dimensions of satisfaction were: married, Karnofsky index more than 70, critical/serious self-reported condition at admission, emergency admission, choice of hospital by her/himself, stay in a medical service, stay in a private room, length of stay less than one week, stay in a service with a mean length of stay longer than one week. The factors associated with inpatient satisfaction elucidated in this study may be helpful in interpreting patient satisfaction scores when comparing hospitals, services or time periods, in targeting patient groups at risk of worse experiences and in focusing care quality programs.     

浅谈医事法学视野下知情同意权的制度研究

知情同意权是医患关系的一项重要内容,它既是患者的权利,同时也是医生的义务.医疗知情同意的实现,有助于增进医患之间和谐的关系.要确保知情同意权的有效实现,不仅需要医患双方对知情同意的深入理解和正确认识,还需要相应的法律制度做保障.     

Implementing a Prospective Study of Women Seeking Abortion in the United States: Understanding and Overcoming Barriers to Recruitment

BackgroundThe Turnaway Study is designed to prospectively study the outcomes of women who sought—but did not all obtain—abortions. This design permits more accurate inferences about the health consequences of abortion for women, but requires the recruitment of a large number of women from remote health care facilities to a study a sensitive topic. This paper explores the Turnaway Study's recruitment process.MethodsFrom 2008 to 2010, the staff at 30 abortion-providing facilities recruited eligible female patients. Eight interventions were evaluated using multilevel logistic regression for their impact on eligible patients being approached, approached patients agreeing to go through informed consent by phone, and enrolled patients completing the baseline interview.FindingsAfter site visits, patients had roughly twice the odds of being approached by facility staff and twice the odds of then agreeing to go through informed consent. When all recruitment steps were considered together, the net effect of site visits was to increase the odds that eligible patients participated by nearly a factor of six. After the introduction of a patient gift card incentive, patients had over three times the odds of agreeing to go through informed consent. With each passing month, however, staff demonstrated a 9% reduced odds of approaching eligible patients about the study.ConclusionPrioritizing scientific rigor over the convenience of using existing datasets, the Turnaway Study confronted recruitment challenges common to medical practice-based studies and unique to sensitive services. Visiting sites and communicating frequently with facility staff, as well as offering incentives to patients to hear more about the study before informed consent, may help to increase participation in prospective health studies and facilitate evaluation of sensitive women's health services.     

Impact of a clinical pathway for stroke patients

OBJECTIVE: To assess the impact of the implementation of a clinical pathway for stroke patients. METHODS: We performed a controlled intervention study without random allocation that compared two non-concomitant cohorts of stroke patients corresponding to the periods immediately before (control group) and after (intervention group) the implementation of a clinical pathway. The main outcome measures were: a) quality of care indicators; b) improvements in functional capacity (Barthel score) and neurological function (Canadian scale); c) nosocomial complications; d) satisfaction, and e) mean length of hospital stay. RESULTS: One hundred and thirty-nine patients were recruited. Sixty-nine corresponded to the period before implementation of the pathway and 70 corresponded to the period after implementation. There were no significant differences between the two groups on admission. A 36.5% reduction in the time from admission to mobilization was observed. No significant differences were observed between the groups for the other quality of care indicators, or in improvements in functional and neurological capacity. Nosocomial complications occurred in 44.5% of patients in the control group compared with 28.6% in the intervention group (p = .039). No significant differences were observed in the overall satisfaction assessment, but patients in the intervention group showed greater satisfaction in the dimensions of "information" and "trust and professionalism". The mean length of hospital stay was reduced from 11 to 10 days. CONCLUSIONS: The implementation of the stroke clinical pathway contributed to reducing the length of hospital stay and the number of inpatient complications, as well as to improving some quality of care indicators.