基于住院患者体验的地市级公立医院服务质量研究

[目的]分析地市级公立医院住院患者在医疗技术、医德医风、服务态度、流程管理、医疗费用、就医环境等方面的就医体验,对地市级公立医疗服务质量进行科学评估,为进一步提高地市级公立医院服务质量提供依据。[方法]从某市域内选取4家公立医院的518名患者进行面对面问卷调查。采用描述性分析方法、Friedman M秩和检验、Pearson相关分析方法了解样本基本情况和住院患者对服务质量的体验评价情况,采用t检验、方差分析、Kruskal-Wallis检验和多元线性回归分析方法探讨影响住院患者总体体验的主要因素。[结果]地市级公立医院住院患者服务质量总体体验得分为(3.36±1.75)分,6个维度体验感得分依次为:医德医风>服务态度>医疗技术>流程管理>医疗费用>就医环境;年龄、职业类别、医生技术水平、杜绝索礼受贿、护士态度和善、合法权益保护、住院费用明白合理、等待入院天数、住院环境安静和住院费用可承受是影响住院患者体验的主要影响因素(P<0.05)。[结论]地市级公立城市住院患者服务质量体验评价处于一般水平,对医德医风的体验感较高,对住院环境和住院费用可承受的体验感较差。总体来说,年龄越大,住院患者体验越低;职业类别、医生技术水平、杜绝索礼受贿、护士态度和善、合法权益保护、住院费用明白合理、等待入院天数、住院环境安静和住院费用可承受是影响住院患者总体体验的正性因素。     

以病人为中心构建病例质控平台——重点病人安全一般病人满意的质控艺术

探寻质控单元是医院与主管部门长期以来关心的课题。以病人为中心改进服务，要求以病例为质控单元。通过多角度分型，识别病人的需要，抓住重点病人。要制订分型标准，由粗到细，不断完善。要建立两点一线动态分型流程，住院全程分型，全程质控。要进行病例质量评价，激励医生护士管好分管的第一位病人。     

深圳市门诊和住院服务满意度评估及比较分析

目的：测量和评估患者对医疗卫生服务的满意度，为政府部门和医院改善患者满意度提供政策依据和建议。方法：对深圳市15家医院的门诊患者（n=1057）和住院患者（n=666）进行满意度问卷调查，应用描述性分析方法、Likert标准评分法、方差分析、主成份分析等研究方法评估满意度及其影响因素。结果：①评分情况：门诊、住院满意度总得分分别为63.45和84．27。门诊满意度评分与住院满意度评分有显著性差异，后者高于前者；②主成份分析：服务态度、服务质量、服务交流、医患关系是医院门诊和住院服务重要建设内容；结论：深圳市医院门诊服务患者满意度较低，处于一般的水平，而住院服务患者满意度较高。     

精神分裂症患者口腔卫生健康状况调查

目的了解并分析不同住院时间精神分裂症患者的口腔卫生保健状况。方法随机选择100例长期住院的精神分裂症患者,住院时间1～5年和5年以上患者各50例。采用WHO推荐的龋病、牙周病调查标准,对两组患者进行口腔健康调查研究。结果两种住院时间精神分裂症患者的口腔保健和口腔卫生习惯均较差。住院时间5年及5年以下患者患龋率、人均失牙、牙列完整率,均好于5年以上组。结论长期住院的精神分裂症患者的口腔卫生状况很差,龋病、牙周病和牙缺失情况较严重。对于长期住院的精神分裂症患者的口腔卫生状况,医疗机构积极的治疗和预防措施是必要的,也希望得到家庭和社会的关注。     

武汉市肺结核患者直接医疗费用及其影响因素

  目的  通过对2011-2018年武汉市1.7万例肺结核患者直接医疗费用及其影响因素分析,研究肺结核患者疾病医疗负担,为结核病患者相关保障政策优化提供依据。  方法  对125万条医保结算信息使用秩和检验,对住院、门诊直接医疗费用分组分析;使用多元线性回归和广义线性估计模型,对患者单次住院及年费用进行多因素分析。  结果  次均门诊、次均住院、年人均直接医疗费用依次为147.51元、8 849.57元、9 607.01元,次均门诊报销比6.36%,住院报销比为67.56%。患者性别、年龄、医保类型、医院级别、是否进行手术、是否使用中药及就医发生年份为直接医疗费用的主要影响因素（均有P < 0.01）。  结论  现有肺结核患者住院医疗费用在可负担范围内,贫困结核患者疾病负担较重,结核治疗周期长,门诊保障不足,亟待出台有针对性的门诊报销统筹政策。     

An economic analysis of varicella vaccination for health care workers.

A simulation model was constructed to assess the relative costs and cost-effectiveness of different screening and vaccination strategies for dealing with hospital incidents of varicella exposure, compared with current policies, using data from published sources and a hospital survey. The mean number of incidents per hospital year was 3.9, and the mean annual cost of managing these incidents was pounds 5170. Vaccination of all staff would reduce annual incidents to 2.2 at a net cost of pounds 48,900 per incident averted. Screening all staff for previous varicella, testing those who are uncertain or report no previous varicella, and vaccinating those who test negative for VZV antibodies, reduces annual incidents to 2.3 and gives net savings of pounds 440 per incident averted. Sensitivity analyses do not greatly alter the ranking of the options. Some form of VZV vaccination strategy for health care workers may well prove a cost-effective use of health care resources.     

Audit of deaths in general practice: pilot study of the critical incident technique.

OBJECTIVE--To develop and pilot a method for conducting an audit of deaths in general practice by the critical incident technique. DESIGN--Prospective use of the technique within a primary health care team, with the aid of a facilitator, to analyse the events surrounding patients' deaths. SETTING--One inner city academic general practice. PARTICIPANTS--Practice team, comprising general practitioners, trainee, practice manager, practice nurse, and attached health visitor and district nurses. MAIN MEASURES--Identification and classification of critical incidents associated with the case studies of eight recently decreased patients in the practice and subsequent impact on the practice. RESULTS--Among the eight case studies, 57 critical incidents were identified (mean 7.1 per case, range 2 to 15). A failure of communication was the most common factor identified in incidents giving rise to concern, but positive factors in patient care were also identified. Changes in practice included developing protocols for follow up of bereaved relatives and carers and a checklist to ensure completion of administrative follow up tasks resulting from the patient's death; cases of recent deaths and terminally ill patients were reviewed monthly. The practice team found the method acceptable and felt that the discussions had provided useful opportunities for reflecting on their role in patient care. CONCLUSIONS--The critical incident technique fulfils the needs of an audit of deaths in general practice; however, further evaluation based on more cases from different practices is now required.     

Comparing public and private hospital care service quality in Turkey

PURPOSE: The aim of this article is to examine the differences in service quality between public and private hospitals in Turkey. DESIGN/METHODOLOGY/APPROACH: This study applies the principles behind the SERVQUAL model and compares Turkey's public and private hospital care service quality. The study sample contains a total of 200 outpatients. Through the identification of 40 service quality indicators and the use of a Likert-type scale, two questionnaires containing 80-items was developed. The former measured patients' expectations prior to admission to public and private hospital service quality. The latter measured patient perceptions of provided service quality. FINDINGS: The results indicate that inpatients in the private hospitals were more satisfied with service quality than those in the public hospitals. The results also suggest that inpatients in the private hospitals were more satisfied with doctors, nurses and supportive services than their counterparts in the public hospitals. Finally, the results show that satisfaction with doctors and reasonable costs is the biggest determinants of service quality in the public hospitals. ORIGINALITY/VALUE: Consequently, SERVQUAL, as a standard instrument for measuring functional service quality, is reliable and valid in a hospital environment.     

三级综合医院患者无效住院日影响因素研究

目的分析患者无效住院日影响因素,降低无效住院天数,减轻患者负担,提高三级综合医院服务效率和质量。方法采用文献分析法选取三级综合患者无效住院日影响因素指标集,运用德尔菲法构建三级综合医院患者无效住院日影响指标体系。结果参与咨询的专家权威程度平均为0.868 3,通过两轮专家咨询,最终得出21个三级综合医院患者无效住院日影响因素,其中医方11个、患方6个、社会方面4个。结论将患者无效住院日影响因素分为医方、患方、社会三个层面,针对不同影响因素,采取应对策略,最终提高医疗资源利用效率,降低患者住院经济负担。