性别分析在医院服务质量评价和管理中的应用

目的通过住院病人体验和满意监测数据分析,探讨病人性别对医疗服务的期望和满意,以及对评价医疗服务质量的影响,为针对病人特点提供以患者为中心的医院服务提供科学的依据。方法北京的三所医院采用病人满意度监测工具VPSM对住院病人进行邮寄调查,对总体服务指数、各服务阶段质量指数,以及各监测项目进行病人性别间比较分析和统计检验。结果性别间的总体质量指数差异无显著性。各阶段质量指数中,男女病人的可及性和入院服务指数分别为2.98和2.72(p<0.05);男女病人的物理环境指数分别为2.86和2.49(p<0.01)。某些特定监测项目男病人的体验评价高于女病人。结论住院男女病人之间对住院服务体验和满意在总体上和大多数技术性服务方面是相同的,但女病人对人际服务质量和非医学服务,特别是入院服务和物理环境有较高期望。病人对服务体验和质量评价上的性别差别,提示特定病人具有的特定服务期望和需要,应有针对性地满足他们的需要,最大化地实现病人期望,不断提高医院整体服务水平。     

北京肿瘤医院住院病人满意度连续性监测

目的发现医疗服务中存在的问题,提出针对性的改进措施,以改善医疗服务质量。方法澳大利亚住院病人满意度监测工具(VPSM),采取随机抽样的方法,在2006年4月和12月分别抽取某一周所有的出院病人进行院外调查,分析2次监测住院病人观点的变化。结果与第一次调查相比,第二次调查时病人的总满意度、住院服务有效性评价、各服务质量指数等均有显著性提高。通过监测提出了在医院服务可及性、入院服务、物理环境、出院服务和随访等方面需要提高质量的建议,并通过第二次监测对医院有针对性的质量改进措施的效果进行了评价。研究还指出,在解释病人调查结果的时候应该考虑到年龄、性别、付费方式、住院日数和病人居住地等因素的影响。结论利用VPSM可以评价医院质量改进措施的效果以及进一步质量改进的重点。VPSM所采用的分析方法简单直观,可为管理者提供持续质量改进的科学证据。     

北京某综合医院住院患者满意度调查对比研究

目的建立一套符合我国国情、体现病人需要与期望的综合医院医疗服务满意度测评指标体系,为医院医疗服务质量的评价与改善提供客观的测量工具。方法采用北京大学医学部住院患者体验和满意监测（PKU—VPSM）工具及在其基础上改进的问卷,对北京某大型综合医院的住院患者进行信函问卷调查。结集2套问卷对比研究结果表明,2套问卷中在医生告知病情、住院流程、出院流程3道问题调查结果存在差异（P〈0．05）,其余配对调查问题均无明显差异（P〉0．05）。结论通过2套问卷调查结果对比研究表明,所设计的调查问卷能够客观地发现医院目前存在的问题,可以为医院医疗服务质量的评价与改进提供客观的测量工具与数据。     

PKU-VPSM工具在全面持续改进医疗服务质量中的价值

目的和方法北京大学医学部住院患者体验和满意监测(PKU-VPSM)工具是在维多利亚州患者满意监测(VPSM)的基础上开发出来的持续医院质量改进工具。2007年,北京大学医院管理研究中心使用该工具对北京地区3所大型综合医院实施了监测,并将其作为一个重要工具以辅助医院更好地持续改进服务质量。结果和讨论以被监测医院中的1所医院(A医院)为例,较为详细地介绍PKU-VPSM工具在应用PDCA循环法全面持续改进服务质量中的价值。PKU-VPSM可以在PDCA循环法的多个阶段发挥作用。     

北京某医院住院病人满意度和体验的中澳比较

介绍了北京某医院引进澳大利亚病人满意度监测方法．及其在试验阶段的初步结果．并与澳大利亚的病人满意度监测结果进行比较分析。在工具引进过程中．采用了测量工具开发模型．遵循心理测量学的基本原则．并利用相关利益集团参与的方法检验测量工具的适用性。结果发现．经过对测量工具的开发研究．澳大利亚的病人满意度监测工具可以适用于中国的医院。最后提出进一步完善的建议。     

PKU-VPSM工具在全面持续改进医疗服务质量中的价值

目的和方法北京大学医学部住院患者体验和满意监测(PKU-VPSM)工具是在维多利亚州患者满意监测(VPSM)的基础上开发出来的持续医院质量改进工具。2007年,北京大学医院管理研究中心使用该工具对北京地区3所大型综合医院实施了监测,并将其作为一个重要工具以辅助医院更好地持续改进服务质量。结果和讨论以被监测医院中的1所医院(A医院)为例,较为详细地介绍PKU-VPSM工具在应用PDCA循环法全面持续改进服务质量中的价值。PKU-VPSM可以在PDCA循环法的多个阶段发挥作用。     

北京地区3所大型综合医院住院患者体验和满意监测

目的了解北京3所大型综合医院的住院患者对医疗服务质量的看法和评价,为持续改进医疗服务质量提供科学依据。方法采用北京大学医学部住院患者体验和满意监测(PKU-VPSM)工具,对北京3所大型综合医院的住院患者进行信函问卷调查。结果3所医院的总体满意度平均得分为80.2分,医疗服务价值感知平均得分为74.4分,3所医院的总体服务质量指数平均得分为56.0分。结论3所医院为住院患者提供的服务和帮助总体上能够让广大住院患者满意和认可,反映出随着"医院管理年"和"创建人民满意医院"活动的持续开展,医院的服务水平和医患关系有了很大的进步和改善。虽然总体满意度得分接近或超过80分,但总体质量评价得分不到60分,说明医院服务质量仍然存在着较大的提升空间。     

北京地区3所大型综合医院住院患者体验和满意监测

目的了解北京3所大型综合医院的住院患者对医疗服务质量的看法和评价,为持续改进医疗服务质量提供科学依据。方法采用北京大学医学部住院患者体验和满意监测(PKU-VPSM)工具,对北京3所大型综合医院的住院患者进行信函问卷调查。结果3所医院的总体满意度平均得分为80.2分,医疗服务价值感知平均得分为74.4分,3所医院的总体服务质量指数平均得分为56.0分。结论3所医院为住院患者提供的服务和帮助总体上能够让广大住院患者满意和认可,反映出随着“医院管理年“和“创建人民满意医院“活动的持续开展,医院的服务水平和医患关系有了很大的进步和改善。虽然总体满意度得分接近或超过80分,但总体质量评价得分不到60分,说明医院服务质量仍然存在着较大的提升空间。     

住院病人满意度测评体系的研究

[目的]探索建立科学的住院病人满意度测评体系。[方法]采用专家经验法，通过数据统计分析，确定影响住院病人满意度的主要因素并测算其各自权重，设计住院病人满意度调查问卷，构建病人满意度计算公式，拟定满意度测评方案，建立住院病人满意度信息管理系统。[结果]初步建立了满意度测评指标体系。[结论]以现代管理科学理论建立的住院病人满意度评估体系可以科学、客观、全面的反映病人对医疗服务的真实满意程度，是持续改进服务质量的有效工具。     

某院住院患者满意度实证探析

目的 引入第三方进行患者满意度调查,旨在了解住院患者对医院医疗服务的满意情况,寻找影响患者满意度的根本因素,为医院管理者改进医疗服务质量提供参考.方法 对某县医院的120名住院患者或家属进行问卷调查,对个别住院患者或家属进行个人深入访谈.结果 住院病人对医院的总体满意度为83.70%.在各项满意度中,医德形象满意度最高,为83.70%;诊疗费用满意度最低,为77.17%.结论 坚持以病人为中心,对患者进行合理分层,对不同层次的患者开展多层次、多元化的服务,同时努力降低医院的诊疗费用、提高服务质量、改进医院环境和服务态度,是医院提高患者满意度的有效途径.     

Inter-regional competition and quality in hospital care

This study analyzes the effect of episode-of-care payment and patient choice on waiting time and the comprehensive quality of hospital care. The study assumes that two hospitals are located in two cities with different population sizes and compete with each other. We find that the comprehensive quality of hospital care as well as waiting time of both hospitals improve with an increase in payment per episode of care. However, we also find that the extent of these improvements differs according to the population size of the cities where the hospitals are located. Under the realistic assumptions that hospitals involve significant labor-intensive work, we find the improvements in comprehensive quality and waiting time in a hospital located in a small city to be greater than those in a hospital located in a large city. The result implies that regional disparity in the quality of hospital care decreases with an increase in payment per episode of care.     

中国县级公立医院医保支付方式改革与医院控费策略研究

目的：分析六省部分县级公立医院医保支付方式与医院控费策略的实施情况,探讨医保支付方式与医院控费策略选择之间的相关性,为改进医保支付方式,优化医院控费策略提供建议。方法：采用问卷调查的方式收集并描述样本医院医保支付方式和医院控费策略情况,采用Stata 14.0软件进行数据统计和分析,探究二者之间相关性。结果：按项目付费、总额预付和按病种付费是最主要的支付方式。样本医院采取的控费策略主要有费用控制策略、限制供应策略、质量管理策略等,且其中更多的医院选择了质量管理策略,不同支付方式下的控费策略选择具有显著性差异。结论：医保支付方式和医院控费策略选择之间存在相关性,建议在制定支付方式相关政策时,配套合理医院控费策略降低医院费用超支风险。     

金寨县参合农民新型农村合作医疗制度满意度分析

目的：为了解农民对新型农村合作医疗制度（新农合）的满意情况,分析其影响因素,并提出合理建议,对安徽省金寨县参合农民的满意度进行调查。方法：对安徽省金寨县的部分乡村采用分层抽样抽取了354位农民,运用有序Logistic回归模型分析相关因素。结果：与农民新农合满意度相关的因素有住院报销比例满意、医院服务质量和态度、定点医院付款时间、定点医院条件,统计学意义显著（P〈0.01）。结论：改善医院服务质量和态度,缩短定点医院付款时间,提高住院报销比例及改善定点医院的条件均可提高农民对新农合的满意度。     

Measuring hospital input price increases: the rebased hospital market basket

The input prices indexes used in part to set payment rates for Medicare inpatient hospital services in both prospective payment system (PPS) and PPS-excluded hospitals were rebased from 1982 to 1987 beginning with payments for fiscal year 1991. In this article, the issues and evidence used to determine the composition of the revised hospital input price indexes are discussed. One issue is the need for a separate market basket for PPS-excluded hospitals. Also, the payment implications of using hospital-industry versus economywide measures of wage rates as price proxies for the growth in hospital wage rates are addressed.     

Patient satisfaction in Bangkok: the impact of hospital ownership and patient payment status.

INTRODUCTION: Patient satisfaction with care received is an important dimension of evaluation that is examined only rarely in developing countries. Evidence about how satisfaction differs according to type of provider or patient payment status is extremely limited. OBJECTIVE: To (i) compare patient perceptions of quality of inpatient and outpatient care in hospitals of different ownership and (ii) explore how patient payment status affected patient perception of quality. METHODS: Inpatient and outpatient satisfaction surveys were implemented in nine purposively selected hospitals: three public, three private for-profit and three private non-profit. RESULTS: Clear and significant differences emerged in patient satisfaction between groups of hospitals with different ownership. Non-profit hospitals were most highly rated for both inpatient and outpatient care. For inpatient care public hospitals had higher levels of satisfaction amongst clientele than private for-profit hospitals. For example 76% of inpatients at public hospitals said they would recommend the facility to others compared with 59% of inpatients at private for-profit hospitals. This pattern was reversed for outpatient care, where public hospitals received lower ratings than private for-profit ones. Patients under the Social Security Scheme, who are paid for on a capitation basis, consistently gave lower ratings to certain aspects of outpatient care than other patients. For inpatient care, patterns by payment status were inconsistent and insignificant. CONCLUSIONS: The survey confirms, to some extent, the stereotypes about quality of care in hospitals of different ownership. The results on payment status are intriguing but warrant further research.     

Association of hospital ownership with patient transfers to outpatient care under a prospective payment system in Taiwan

Case payment, a prospective payment system akin to diagnosis-related groups (DRGs) has in-built incentives for hospitals to transfer inpatients to their own ambulatory care units following early discharge. This study used nation-wide inpatient claims data on a total of 100,730 patients treated in 2000 in (Taiwan): cesarean section (59,364 cases), femoral/inguinal hernia operation (18,675 cases), and hemorrhoidectomy (22,691 cases), all reimbursed by case payment, to explore the relationship between hospital ownership and patient transfers to outpatient treatment. For all three diagnoses, for-profit (FP) hospitals not only had lower lengths of stay (LOS) compared to public hospitals, but also showed very high odds of patient transfer to their own outpatient units, after controlling for institutional variables, (hospital level, teaching status, and geographic location), hospital competitive environment (the Herfindal-Hirschman index), and patient variables (gender, age, length of stay, and number of secondary diagnoses, a proxy for severity of illness). Similar, though slightly lower odds were observed with not-for-profit (NFP) hospitals relative to public hospitals. The findings support the property rights theory, suggesting that in Taiwan, institutional profit maximization motives may be driving patient transfers under the case payment diagnoses, rather than medical care needs. In NFP hospitals, their physician compensation mechanism, driven largely by care volumes provided by each physician, appears to be driving the disproportionately greater likelihood of patient transfer to outpatient care.