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21.
Background
The public hospital reform in China was launched in April 2009. Whether patients are satisfied with medical services or not is an important index to measure the effectiveness of the public hospital reform. We aimed to explore whether patients experience improved medical service under the public hospital reform.Methods
Patient-reported experience measures (PREMs) were used to evaluate medical service performance. We designed a questionnaire to collect patient-reported experiences, using a scoring method based on a scale of one to ten, with one being very poor and ten being excellent. A total of nine urban public hospitals from four provinces (Fujian, Jiangsu, Anhui, and Shanxi) were selected for a field survey in August 2016. We chose two cities as sample sites in each province; one city that had undergone reform and one that had not. In addition, we chose Maanshan city from Anhui province (which underwent public hospital reform well from 2009) as our ‘typical’ sample city. In each city, the biggest general hospital was selected to participate in the study. We ran face-to-face interviews with 2633 patients (we planned to collect data from 200 outpatients and 100 inpatients in each hospital for a sample size 15 times the number of independent variables (20) from nine hospitals. Data were collected from outpatient and emergency patients who had just completed their treatment, inpatients who were being prepared for discharge, or patients who remained in hospital for more than one week. The age of participants was from 0 to 93 (surveys for children under the age of 15 were completed by their parents or guardians), 1199 (45·5%) were male, 1434 (54·5%) were female. We explored factors that might influence performance rating using single-factor analysis of variance and correlation analysis (for example, type of medical insurance, disease diagnosis, disease type, disease severity, and the public hospital reforming policy).Findings
A total of 2633 participants (a minimum of 268 participants from each hospital) were interviewed, including 1703 outpatients (64·68%) and 930 inpatients (35·32%). Overall, the evaluation of medical services was positive. Question relating to the relationship between doctors and patients had the highest score (7·986), whereas the lowest score was given for question relating to medical service quality and effectiveness (4·917). Question relating to medical costs had a lower score (6·882). The total performance scores differed significantly by patient type, age, sex, marital status, educational level, occupation, type of medical insurance, disease diagnosis, disease type, and disease severity.Interpretation
The patient–doctor relationship seems to have improved greatly since the initiation of the public hospital reform, but patients' experience of service quality and efficiency, and medical costs remain unsatisfactory. PREMs could reflect improvements to medical services as a result of the urban public hospital reform, and the public hospital reforming policy might improve the service efficiency and medical costs.Funding
The project is funded by the National Science Foundation of China (number 71473129). 相似文献22.
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支点弯曲位X线片预测脊柱侧凸三维矫形效果的价值 总被引：2，自引：0，他引：2
目的:评价支点弯曲位X线片在预测特发性脊柱侧凸患者脊柱矫形融合术效果的价值。方法:对37例特发性脊柱侧凸患者的43个结构性弯曲行术前站立位﹑仰卧侧屈位和支点弯曲位X线摄片,并与术后一周的站立位X线片比较。测量所有Cobb角并进行统计学评价。结果:胸弯组和腰弯组仰卧侧屈位平均Cobb角分别为43°和22°,支点弯曲位平均Cobb角分别为38°和19°,术后Cobb角分别为37°和19°。前路手术组和后路手术组仰卧侧屈位平均Cobb角分别为47°和13°,支点弯曲位平均Cobb角分别为42°和9°,术后Cobb角分别为41°和9°。严重侧弯组和中度侧弯组仰卧侧屈位平均Cobb角分别为52°和22°,支点弯曲位平均Cobb角分别为49°和19°,术后Cobb角分别为45°和20°。僵硬侧弯组和柔软侧弯组仰卧侧屈位平均Cobb角分别为51°和22°,支点弯曲位平均Cobb角分别为48°和17°,术后Cobb角分别为43°和19°。结论:支点弯曲位X线片比传统摄片能更好地评估特发性脊柱侧凸患者在脊柱矫形融合术中所获得的矫正效果,但对严重或较僵硬的侧凸矫形效果预测较差。 相似文献
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就南京市1981--1985年(简称前五年)及1986--1990年(简称后五年)居民的寿命表作了分析。结果提示:随着时间的推移,居民的各种寿命表指标均在发生改变,其中寿命表死亡概率、年龄别死亡率均不同程度在下降,而尚存率、预期寿命等均不同程度在提高。预期寿命男性由前五年的69.91岁增加到后五年的71.77岁,女性由73.81岁增加到75.43岁,明显高于全国同期水平。居民的尚存半数年龄亦由前五年的73.4岁后移至77.1岁,女性由74.6岁后移至78.4岁. 相似文献
29.
目的 应用动态四维CT血管造影(4D-CTA)评价急性缺血性脑卒中(AIS)患者脑侧支循环状态并分析患者脑侧支循环状态与其预后的相关性。方法 收集2020年1月至9月江苏省滨海县人民医院最终纳入研究的47例AIS患者的基线资料及影像学变量资料。所有患者均于发病4.5h内接受4D-CTA检查,应用多时相CTA(mCTA)脑侧支循环评分与区域软脑膜侧支循环(rLMC)评分对AIS患者脑侧支循环状态进行评估,并采用90d改良Rankin量表(mRS)评估其神经功能预后。根据mRS评分结果将患者分为侧支循环不良组(19例)与侧支循环良好组(28例)。采用SPSS 25.0软件分析数据,根据数据类型,分别采用χ2检验、t检验或秩和检验进行组间比较。采用Spearman相关分析各指标间的相关性。应用logistic回归分析影响AIS患者神经功能预后不良的指标,并进一步绘制受试者工作特征(ROC)曲线探讨不同指标的预测价值。结果 与侧支循环良好组相比,侧支循环不良组美国国立卫生研究院卒中量表(NIHSS)评分更高,半影体积(Tmax＞6s)及梗死核心体积(rCBF<30%)更大,错配比更小,mCTA评分、rLMC评分及90d mRS评分更低(P＜0.05)。mCTA评分与基线NIHSS评分、半影体积(Tmax＞6s)、梗死核心体积(rCBF<30%)、错配比呈负相关;与rLMC评分、90d mRS评分呈正相关。rLMC评分与基线NIHSS评分、半影体积(Tmax＞6s)、梗死核心体积(rCBF<30%)、错配比、90d mRS评分均呈负相关;与mCTA评分呈正相关。多因素logistic回归分析显示,mCTA评分、基线NIHSS评分均是预测AIS患者神经功能预后不良的指标。ROC结果显示,mCTA评分+基线NIHSS评分联合预测AIS患者神经功能预后不良的价值较单一指标更佳,ROC曲线下面积(AUC)为0.918,灵敏度为89.6%,特异度为92.4%。结论 mCTA评分+基线NIHSS评分预测AIS患者的神经功能预后具有更好的价值,当mCTA脑侧支循环评分≤3分、基线NIHSS评分＞5分时,预示AIS患者神经功能预后不良。 相似文献
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秦汉时期之伤寒热病理论溯源 总被引：1，自引：0，他引：1
张志斌 《上海中医药大学学报》2008,22(4):27-31
秦汉时期的伤寒热病概念,大致在“伤寒则病热”宗旨下发展。病名以伤寒为总称,包括狭义伤寒、中风、湿温、热病、温病,以及风温、暑病（中暑）、中湿,病因为伤寒。《内经》强调留邪病机,部位不一,提到三套辨证方法：六经辨证、皮肌骨热辨证及五脏热辨证。《难经》中提出“伤寒有五”。《伤寒杂病论》的论述重点放在中寒即发的＂伤寒＂方面,将其中的六经辨证法发展为灵活而相对完整的辨证论治体系。 相似文献