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1.
[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。 相似文献
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《L'Encéphale》2019,45(2):107-113
IntroductionIn psychiatric inpatient settings seclusion is a last resort to ensure the safety of the patient, other patients, and staff from disturbed behaviors. Despite its major interest for patients, seclusion could negatively impact treatment adherence and patient/staff relationships. Indeed, some secluded patients report a feeling of guilt during the measure and do not consider seclusion to be a healthcare intervention. To be more beneficial and to reduce the feeling by patients of being forced, seclusions should be as short and rare as possible. In other words, measures to reduce seclusion are available and have been clearly identified. Such measures could be applied, in the first instance, in patients with longer duration. In this way, the aim of this study was to investigate predictive factors of a seclusion of long duration.MethodsOur study was based on the dataset of the EPIC study, an observational prospective French multicenter study of seclusion and restraint. The EPIC study occurred in seven French psychiatric hospitals in the southern region of Paris. Inclusions were realized for 73 days and allowed a data collection of 302 seclusion measures. Of these measures 236 were effectively a seclusion in a standardized room. Because the median duration was 7 days, we defined two groups of patients: duration < 7 days and duration ≥ 7 days. Our variable to be explicated was duration ≥ 7 days. Explicative variables available in EPIC study were age, sex, forced hospitalization, autoagressivity, heteroagressivity, use of sedative treatment (oral or intramuscular), history of seclusion and patient diagnoses. We used bivariate and multivariate analyses to explore the association between a seclusion duration ≥ 7 days and explicative variables. Diagnoses were classified as psychotic disorders, mood disorders and others diagnoses. To be included in multivariate logistic regressions, diagnoses were treated as dummy variables (mood disorder vs psychotic disorders; psychotic disorders vs others; mood disorders vs others). Statistical analyses were performed using SPSS software 20.0 and R 3.4.0.ResultsOf the 236 measures of seclusion the mean age was 38.2 (±12.8), 196 (83%) patients were forcibly hospitalized prior to their seclusion, 147 (62%) had a diagnosis of psychotic disorder, 43 (18%) a diagnosis of mood disorder and 33 (14%) an “other diagnosis”. Mean duration was 10.2 (1.5) days and median was 7.1 days. One hundred and thirty-five (47%) patients were in the group of duration ≥ 7 days. In bivariate analyses, variables associated with a duration ≥ 7 days were: being in forced hospitalization prior to the seclusion (P = 0.04), administration of a sedative treatment (P = 0.01) and against the group of others diagnoses the diagnosis of mood disorders (P < 0.0005) and psychotic disorders (P = 0.001). Multivariate analyses showed that, against the group of other diagnoses, the group of psychotic disorders [OR = 3.3, CI 95% (1.3–8.4), P = 0.01], the group of mood disorder [OR = 2.7, CI 95% (1.4–4.9), P = 0.002] and administration of sedative treatment [OR = 8.1, CI 95% (2.0–32.5), P = 0.003] were significantly associated with a duration ≥ 7 days. These results were independent from other confusion variables. Considering the hospitalization status, psychotic disorders was the only diagnosis which showed an association between duration ≥ 7 days and forced hospitalization [OR = 2.9 CI 95% (1.1–7.8), P = 0.03].ConclusionOur study highlighted two profiles of higher risk to remain ≥ 7 days in seclusion. The first one is patients with a diagnosis of mood disorder who needed sedative treatment. The second one is patients with a diagnosis of psychotic disorder who needed sedative treatment and forced hospitalized before seclusion. Thus, these two profiles could be a good target to practice, in the first instance, measures to reduce seclusion duration in psychiatry settings. 相似文献
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Tina Hsu Nitya Nathwani Matthew Loscalzo Vincent Chung Joseph Chao Chatchada Karanes Marianna Koczywas Stephen Forman Dean Lim Tanya Siddiqi Anthony Stein Przemyslaw Twardowski Auayporn Nademanee Sumanta Pal Eduardo Siccion Marjorie Hein Chie Akiba Leanne Goldstein David Smith Huiyan Ma Tao Feng Arti Hurria 《Journal of the American Geriatrics Society》2019,67(5):978-986
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目的探讨基于患者参与框架的住院老年患者跌倒预防干预策略的实施效果。方法根据住院时间将2019年1~6月收治的58例老年患者作为对照组,2019年7~12月收治的58例作为观察组。对照组按常规实施预防跌倒措施,观察组基于患者参与框架制订并实施住院老年患者跌倒预防干预策略,包括“告知、参与、赋权、合作及电子化信息支持”五部分内容。比较干预前后两组参与跌倒预防知信行水平、跌倒效能水平及跌倒发生率。结果干预后观察组参与跌倒预防知识、态度及行为得分和跌倒效能得分显著高于对照组(P<0.05,P<0.01);观察组住院期间无跌倒发生,对照组发生2例。结论基于患者参与框架实施预防住院老年患者跌倒干预策略,可提高患者参与跌倒预防知信行水平和跌倒效能,降低跌倒发生率,保障患者安全。 相似文献
6.
目的构建住院患者护理难度评价指标体系,为精准评估护理工作量提供工具。方法通过文献回顾及半结构式访谈初步制订住院患者护理难度评价指标体系,采用德尔菲法对28名专家进行两轮函询。结果确立的评价指标体系包含6项一级指标(疾病严重程度、日常生活自理能力、精神心理状况、依从性、社会支持状况和期望值)及所属的21项二级指标。专家积极度为100%,专家权威系数为0.840,专家意见协调程度一、二级指标分别为0.462、0.414(均P0.01)。结论构建的住院患者护理难度评价指标体系可信度较高,进一步验证后可用于护理工作量的精准评价。 相似文献
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目的:应用智能药柜(ADC)建立住院患者用药分散调剂模式,缩短用药医嘱执行时间,提高药师、护士工作效率,提升药品管理质量。方法:介绍某院ADC分散调剂模式的构建方法及取得的效果。结果:ADC分散调剂模式实现了缩短住院医嘱执行时间,提高药师、护士工作效率,提高病区药品管理质量的目标。结论:全院范围应用ADC分散调剂在我国尚属较新的管理模式,还需要积累总结经验,优化工作流程,完善质量控制体系,让这种模式的优势得到更充分的体现,让药师可以借助信息化管理手段将更多精力用于专业技术性工作,实现工作模式转型。 相似文献
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目的 探讨影响住院行结肠镜诊疗老年患者肠道准备质量的主要因素,分析相应因素下肠道准备不充分的风险分级及参考界值。方法 回顾性分析在解放军总医院第二医学中心住院行结肠镜诊疗的患者病例资料,包括基本资料、基础疾病、肠道准备相关情况及肠道准备质量,采用病例对照研究,进行单因素分析及多因素回归分析探讨肠道准备质量的影响因素。结果 共160例患者纳入研究,肠道准备合格率为71.25%,多因素回归分析显示,年龄(OR=0.899,P<0.001)、排便次数(OR=2.223,P<0.001)及肠道准备方案(OR=0.275,P=0.007)是老年住院行结肠镜诊疗患者肠道准备质量的独立影响因素。进一步分层分析,<60岁、60~79岁、≥80岁各年龄段肠道准备合格率递减,排便次数<5次、5~6次、≥7次各段肠道准备合格率明显递增。结论 以60岁和80岁为肠道准备不充分的风险预测参考界值,随着年龄增长肠道准备不充分的风险倍增;肠道准备合格率随排便次数增多而升高,以排便5次和7次划分肠道准备不充分的风险等级具有临床价值;分次肠道准备方案能提高肠道准备的质量。 相似文献
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Nandini Datta PhD Jennifer Derenne MD Mary Sanders PhD James D. Lock MD PhD 《The International journal of eating disorders》2020,53(11):1774-1779
The 2019 novel coronavirus disease (COVID-19) pandemic has forced many eating disorder medical stabilization units to consider adjustments that uphold both the quality of care delivered to patients while also observing social distancing public health directives for patients and staff. To date, inpatient facilities for eating disorders (both medical stabilization units and higher level of care facilities) have not needed to consider how to translate services to electronic platforms, given that most of these programs have in-person staff. We outline our transition to telehealth broadly, emphasizing some unexpected benefits of using telehealth services that we plan on integrating into our work-flow post COVID-19. These may be useful for other higher level of care eating disorder programs, including medical stabilization units, residential, partial hospitalization, and intensive outpatient programs. We also highlight aspects of transition that have been more challenging for this particular patient population, warranting the need for in-person services. 相似文献