基于患者类型的医患沟通与患者就医感知价值关系研究

沟通性是患者就医感知价值的重要指标因素。文章通过在台州医院进行的实证研究,对医患沟通与患者就医感知价值的关系进行了深入分析,检验了医患沟通与患者就医感知价值间的正相关性。同时,以学历高低、有无不愉快经历为维度,对患者进行分类,检验了患者类型对两者关系的调节作用,探讨了学历高低、有无不愉快经历对患者就医感知价值评价的影响。     

国内外患者就医感知价值研究述评

患者就医感知价值研究是顾客感知价值理论在医疗服务领域研究的延伸.现有的研究主要集中在就医感知价值内容、就医感知价值测量以及患者行为关系影响三个方面.整体来看,国外的患者就医感知价值研究层次与当前的顾客感知价值研究基本保持同步,即已进行到了价值测量和行为关系深入探究阶段.而国内主要停留在概念导入和观点探讨阶段,严重滞后于国外研究和国内其他服务管理领域的相关研究.     

患者就医等候时间、就医便利性和就医感知价值关系研究

文章针对患者就医感知价值中的“看病难”问题,围绕患者就医等候时间、就医便利性和就医感知价值的关系展开理论研究,并结合台州医院的案例进行了实证检验。研究发现,在知名度较高的大型医院里,患者个人时间充裕程度与就医感知便利性无相关性,患者就医感知便利性与就医感知价值呈正相关性;患者个人就医时间充裕程度与就医感知价值无相关性,而患者特征对其时间充裕程度、就医感知便利性有一定影响。     

基于需求层次理论的异地互联网医疗患者感知价值体系的构建△

目的：构建基于需求层次理论的互联网医疗患者感知价值体系。方法：利用文献分析法和异地患者价值需求调查问卷结果，初步形成互联网医疗患者感知价值的相关评价指标。利用李克特五级量表设计咨询调查问卷，采用德尔菲法对35名专家进行两轮问卷咨询，采用层次分析法进行各项指标权重排序，采用权威系数检验专家咨询的可靠性。结果：经过两轮专家咨询后，确定包含5个一级指标（生存、安全、社交、尊重、自我价值）、10个二级指标（名誉价值、精神价值、技术价值等）、28个三级指标的互联网医疗患者感知价值指标体系。结论：构建的指标体系具有较高的科学性、稳定性和社会意义，能够切实反映患者互联网医疗的价值需求及感知，为进一步构建“以患者为中心”的互联网诊疗模式提供理论基础。     

一站式医疗结算项目应用效果分析

目的分析上海某三甲医院一站式医疗结算项目的医疗服务现状,评价该项目的实际应用效果。方法选取最新患者信息数据和近5年门诊时间序列数据,以患者地域年龄构成和挂号人次、结算人次、充值人次、充值数额等为研究指标,对该院一站式医疗结算项目现状进行分析,并提出对策建议。结果该院所应用的一站式医疗结算项目逐渐得到患者认可,使用频率逐年上升,为患者提供了便捷就医服务。但由于患者预存金额普遍较低,影响了最优流程的实现。结论加大宣传力度,通过多种方式推广一站式医疗结算方式,切实缓解患者就医矛盾。     

影响新老患者就医感知价值因素的实证研究——以台州医院为例

新老患者就医时的价值感知存在一定差异，医疗机构需要针对这种差异采取不同的服务策略，才能有效提升医疗服务质量。文章采用理论研究结合实证调研的方法，调查了新老患者在就医感知价值上的差异，分析了产生这些差异的影响因素，在基础上，给出了医疗机构有效提升服务质量的策略建议。     

台州医院——浙江大学医院管理研究基地

自2005年开始，浙江省台州医院与浙江大学的研究人员展开医院管理领域的研究合作，共同探索在中国医疗情境下提升医院管理水平的理论和实践方式方法。研究学科带头人为浙江省台州医院陈海啸教授和浙江大学张大亮教授，研究范围涉及到医疗质量改进、临床路径应用、患者满意度评价、患者就医感知价值、医患关系、医院知识管理、医院发展战略等领域。     

基于ACSI和ECSI模型的住院患者满意度影响因素研究

目的利用美国顾客满意度指数(ACSI)和欧洲顾客满意度指数(ECSI)模型,研究住院患者满意度的因子构成和效应值,构建住院患者满意度评价模型,分析影响住院患者满意度的相关因素。方法通过查阅文献和咨询相关专家,自行设计住院患者满意度调查问卷。采用偶遇抽样法进行问卷调查,并对问卷进行信度、效度分析。结果住院患者满意度评价模型包含了医院形象、患者期望、感知质量、感知价值和患者满意度5个变量。感知质量对患者满意度的影响最大,总效应值为0.905,医院形象和感知价值的总效应值分别为0.394和0.588,患者期望对患者满意度的直接效应为负面效应(效应值-0.226),间接效应为正面效应(效应值0.696),总效应值为0.470。结论在医疗服务活动中,可以通过患者期望、感知质量和感知价值3个途径提高患者满意度,其中以提高感知质量为重点。同时医生应尽可能详细地为患者解释病情,让患者参与诊疗计划的制定。     

多元主体治理视角下患者就医获得感影响因素研究

目的分析政府、公立医院、社会多元主体对患者就医获得感的治理作用及影响,为增强患者就医获得感乃至进一步协同提升患者满意度提供借鉴及思考。方法采用定额抽样的方法对浙江省15家城市和县级公立医院的住院患者进行问卷调查,通过多重线性回归分析患者就医获得感的治理影响因素。结果政府对医疗服务公平性问题改善情况、居住地医疗机构整体规划和布局合理性、分级诊疗政策引导效果等因素影响患者就医获得感(P<0.05),医院公平公正处理医疗纠纷、对基层医疗卫生机构转诊提供便利以及为患者提供便利畅通的投诉渠道影响患者就医获得感(P<0.05),社会公众积极主动向政府反映医患双方意见及诉求、社会专业组织发挥医疗行业行为自律和内部监督职责、患者对当前医生群体所处社会医疗环境看法等因素影响其就医获得感(P<0.05)。结论可以通过推动政府切实履行职责、提升医院管理水平和调动社会公众参与治理积极性以协同增强患者就医获得感。     

医疗服务满意度影响因素分析

通过构建患者满意度的概念模型,分析影响患者对医疗服务满意度的八个因素,即需求、期望、感知绩效、感知价值、需求满足、患者满意度患者忠诚和医院声誉,结合医疗行业的特性对这些变量设立度量指标,根据调查所得数据,利用SPSS 13.0和AMOS 17.0工具,分析这些因素的影响路径及程度。     

患者价值差异模型的构建及启示

患者价值是顾客价值理论在医疗领域的延伸,由于医疗行业的特殊性,患者和医生在不同的角度对患者价值的理解具有差异。通过剖析患者价值维度,构建了患者价值差异模型,探索医疗服务提供方与患者在患者价值方面存在的差异。根据模型启示,提出将患者价值纳入患者满意度评价范畴,注重患者情感需要来提高患者感知价值,以及将患者价值纳入制度化建设从而实现患者价值与医疗机构价值的统一。     

患者医疗服务价格感知机理与影响因素研究

文章聚焦于患者医疗服务价格感知的影响因素及其影响机理,采用理论与实证研究方法,探寻了把握患者医疗服务价格感知影响因素的具体方法,并根据研究结果提出了以患者类型及医疗服务项目类型为维度的改善患者医疗服务感知价值的管理策略。     

Factors related to patients' satisfaction with their medical care

Patient satisfaction has become a frequently researched outcome measure of the quality of health-care delivery. This article reviews research of patient satisfaction after recent, identifiable medical care visits. Results of the reviewed studies are grouped into 13 factors of the medical care setting and of the physicians' competence and relationships to their patients which may be related to patient satisfaction. The factors with the clearest relationship to satisfaction include the accessibility of medical care, the organizational structure of clinics, treatment length, perceived competence of physicians, clarity and retention of physicians' communication to patients, physicians' affiliative behavior, physicians' control, and patients' expectations. Other factors with more complicated or no apparent relationship to satisfaction were mode of payment, clarity of patients' communication to physicians, physicians' personality, patients' sociodemographic characteristics, and patients' health status. The additive and potential interactive effects of these factors are discussed. Additional studies of the interactive aspects of the physician-patient raltionship are encouraged, and implications for further research are presented, with emphasis on sampling, measurement, and design issues.     

Tales of time, terms, and patient information-seeking behavior-an exploratory qualitative study

This study explores patients' and physicians' perceptions of the use of medical terminology in patient-physician communication. Perceptions of time emerge as an overarching theme and the relationships between perceived time pressures and medical terms are analyzed. Data for this qualitative exploratory study were collected in 28 semistructured interviews with native and nonnative English-speaking physicians and patients. Interviews were recorded, transcribed and analyzed in NVivo 8, applying principles from grounded theory. Participants commonly perceived time pressures on consultations. Findings indicate that together, perceived time pressures and medical terminology influence patient participation and the development of rapport in medical encounters. Patient information-seeking behavior was reported to be lower in short, terminology-dense consultations and increased in longer, terminology-sparse consultations. Data suggest that monitoring the use of medical terms in combination with taking time to provide appropriate explanations can function as a partnership-building strategy. Physicians who adopt this strategy could foster better patient-physician relationships and facilitate increased patient information-seeking behavior.     

Tales of Time,Terms, and Patient Information-Seeking Behavior—An Exploratory Qualitative Study

This study explores patients' and physicians' perceptions of the use of medical terminology in patient–physician communication. Perceptions of time emerge as an overarching theme and the relationships between perceived time pressures and medical terms are analyzed. Data for this qualitative exploratory study were collected in 28 semistructured interviews with native and nonnative English-speaking physicians and patients. Interviews were recorded, transcribed and analyzed in NVivo 8, applying principles from grounded theory. Participants commonly perceived time pressures on consultations. Findings indicate that together, perceived time pressures and medical terminology influence patient participation and the development of rapport in medical encounters. Patient information-seeking behavior was reported to be lower in short, terminology-dense consultations and increased in longer, terminology-sparse consultations. Data suggest that monitoring the use of medical terms in combination with taking time to provide appropriate explanations can function as a partnership-building strategy. Physicians who adopt this strategy could foster better patient–physician relationships and facilitate increased patient information-seeking behavior.     

Factors impacting perceived threat of malpractice lawsuits by various medical specialists

A study was undertaken to examine perceived threat of malpractice lawsuits affecting different physician specialties and to examine factors that impact such perceptions of those specialties. The study used data collected by the Center for Studying Health System Change's 2008 Health Tracking Physician (HTP) Survey. The 2008 HTP data set consisted of 4720 physicians belonging to the American Medical Association. Primary care physicians, medical specialists, surgical specialists, psychiatrists, and obstetricians/gynecologists (ObGyns) physicians participated in the 2008 HTP Survey. The order (from high to low) of perceived threat of malpractice lawsuits for various specialists is surgical specialists (3.87), ObGyns (3.81), medical specialists (3.60), primary care physicians (3.55), and psychiatrists (3.12). Regression results indicate that patient interaction, insufficient care quality, competition, medical school, age, and career satisfaction impacted perceived threat of malpractice lawsuits for most of the specialties. For ObGyns, white non-Hispanic was the only factor that impacted perceived threat of malpractice lawsuits. The perceived threat of malpractice lawsuits varies by specialists. Patient interaction, insufficient care quality, competition, medical school, and career satisfaction are major predictors of such threats for most physician specialties.     

Towards patient-centered health services in India--a scale to measure patient perceptions of quality.

OBJECTIVE: . (i) To develop a reliable and valid scale to measure in-patient and outpatient perceptions of quality in India and (ii) to identify aspects of perceived quality which have large effects on patient satisfaction. DESIGN: Cross-sectional survey of health facilities and patients at clinics. SETTING: Primary health centers, community health centers, district hospitals, and female district hospitals in the state of Uttar Pradesh in north India. MAIN OUTCOME MEASURES: Internal consistency, validity, and factor structure of the scale are evaluated. The association between patient satisfaction and perceived quality dimensions is examined. RESULTS: A 16-item scale having good reliability and validity is developed. Five dimensions of perceived quality are identified-medicine availability, medical information, staff behavior, doctor behavior, and hospital infrastructure. Patient perceptions of quality at public health facilities are slightly better than neutral. Multivariate regression analysis results indicate that for outpatients, doctor behavior has the largest effect on general patient satisfaction followed by medicine availability, hospital infrastructure, staff behavior, and medical information. For in-patients, staff behavior has the largest effect followed by doctor behavior, medicine availability, medical information, and hospital infrastructure. CONCLUSIONS: The scale developed can be used to measure perceived quality at a range of facility types for outpatients and in-patients. Perceived quality at public facilities is only marginally favorable, leaving much scope for improvement. Better staff and physician interpersonal skills, facility infrastructure, and availability of drugs have the largest effect in improving patient satisfaction at public health facilities.