坚持以人为本 构建和谐医患关系

构建和谐医患关系是建设和谐社会的重要内容,本文通过分析医患关系现状以及医患关系紧张的原因,探讨建设和谐医患关系的方法和途径。     

The four Ps of patient experience: A new strategic framework informed by theory and practice

This article proposes a new strategic framework to assist healthcare organizations in achieving great patient experiences in the healthcare setting. We synthesize models of practice and literature relevant to the patient experience in order to propose the four Ps of patient experience. Key levers used in this model are: (a) trained autonomous physicians, (b) multidisciplinary partners, (c) alternative places of care delivery matched to patient conditions and needs, and (d) standardized yet flexible processes. Healthcare leaders will be able to use the proposed framework to develop detailed strategies toward improving patient satisfaction and experiences.     

职业病病人经济风险分担机制探讨

通过对我国当前职业病病人经济风险分担机制及其问题进行剖析发现,我国职业病病人经济风险分担机制是用人单位为主要负担者、政府保基本、个人或非盈利组织为补充,但实践中还存在诊断和鉴定过程比较繁琐、落实工伤待遇比较困难、赔偿和其他保障救助不到位等问题。建议更加重视应对职业病病人经济风险,诊断鉴定过程中让劳动者少跑路、少等待、少提供材料、少额外开销,施行《工伤保险条例》时让劳动者应参保尽参保、应赔付尽赔付、保障水平"就高不就低",同时,充分利用现有大病救助制度,鼓励利用市场机制分散病人经济风险,拓宽救助渠道,提高救助精准性。     

医疗服务患者体验的概念和评价实践

患者体验逐渐被认为是医疗服务质量的三大基石之一。本研究评述了患者体验相关概念和国内外患者体验评价研究进展,在分析英国国家卫生服务患者调查和美国卫生系统消费者评价以及国内患者体验评价现况的基础上,提出了未来研究在方法学和评价实践层面值得关注的重点。     

Race and Ethnic Disparities in Cervical Cancer Screening in a Safety-Net System

Objectives: The three objectives of this research were: 1) to examine the use of Pap smear tests among low-income women, including minority and immigrant women who were patients in a safety-net healthcare system; 2) to identify policy relevant variables that could lead to changes in use of Pap smear screening services for these women; and 3) to contribute to the literature on use of Pap smear screening, especially among minorities and immigrants. The Behavioral Model for Vulnerable Populations was used as the theoretical framework. Methods: Pap smear screening predictors were examined using telephone interviews with a random sample of women aged 18–60, including 465 Non-Hispanic Whites, 285 African Americans, 164 Hispanic Americans, and 256 Hispanic immigrants, enrolled in a safety-net healthcare system in Texas in Fall 2000. Binary logistic regression analysis was used. Results: The research revealed that Non-Hispanic Whites were most likely to have been screened ever and in the past 3 years, followed by African Americans, Hispanic immigrants, and Hispanic Americans. Among Hispanics, immigrants were most likely to have had Pap smear screening, supporting the “healthy immigrant hypothesis.” Older women were most likely to have ever been screened, with younger women, most likely in the past year. Having a usual source of healthcare and a checkup for current pregnancy increased screening, while competing needs (food, clothing, housing) affected screening negatively. Conclusions: Culturally competent, community-based care for women is needed to increase Pap smear screening among minority groups, especially Hispanic immigrant and Hispanic American women.     

Investigation of the ways in which patients' reports of their satisfaction with healthcare are constructed

A characteristic feature of patient satisfaction research is the consistently high level of satisfaction recorded. More reliable and relevant inquiry tools are constantly being developed, but underlying psychological and social pressures that could promote such a consistent and undiscriminating response have been little investigated. Williams et al. (1998) explored the phenomenon and concluded that, by considering issues of duty and culpability, patients could make allowances for poor care, and avoid evaluating it negatively. Their study was in community mental health. This study follows up their work within elective orthopaedic surgery, and investigates the pressures promoting such apparent transformation of opinion. Using a longitudinal design, and in-depth qualitative interviews, the patient's process of reflection was explored. Three psycho-social pressures were identified that appear to work together to make the transformation of opinion almost the default process. They are: the relative dependency of patients within the healthcare system; their need to maintain constructive working relationships with those providing their care; and their general preference for holding a positive outlook. It is suggested that, while it is the patient's prerogative to re-interpret the quality of their care positively, it is not the prerogative of the inquirer to accept this re-interpretation as representative of the patient's experience. Methods of inquiry are needed which access something of patients' development of opinion, and thereby something of their initial, often more negative, untransformed responses to their healthcare experiences.     

Patient��s Utilization and Perception of the Quality of Curative Care in Community Health Centers of the Fifth Commune of Bsamako

Background:

Community health centers are an important component of the health system in Mali. Despite the adhesion of the populations and the commitment of the authorities, many things must be done to improve the quality of care provided in those structures.

Objectives:

The study aimed to know the patients’ utilization and perception of the curative care in the community health centers of Bamako and the physicians’ satisfaction of their work condition and perspective in the community health sector.

Materials and Methods:

A cross-sectional study was conducted in nine community health centers of Bamako in 2008. A total of 270 patients were interviewed through a face-to-face interview. Thirteen physicians took a self-administrated questionnaire relating to their material and financial conditions and their plan for the future.

Results:

The sample was characterized by the low literacy (32.6%) and socio-economic level (15.9% of steady income).139 patients claimed the nearness as the reason of the choice of the health center whereas only 51 claimed the health staff skill. The women felt more satisfied than men (P=0.005) and illiterates felt more satisfied than bachelors and beyond (P=0.034). The patients claimed the reduction of waiting time, the improvement of information and the creation of news services. 30.80% of physicians were satisfied from their material and financial conditions, 38.46% were motivated and 76.92% planned to leave their health center.

Conclusion:

Although a high level of satisfaction regarding the provided service was observed, user reported some shortage in the quality of care and claimed a widening of CSCom capability.     

The Roadmap for Implementing Value-Based Healthcare in European University Hospitals—Consensus Report and Recommendations

ObjectivesValue-based healthcare (VBHC) aims at improving patient outcomes while optimizing the use of hospitals’ resources among medical personnel, administrations, and support services through an evidence-based, collaborative approach. In this article, we present a blueprint for the implementation of VBHC in hospitals, based on our experience as members of the European University Hospital Alliance.MethodsThe European University Hospital Alliance is a consortium of 9 large hospitals in Europe and aims at increasing the quality and efficiency of care to ultimately drive better outcomes for patients.ResultsThe blueprint describes how to prepare hospitals for VBHC implementation; analyzes gaps, barriers, and facilitators; and explores the most effective ways to turn patient pathways into a process that results in high-value care. Using a patient-centric approach, we identified 4 core minimum components that must be established as cornerstones and 7 organizational enablers to waive the barriers to implementation and ensure sustainability.ConclusionThe blueprint guides through pathway implementation and establishment of key performance indicators in 6 phases, which hospitals can tailor to their current status on their way to implement VBHC.     

市场经济条件下医患矛盾的利益视角

医患关系失调的背后是利益冲突问题,在市场经济条件下尤其是这样.为改善医患关系,一方面要继续坚持以医德为本,强调医务工作的社会责任;另一方面要正视医患矛盾中的利益问题,探究利益问题在医患矛盾上聚焦的原由,重视从法律、道德和制度层面上构建整合机制,积极化解医患利益冲突,从根本上改善医患关系.     

我国老年人口今年将突破2亿其中半数为空巢

  目的  了解老年人日常生活活动能力（ADL）现状及其影响因素,为更好的保障老年人的合法权益提供参考依据。  方法  于2017年6月 — 2018年3月采用多阶段分层抽样方法,对山东省青岛市7个区19家医养结合机构800位 ≥ 60岁入住老年人进行问卷调查和焦点访谈;采用 χ²检验和多元线性回归对影响老年人ADL的因素进行分析。  结果  老年人ADL总体得分为（30.19 ± 15.289）分;800名老年人中,有ADL障碍的比例为59.13 %,ADL下降的比例为17.00 %,ADL正常的比例为23.88 %。多因素分析显示,影响老年人ADL的因素为健康状况、教育程度、户籍类型、医养结合机构服务模式和医保种类（t = 8.852、– 3.582、– 2.976、2.505、– 1.752,P < 0.05）。  结论  大多数入住医养机构的老年人ADL明显障碍或功能下降,影响老年人ADL 的因素包括躯体、社会和医养机构服务模式等。     

医疗主体履行告知义务系统模式研究

目的：建立医疗主体履行告知义务模式,提高告知义务的操作性,实现告知义务的确定性和医患关系调整的有效性。方法：理论考证法、实践借鉴法。结果：建立了医疗行为中医疗主体履行告知义务系统的五结构模式。结论：该模式对医疗主体落实告知义务具有积极作用。     

疗养院开展主任课堂的做法

本文结合疗养院业务训练的特点，从充分认识主任课堂的重要性，努力增强主任课堂的时效性等方面入手探讨主任课堂的组织筹划，并进行有益的尝试，对促进疗养院各专业人才学术交流和资源共享，提高疗养院工作绩效提供了借鉴。     

The ultimate question? Evaluating the use of Net Promoter Score in healthcare: A systematic review

BackgroundPatient experience is a complex phenomenon that presents challenges for appropriate and effective measurement. With the lack of a standardized measurement approach, efforts have been made to simplify the evaluation and reporting of patient experience by using single‐item measures, such as the Net Promoter Score (NPS). Although NPS is widely used in many countries, there has been little research to validate its effectiveness and value in the healthcare setting. The aim of this study was to systematically evaluate the evidence that is available about the application of NPS in healthcare settings.MethodsStudies were identified using words and synonyms that relate to NPS, which was applied to five electronic databases: Medline, CINAHL, Proquest, Business Journal Premium, and Scopus. Titles and abstracts between January 2005 and September 2020 were screened for relevance, with the inclusion of quantitative and qualitative studies in the healthcare setting that evaluated the use of NPS to measure patient experience.ResultsTwelve studies met the inclusion criteria. Four studies identified benefits associated with using NPS, such as ease of use, high completion rates and being well‐understood by a range of patients. Three studies questioned the usefulness of the NPS recommendation question in healthcare settings, particularly when respondents are unable to select their service provider. The free‐text comments section, which provides additional detail and contextual cues, was viewed positively by patients and staff in 4 of 12 studies. According to these studies, NPS can be influenced by a wide range of variables, such as age, condition/disease, intervention and cultural variation; therefore, caution should be taken when using NPS for comparisons. Four studies concluded that NPS adds minimal value to healthcare improvement.ConclusionThe literature suggests that many of the proposed benefits of using NPS are not supported by research. NPS may not be sufficient as a stand‐alone metric and may be better used in conjunction with a larger survey. NPS may be more suited for use in certain healthcare settings, for example, where patients have a choice of provider. Staff attitudes towards the use of NPS for patient surveying are mixed. More research is needed to validate the use of NPS as a primary metric of patient experience.Patient or Public ContributionConsumer representatives were provided with the research findings and their feedback was sought about the study. Consumers commented that they found the results to be useful and felt that this study highlighted important considerations when NPS data is used to evaluate patient experience.     

Associations between technical quality of diabetes care and patient experience

Aims It has long been held that high‐quality care has both technical and interpersonal aspects. The nature and strength of any association between both aspects remain poorly explored. This study investigated the associations between diabetes patients’ reports of receiving recommended care (as measures of technical quality) and their experience and ratings (as measures of interpersonal care). Methods Using data from a cross section of 3096 patients with diabetes nested within 24 diabetes‐care‐networks, we conducted multilevel regression analysis of the relationships between nine indicators of receiving care recommended in practice guidelines and: six scales of patient experience and global ratings of general practitioner, nurses, and overall diabetes care. Results On average, reporting having received recommended care was associated with reporting better patient experience and ratings. The extent and frequencies of these associations varied across the different care processes. Receiving foot examination, physical activity advice, smoking status check, eye examination, and HbA_1c testing, but not nutritional advice, urine, cholesterol or blood pressure checks, were statistically associated with better patient experience and global ratings. Those who received HbA_1c testing rated their overall care 1.002 points higher (95% confidence interval: 0.726–1.278) on a scale of 0–10 than those who did not. Conclusions Higher self‐reported technical quality of care in diabetes appears to be frequently but not always associated with better experiences and ratings. It is possible that the former leads to the latter and/or that both share a common cause within providers. Both care aspects do not seem interchangeable during performance assessment.     

实施第三方评估 客观评价患者满意度

病人满意度评价是医疗机构和医务人员诊疗活动结果及诊疗服务质量的指标之一．日益受到卫生管理人员和专业人员的重视。聘请第三方对医院社会满意度进行客观、全面地评价,能够有效指导医院改进不足,完善服务,进一步提升“以病人为中心”的人文化服务质量。对构建和谐的医患关系有着重要的现实意义。     

糖尿病自我管理方法在城乡社区运用的效果评价

目的对糖尿病自我管理方法在城乡社区运用的效果进行评价。方法采用小组集中授课和专业人员随访的方式对教育对象进行2型糖尿病防治知识教育,帮助其掌握自我管理的技能,提高自我管理能力。在教育前后进行问卷调查及体格检查,在教育中进行知识测试。分析城市和农村2个社区中糖尿病患者血糖变化的情况及自我管理能力变化的情况。结果(1)城市社区糖尿病患者开展自我管理教育后血糖有明显改善。(2)城市、农村社区糖尿病患者自我管理能力普遍提高。结论文化程度高、依从性好的城市社区开展糖尿病患者的自我管理,在提高自我管理技能,控制血糖等方面效果更为显著。在农村坚持开展糖尿病患者自我管理,也会提高其管理的技能。     

Validation of the quality of life in depression scale in a population of adult depressive patients aged 60 and above

The aim of this study is to evaluate the validity of the Dutch version of the Quality of Life in Depression Scale (QLDS) in a population of depressive patients aged 60 years and over, who were seen on an outpatient basis by psychiatrists in the Flemish region of Belgium. A sample of severely depressive patient was followed during an height-week medical treatment. During this period, each patient was evaluated four times with the Hamilton Rating Scale for Depression and with the QLDS. We observed that the QLDS was very sensitive to the failing of the quality of life in depressive states. The QLDS was also a very good measure of change during the improvement of depressives states. Furthermore, the scale appears to be very homogeneous across the depressive states range. The results are very encouraging, and constitute strong corroboration of the construct validity of the scale.     

公立医院定员定编政策存在的问题与对策

目前公立医院以床位数为基础定员定编的方法存在很多弊端,应该综合考虑医院战略、业务量、当地经济发展水平、相关政策、竞争对手等因素。通过医院历史数据,确定医院员工数量与业务量之间的关系,预测未来医院员工总数,通过部门预测法等方法预测各部门人员数量。     

基于扎根理论的社区医养结合服务公私合作模式研究

目的：探讨社区医养结合服务公私合作模式的动因、策略和障碍，为我国社区医养结合服务供给侧改革提供参考。方法：运用扎根理论法，聚焦社区医养结合服务公私合作的典型案例，借助Nvivo12质化分析软件对相关主体的访谈记录及政策文本资料进行编码和分析。结果：经过开放性编码、主轴性编码及选择性编码，共得到51个初级概念、12个范畴和3个主范畴。根据扎根理论“条件-现象-行动/互动策略-结果”的典范模型，自下而上建构起社区医养结合服务公私合作的理论模型。结论：社区医养结合服务公私合作的动因包括老年人医养需求高、国家政策导向和地方政府推动；合作的策略包括建立伙伴关系、资源整合与共享、动员老年人参与；合作的障碍有体制困境、双方信任缺失、基层服务能力有限、激励不到位、公益性与趋利性的矛盾、缺少第三方监督评估。