非医疗技术服务影响因素认知的性别差异及改善对策

目的探究医生和患者对非医疗技术服务影响因素认知的性别差异,为提高非医疗技术服务提供新的视角和方法。方法使用文献分析法和专家访谈法设计非医疗技术服务影响因素调查问卷;使用方便抽样法对医生和患者进行问卷调查;使用频数分析法和灰色关联法确定非医疗技术服务影响因素及其排名;使用Wilcoxon秩和检验的方法结合R软件确定医生和患者对非医疗技术影响因素认知的性别差异;使用文献分析法,分析差异产生的原因,最终提出合理化建议。结果在医生群体中,女性医生对"医生重视与患者的沟通交流"更重视(P0.05);在患者群体中,女性患者更重视"医生工作事业心"(P0.01)、"医生热爱本职工作"(P0.05)、"医生遵守法规和工作制度"(P0.05)和"医生不歧视患者"(P0.05)。结论不同性别的群体对非医疗技术服务影响因素的认知存在一定的差异;医疗服务机构应提高男性医生对沟通能力的重视程度,重视患者对非医疗技术服务的诉求,在医疗活动中提高对女性患者的人文关怀。     

基于行为经济学理论的医患关系与医生决策行为研究

通过梳理医患关系与医生决策行为相关的行为经济学理论,构建医疗纠纷背景下基于损失厌恶、易得性直觉推断、框架效应等理论的医生决策行为模型。目的在于理解医生决策过程的各个环节、存在的偏好以及由于行为偏差而造成的社会福利损失;解释医疗纠纷对医生决策行为的影响;为提高医疗服务质量,避免医疗资源浪费,降低非必要卫生支出提供理论依据。     

基于健康大数据监测平台的移动医疗APP设计

移动医疗对现代医疗机构的管理运营理念、诊疗流程以及决策行为模式产生重大影响,使得其决策越来越依赖于数据分析和管理。本文提出的基于健康大数据监测平台的移动医疗APP系统框架,通过EHRs决策数据关联分析,实现电子病历再利用,有效识别符合临床试验条件的患者,减少因临床试验招募困难而存在的潜在延误。该模式在医生询诊患者的过程中增加诊断决策信息交互渠道,实现医疗决策系统服务价值增值,对于医疗决策系统品质和效率的提升具有重要意义。     

基于临床医生认知的精准医疗服务实施影响因素研究

目的了解临床医生认知对精准医疗服务实施的影响因素,为精准医疗服务工作的实施与推进提供参考依据。方法采用电子问卷调查方法,于2019年7—9月,对12个省(自治区、直辖市)48家医院的临床医生进行问卷调查,有效问卷341份。问卷包括医生精准诊断能力、患者知晓与采纳、患者隐私保护、组学技术创新发展、生物医学大数据共享平台建设等17项内容。对调查数据进行描述性统计和因子分析。结果从回收的问卷中识别出影响精准医疗服务的3个维度,即外部支撑因素、医院驱动能力、患者信息提供与保护,其正交旋转后的方差贡献率分别为35.157%、22.234%、16.343%。结论建议发展外部支撑因素、提升医院驱动能力、保证患者信息接受畅通与隐私信息安全,为精准医疗服务的实施提供重要基础和保障。     

按病种分值付费对医生行为的影响——基于实验经济学

本文通过收集临床医学及其他相关医学专业学生的调查问卷,从总体水平、3种健康类型、15种患者类型以及最优服务量决策4个方面,以医学生在不同医保支付方式下的医疗卫生服务提供量的决策模拟分析按病种分值付费对医生行为的影响。结果显示,两种支付方式下医生的医疗卫生服务提供量具有显著差异,按项目付费使得医生提供过多的医疗服务数量,而按病种分值付费能够有效规范医生医疗服务提供行为,做出更多适合病人的最优决策。建议继续完善按病种分值付费,支付方式应更具灵活性;医生薪酬标准多元化,健全医生激励补偿机制;建立健全医疗服务监测评估机制。     

公立医院医生决策行为效用分析：价格管制下公立医院医生的行为分析

国内外学者从信息不对称角度分析研究了支付制度及价格管制对医生的医疗决策行为的影响,也提出了许多有深度的建议与对策.利用行为金融理论来分析价格管制的情况下我国"看病贵、看病难"医疗困境产生的根本原因,通过构建公立医院医生效用函数模型,说明公立医院医生的决策行为是造成"看病贵、看病难"的根本原因,为目前医疗困境提供新的理论解释,为医疗改革提供新的思路.     

在线医疗社区医生的参与行为特征分析

目的 探究在线医疗社区医生用户群体结构,识别各类医生用户的参与行为特征,为提升在线社区医疗的服务质量提供依据。方法 以“好大夫在线”平台的医生用户数据为研究对象,在特征分析的基础上采用改进的k-prototypes算法对医生用户群体进行聚类分析。结果 通过特征分析,将医生用户划分为4类,包括成长型用户、边缘服务型用户、头部流量用户和潜在头部用户,并为各类用户提出了精细化管理策略。结论 针对在线医疗社区医生的参与行为进行分析可为提高在线医疗社区医生的实践价值和服务能力提供有力的决策支撑。     

我国公立医院医生的价值医疗服务动机探究——概念建构与量表测度

健康中国建设行动彰显了以患者为中心的价值医疗理念,对医生医疗服务行为的价值诉求也日益提高。本研究试图将一般公共组织中公共服务动机概念引入公立医院之中,提出“价值医疗服务动机”概念,作为公立医院医生的一种公共服务动机表达。本文通过质性分析和量化测度,建构出“公立医院医生价值医疗服务动机”的概念,包含责任承诺、专业坚守、声誉维护、规范遵从四个概念维度,据此形成价值医疗服务动机量表。研究发现我国公立医院医生具有多维价值特征的医疗服务动机,呈现不同动机表达或行为倾向,在实现以患者为中心的价值医疗目标实践中,不断处理与平衡其中的公共价值冲突。该量表能够为测度医生价值医疗服务动机提供有效工具,为进一步发现医生价值医疗服务动机的影响因素,提升公立医院医疗服务能力、改善医疗行为、促进医患信任等提供理论与实践支持。     

住院患者对医生的信任水平及自我效能与医疗决策行为的关系研究——以医患互动为中介

目的：通过调查杭州市住院患者参与医疗决策行为现状,分析其主要影响因素和机制,为提高杭州市住院患者参与医疗决策积极性、有效性提出建议。方法：采用分层随机抽样的方法,参考成熟量表后自行设计的调查问卷,对杭州市二、三级医院的750名住院患者进行调查;用结构方程模型分析住院患者对医生的信任水平、参与决策自我效能、医患互动与其参与医疗决策行为的作用机制。结果：不同家庭月收入、住院科室、过去一年住院次数、本次入院决策方案制定方式的患者参与医疗决策行为得分有显著性差异(均P＜0.05)。患者参与医疗决策行为与其对医生的信任水平呈负相关;与其自我效能和医患互动呈正相关(P＜0.01)。患者对医生的信任水平和自我效能直接影响患者参与医疗决策行为,直接效应值分别为-0.373、0.358(P<0.001);医患互动在对医生的信任水平、自我效能与患者参与医疗决策行为之间的关系中起较显著的中介作用,中介效应值分别为-0.089、0.328(P<0.001)。结论：医患互动的中介效应可以促进患者参与医疗决策行为的积极性和有效性,医疗卫生机构应以患者为中心,优化住院患者参与医疗决策的途径,加强对医务人员医患互动能力和意识的培训,切实提高患者参与医疗决策行为的主动性和有效性。     

基于行动者网络理论的精准医疗服务体系运行机制探讨

行动者网络理论借鉴了系统科学、社会学和管理学等理论,为研究技术-社会二元观点提供了新视角。作者引入行动者网络理论,以技术-社会的视角,分析了精准医疗服务体系运行的构成主体及其关系,研究了该行动者网络的转译过程。分析显示,影响精准医疗服务体系运行的主体有医院、患者、政府、科研机构、技术型企业、高等院校,即精准医疗服务的供给者、需求者、管理者、筹资者以及技术支持者。其中,82.72%(335/405)的临床医生认为医院是影响精准医疗服务体系运行的核心行动者;71.60%(290/405)的临床医生认为开展医务工作者培训是当前医院的工作重点,即为该行动者网络的强制通行点。通过开展培训,可提高医疗工作者及医院的精准医疗服务能力。     

The significance of patients' perceptions of physician conduct

The provision of high quality medical care and the insurance of patient satisfaction depend in part upon the ability and willingness of physicians to establish rapport with their patients and to develop effective physician-patient communication. In this study, patients' overall satisfaction with their physicians' care was assessed in relation to their perceptions of their physicians' (1) proficiency at communicating and listening to details of the illness and medical treatment, (2) capability of providing affective care, and (3) technical competence. Perceptions of physician behaviors were measured by a questionnaire administered to 329 patients of 54 residents in a family practice center. The relationship between the perceptions of patients and their satisfaction with medical care was examined both for the entire sample and among groups of patients with differing demographic characteristics. Results indicate an important link between patients' perceptions of socioemotional aspects of the physician-patient relationship and their reported satisfaction with medical care. Noticeable differences were found to exist in the importance that patients with different demographic characteristics placed on various aspects of their physicians' conduct.     

医生职业风险认知对防御性医疗行为的影响

以在职医生为调查对象,采用半结构式访谈法收集资料,用扎根理论方法分析医生职业风险认知与防御性医疗的关系。发现医生由于感知到各种职业风险会导致出现紧张、焦虑及抑郁,职业认同感降低等心理问题,同时在医疗工作中会出现不敢冒险与创新,工作积极性被打击,工作出错的概率增加等情况;为应对职业风险,医生在医疗决策时为自保会采取多开检查治疗项目,增加会诊,选择性收治病人,通过医疗知情同意以推卸责任等不利防御;感知到职业风险同时也会促使医生改善服务态度,更加谨慎小心,提升专业技能等方式来降低职业风险。医生职业风险认知是防御性医疗行为的主要动因,二者之间也可能互为因果。     

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.     

医保支付方式由后付制向预付制改革对供方医疗服务行为影响的机制和发展路径

全民医保制度下,支付方式提供了影响供方医疗服务行为的手段,成为调节卫生资源配置的重要杠杆.医保支付方式由后付制向预付制的改革,通过财务风险的转移调整对医疗机构和医生行为的激励,控制供方诱导需求行为带来的费用上涨,成为医疗保险制度改革的重要方向.但其发挥作用的基础是医疗服务提供方对支付方式的反应.医疗服务目标的多维性、医...     

The Effects of Introducing Mixed Payment Systems for Physicians: Experimental Evidence

Mixed payment systems have become a prominent alternative to paying physicians through fee‐for‐service and capitation. While theory shows mixed payment systems to be superior, causal effects on physicians' behavior when introducing mixed systems are not well understood empirically. We systematically analyze the influence of fee‐for‐service, capitation, and mixed payment systems on physicians' service provision. In a controlled laboratory setting, we implement an exogenous variation of the payment method. Medical and non‐medical students in the role of physicians in the lab (N = 213) choose quantities of medical services affecting patients' health outside the lab. Behavioral data reveal significant overprovision of medical services under fee‐for‐service and significant underprovision under capitation, although less than predicted when assuming profit maximization. Introducing mixed payment systems significantly reduces deviations from patient‐optimal treatment. Although medical students tend to be more patient regarding, our results hold for both medical and non‐medical students. Responses to incentive systems can be explained by a behavioral model capturing individual altruism. In particular, we find support that altruism plays a role in service provision and can partially mitigate agency problems, but altruism is heterogeneous in the population. Copyright © 2015 John Wiley & Sons, Ltd.     

Customer Convergence

This article explores the interrelationships between three categories of service quality in healthcare delivery organizations: patient, employee, and physician satisfaction. Using the largest and most representative national databases available, the study compares the evaluations of hospital care by more than 2 million patients, 150,000 employees, and 40,000 physicians. The results confirm the relationship connecting employees' satisfaction and loyalty to their patients' satisfaction and loyalty. Patients' satisfaction and loyalty were also strongly associated with medical staff physicians' evaluations of overall satisfaction and loyalty to the hospital. Similarly, hospital employees' satisfaction and loyalty were related to the medical staff physicians' satisfaction with and loyalty to the hospital. Based upon the strength of the interrelationships, individual measures and subscales can serve as leverage points for improving linked outcomes. Patients, physicians, and employees, the three co—creators of health, agree on the evaluation of the quality of that service experience. The results demonstrate that promoting patient—centeredness, enhancing medical staff relations, and improving the satisfaction and loyalty of employees are not necessarily three separate activities in competition for hospital resources and marketing leadership attention.     

The Impact of Perceived Barriers on Primary Care Physicians' Screening Practices for Female Partner Abuse

ABSTRACT

Objectives: Our purpose was to examine primary care physicians' screening practices for female partner abuse in different clinical situations and to investigate the relationship between perceived barriers and screening practices.

Methods: A cross-sectional survey was mailed to Alaska physicians practicing in the following specialties: family practice, internal medicine, obstetrics/gynecology and general practice.

Results: The survey response rate was 80 percent (305/383). The majority (85.7%) of primary care physicians screened often or always when a female patient presents with an injury, but they rarely screened at initial visits (6.2%) or annual exams (7.5%). More than one-third of respondents estimated that 10% or more of their female patients had experienced some type of intimate partner abuse. Several barriers to screening described in the literature were not predictive of physicians' screening practice patterns. Physicians' perceptions that abuse is prevalent among their patients and physicians' beliefs that they have a responsibility to deal with abuse were the only variables independently associated with screening at initial visits and annual exams. The only variable predictive of screening when a patient presents with an injury was physicians' perceived prevalence of abuse.

Conclusion: Primary care physicians have not integrated screening for partner abuse into routine care. Strategies to increase awareness of the high prevalence of abuse in the primary care setting and to educate providers on the negative health effects of victimization can help physicians to acknowledge their responsibility in addressing abuse and the importance of screening at routine visits. Further rigorous studies are needed to identify and evaluate predictors of screening for abuse.     

Preventive content of adult primary care: do generalists and subspecialists differ?

We compared preventive care performed by 20 generalists and 20 subspecialists practicing in Santa Clara and San Mateo Counties, California, by auditing charts of adult primary care patients for compliance with recommendations of the Canadian Task Force on the Periodic Health Examination. Generalists and subspecialists both provided 49 per cent of recommended preventive services. The two groups did not differ significantly in performance of any individual service. Performance varied widely within both groups. Of many factors explored, only two were associated with more preventive services: provision of a complete physical examination to the patient, and a physician''s belief in the importance of a given service. The "generalist vs. subspecialist" debate assumes that a physician''s specialty classification is an important predictor of behavior. For the performance of preventive care, this was not true in our study. Instead, physicians'' beliefs and practice habits may be major determinants of the quality of preventive care provided. These exploratory findings needed confirmation in other settings.     

The Effect of Medicaid Policies on the Diagnosis and Treatment of Children's Mental Health Problems in Primary Care

Primary care physicians play a substantial role in diagnosing and treating children's mental health disorders, but Medicaid managed care policies may limit these physicians' ability to serve low‐income children. Using data from the universe of Medicaid recipients in three states, I evaluate how Medicaid managed care policies impact primary care diagnosis and treatment of children's mental health disorders. Specific policies examined include the presence of a behavioral carve‐out, traditional health maintenance organization, or primary care case management program. To alleviate concerns of endogenous patient sorting, my preferred identification strategy uses variation in Medicaid policy penetration to instrument for individual plan choices. I show that while health maintenance organizations reduce diagnosis and non‐drug treatment of mental health disorders, primary care case management program policies shift in diagnosis and treatment from within primary care to specialist providers such as psychiatrists, where serious mental health conditions are more likely to be identified. Copyright © 2013 John Wiley & Sons, Ltd.     

The Impact of Patient Participation on Physicians' Information Provision During a Primary Care Medical Interview

This study investigated the impact of patients' participation on physicians' information provision during a primary care medical interview. When communicating with high-participation patients, physicians provided significantly more information overall, more information in response to patients' questions, and volunteered more information than when interacting with low-participation patients. The most significant differences with respect to volunteered information involved communication about treatment and tests or procedures. These results were interpreted to suggest that high-participation patients' communication style promotes better alignment of patients' and physicians' goals and agendas.

Overall, the results suggest that patients' style of participation during a medical interview significantly influenced the extent and type of information physicians provided. Given that patients' biggest complaint about physicians often is a lack of desired information, this study has important implications for physician–patient communication.