电话回访出院患者服务满意度分析

目的通过电话回访出院患者,给予后续服务,提高群众满意度。方法患者出院后一个月内临床科室主管医师电话回访出院患者,进行生理健康、心理安抚的服务。患者出院后一个月内由医院行风办专职人员负责电话回访,进行服务满意度的调查。结果 2012年3月-2014年2月8个传染病区住院患者共18340例次,实际回访总数为7854例,回访成功率为42.82%;2012年3月-2014年2月全院病区住院患者共89534例次,实际回访总数为43138例,回访成功率为48.18%。2013年3月1日-2014年2月28日与2012年3月1日-2013年2月28日比较,其中8个临床科室有4个比较项有提高,其他科室各项满意率都在96%以上,患者满意度较高,全院总满意率为97.23%,亦有提高。结论电话回访体现了医院服务内涵的社会延续,是医院实现人本理念管理、优化患者服务的便捷平台,提高了患者对医院服务的满意度。     

Palliative Care

Over 4 million American Indians and Alaskan Natives live in communities that receive health care primarily from the federal Indian Health Service or tribal health programs. Palliative care has only recently been formally addressed for these communities. An Indian Health Service program introduced the topic and several programs are ongoing. Needs for and barriers to palliative care in native peoples' communities are discussed and several successful programs at various stages of development and implementation are described.     

Emergency Medical Service (EMS) systems in developed and developing countries

OBJECTIVES: To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries. METHOD: We collated de-identified patient-level data from national or local trauma registries in Australia, Austria, Canada, Greece, Germany, Iran, Mexico, New Zealand, the Netherlands, the United Kingdom and the United States. Patient and injury-related characteristics of trauma victims with injury severity score (ISS) >15 and the pre-hospital trauma care provided to these patients were compared among different countries. RESULTS: A total of 30,339 subjects from one or several regions in 11 countries were included in this analysis. Austria (51%), Germany (41%) and Australia (30%) reported the highest proportion of air ambulance use. Monterrey, Mexico (median 10.1min) and Montreal, Canada (median 16.1min) reported the shortest and Germany (median: 30min) and Austria (median: 26min) reported the longest scene time. Use of intravenous fluid therapy among advanced EMS systems without physicians as pre-hospital care providers, varied from 30% (in the Netherlands) to 55% (in the US). The corresponding percentages in advanced EMS systems with physicians actively involved in pre-hospital trauma care, excluding Montreal in Canada, ranged from 63% (in London, in the UK) to 75% in Germany and Austria. Austria and Germany also reported the highest percentage of pre-hospital intubation (61% and 56%, respectively). CONCLUSION: This study provides an early look at international variability in patient mix, process of care, and performance of different pre-hospital trauma care systems worldwide. International efforts should be devoted to developing a minimum standard data set for trauma patients.     

Fourteen years of litigation claims in cardiothoracic surgery in the United Kingdom National Health Service

Approximately 36 400 cardiac and 23 100 thoracic operations are carried out in the United Kingdom between 2006 and 2015. National Health Service (NHS) resolution, as known as the NHS litigation authority, is one of the essential bodies of the Department of Health. Its purpose is to provide NHS expertise to resolve concerns fair and square share learning for improvement. We aim to evaluate and increase awareness of medicolegal cases in cardiothoracic surgery. Total numbers and details of claims coded by NHS resolution in cardiothoracic surgery from 2004 to 2017 were requested under the Freedom of Information Act 2000. The data provided in successful claims is further breakdown into damages paid to the claimant, defence cost, claimant cost paid and the sum of the three. In contrast, unsuccessful claims only include the defence cost. Moreover, data provided also includes further analysis of primary causes and primary injuries for Claims Closed/Settled with damages paid. There were 753 claims recorded from 2004 to 2017, of which 415 (55.11%) were successful. The number of claims has been steadily increasing since 2004, with two significant raises from 2009/10 to 2010/11 (37‐55, 48.64% raise) and 2012/13 to 2013/14 (49‐69, 40.82% raise). The mean successful claim ratio was 69.58% (range, 47.56%‐ 83.33%) There is also a steady increase in the successful ratio from 2004 to 2017. In summary, this is the first study published in relation to litigation claims on cardiothoracic surgery in the United Kingdom. The results have provided insight on claims made against cardiothoracic surgery.     

Combined liver–kidney transplantation versus liver transplant alone based on KDIGO stratification of estimated glomerular filtration rate: data from the United Kingdom Transplant registry – a retrospective cohort study

Patient selection for combined liver–kidney transplantation (CLKT) is a current issue on the background of organ shortage. This study aimed to compare outcomes and post‐transplant renal function for patients receiving CLKT and liver transplantation alone (LTA) based on native renal function using estimated glomerular filtration rate (eGFR) stratification. Using the UK National transplant database (NHSBT) 6035 patients receiving a LTA (N = 5912; 98%) or CLKT (N = 123; 2%) [2001–2013] were analysed, and stratified by KDIGO stages of eGFR at transplant (eGFR group‐strata). There was no difference in patient/graft survival between LTA and CLKT in eGFR group‐strata (P > 0.05). Of 377 patients undergoing renal replacement therapy (RRT) at time of transplantation, 305 (81%) and 72 (19%) patients received LTA and CLKT respectively. A significantly greater proportion of CLKT patients had severe end‐stage renal disease (eGFR < 30 ml/min/1.73 m²) at 1 year post‐transplant compared to LTA (9.5% vs. 5.7%, P = 0.001). Patient and graft survival benefit for patients on RRT at transplantation was favouring CLKT versus LTA (P = 0.038 and P = 0.018, respectively) but the renal function of the long‐term survivors was not superior following CLKT. The data does not support CLKT approach based on eGFR alone, and the advantage of CLKT appear to benefit only those who are on established RRT at the time of transplant.     

儿科病房二区开展温暖护理服务对护理质量的影响

目的探讨儿科病房二区开展温暖护理服务对护理质量的影响。方法选择2017年1～12月在我院儿科接受温暖护理的100例患儿作为观察组,另选择2016年1～12月实施温暖护理前的100例为对照组,比较干预前后的护理质量评分变化情况。对比两组患儿家长对护理服务的护理满意度。结果实施前的护理质量评分(78.69±17.25)分,实施温暖护理服务后的护理质量评分达(92.72±19.23)分,实施前后的护理质量评分比较差异有统计学意义(P0.05)。观察组患儿家长对护理人员的护理服务满意度显著高于对照组,差异有统计学意义(χ~2=11.862,P0.05)。结论儿科病房二区开展温暖护理服务有利于提高护理质量,提高护理满意度,促进护患关系。     

医养结合社区居家养老中心供给服务质量评价指标体系的构建研究

背景 　为应对老龄化,我国对医养事业给予大力扶持,致使医养结合社区居家养老服务机构数量剧增。但因我国“未富先老”的国情及养老事业起步较晚,医养结合养老模式存在医疗服务不规范和服务质量评价体系不健全等诸多问题。目的　构建医养结合社区居家养老中心供给服务质量评价指标体系。方法　于2017年6—8月,采用目的抽样法抽取北京市、天津市、河北省20个社区养老服务驿站（中心）和15个社区日间照料中心进行实地调研和访谈,形成医养结合社区居家养老中心供给服务质量评价指标体系（初版）;于2017年11月—2018年1月选取23名专家,通过亲自发放或电子邮件发放3轮函询问卷,由专家对指标的合适性、重要性、熟悉程度及判断依据做出判断;函询结束后,整理专家咨询结果,计算专家积极系数、权威系数、协调程度和指标重要性赋值、满分比、变异系数。结果　3轮函询专家积极系数分别为88.5%、100.0%、100.0%,专家权威系数分别为0.905、0.909、0.922,变异系数分别为0.06~0.24、0~0.17、0~0.22,Kendall's W系数分别为0.249、0.252和0.316。依据指标筛选标准,综合专家意见后,第1轮删除12个指标、增加16个指标,第2轮删除5个指标、修改1个指标、增加1个三级指标,第3轮无删除、修改、增加指标,最终形成了3个一级指标、15个二级指标、64个三级指标的医养结合社区居家养老中心供给服务质量评价指标体系。结论　构建的医养结合社区居家养老中心供给服务质量评价指标体系的专家意见集中度较高,结果可靠性较强,可为医养结合社区居家养老中心服务质量的评价、建设和改进提供依据。     

基于SERVQUAL量表的以家庭医生为主体的社区中医药健康管理服务评价

背景　中医药健康管理服务在预防、保健、医疗、养生、康复等方面具有综合优势,应充分发挥中医药简、便、验、效的优势和特色,实践和探索中医药健康管理融入家庭医生制服务。本文运用修订后SERVQUAL量表了解社区居民对中医药健康管理服务的实际需求,找出期望服务和实际感知服务之间的差距,促进服务质量的持续改进。目的　基于经典SERVQUAL量表,探索从患者角度评价医疗服务质量,了解辖区居民对社区卫生服务中心中医药健康管理服务的总体评价,为改善社区中医药健康管理服务质量提供支撑。方法　选择2016年2月在大团社区卫生服务中心进行中医药健康管理服务的社区居民。调查其人口学特征,并采用自行设计的修订后SERVQUAL量表调查居民对社区卫生服务中心家庭医生团队提供中医药健康管理服务的期望值及对其重要程度的评价、对实际获得社区中医药健康管理服务的感受值。结果　共发放问卷350份,回收有效问卷350份,有效回收率为100.0%。社区中医药健康管理服务所有条目的评分为负值,但趋近于0,对应的百分制评分均在90分以上。中医药健康管理服务的总体服务质量评分为-0.148 7分,总体服务质量百分制评分为96.28分。6个维度中,居民对有形性的满意度最高,评分为-0.075 0分,百分制评分为98.12分;满意度最低的是费用可接受性,评分为-0.199 2分,百分制评分为95.02分。象限分析结果显示,象限1保持区域分布的条目最多（13项）,象限4需要改进区域分布的条目最少（2项）。结论　修订后SERVQUAL量表能够科学客观地测量居民对于中医药健康管理服务的真实评价,居民对目前家庭医生团队提供的中医药健康管理服务水平整体非常认可,其中对于规范地提供所承诺服务的能力和就诊环境非常满意,而接受服务的等待环节和相关费用设置方面需要优先重点改进和优化。     

医养结合养老机构服务绩效评价指标体系的构建

背景　当前我国医养结合养老机构绩效评价不够完善,难以保障养老服务的质量,而养老机构绩效评价的结果直接关系到养老服务的质量和养老机构的发展,因此需构建一套医养结合养老机构服务绩效评价指标体系。目的　构建一套科学合理的医养结合养老机构服务绩效评价指标体系并对其进行检验。方法　2018年8-11月,以电话、面谈等方式对专家进行两轮咨询。接受咨询的专家工作年限均大于10年,从事社会福利行业管理、养老机构管理、老年病管理、卫生行政管理、卫生管理教学、临床医学等研究工作、具有副高级及以上职称。采用层次分析法（AHP）、隶属度分析法等从投入、产出、结果3个维度确定医养结合养老机构服务绩效评价指标体系和权重,采用Cronbach's α系数对评价指标体系进行信度检验。结果　两轮专家权威程度的熟悉程度（Cs）分别为0.679、0.768,选定依据（Ca）分别为0.614、0.657,权威系数（Cr）分别为0.646、0.713。两轮专家咨询的肯德尔协调系数（Kendall's W）分别为0.394、0.426,两轮咨询的Kendall's W值比较,差异有统计学意义（χ2=481.049、504.768,P<0.001）。经过专家咨询、调整、改进,构建了3个一级维度、8个二级维度和49个三级指标组成的医养结合养老机构服务绩效评价指标体系,并对每个指标赋予了相应的权重系数,3个一级维度的权重分别是0.216 3、0.576 2、0.207 5,合成权重CR均<0.10。信度检验结果显示,各个维度的Cronbach's α系数和总的Cronbach's α系数均>0.800。结论　构建一套医养结合养老机构服务绩效评价指标体系,该指标框架的可靠性和可信性程度较高,为有关部门决策提供科学可行的依据。     

民族医药移动信息平台设计与实现

以广西中医药大学已建成的民族医药专业数据库作为依托,基于微信公众平台设计和实现一个功能完善、简单易用的民族医药移动信息平台。介绍平台设计思路、设计原则、功能模块、关键技术、预期结果等方面。