中国妇幼医疗机构住院患者总体满意度影响因素多水平线性模型分析
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摘要
目的了解中国改善医疗服务行动实施2年来妇幼医疗机构住院患者的总体满意度及其影响因素,为促进妇幼机构提升服务水平和提高服务质量提出改进建议。方法收集2015年和2016年"全国改善医疗服务行动"第三方评估中全国33家妇幼医疗机构9 802例住院患者满意度调查结果和医疗机构年度卫生统计数据,采用多水平线性模型分析妇幼医疗机构住院患者满意度的影响因素。结果中国妇幼医疗机构住院患者总体满意度为(4.59±0.63)分,15个核心指标中,满意度最高的为"护士态度和善"[(4.70±0.58)分]和"医生耐心询问病情"[(4.70±0.56)分],满意度最低的为"我表扬和投诉医护人员的渠道畅通"[(3.11±2.16)分];对中国妇幼医疗机构住院患者总体满意度影响最大的为"本次住院费用明白、合理"(β=0.174 3,t=24.53,P <0.001),其次是"我感受到了医护人员给予我的尊重和安慰"(β=0.123 0,t=11.15,P <0.001),"医生耐心询问病情"和"护士态度和善"均是影响中国妇幼医疗机构住院患者总体满意度的重要指标(均P <0.001)。结论医疗费用仍是妇幼医疗机构住院患者主要关注的内容,而医护人员的服务意识越来越成为患者住院体验的重要因素,优化医疗资源配置和加强护理服务是进一步改善住院医疗服务的重点。
Objective To examine the overall satisfaction to medical service and its influencing factors among inpatients in tertiary maternal and child health institutions two years after the implementation of the National Healthcare Improvement Initiative, and to propose recommendations for improving medical service in maternal and child health institutions.Methods The data on 9 802 inpatients were extracted from surveys of Third Party Evaluation on Satisfaction to Medication in 33 maternal and child health institutions across China and the surveys were conducted during 2015 and 2016 under the National Healthcare Improvement Initiative. Multilevel linear model was used to analyze influencing factors of satisfaction to medical service among the inpatients. Results The overall score of satisfaction to medical service was 4.59 ± 0.63 for all the inpatients. Among the 15 domain satisfaction scores, the highest was 4.70 ± 0.58 for nurses′ kindness during care service and4.70 ± 0.56 for doctors′ patience when inquiring illness condition; whereas the lowest was 3.11 ± 2.16 for clear pathway for praising or complaining. Among influencing factors for the overall satisfaction of the inpatients, the strongest was reasonable hospitalization expenditure and its clear list for the expenditure-related medical service items(β = 0.174 3, t = 24.53, P <0.001), followed by perceived respect and comfort from medical staff(β = 0.123 0, t = 11.15, P < 0.001), doctors' patience when inquiring illness condition(P < 0.001) and nurses′ kindness during care(P < 0.001). Conclusion Medical cost still plays a critical role on satisfaction to medical service among inpatients in maternal and child health institutions, but medical staff's service attitude becomes an important factor of satisfaction to medical service among inpatients; the results suggest that optimizing medical resources allocation and strengthening nursing care are key points for improving hospitalization medication.
Objective To examine the overall satisfaction to medical service and its influencing factors among inpatients in tertiary maternal and child health institutions two years after the implementation of the National Healthcare Improvement Initiative, and to propose recommendations for improving medical service in maternal and child health institutions.Methods The data on 9 802 inpatients were extracted from surveys of Third Party Evaluation on Satisfaction to Medication in 33 maternal and child health institutions across China and the surveys were conducted during 2015 and 2016 under the National Healthcare Improvement Initiative. Multilevel linear model was used to analyze influencing factors of satisfaction to medical service among the inpatients. Results The overall score of satisfaction to medical service was 4.59 ± 0.63 for all the inpatients. Among the 15 domain satisfaction scores, the highest was 4.70 ± 0.58 for nurses′ kindness during care service and4.70 ± 0.56 for doctors′ patience when inquiring illness condition; whereas the lowest was 3.11 ± 2.16 for clear pathway for praising or complaining. Among influencing factors for the overall satisfaction of the inpatients, the strongest was reasonable hospitalization expenditure and its clear list for the expenditure-related medical service items(β = 0.174 3, t = 24.53, P <0.001), followed by perceived respect and comfort from medical staff(β = 0.123 0, t = 11.15, P < 0.001), doctors' patience when inquiring illness condition(P < 0.001) and nurses′ kindness during care(P < 0.001). Conclusion Medical cost still plays a critical role on satisfaction to medical service among inpatients in maternal and child health institutions, but medical staff's service attitude becomes an important factor of satisfaction to medical service among inpatients; the results suggest that optimizing medical resources allocation and strengthening nursing care are key points for improving hospitalization medication.
引文
[1]中华人民共和国中央人民政府.中华人民共和国人口与计划生育法[EB/OL].(2015-12-28)[2017-02-20].http://www.gov.cn/xinwen/2015-12/28/content_5028414.htm.
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[4]谢美华,黄友泉,董圣鸿,等.多层多项Logit模型:原理与应用[J].心理学探新,2013,33(5):430-437.
[5]王济川,谢海义,姜宝法.多层统计分析模型--方法与应用[M].北京:高等教育出版社,2008.
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[7]李丽清.基于聚类分析的江西省三甲医院患者满意度评价研究[J].中国卫生统计,2011,28(4):420-430.
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[10]赵红云,李秋洁,曹俊环,等.护理人力资源配置与患者护理满意度的相关性研究[J].护理管理杂志,2009,9(4):6-12.
[11]Potter P,Barr N,McSweeney M,et al.Identifying nurse staffing and patient outcome relationships:a guide or change in care delivery[J].Nur Econ,2003,21(4):158-167.
[12]徐奕旻,吴瑛,张艳,等.全国医院护士人力资源现状的调查[J].中华护理杂志,2016,51(7):819-822.
[13]梁志强,尹爱田,韩志琰,等.县乡两级住院满意度及影响因素分析[J].中国公共卫生,2014,30(3):321-324.
[14]潘登,陈烈平,陈巧钗,等.新医改背景下看病难与看病贵问题实证分析[J].中国全科医学,2014,17(1):67-70,74.
[15]王敏,兰迎春,赵敏.患者预设性不信任与医患信任危机[J].医学与哲学,2015,36(3A):47-50.
[16]高翔,张新宇,李硕,等.江苏省医患关系现状分析[J].中国公共卫生,2016,32(8):1013-1016.
[17]梁韵,姜锴明,屈万勇,等.我国近五年暴力伤医事件之原因及对策研究综述[J].医学与法学,2016,8(2):76-80.
[18]王亮,李梅君,张新庆,等.暴力侮辱伤医状况的调查分析[J].医学与哲学,2014,35(9A):47-49,73.
[19]夏磊,马丽春,艾祎,等.652例住院患者满意度分析与评价[J].中国医院管理,2015,35(2):59-61.
[20]郑秋莹,蔡乐.医疗服务中过程质量与结果质量对患者满意度的影响[J].中国卫生产业,2014,11(16):164-165.
[21]石景芬,龚永,李元峰,等.住院患者满意度实证研究及影响因素结构方程模型构建[J].中国循证医学杂志,2015,15(7):786-792.
[22]胡艳丽,邵军,陈阳生.住院患者满意度实证分析[J].中国卫生质量管理,2016,23(3):53-56.
[2]王晓慧.“全面二孩一年半”迎生育高峰:2017年新生二孩或超900万[N].华夏商报,2017-08-19(002).
[3]中华人民共和国国家统计局.年度数据[DS/OL].(2017-01-20)[2018-01-11].http://data.stats.gov.cn/adv.htm?m=advquery&cn=C01.
[4]谢美华,黄友泉,董圣鸿,等.多层多项Logit模型:原理与应用[J].心理学探新,2013,33(5):430-437.
[5]王济川,谢海义,姜宝法.多层统计分析模型--方法与应用[M].北京:高等教育出版社,2008.
[6]Okuda M,Yasuda A,Tsumoto S.Factors of patient satisfaction based on distant analysis in HCAHPS databases[C]//IEEEInternational Conference on Data Mining Workshop.IEEE,2014:328-337.
[7]李丽清.基于聚类分析的江西省三甲医院患者满意度评价研究[J].中国卫生统计,2011,28(4):420-430.
[8]北京协和医学院公共卫生学院.全国改善医疗服务行动第三方评估报告(2016-2017)[R].北京:北京协和学院公共卫生学院,2017.
[9]钱莹,池霞.某三甲妇幼保健院医务人员职业倦怠现状及其压力源与社会支持研究[J].江苏卫生事业管理,2017,28(1):2-5.
[10]赵红云,李秋洁,曹俊环,等.护理人力资源配置与患者护理满意度的相关性研究[J].护理管理杂志,2009,9(4):6-12.
[11]Potter P,Barr N,McSweeney M,et al.Identifying nurse staffing and patient outcome relationships:a guide or change in care delivery[J].Nur Econ,2003,21(4):158-167.
[12]徐奕旻,吴瑛,张艳,等.全国医院护士人力资源现状的调查[J].中华护理杂志,2016,51(7):819-822.
[13]梁志强,尹爱田,韩志琰,等.县乡两级住院满意度及影响因素分析[J].中国公共卫生,2014,30(3):321-324.
[14]潘登,陈烈平,陈巧钗,等.新医改背景下看病难与看病贵问题实证分析[J].中国全科医学,2014,17(1):67-70,74.
[15]王敏,兰迎春,赵敏.患者预设性不信任与医患信任危机[J].医学与哲学,2015,36(3A):47-50.
[16]高翔,张新宇,李硕,等.江苏省医患关系现状分析[J].中国公共卫生,2016,32(8):1013-1016.
[17]梁韵,姜锴明,屈万勇,等.我国近五年暴力伤医事件之原因及对策研究综述[J].医学与法学,2016,8(2):76-80.
[18]王亮,李梅君,张新庆,等.暴力侮辱伤医状况的调查分析[J].医学与哲学,2014,35(9A):47-49,73.
[19]夏磊,马丽春,艾祎,等.652例住院患者满意度分析与评价[J].中国医院管理,2015,35(2):59-61.
[20]郑秋莹,蔡乐.医疗服务中过程质量与结果质量对患者满意度的影响[J].中国卫生产业,2014,11(16):164-165.
[21]石景芬,龚永,李元峰,等.住院患者满意度实证研究及影响因素结构方程模型构建[J].中国循证医学杂志,2015,15(7):786-792.
[22]胡艳丽,邵军,陈阳生.住院患者满意度实证分析[J].中国卫生质量管理,2016,23(3):53-56.