摘要
目的分析转诊患者对县域医疗共同体(以下简称医共体)医疗服务的满意度,为进一步提高医共体内医疗服务质量和服务连续性提供参考。方法2021年4—7月,采用系统抽样方法,选取2家医共体的牵头医院及3家成员单位的门诊患者,以及非医共体的2家县级医院和5家基层医疗卫生机构的门诊患者进行问卷调查,共纳入患者660例。问卷内容包括主要人口学信息和4个维度的15个满意度题项。采用倾向得分匹配法消除混杂因素,采用因子分析法计算医共体和非医共体的上/下转诊患者满意度,以M(IQR)表示,采用系统动力学方法分析患者满意度对转诊意愿的影响。结果收回有效问卷641份,经1∶2倾向性得分匹配后,最终纳入患者591例,其中上转患者非医共体组102例,医共体组273例;下转患者非医共体组76例,医共体组140例。上/下转诊患者的总体满意度得分分别为4.26(1.01)分和4.29(1.14)分;医共体组上转患者的总体满意度、医疗服务满意度、技术服务质量满意度和非技术服务质量满意度高于非医共体,下转患者的总体满意度和非技术服务质量满意度显著高于非医共体组,差异有统计学意义(P<0.05)。医共体内患者转诊满意度越高,转诊意愿越强。结论医共体组转诊患者的满意度整体高于非医共体组。医共体建设提供了转诊患者满意度,但仍需进一步促进优质医疗资源有效下沉,提升基层医疗卫生机构服务水平,实施差异化医保报销政策,提高医共体内医疗服务连续性。
Objective To analyze the satisfaction of referral patients for the medical services provided by the countywide medical community,for reference in further improving its quality and continuity of medical services.Methods From April to July 2021,a systematic sampling method was adopted to selected the survey subjects from the outpatients from the leading hospitals and three affiliated units of two medical communities,as well as those from two county-level hospitals of non medical communities and five grass-roots medical and health institutions.A total of 660 patients were included in the questionnaire survey.The questionnaire covered key demographic information and 15 satisfaction questions under 4 dimensions.The propensity score matching method was used to reduce confounding factors,factor analysis was used to calculate the satisfaction of referral patients in the medical community group and the non-medical community group,and the systematic dynamics approach was used to analyze the effect of patient satisfaction on referral intention.Results A total of 641 valid questionnaires were collected.Based on a 1∶2 propensity score matching,591 patients were finally enrolled,consisting of 102 up-referral cases from the non-community group and 273 such cases from the community group,as well as 76 down-referral cases from the non-community group and 140 such cases from the community group.The overall satisfaction scores by both up and down referral patients were 4.26(1.01)and 4.29(1.14)respectively.The overall satisfaction,medical service satisfaction,technical service quality satisfaction and non-technical service quality satisfaction of up-referral patients,as well as the overall satisfaction,non-technical service quality satisfaction of down-referral patients of the community group were higher than those from the non-community group,with differences statistically significant(P<0.05).The higher satisfaction of patients with their referral in the community,the stronger their referral willingness.Conclusions The overall satisfaction of refrerral patients in the medical community group is higher than that of the non medical community group.The construction of county medical community has promoted the improvement of satisfaction of referral patients.However,it is still imperative to encourage high-quality medical resources to support primary institutions,to enhance the service level of primary medical and health institutions,to implement differentiated medical insurance reimbursement policies,and to improve the continuity of medical services within the community.
作者
杜晓楠
张萌
冯颖超
夏青云
徐烟云
苗豫东
吴建
Du Xiaonan;Zhang Meng;Feng Yingchao;Xia Qingyun;Xu Yanyun;Miao Yudong;Wu Jian(College of Public Health,Zhengzhou University&Henan Province Health Economics and Technology Assessment Center,Zhengzhou 450001,China;Department of Health Management and Policy,School of Public Health,Hangzhou Normal University,Hangzhou 310036,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2022年第8期580-584,共5页
Chinese Journal of Hospital Administration
基金
国家社会科学基金(19BGL250,21BGL222)。
关键词
医疗服务
医疗共同体
转诊患者
满意度
倾向得分匹配
Medical services
Medical community
Referral patients
Satisfaction
Propensity score matching
