Kano模型在区域脑卒中人群服务模式建立中的探索与实践

Development and Regional Performance Examination of a Kano Model-based Service Pattern for the Stroke Population:an Exploratory Study

目的通过对社区脑卒中高危人群的Kano需求调查,分析社区脑卒中高危人群服务条目需求状况和满意度,为社区脑卒中高危人群服务模式的建设提供决策参考。方法选取2017-06-12至2017-09-05前往芷江西路街道社区卫生服务中心门诊就诊的脑卒中高危居民作为调查对象。采用自行设计的调查问卷进行调查。调查问卷内容包括脑卒中高危人群基本信息、社区脑卒中卫生服务条目Kano需求调查表。分析居民社区脑卒中卫生服务Kano需求。结果共发放调查问卷202份,回收有效调查问卷202份,有效回收率为100.0%。西药治疗属于魅力属性;西药治疗的满意度、重要度均最高,居民满意度和重要度均较高的服务条目有指标监测、转诊服务、西药治疗、物理康复。既往未发生过脑卒中的居民认为转诊服务属于魅力属性,满意度最高的是转诊服务,重要度最高的是物理康复;既往发生过脑卒中的居民认为西药治疗属于魅力属性,满意度和重要度最高的均是西药治疗。既往未发生过脑卒中的居民的满意度和重要度均较高的服务条目是转诊服务,满意度较低但重要度较高的服务条目有指标监测、中药治疗、针灸、西药治疗、物理康复、运动康复;既往发生过脑卒中的居民的满意度和重要度均较高的服务条目是指标监测、西药治疗、物理康复。既往脑卒中发生次数<3次的居民认为西药治疗属于魅力属性,满意度最高的是普及宣教,重要度最高的是西药治疗;既往脑卒中发生次数≥3次的居民认为强化教育属于魅力属性,药膳服务为魅力属性或无差异属性,中药治疗为反向属性,西药治疗为魅力属性或必备属性,满意度最高的是强化教育,重要度最高的是西药治疗。既往脑卒中发生次数<3次居民的满意度和重要度均较高的服务条目是指标监测、转诊服务、西药治疗、物理康复;既往脑卒中发生次数≥3次居民的满意度和重要度均较高的服务条目是西药治疗,满意度较低但重要度较高的服务条目是运动康复。结论对于社区脑卒中高危人群,西药治疗成为各项社区卫生服务中心开展的脑卒中卫生服务中的魅力属性服务,但对于不同发病次数的脑卒中高危人群,其所认为的魅力属性服务又各有差异;社区开展的多项脑卒中预防工作并不受社区居民的重视,提示社区卫生服务中心有待加强宣传和提升预防服务的吸引力,以引导社区居民服务需求质量属性的转变,同时应注意服务的设置应因人而异。

Objective To investigate the healthcare demands and level of satisfaction with healthcare among community-dwelling individuals with high risk of stroke with a Kano model-based questionnaire survey,providing a reference for the development of service patterns for such populations.Methods This survey was conducted in a sample of community-dwelling individuals with high risk of stroke receiving outpatient healthcare in West Zhijiang Road Community Health Service Center from June 12th to September 5th,2017 with a self-developed Kano model-based questionnaire for collecting the demographic characteristics and attitude toward the community-based services for populations with high risk of stroke.And an analysis of the survey results was carried out.Results All the participants（202） responded positively to the survey,with a response rate of 100.0%.For all of them,western medicine therapy had attractive quality;the 4 services winning high level of satisfaction and self-rated significance were measurement of 3 indicators（blood pressure,blood lipids,fasting blood glucose）,referral service,western medicine therapy and physical rehabilitation,in particular,western medicine therapy won the highest level of satisfaction and self-rated significance among all the services.From the perspective of those without a history of stroke,referral service had attractive quality,and it won the highest level of satisfaction and high level of self-rated significance;measurement of 3 indicators,Chinese medicine therapy,acupuncture therapy,western medicine therapy,physical rehabilitation and exercise rehabilitation were of high level of self-rated significance despite winning low level of satisfaction,in particular,physical rehabilitation had the highest level of self-rated significance of all the services.In the view of individuals with a history of stroke,western medicine therapy possessed attractive quality;measurement of 3 indicators,western medicine therapy and physical rehabilitation gained high level of both satisfaction and self-rated significance,in particular,western medicine therapy achieved the highest level of satisfaction and self-rated significance.In the opinion of those with stroke onset times less than 3,western medicine therapy had attractive quality,and it won the highest level self-rated significance,but public education of stroke-related data achieved their highest level of satisfaction;measurement of 3 indicators,referral service,western medicine therapy and physical rehabilitation gained high level of both satisfaction and self-rated significance.In the eyes of those with stroke onset times ≥ 3,intensive education of stroke-related data had attractive quality,dietary therapy was of attractive quality or indifferent quality,but Chinese medicine therapy was of reverse quality,western medicine therapy had attractive quality or must-be quality;western medicine therapy won a high level of satisfaction and the highest level of self-rated significance,intensive education of stroke-related data achieved the highest level of satisfaction,exercise rehabilitation won high level of selfrated significance despite gaining low level of satisfaction.Conclusion Western medicine therapy was evaluated as a service with an attractive quality in all the participants.However,the assessed service with an attractive quality differed significantly between participants by onset times of stroke.The community-based preventive services for stroke was not valued by the participants,which demonstrates that the community health center should further intensively publicize such preventive services and make these services be more attractive,guiding such a population to change the quality attributes given to the needed services.In addition,the community-based services delivered should be different from person to person.