区域医疗联合体下肺结节社区早期筛查转诊服务业务流程再造效果评价

Evaluation of effect of community early screening and referral process reengineering of patients with pulmonary nodules under the regional medical consortium

目的:对肺结节社区早期筛查转诊服务进行业务流程再造,为规范和改善肺结节患者诊疗行为、提升肺结节社区早期筛查转诊服务效率提供参考。方法:选取2018年4月—2019年3月于上海市闵行区华漕社区卫生服务中心首诊后转诊的肺结节患者进行问卷调查,符合纳入标准并参与调查的患者共70例,共发放问卷70份,回收有效问卷68份。以接受业务流程再造后肺结节转诊服务的35例患者为流程再造组,以接受转诊建议后自行就诊的33例患者为对照组。结果:两组患者肺结节早期筛查转诊服务总平均得分分别为(51.17±10.18)分、(39.70±8.64)分,差异有统计学意义(P<0.01)。流程再造组的确诊时间、等候时间、确诊前就诊次数、随访次数、复诊频次、就诊费用、重复检查率、就诊延误率和转诊满意度条目的平均得分均明显高于对照组,差异有统计学意义(P均<0.01);两组患者的诊断准确率得分差异无统计学意义(P>0.01)。结论:区域医疗联合体下肺结节社区早期筛查转诊服务业务流程再造工作取得了预期效果,改善了患者的就医感受度和满意度。

Objective:To reengineer the business process of early screening and referral services for pulmonary nodules(PN)in the community to provide a reference for standardizing and improving the diagnosis and treatment behavior of patients with PN and improving the efficiency of early screening and referral services for PN in the community.Methods:The patients with PN who were first diagnosed in Huacao Community Health Service Center in Minhang District of Shanghai and referred from April 2018 to March 2019 were selected for questionnaire survey,a total of 70 patients met the inclusion criteria and participated in the survey,a total of 70 questionnaires were distributed and 68 valid questionnaires were collected.Thirtyfive patients who received PN referral service after business process reengineering were taken as the process reengineering group,and 33 patients who accepted the referral suggestion were selected as the control group.Results:The total average scores of the early screening and referral service for PN in the two groups were(51.17±10.18)points and(39.70±8.64)points,respectively,and the difference was statistically significant(P<0.01).The average scores of diagnosis time,waiting time,number of visits before diagnosis,number of follow-ups,frequency of follow-up visits,cost of visits,repeated examination rate,delay rate of visits,and referral satisfaction items of the process reengineering group were significantly higher than those of the control group,and the differences were statistically significant(all P<0.01);there was no significant difference between the two groups in the accuracy rate of diagnosis(P>0.01).Conclusion:The business process reengineering of the community early screening and referral service for PN under the regional medical consortium has achieved the expected results,and improve the patient’s medical perception and satisfaction.