The Empathic Patient Centered Approach in the Anesthetic Preoperative Interview

Background: Multiple studies in the primary care field have indicated the benefits of using a patient centered approach in communication with the patient;such interviewing methods have been shown to improve patient satisfaction and adherence. There is a scarcity of anesthetic literature regarding communication skills in the perioperative period. The goal is to analyze to what extent empathic patient-centered communication methods are being used by anesthesia providers. Communication scores will be compared among providers, as well as to providers across several different subspecialties. Methods: This study is an observational descriptive study at a large tertiary care center, University Hospital in Newark, NJ. The observer observes and grades patient interviews, scoring against established criteria using an adapted version of the Kalamazoo grading tool. The researcher observes and grades the preoperative interview using the adapted Kalamazoo scale. At the end of the observed encounter, the anesthesia providers are asked to fill out a brief form detailing their demographic history, details regarding the providers’ length and type of clinical education and training, undergraduate education, previous communication training, number of years of practice, primary language, gender, and age will be obtained. Results: Anesthesia providers included in the study were physician anesthesiologists, residents, and nurse anesthetists. The average Kalamazoo score was 28.7 amongst all providers. There was no significant effect of provider level on the score at the p Conclusions: The data revealed anesthesia providers provide patient-centered encounters with a mean score of 28.7, which is higher than the average for providers from multiple different specialties observed in Joyce, et al. study (mean score of 25.25). The subcategories “Understanding patient’s perspective” and “reaches agreement” scored 3.86, and 3.83, respectively. This may indicate that anesthesia providers can improve on allowing the patient to communicate their understanding of anesthesia, as well as collecting information from the patient that can affect their anesthesia (i.e., severe nausea following previous anesthesia).

A Comparison between Patients’ and Residents’ Perceptions of Patient Centeredness and Communication Skills among Physicians Working at Jordan University Hospital

Aim: This research aims to evaluate patient-centeredness and communication skills from the patients’ point of view and that of the physicians’ point of view and compares the two outcomes. Methods: This was a cross-sectional study with a convenient sample of 418 patients and 94 residents. Instrument of the study was a structured questionnaire that aimed to evaluate patient centeredness and communication skills of the residents. Results: Residents gave themselves a significantly higher score than the score given to them by patients in most studied aspects such as the extent to which the doctor discussed the patient’s problem, the extent to which the doctor explained the problem, the doctor introduced himself, the doctor greeted the patient properly and others. The only aspect for which patients gave residents higher score than that residents gave themselves was the extent to which the doctor asked the patient about what is expected to be done (ECG, CT scan, giving antibiotics, …). Conclusion: A transformation from doctor centered approach to patient centered approach is needed.

医生“以患者为中心”自我效能中文版量表的信效度研究

目的汉化“以患者为中心”自我效能量表(The self-efficacy in patient-centeredness questionnaire,SEPCQ),并检验其在医生群体中应用的信效度,为评估医生“以患者为中心”的自我效能水平提供可靠工具。方法遵循Brislin量表翻译原则,经过直译、回译、文化调适及预调查,形成中文版SEPCQ。采用分层随机抽样方法,选取珠三角、粤东、粤西及粤北地区26所三甲综合医院1318名临床医生进行问卷调查,并检验量表心理测量学特性。结果中文版SEPCQ具有较好的内部一致性(Cronbach’sα=0.988)和折半信度(Guttman系数=0.961)。探索性及验证性因子分析结果均反映量表结构效度良好。量表共包含识别患者需求、共享信息和权力、应对沟通挑战3个维度、26个条目,与原量表结构基本一致,累积方差解释率为85.162%。验证性因子分析显示模型拟合良好。结论中文版SEPCQ在医生群体中应用具有较好的信效度,可作为评估中国医生“以患者为中心”自我效能水平的工具。

在线医患闲聊话语情感支持的语用研究

作为一种常规化与边缘化的谈话方式,闲聊在医患交流中的积极作用受到学界广泛关注。尽管医患闲聊的积极作用主要体现在人际功能的实现,却鲜有研究将情感支持这一推进人际关系的言语行为纳入医患闲聊研究视阈中。基于此,本研究以春雨医生线上经典问答为语料(约25万字),重点考察中国医患闲聊中的情感支持策略。研究结果表明,医生在线上闲聊过程中,主动利用移情、安慰、接纳、保证、伙伴关系等情感支持策略,拉近医患距离、建立医患信任、构建特定身份。作为虚拟“社会资本”的医患闲聊亦具有潜在的“货币资本”价值,并为中国特色社会主义医患交流“文化资本”的形成奠定基础。

基于患者体验的医院绩效评价研究进展

文章在解释患者报告健康状况和患者体验内涵的基础上,介绍了国内外基于患者体验的医院绩效评价研究并比较国内外相对成熟的基于患者体验的医疗服务质量评价量表。借鉴国外医院绩效评估经验,提出下一阶段我国公立医院绩效评价的重要内容,为建立系统、科学的公立医院绩效评价体系提供借鉴。

以病人为中心的思想是医院文化建设的根本内涵

医院文化作为一种高科技含量的特殊服务行业文化,是企业文化的一种特殊形式,应纳入我国社会主义丈化建设的大框架之中。“以病人为中心”的思想可以比较准确地概括我国社会主义医院文化的基本特点。在全体员工中牢固地树立“以病人为中心”的思想观念是医院文化建设的基本内涵。“以病人为中心”是以“为人民服务”为核心的社会主义道德在卫生行业的特征性描述,并体现了“以人为本”的伦理思想。“以病人为中心”的医院文化能够最充分地说明医院在目前的社会主义市场经济情况下所应采取的经济与经营活动策略。

医院以病人为中心运行模式的设计与思考

要使以病人为中心的工作处于常规运行状态,关键是建立一种与之相适应的运行模式。为此,医院服务模式必须由微观方面的改革向宏观方面的改革深化;医疗模式实现以医生为中心到以病人为中心的转变;管理模式实现由技术管理迈向素质管理的跨越。

以病人为中心研究的演进路径、热点与前沿分析

目的:探究不断发展变化的以病人为中心的概念,分析其研究热点和趋势。方法:以1997年-2014年SCI数据库中收录的以病人为中心的全部文献作为研究对象,应用Cite Space可视化软件绘制文献共被引网络图谱,并进行关键词聚类和膨胀词探测分析。结果:10篇关键节点文献很好地展示了以病人为中心领域研究的演进路径,并得到7个主要聚类以及4个最新突现词。结论:以病人为中心经历了维度归纳——概念正式化——实践应用的发展历程。研究热点与前沿主要包括:以病人为中心的过程与结局之间的影响机制研究、基层医疗实践新方法研究、以病人为中心的疗效比较研究、以病人为中心的测量与评估。

论以人为本的和谐医患关系在中国的构建

医疗卫生事业与人民的健康和生命密切相关,发展医疗卫生事业是构建社会主义和谐社会的重要内容。但是目前我国的医患冲突屡屡发生,医患关系呈紧张局势。因此,客观分析医患关系现状及不和谐原因,坚持以人为本的科学发展观为指导,积极构建以良好的医疗行为规范和职业道德伦理为核心的和谐医患关系,是新时期搞好我国医疗卫生事业的关键。

临床药学服务沟通的基本技能与模型应用

目的探讨沟通的基本技能以及药物相关咨询框架在临床药学服务中的应用。方法通过翻阅现有书籍与文献检索,了解药师-患者沟通基本技能及现有可应用于临床药学服务的沟通模型。结果多数涉及药师-患者沟通的研究仅涉及沟通技巧及意义的叙述,仅有少数学者使用模型构建临床药学服务的有效沟通模式。本文通过阐述如何与患者建立良好的信任关系,仔细倾听并向患者表达同理心,同时在沟通中运用口头语言、肢体语言及书面语言等临床药学服务沟通的基本技能,并结合药物相关咨询框架叙述其在临床药学服务沟通中的应用。结论药物相关咨询框架可为药学服务人员沟通的技能提升提供参照,有助于提高患者用药安全性及患者依从性,改善医院临床药学服务质量。

Application of KDQOL-SF^(TM) 1.3 version in evaluating quality of life of maintenance hemodialysis patients in multiple centers

Objective To understand the quality of life(QOL)and its influencing factors in maintenance hemodialysis patients(hemodialysis maintenance,MHD),and to provide theoretical basis for improving QOL of patients.Methods A cross-sectional study was conducted in the blood purification centre in 8 hospitals in Hefei,and patients’clinical data were collected.KDQOL-SF self-ad-

The Accountable Care Organization results:Population health management and quality improvement programs associated with increased quality of care and decreased utilization and cost of care

Objective:The Accountable Care Organization(ACO)model of health care delivery is based on new payment models for general practice to reward improved quality and decreased cost of care.Methods:Banner Health Network(BHN)is one of the original CMS Pioneer ACO programs and implemented a comprehensive disease management program based on the collaborative care model.Key performance indicators for CMS reflected quality and cost of care.Results:BHN has demonstrated both improved quality and cost savings in the first two years of the pilot program.The disease management program based on the collaborative care model appears to have improved patient health outcomes based on quality improvement measures.In addition the program has reduced emergency department and hospital utilization,resulting in cost savings.Conclusions:The BHN quality improvement program is the platform for analyzing and improving on the BHN ACO model.This model appears to have excellent application to the China health care system that is also focused on prevention and improvement of chronic disease and cost-effectiveness.