An Evaluation Scale of Medical Services Quality Based on “Patients' Experience”

An evaluation scale of medical services quality was developed on the basis of ＂patients＇ experience＂. The questionnaires were developed by, among others, searching relevant literature, col- lecting well-established assessment scales, measuring patients＇ experience and satisfaction, brain-storming, literature analysis. Delphi method was adopted for expert consultation. Scale items were screened and revised. The key indexes were converted. Field surveys were conducted for testing the reliability and validity of the scale. Our modified evaluation scale for measuring medical services quality based on ＂patients＇ experience＂ included 6 dimensions （tangibility, reliability, responsiveness, assurance, empathy and continuity）, and 50 items. The novel scale based on ＂patients＇ experience＂ may better serve the purpose of assessin~ medical services quality.

Construction of a New Model of Contactless Medical Services for Outpatients Based on the Project-Achieving Quality Control Circle

Objective: To carry out empirical research on the role of project-achieving quality control circle (QCC) in constructing a new model of contactless medical service for outpatients. Methods: A QCC, consisting of information office members from a grade A tertiary hospital in Wenzhou, was established to conduct a research project with the theme “Constructing a new model of contactless medical service based on outpatients’ experience.” According to the ten steps and PDCA cycle, an analysis was carried out before and after the QCC activities, focusing on improving pre-consultation services, providing steward-like services, and facilitating post-consultation management. Results: After the QCC activities, the mobile appointment rate, missed appointment rate, the proportion of smart check-ins, and the average check-in time were 55.68%, 4.02%, 39.75%, and 8.24 ± 3.66 min, respectively;in contrast, before the activities, they were 32.00%, 7.88%, 0.00%, and 14.96 ± 4.98 min, respectively;the difference between the two groups was statistically significant (χ2 = 3480.112, 4994.496;Fisher’s exact probability = 963788.570;t = 5.323, P < 0.001). Many experts have also visited the hospital to learn about this system, thus rendering social and economic benefits. Conclusion: Project-achieving QCC activities are suitable for complex situations, such as constructing a new model of contactless medical service, and can significantly improve outpatient service quality, enhance patients’ experience, and improve the abilities of circle members.

Medical consultation in ulcerative colitis:Key elements for improvement

Ulcerative colitis(UC)is a chronic inflammatory disease with a high impact.In order to improve patient outcomes,the clinician-patient relationship in daily practice is critical.Clinical guidelines provide a framework for UC diagnosis and treatment.However,standard procedures and the medical content focused upon medical consultations in UC patients has not yet been defined.Moreover,UC is a complex disease,given that patient characteristics and patient needs have been proven to vary during clinical consultation since establishing the diagnosis and upon the course of the disease.In this article,we have discussed the key elements and specific objectives to consider in medical consultation,such as diagnosis,first visits,follow-up visits,active disease patients,patients on topical therapies,new treatment initiation,refractory patients,extra-intestinal manifestations,as well as challenging situations.The key elements have been mentioned to comprise effective communication techniques,motivational interviewing(MI),as well as information and educational aspects,or organizational issues.The key elements to be implemented in daily practice were reported to comprise several general principles like duly prepared consultations,in addition to honesty and empathy with patients,as well as effective communication techniques,MI,information and educational points,or organizational issues.The role of other healthcare professionals such as specialized nurses,psychologists,or the use of checklists was also discussed and commented on.

Experience of the patient's success in facing post-stroke urinary incontinence: the patient's perspective

Objective:Post-stroke urinary incontinence(UI)is one of the sequelae of stroke.This situation affects all aspects of the patient’s life–physically,psychologically,socially,and spiritually.This study aimed to investigate the experience of patients’success in facing a post-stroke UI.Methods:A qualitative study using the Rapid Assessment Procedure(RAP)approach was used in this study.Informants were selected using purposive sampling.In-depth interviews with as many as 8 patients who had recovered from post-stroke UI and living in the greater area of Southeast Sulawesi(Indonesia)were conducted.In-depth interviews were also conducted with 8 caregivers and 2 nurses.Data were analyzed using a thematic analysis approach and interpretation of data was based on Humanbecoming theory and Self-care deficit theory of nursing.Results:Five successful things the patients experienced during post-stroke UI were identified.The five successes were as follows:they provided information to get to know and understand post-stroke UI,followed the procedures to overcome post-stroke UI,conducted self-control exercises and stayed motivated,performed daily activities independently according to ability,and made use of family suppor t and peers’attention.Conclusions:These findings indicated that persistence,belief,independence,and social support(family and peer)made patients to successfully face their post-stroke UI and improved their quality of life.These findings also became the basis for developing a poststroke UI management model based on Humanbecoming theory and Self-care deficit theory of nursing.

Enhancing Quality of Patients Care and Improving Patient Experience in China with Assistance of Artificial Intelligence

Improving health of Chinese people has become national strategy according to the Healthy China 2030.Patient experience evaluation examines health care service from perspective of patients;it is important for improving health care quality.Applying artificial intelligence(AI)in patient experience is an innovative approach to assist continuous improvement of care quality of patient service.A nursing quality platform based on patient experience data which is empowered by AI technologies has been established in China for the purpose of surveillance and analysis of the quality of patient care.It contains data from nearly 1300 healthcare facilities,based on which portraits of nursing service qualities can be drawn.The patient experience big data platform has shown potentials for healthcare facilities to improve patient care quality.More efforts are needed to achieve the goal of enhancing people’s sense of health gain.

Evaluation of Patients’ Experience Following Dental Implant Surgical Procedure

Background: Patient’s acceptability of dental implant prostheses may be influenced the fact that a surgical procedure is involved. Adequate relevant information by the dental professionals pre-surgery, is therefore, paramount to alleviating the fear of surgery and contribute positively to patient’s ability to cope with post-surgical experience. This study, therefore, aimed at evaluating the postsurgical experience of the dental implant patients. As against what was expected, and relate this with the information given pre surgery. Methodology: Post treatment self-completed questionnaires were administered to consented patients that had dental implants placed between July 2017 and December 2019. The surgical procedure followed the standard protocol and data related to post-surgical experience were collected one week after the surgery to obtain information on the level of pain/discomfort and amount of swelling experienced following surgery. The effect of the information on coping ability following surgery was also assessed. Data were analyzed using descriptive statistics (p value ≤ 0.05). Results: Twenty-seven patients received 44 implants to replace 48 teeth. The mean age of the patients was 45 ± 16.3 (SD) years. Teeth mostly replaced were the maxillary central incisors (39.6%). The majority of the patients 77.7% reported to experience less pain/discomfort than expected and 66.6% had less swelling than expected. While 29.6% felt they had excellent explanation of what to expect, 51.9% said they had good explanation. The post-surgical experience between males and females was not statistically significant (pain: p = 0.08, swelling: p = 0.64). However, the majority (8/12) that had good to excellent information preoperatively, had significantly less discomfort than expected. Conclusion: Positive, encouraging and satisfactory experience of patients following implant surgical procedure is related to adequate and correct information pre-surgery.

What Is the Personal Experience of IBD Patients about Their Anti-TNF-Alpha Therapy?

AIM: To evaluate and compare the patients opinion on the two types of anti- TNF-α therapies in a Hungarian cohort of IBD patients. METHODS: This was a prospective, multicentre, questionnaire-based observational study carried out in three Hungarian tertiary centres. From April to September 2014, an anonymous questionnaire was distributed to patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD), who have received infliximab (IFX) and/or adalimumab (ADA). The survey focused on the preferences of the two anti-TNF-α therapies on the basis of the efficacy, the administration routes and the side effects. RESULTS: 292 IBD patients, 216 CD, 75 UC and 1 indeterminate colitis patient completed the questionnaire. The mean duration of biological therapy was 1.7 (1 - 7) years. IFX treated patients noticed improvement of symptoms at 4 - 5 weeks while ADA treated patients noticed at 5 - 6 weeks. There was no difference between the patients’ satisfaction regarding the types of anti-TNF-α therapy if they received both. However, subcutaneous administration was preferred by ADA-treated patients previously receiving IFX (p = 0.007) compared to intravenous route and they did not intend to change the mode of therapy (p = 0.040). 90% of the patients, receiving only IFX or ADA were satisfied with their present therapy. The majority of patients (186/292, 63.7%) would not switch therapy. 63 of 291, 22% of the patients reported to have some concern with biological therapy—the majority (32/63, 50.8%) due to fear from side effects. CONCLUSION: Generally, patients preferred and would not change the present anti-TNF-α therapy, however, subcutaneous administration was preferred among those patients who had have experience with both.

Nurses'experiences in voluntary error reporting:An integrative literature review

Objective:This integrative review aimed to examine and understand nurses’experiences of voluntary error reporting(VER)and elucidate factors underlying their decision to engage in VER.Method:This is an integrative review based on Whittemore&Knafl five-stage framework.A systematic search guided by the PRISMA 2020 approach was performed on four electronic databases:CINAHL,Medline(PubMed),Scopus,and Embase.Peer-reviewed articles published in the English language from January 2010 to December 2020 were retrieved and screened for relevancy.Results:Totally 31 papers were included in this review following the quality appraisal.A constant comparative approach was used to synthesize findings of eligible studies to report nurses'experiences of VER represented by three major themes:nurses'beliefs,behavior,and sentiments towards VER;nurses'perceived enabling factors of VER and nurses'perceived inhibiting factors of VER.Findings of this review revealed that nurses’experiences of VER were less than ideal.Firstly,these negative experiences were accounted for by the interplays of factors that influenced their attitudes,perceptions,emotions,and practices.Additionally,their negative experiences were underpinned by a spectrum of system,administrative and organizational factors that focuses on attributing the error to human failure characterized by an unsupportive,blaming,and punitive approach to error management.Conclusion:Findings of this review add to the body of knowledge to inform on the areas of focus to guide nursing management perspectives to strengthen institutional efforts to improve nurses'recognition,reception,and contribution towards VER.It is recommended that nursing leaders prioritize and invest in strategies to enhance existing institutional error management approaches to establish a just and open patient safety culture that would promote positivity in nurses’overall experiences towards VER.

Safety of the Patient from the Medication

Currently, more than 7% of admissions to acute care hospitals am related with AEMs （adverse events to medications）. AEMs are the sixth cause of death, causing a cost of over $5.6 million dollars （USD） per hospital per year. There is an estimate that between 19% and 23% of hospitalized patients will have an adverse effect within the first 30 days after being discharged, 14.3% will be re-admitted and 70% of these events will be related to a medication prescription. Fortunately, at least 58% of these AEMs are preventable, since they result from a lack of information on the medication, prescription and dosage errors and from the abuse and underuse of the same. Polymedicated patients, especially the elderly with multiple pathologies and/or chronic patients that need to be admitted into the hospital more frequently, usually to internal medicine, neurology, psychiatry, rehabilitation and intensive care, are precisely the most liable to suffer from medication errors. It must be the objective to aim for the increase in the patient safety standards when it comes to medications.

Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

基于改善患者就医体验的门诊服务模式构建与效果分析

门诊服务质量直接影响患者就医体验。绵阳市中心医院以患者为中心,聚焦就医流程、服务要素、特殊群体就医需求、组织保障等,简化服务流程,优化服务要素配置,满足特殊群体就医需求,实现了门诊服务的精细化管理,改善了患者就医体验。

老年友善门诊多元化管理的研究与分析

目的通过优化老年患者的就医服务模式,方便老年患者就医,提升老年患者就医体验。方法选取就诊济宁医学院附属医院内分泌遗传代谢科、神经内科、心血管内科、消化内科的800例老年患者,根据管理的时间不同分为对照组和观察组。将2021年1—6月管理前,就诊内分泌遗传代谢科、神经内科、心血管内科、消化内科的400例老年患者设为对照组,采用常规老年服务模式;2023年1—6月管理后,就诊内分泌遗传代谢科、神经内科、心血管内科、消化内科的400例老年患者设为观察组,采用友善服务模式。分别从老年患者门诊等待时间和门诊服务满意度比较2组管理效果。结果管理后,观察组门诊等待时间短于对照组,差异有统计学意义(P<0.05);观察组老年患者门诊服务总满意度为97.00%,高于对照组的92.00%,差异有统计学意义(P<0.05)。结论多元化的老年友善门诊服务管理可以缩短老年患者就诊等待时间,提高门诊服务满意度,有效改善老年患者的就医体验。

基于文献计量学的患者服务管理研究热点与趋势分析

目的:探讨近年来患者服务管理的研究现状及热点趋势。方法:以“患者服务管理”或“患者体验”为关键词,在中国知网(CNKI)数据库进行检索,检索时间为2015-2023年;利用CiteSpace软件对检索到的文献进行数据处理和可视化分析。结果:共检索到393篇有效文献,主要集中在满意度、患者体验、服务质量、门诊管理、护理质量及投诉管理等方面。结论:患者服务管理领域的研究重点关注满意度、患者体验、就医体验和服务质量等方面;数字化技术和信息技术等新技术的出现为患者服务管理领域的发掘和拓展带来了新的机遇和挑战。

患者旅程地图在慢性病照护中的研究进展

阐述患者旅程地图的概念、起源与发展、基本原则、应用目的、构建方法。提出患者旅程地图是医护人员、慢性病患者和家属之间信息共享的重要工具。未来应结合我国国情及相关政策针对不同类型的慢性病患者展开患者旅程地图的探索,以优化慢性病患者就医体验及长期照护质量。

以入院新模式为抓手提升患者就医体验的实践与探索

目的通过对某大型综合公立三甲医院入院新模式工作开展前后相关指标进行分析,探索提升患者就医体验的有效途径。方法采用回顾性分析和问卷调查的方法,分析入院新模式工作开展前后患者住院便捷性、及时性、患者满意度等方面的变化。结果入院新模式开展后,待床患者收治率明显升高,患者待床时间降低,办理入院手续时间明显缩短,床位使用率提高,患者术前平均住院日下降,急危重症患者收住量增加,四级手术占比、住院患者满意度等指标提升。结论入院新模式工作的开展,提高了服务效率和服务质量,提升了患者就医体验、提高了患者满意度,值得推广。

基于集团化管理模式的国企医院门诊服务改善实践与效果

目的探索国企医院改善医疗服务、提升患者体验的管理模式,分析集团化管理模式下门诊服务改善专项行动的实践效果。方法基于集团化管理模式,聚焦门诊就诊各环节,结合医院发展现状、特色优势、门诊就诊环境、患者需求等,采取有针对性的干预措施,开展持续性的门诊服务改善专项行动。以参与门诊服务改善专项行动的32家医院为样本,采用SPSS 27.0等分析软件,通过对患者满意度和门诊人次等相关指标进行回顾性分析,探究集团化管理模式下的国企医院门诊服务改善的实践效果。结果实施门诊服务改善专项行动1年后,门诊患者满意度和门诊人次均显著提升,且这种积极效果普遍存在,不受医院级别、员工数、床位规模等因素的影响,但医院所属区域会影响门诊患者满意度的提升程度。结论集团化管理模式能够普遍有效地改善国企医院的门诊服务,提升患者体验,国企医院门诊服务改善在坚持以公益性为主导的同时兼顾了经营效益。

中国南北两地2型糖尿病患者二线用药偏好差异研究

背景近年来我国糖尿病患病人数位列全球第一。《中国老年2型糖尿病防治临床指南(2022年版)》推荐二甲双胍为一线降糖用药的同时,强调“以患者为中心”,根据患者的临床特征及其偏好选择适当的二线降糖药进行联合用药。由于我国南北两地2型糖尿病患病率、生活行为等方面存在较大差异,两地2型糖尿病患者二线用药偏好是否存在差异还有待进一步论证。目的分析南北两地2型糖尿病患者二线用药偏好差异,为临床和卫生管理决策提供实证依据。方法于2021年10月—2022年1月,采用离散选择实验设计调查问卷,多阶段随机整群抽样与方便抽样相结合,调查南北两地2型糖尿病患者二线用药偏好,构建混合Logit模型进行偏好分析。结果本研究共发放问卷1443份,回收有效问卷1388份,有效回收率为96.19%。Logit模型分析结果显示,血糖控制效果、发生低血糖事件的风险、发生胃肠道不良反应的风险、能否保护心血管、服药方式、自付费用是南方患者对二线用药偏好的影响因素(P<0.05),南方2型糖尿病患者偏好自付费用为0元/月、无胃肠道不良反应风险、血糖控制效果很强、无低血糖事件风险、能保护心血管和服药方式为口服的二线降糖药物(P<0.05),当发生胃肠道不良反应的风险由较高换为无风险时,南方患者每月愿意支付408.06元。血糖控制效果、发生低血糖事件的风险、发生胃肠道不良反应的风险、能否保护心血管、服药方式、自付费用、半年内体质量变化是北方患者对二线用药偏好的影响因素(P<0.05),北方2型糖尿病患者偏好自付费用为0元/月、血糖控制效果很强、无低血糖事件风险、能保护心血管、无胃肠道不良反应风险、服药方式为口服和半年内体质量变化降低2.0 kg的二线降糖药物(P<0.05),当治疗血糖控制效果很弱换为很强时,北方患者每月愿意支付435.98元。结论除自付费用外,南方2型糖尿病患者更关注胃肠道不良反应,而北方2型糖尿病患者更重视血糖控制效果,南北两地2型糖尿病患者二线用药偏好存在差异。地域差异为2型糖尿病患者个性化治疗提供了依据,临床诊治需要“以患者为中心”,注重个体偏好差异。

某三级公立医院创建适老化门诊就医模式的实践探索

随着老龄化社会的到来,老年患者正逐渐成为医疗机构服务的主要对象,给卫生健康行政管理工作带来严峻挑战。针对老年群体生理、心理及社会能力等方面的特殊性,创建适老化门诊就医模式是满足其日益增长的卫生服务需求的可行措施。某三级公立医院从优化门诊就诊环境、打造专病门诊、推行线上与线下多学科协作诊疗模式、信息系统“适老化”改造、线下护理门诊与“互联网+护理”模式并进、建立一站式服务中心等方面着手,进行创建适老化门诊就医模式的实践探索,为老年患者提供高质量的人文医疗服务,有效改善了老年患者的就医体验,提升了就医便利性,促进了医疗公平的实现,为医疗机构创建适老化门诊就医模式提供了借鉴与参考。

基于ESIA法的大型医院窗口服务建设探索

目的:以患者就医体验为切入点,分析大型医院窗口服务中存在的不足,探讨如何将医院窗口服务建设体系化、品牌化,从而提高医院社会服务能力和群众满意度。方法:采用ESIA法对医院窗口服务流程进行优化。结果:窗口服务质量显著提升,患者投诉减少,各项医疗指标和社会满意度显著上升。结论:ESIA法对于提升医院窗口服务质量,改善患者就医体验具有指导意义。

基于数据挖掘技术探析姚守恩治疗荨麻疹的用药规律

目的:利用数据挖掘技术分析探讨姚守恩治疗荨麻疹的用药规律。方法:基于中医传承计算平台V 3.0软件,收集姚守恩治疗荨麻疹的病历,将数据录入软件,对录入的处方进行四气五味统计、药物频次统计及关联规则分析等数据挖掘,并分析用药规律。结果:共纳入处方3418首,涉及中药282味,使用频次较高的药物有防风、浮萍、茯苓、甘草、炒白术等,药性以温、寒、平为主,药味以甘、辛、苦为主,归经以肺经、脾经、肝经、心经、肾经为主;常用药对有“防风-浮萍”“防风-茯苓”“浮萍-茯苓”“防风、浮萍-茯苓”等;聚类分析得出新方3首,功效以疏风散寒、清热解表、凉血、益气健脾为主。结论:姚守恩认为风邪是荨麻疹发病的关键,外邪犯肺、饮食损脾均可致气血亏虚,久之阴血损耗,则生风生燥,又复感风邪,治疗以疏风散寒、清热补肺、健脾益气为法,兼以润燥祛风。