本文關(guān)鍵詞： 醫(yī)院 市立 醫(yī)生病人關(guān)系 質(zhì)量指標(biāo) 衛(wèi)生保健　出處：《中國(guó)全科醫(yī)學(xué)》2017年06期 　論文類型：期刊論文

【摘要】：背景目前我國(guó)公立醫(yī)院的評(píng)價(jià)考核體系非常不完善,傳統(tǒng)"自上而下"式的醫(yī)院績(jī)效考評(píng)收效甚微。目的構(gòu)建基于醫(yī)患雙方的公立醫(yī)院聲譽(yù)評(píng)價(jià)指標(biāo)體系,緩解醫(yī)患雙方信息失衡局面,引導(dǎo)患者合理就醫(yī)。方法基于廣泛的文獻(xiàn)研究和專家咨詢法構(gòu)建基于醫(yī)患雙方的公立醫(yī)院聲譽(yù)評(píng)價(jià)指標(biāo)體系,包括醫(yī)務(wù)人員(一級(jí)指標(biāo)7個(gè),二級(jí)指標(biāo)30個(gè))和患者(一級(jí)指標(biāo)5個(gè),二級(jí)指標(biāo)16個(gè))兩部分。將其二級(jí)評(píng)價(jià)指標(biāo)按醫(yī)務(wù)人員與患者兩部分分別轉(zhuǎn)換成醫(yī)務(wù)人員調(diào)查問卷(包括7個(gè)維度、30個(gè)條目)和患者調(diào)查問卷(包括5個(gè)維度、16個(gè)條目)。2015年3—5月,采用整群隨機(jī)抽樣法在江蘇省蘇南、中、北地區(qū)各選取2家三級(jí)醫(yī)院(西醫(yī)院、中醫(yī)院各1家)的醫(yī)務(wù)人員和患者進(jìn)行問卷調(diào)查。采用描述性分析、相關(guān)性分析和極端組差異顯著性檢驗(yàn)評(píng)價(jià)公立醫(yī)院聲譽(yù)評(píng)價(jià)指標(biāo)體系信度,運(yùn)用KMO檢驗(yàn)、Bartlett's球形檢驗(yàn)、主成分分析法與因子最大差異旋轉(zhuǎn)法評(píng)價(jià)公立醫(yī)院聲譽(yù)評(píng)價(jià)指標(biāo)體系結(jié)構(gòu)效度。結(jié)果共向醫(yī)務(wù)人員發(fā)放問卷150份,回收有效問卷126份,有效回收率為84.0%;共向患者發(fā)放問卷210份,回收有效問卷210份,有效回收率為100.0%。醫(yī)務(wù)人員調(diào)查問卷總得分平均數(shù)為3.64分,各條目得分平均數(shù)為2.71~4.22分,各條目得分的標(biāo)準(zhǔn)差平均數(shù)為0.81,各條目得分均出現(xiàn)過1~5分;患者調(diào)查問卷總得分平均數(shù)為3.47分,各條目得分平均數(shù)為2.57~4.05分,各條目得分的標(biāo)準(zhǔn)差平均數(shù)為0.84,各條目得分均出現(xiàn)過1~5分。醫(yī)務(wù)人員、患者調(diào)查問卷各條目得分與總得分校正的項(xiàng)總計(jì)相關(guān)性(ITC)均0.400。醫(yī)務(wù)人員、患者調(diào)查問卷的總體Cronbach'sα系數(shù)分別為0.950、0.938。將醫(yī)務(wù)人員與患者分別依據(jù)其總得分前后27%極端區(qū)域劃分成高分組(醫(yī)務(wù)人員34例,患者57例)和低分組(醫(yī)務(wù)人員34例,患者57例),醫(yī)務(wù)人員、患者高分組調(diào)查問卷各條目得分均高于低分組(P0.05)。醫(yī)務(wù)人員調(diào)查問卷的KMO=0.808,Bartlett's球形檢驗(yàn)χ~2=2 920.623,df=435,P0.001;患者調(diào)查問卷的KMO=0.930,Bartlett's球形檢驗(yàn)χ~2=1 969.937,df=120,P0.001;均滿足主成分分析要求。對(duì)醫(yī)務(wù)人員調(diào)查問卷進(jìn)行主成分分析,根據(jù)因子特征值≥1.000的標(biāo)準(zhǔn),共提取了7個(gè)公因子,分別命名為服務(wù)質(zhì)量、創(chuàng)新能力、技術(shù)、人員素質(zhì)、公共關(guān)系、費(fèi)用、社會(huì)責(zé)任承擔(dān),累積貢獻(xiàn)率為72.800%,且各條目的載荷值均大于0.500。對(duì)患者調(diào)查問卷進(jìn)行主成分分析,根據(jù)因子特征值≥1.000的標(biāo)準(zhǔn),共提取了4個(gè)公因子,分別命名為服務(wù)質(zhì)量、費(fèi)用、技術(shù)、社會(huì)責(zé)任承擔(dān),累積貢獻(xiàn)率為75.079%,且各條目的載荷值均大于0.500。結(jié)論基于醫(yī)患雙方的公立醫(yī)院聲譽(yù)評(píng)價(jià)指標(biāo)體系具有較好的信度和結(jié)構(gòu)效度,具有一定的科學(xué)性與應(yīng)用價(jià)值。
[Abstract]:Background at present, the evaluation and assessment system of public hospitals in our country is very imperfect, and the traditional "top-down" type of hospital performance evaluation has little effect. Objective to construct a public hospital reputation evaluation index system based on both doctors and patients. Methods based on extensive literature research and expert consultation, a public hospital reputation evaluation index system based on both doctors and patients was established, including medical staff (7 first-class indexes). (II) 30 indicators) and patients (5 indicators at the first level), The second level evaluation index is converted into medical staff questionnaire (including 7 dimensions, 30 items) and patient questionnaire (including 5 dimensions) according to the two parts of medical staff and patients. March to May, 2015, The cluster random sampling method was used to investigate the medical staff and patients of two tertiary hospitals (one in west hospital and one in Chinese medicine hospital) in Jiangsu Province. Correlation analysis and extreme group significant test to evaluate the reliability of public hospital reputation evaluation index system, KMO test was used to test Bartletts-sphere test. Results 150 questionnaires were sent out to medical staff, 126 valid questionnaires were collected, the effective recovery rate was 84.0, 210 questionnaires were sent out to patients. 210 valid questionnaires were collected, and the effective recovery rate was 100.00.The average of the total score of the questionnaire was 3.64, the average score of each item was 2.71 ~ 4.22, the average standard deviation of each item was 0.81, and the scores of each item were 1-5 points. The average of the total score of the questionnaire was 3.47, the average score of each item was 2.574.05, the standard deviation of each item was 0.84, and the scores of each item were 1 ~ 5. The correlation between the scores of each item in the questionnaire and the total score was 0.400.Medical staff, The total Cronbach's 偽 coefficient of the questionnaire was 0.950 and 0.938 respectively. According to the total score of 27% extreme areas, the medical staff and the patients were divided into high score group (34 medical personnel, 57 patients) and low group (34 medical staff). 57 patients, medical staff, The scores of each item in the high score group of patients were higher than those in the low group (P0.050.The KMO-0.808 / Bartletts spherical test 蠂 ~ 2 920.623 ~ (3) 3 ~ (3)) P 0.001; the KMO-0.930 (Bartletts) spherical test 蠂 ~ (2) (1) (1 969.937) dfU ~ (120) P0.001; all met the requirements of principal component analysis (PCA). Volume for principal component analysis, According to the criterion of factor characteristic value 鈮，

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