本文選題：婚前保健 + 質(zhì)量評價�。� 參考：《福建醫(yī)科大學(xué)》2012年碩士論文

【摘要】：研究目的本課題立足于免費(fèi)依法婚檢政策，從供需雙方角度對福建省婚前保健服務(wù)結(jié)構(gòu)、過程、結(jié)果進(jìn)行全面的質(zhì)量評價，探究服務(wù)中存在的問題和主要影響因素，進(jìn)而提出有針對性的質(zhì)量改進(jìn)對策與建議。 研究方法參考美國學(xué)者多那比第安(Avedis Donabedian)提出的“結(jié)構(gòu)—過程—結(jié)果”醫(yī)療服務(wù)質(zhì)量三維理論，采用文獻(xiàn)分析法、觀察法、問卷調(diào)查法和半結(jié)構(gòu)式訪談法收集資料,并運(yùn)用統(tǒng)計描述、統(tǒng)計推斷、公平性分析等方法進(jìn)行分析，最后提出有針對性的對策和建議。 研究結(jié)果1.結(jié)構(gòu)質(zhì)量：在免費(fèi)依法婚檢政策的推行下，全省婚前保健服務(wù)網(wǎng)絡(luò)已基本建立，但仍存在各地婚檢補(bǔ)貼標(biāo)準(zhǔn)懸殊、婚檢醫(yī)師數(shù)量和結(jié)構(gòu)分配不均、無專用衛(wèi)生咨詢室和衛(wèi)生宣教室等問題。2.過程質(zhì)量：大多數(shù)婚檢機(jī)構(gòu)雖然按照規(guī)范要求開展了婚檢服務(wù)，但仍存在諸如服務(wù)流程不合理、轉(zhuǎn)診機(jī)制不健全、婚檢“只檢不治”、衛(wèi)生指導(dǎo)與咨詢受忽視和相關(guān)宣傳不到位等問題。3.結(jié)果質(zhì)量：2010年福建省婚前率為高達(dá)97.31%，居全國首位，但供方滿意度不高，婚檢醫(yī)師工作滿意度量表中各項(xiàng)指標(biāo)平均分為3.55，其中得分最低的五項(xiàng)依次為報酬（2.88+1.05）、晉升（3.02+0.98）、工作自主性（3.35+0.92）、做不同事的機(jī)會(3.39+0.91)和醫(yī)院政策(3.43+0.9)，同時45歲以上、中級職稱為主的婚檢醫(yī)師滿意度低于35歲以下、低級職稱為主的醫(yī)師；婚檢對象滿意度量表中各指標(biāo)平均分為4.51分，其中評分最低的五項(xiàng)依次為交通便利(4.21+0.95)、候診條件(4.43+0.81)、候診時間(4.47+0.81)、宣教40min(4.49+0.78)和及時出報告(4.51+0.79)，不同性別、年齡、居住地的婚檢對象滿意度得分存在統(tǒng)計學(xué)差異。 研究結(jié)論在免費(fèi)依法婚檢政策推行下，福建省婚前保健服務(wù)取得一定的成績，如婚檢率、檢出疾病人數(shù)上升，醫(yī)學(xué)指導(dǎo)意見充分尊重公民自主權(quán)，婚檢對象滿意度較高等，但仍存在上述列舉的問題。為進(jìn)一步提高婚前保健服務(wù)質(zhì)量，提出以下建議：制定補(bǔ)貼最低標(biāo)準(zhǔn)、加大婚前保健宣傳、強(qiáng)化機(jī)構(gòu)規(guī)范化建設(shè)、優(yōu)化服務(wù)流程、完善轉(zhuǎn)診機(jī)制、開展個性化指導(dǎo)與咨詢、加強(qiáng)醫(yī)師培訓(xùn)和建立健全激勵機(jī)制等。
[Abstract]:Objective to evaluate the structure, process and results of premarital health care service in Fujian Province from the perspective of supply and demand, based on the policy of free pre-marital medical examination, and to explore the existing problems and main influencing factors in the service. And then put forward targeted quality improvement countermeasures and suggestions. Methods referring to the three-dimensional theory of "structure-process-result" proposed by American scholar Avedis Donabedian, the data were collected by literature analysis, observation, questionnaire survey and semi-structured interview. The methods of statistical description, statistical inference and fairness analysis are used to analyze. Finally, some countermeasures and suggestions are put forward. Results 1. Structural quality: under the implementation of the policy of free and lawful premarital medical examination, the network of premarital health care services in the province has basically been established, but there are still wide disparities in the standard of subsidies for premarital examinations in various localities, and the number and structure of doctors undergoing premarital examinations are not evenly distributed. No special health consultation room and health education room, etc. Process quality: although most premarital inspection institutions have carried out premarital examination services in accordance with the standard requirements, there still exist such services as unreasonable service flow, imperfect referral mechanism, and "only inspection without treatment". Health guidance and counseling neglected and related issues such as inadequate publicity. 3. Results: the premarital rate of Fujian Province in 2010 was as high as 97.31%, ranking first in the country, but the satisfaction of the suppliers was not high. The average score of the five indexes in the scale was 3.55, among which the lowest scores were: remuneration 2.88 1.05, promotion 3.02 0.98, job autonomy 3.350.92, opportunity to be non-colleagues 3.39.91) and hospital policy 3.43 0.9, at the same time, over 45 years old. The satisfaction degree of the premarital examiner with intermediate professional title was lower than that of the doctor under 35 years of age, and the average score of each index in the satisfaction scale of premarital examination object was 4.51. Among them, the five items with the lowest score were convenient transportation 4.29.5, waiting time 4.47.0.81g, waiting time 4.47.881, and timely report 4.51.0.79. there were statistical differences among different sex, age and place of residence. Conclusion under the implementation of the policy of free and legal premarital medical examination, Fujian Province has made some achievements in premarital health care services, such as the rate of premarital examination, the increase in the number of patients detected, the full respect of medical guidance for the autonomy of citizens, and the higher satisfaction of the premarital examination objects, etc. However, there are still problems listed above. In order to further improve the quality of premarital health care service, the following suggestions were put forward: establishing the minimum standard of subsidy, increasing premarital health care propaganda, strengthening the standardized construction of institutions, optimizing service flow, perfecting referral mechanism, and carrying out individualized guidance and consultation. Strengthen the training of doctors and establish a sound incentive mechanism.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R169.1

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