基于医患双方的公立医院声誉评价指标体系研究

发布时间：2018-03-02 08:23

  本文关键词： 医院 市立 医生病人关系 质量指标 卫生保健　出处：《中国全科医学》2017年06期 　论文类型：期刊论文

【摘要】：背景目前我国公立医院的评价考核体系非常不完善,传统"自上而下"式的医院绩效考评收效甚微。目的构建基于医患双方的公立医院声誉评价指标体系,缓解医患双方信息失衡局面,引导患者合理就医。方法基于广泛的文献研究和专家咨询法构建基于医患双方的公立医院声誉评价指标体系,包括医务人员(一级指标7个,二级指标30个)和患者(一级指标5个,二级指标16个)两部分。将其二级评价指标按医务人员与患者两部分分别转换成医务人员调查问卷(包括7个维度、30个条目)和患者调查问卷(包括5个维度、16个条目)。2015年3—5月,采用整群随机抽样法在江苏省苏南、中、北地区各选取2家三级医院(西医院、中医院各1家)的医务人员和患者进行问卷调查。采用描述性分析、相关性分析和极端组差异显著性检验评价公立医院声誉评价指标体系信度,运用KMO检验、Bartlett's球形检验、主成分分析法与因子最大差异旋转法评价公立医院声誉评价指标体系结构效度。结果共向医务人员发放问卷150份,回收有效问卷126份,有效回收率为84.0%;共向患者发放问卷210份,回收有效问卷210份,有效回收率为100.0%。医务人员调查问卷总得分平均数为3.64分,各条目得分平均数为2.71~4.22分,各条目得分的标准差平均数为0.81,各条目得分均出现过1~5分;患者调查问卷总得分平均数为3.47分,各条目得分平均数为2.57~4.05分,各条目得分的标准差平均数为0.84,各条目得分均出现过1~5分。医务人员、患者调查问卷各条目得分与总得分校正的项总计相关性(ITC)均0.400。医务人员、患者调查问卷的总体Cronbach'sα系数分别为0.950、0.938。将医务人员与患者分别依据其总得分前后27%极端区域划分成高分组(医务人员34例,患者57例)和低分组(医务人员34例,患者57例),医务人员、患者高分组调查问卷各条目得分均高于低分组(P0.05)。医务人员调查问卷的KMO=0.808,Bartlett's球形检验χ~2=2 920.623,df=435,P0.001;患者调查问卷的KMO=0.930,Bartlett's球形检验χ~2=1 969.937,df=120,P0.001;均满足主成分分析要求。对医务人员调查问卷进行主成分分析,根据因子特征值≥1.000的标准,共提取了7个公因子,分别命名为服务质量、创新能力、技术、人员素质、公共关系、费用、社会责任承担,累积贡献率为72.800%,且各条目的载荷值均大于0.500。对患者调查问卷进行主成分分析,根据因子特征值≥1.000的标准,共提取了4个公因子,分别命名为服务质量、费用、技术、社会责任承担,累积贡献率为75.079%,且各条目的载荷值均大于0.500。结论基于医患双方的公立医院声誉评价指标体系具有较好的信度和结构效度,具有一定的科学性与应用价值。
[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 伪 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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