白内障日间手术患者满意度调查及影响因素分析

发布时间：2019-05-23 16:17

【摘要】：目的:通过对山西省某医院白内障日间手术的患者进行调查,了解其满意度现状,分析其满意度的影响因素,找到医疗服务过程中的薄弱环节,并提出具体改进措施,从而改善患者就医体验,提高患者满意度,探寻适合医院开展日间手术的流程和管理模式,推动日间手术的持续性发展。方法:选取2016年7月~12月就诊于山西省某医院的白内障日间手术后复查,且符合条件接受问卷调查的患者536人,收回有效问卷524份,有效率97.8%。通过问卷调查白内障日间手术患者的人口社会学特征、日间手术知晓情况和日间手术患者满意度。采用SPSS23.0软件进行统计分析,运用统计描述、卡方检验和二元多因素logistic回归方法分析白内障日间手术患者满意度现状及其影响因素,检验水准为0.05。结果:1.白内障日间手术患者人口社会学特征显示:本次调查患者中,男性214人,女性310人;年龄最小的30岁,最大的88岁,平均年龄为70.1±11.5岁。2.日间手术知晓情况调查结果显示:(1)经X~2检验,手术后日间手术知晓率高于就诊前,差别有统计学意义(X~2=135.666,P0.001)。(2)了解日间手术的途径排名前三位:医生介绍(71.0%)、亲戚朋友告知(20.0%)、术后复查患者相互告知(6.1%)。(3)选择日间手术的主要原因排名前三位:缩短住院等候时间和治疗时间(31.5%)、可以较早回家康复,对自己和家人的生活影响较小(18.3%)、医生推荐(17.6%)。(4)经X~2检验,不同性别的白内障患者对日间手术的知晓率不同,男性高于女性,差别有统计学意义(X_(性别)~2=10.555,p=0.001);不同职业的白内障患者对日间手术的知晓率总体分布不同,离退休人员知晓率最高,差别有统计学意义(X_(职业)~2=19.806,p=0.003);不同平均月收入的白内障患者对日间手术的知晓率总体分布不同,随着收入的增高知晓率增高,差别有统计学意义(X_(平均月收入)~2=14.069,p=0.001);不同医保形式的白内障患者对日间手术的知晓率总体分布不同,参加城镇职工医疗保险的患者知晓率最高,差别有统计学意义(X_(医保形式)~2=14.140,p=0.003)。3.白内障日间手术患者满意度调查结果显示:患者对医院总体满意度为91.2%。对就诊流程的满意度为88.9%;对医疗质量的满意度为98.8%;对医患沟通的满意度为92.9%;对医德医风的满意度为97.5%;对医疗费用的满意度为76.7%;对医院环境的满意度为92.3%。4.白内障日间手术患者满意度二元多因素logistic分析结果显示:文化程度、有无既往手术史、术后对日间手术了解程度对患者满意度产生影响(p0.05)。在文化程度中,以大专/本科的患者为参照分类,中专/高中或初中及以下文化程度的患者与其均存在显著差异,or值分别为3.771、2.546,95%ci分别为(1.513,9.400)、(1.095,5.919),表示文化程度高的患者对日间手术满意度低;有既往手术史的患者与无既往手术史的患者对满意度存在显著差异,or值为4.763,95%ci为(1.729,13.122),有既往手术史的患者满意度是无既往手术史患者满意度的4.763倍;手术后患者对日间手术了解程度与患者满意度存在显著差异,or值为0.411,95%ci为(0.200,0.845),表明不太了解日间手术的术后患者较了解日间手术的术后患者满意度高。结论:1.山西某医院白内障日间手术患者总体满意度为91.2%。在六个维度的满意度评价中,就诊流程和医疗费用的患者满意度相对较低。2.白内障日间手术患者中,不同性别、职业、平均月收入、医疗保险形式对患者知晓率存在影响;不同文化程度、有无既往手术史和手术后对日间手术了解程度对患者满意度均存在影响。3.建议医院加大日间手术宣传力度,增加民众知晓率;多渠道降低医疗费用,完善医保政策;优化医疗服务流程,改变医疗管理模式;针对不同特点的患者提供个性化服务,提高患者满意度。
[Abstract]:Objective: To study the status of the patient's satisfaction, to analyze the influencing factors of the satisfaction degree, to find the weak link in the medical service process, and to put forward concrete improvement measures to improve the patient's medical experience through the investigation of the patients in a hospital in a hospital in Shanxi province. To improve the patient's satisfaction, explore the process and management mode suitable for the day operation in the hospital, and promote the continuous development of the day operation. Methods: From July to December,2016, a group of 536 patients who were admitted to a hospital in Shanxi province were reviewed, and 536 patients were eligible to receive the questionnaire. The effective rate was 52.4% and the effective rate was 97.8%. The demographic and social characteristics, day-to-day and day-to-day operation of patients with cataract surgery were investigated by questionnaire. Statistical analysis, statistical description, chi-square test and multi-factor logistic regression were used to analyze the status of the patient's satisfaction and the influencing factors, and the level of the test was 0.05. Results:1. The demographic and social characteristics of the patients with cataract surgery showed that in this survey, there were 214 males and 310 females, with a minimum age of 30 and a maximum of 88 years, with an average age of 70.1 to 11.5 years. The results of the study of day-to-day operation showed that: (1) After X-2 test, the rate of postoperative day-to-day operation was higher than that before treatment (X ~ 2 = 135.666, P 0.001). (2) To know the way of day-to-day operation was the first three: the doctor's introduction (71.0%), the relatives and relatives (20.0%), and the post-operative reexamination patients (6.1%). (3) The main reason for choosing daytime operation was the first three: to shorten the waiting time of the hospital and the treatment time (31.5%), to be able to go home earlier and to be less affected by the life of the family and the family (18.3%), and the doctor recommended (17.6%). (4) In the X ~ (2) test, the patients with different sex have different knowledge of the daytime operation, the male is higher than that of the female, the difference is of statistical significance (X _ (sex) ~ 2 = 10.555, p = 0.001), and the overall distribution of the patients with different occupational cataract is different from that of the daytime operation. The knowledge of the retired personnel is the highest, the difference is of statistical significance (X _ (occupation) ~ 2 = 19.806, p = 0.003); the average distribution of the average monthly income of the cataract patients is different from that of the daytime operation, and with the increase of the increase of income, The difference is of statistical significance (X _ (average monthly income) ~ 2 = 14.069, p = 0.001); the average distribution of the knowledge of the patients with cataract in different medical insurance forms is different from that of daytime operation, and the knowledge of the patients participating in the medical insurance for urban workers is the highest. The difference was statistically significant (X _ (medical insurance form) ~ 2 = 14.140, p = 0.003). The results of the patient's satisfaction survey showed that the overall satisfaction of the patients was 91.2%. The satisfaction of the medical treatment process was 88.9%, the satisfaction of the medical quality was 98.8%, the satisfaction of the doctor-patient communication was 92.9%, the satisfaction of the medical ethics was 97.5%, the satisfaction of the medical expenses was 76.7%, and the satisfaction of the hospital environment was 92.3%. The two-factor logistic analysis showed that the degree of culture, the history of previous surgery, and the degree of day-to-day operation had an effect on the patient's satisfaction (p0.05). In the degree of culture, there were significant differences between the patients with the junior college/ undergraduate degree as the reference classification, the secondary school/ high school or the middle school and the following culture degree. The OR value was 3.771, 2.546 and 95% CI (1.513, 9.400) respectively (1.513, 9.400), (1.095, 5.919), indicating that the patients with high degree of culture had a low degree of satisfaction with the day operation; Patients with a prior history of surgery had a significant difference in satisfaction with those with no prior history of surgery, or a value of 4.763,95% ci (1.729, 13.122), and a patient satisfaction with a prior history of surgery was 4.763 times that of the patient with no prior history of surgery; Post-operative patients had a significant difference in the degree of day-to-day operation and patient satisfaction, or a value of 0.411,95% ci (0.200, 0.845), indicating that patients with less understanding of day-to-day procedures were more satisfied with post-operative patients who had a better understanding of day-to-day surgery. Conclusion:1. The overall satisfaction of cataract in a hospital in a hospital in Shanxi was 91.2%. In the six-dimensional satisfaction evaluation, the patient satisfaction with the medical procedure and the medical expense is relatively low. The effect of different sex, occupation, average monthly income and the form of medical insurance on the patient's awareness of the patient during the day of cataract surgery was affected by the different degree of culture, the history of prior operation and the degree of understanding of the degree of understanding of the day-to-day operation after the operation. It is suggested that the hospital should increase the daily operation publicity, increase the awareness of the public, reduce the medical expenses through various channels, improve the medical insurance policy, optimize the medical service process and change the medical management mode, and provide the personalized service for patients with different characteristics and improve the patient's satisfaction.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.66

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