Constructing theory model for medical quality and safety management based on grounded theory / 中华医院管理杂志

Objective:To construct future-oriented theoretical management model for medical quality and patient safety.Methods:Procedure grounded theory was applied to code data including 30 expert interview records from July 2021 to June 2022 and the qualitative analysis results of 71 core literatures in Chinese and English, and then the theoretical model was constructed.Results:After three-level coding, 555 reference points, 249 initial concepts, 41 categories, 27 main categories and 7 core categories related to medical quality and safety management were sorted out, and the theoretical model of SQ (I-SPORT) matrix for medical quality and safety management was constructed. This model extended the traditional dimension in quality and safety management.Conclusions:Regarding medical quality and safety management, on one hand, should focus on the systematic improvement of structure, process, results, reengineering, education and training in terms of management functions; on the other hand, it is necessary to improve the organization, employees, resources, technology and tools, and patient experience in terms of management elements.

Hot spots and prospects of medical quality and safety management in China since the new medical reform / 中华医院管理杂志

Objective:To analyze the hot spots and frontiers of medical quality and safety management since the new medical reform, and to provide reference for the continuous improvement of medical quality and safety management.Methods:Chinese literatures related to medical quality and medical safety management in CNKI database from April 2009 to December 2022 were retrieved, and the included literatures were processed and analyzed by CiteSpace software and Excel software.Results:1 921 literatures related to medical quality management and 2 497 literatures related to medical safety management were included. The publication trend showed a " double peak", showing a downward trend. The research hotspots in literature related to medical quality and safety management in China since the new medical reform have focused on practice exploration and influencing factors. The trend of future research is to closely follow the background of the times in medical quality and safety management research and intelligent medical quality and safety management evaluation system research.Conclusions:In the future, research on medical quality and safety management should be more in line with the changes of medical reform policies, focus on high-quality development to deepen the research on micro issues, promote information construction to continuously improve the indicator evaluation system, so as to promote the sustainable and high-quality development of medical quality and safety management in China.

Analysis of inpatient satisfaction and influencing factors in 33 tertiary cancer hospitals in China / 中华医院管理杂志

Objective:To investigate the patient satisfaction at tertiary cancer hospitals in China, and explore its determinants.Methods:Based on the fifth third-party evaluation of China Healthcare Improvement Initiative, an inpatient satisfaction survey was conducted from January 2021 to March 2021 in 33 tertiary cancer hospitals in China. Inpatient satisfaction was analyzed, and Chi-square test and binary multivariate logistic regression were run, using the level of overall inpatient satisfaction as a dependent variable.Results:A total of 5 417 inpatients in tertiary cancer hospitals was recruited with 49.8% men. The inpatient at the age of 35-59 accounted for 56.0%, and they were 52.8±13.9 years old. The level of overall inpatient satisfaction was 98.90%. The inpatient satisfaction rates of meal service, waiting time for admission and psychological counseling service provided by hospital were relatively poor, which were 78.75%, 92.40% and 94.11%, respectively. The regression showed that level of overall inpatient satisfaction in the central and western regions(compared with eastern area), with urban and rural residents basic medical insurance or other type(compared with urban employee basic medical insurance), of breast cancer patients(compared with other disease), with unsured postoperative metastasis(compared with non-postoperative metastasis), with low self-rated health score(compared with the score of between 81 and 100)was lower.Conclusions:The inpatients in tertiary cancer hospitals in China is highly satisfied with the care provided. In the future, more attention should be paid to the dimension of lower patient satisfaction, such as diet and psychological counseling.

Satisfaction analysis of inpatient experience improvement in 136 tertiary public hospitals in China / 中华医院管理杂志

Objective:To summarize the progress and achievement of inpatient experience improvement in public hospitals in China from 2016 to 2021, so as to provide basis for further improving hospitalization experience and raising inpatient satisfaction.Methods:Based on the five Third-party Evaluations of China Healthcare Improvement Initiative from 2016 to 2021, descriptive trend analysis was conducted on inpatient process, cost and inpatient satisfaction, and the inpatient satisfaction in different regions and different types of institutions was compared.Results:The overall satisfaction of hospitalized patients in the fifth evaluation in 2021(98.5%)was higher than that in the first evaluation in 2016(96.2%). The western region and maternal and child institutions had the most obvious improvement in the comparison of regional and institutional types. The improvement of inpatients′ satisfaction with diet was not obvious. Inpatients were most dissatisfied with " high medical expenses" , " cumbersome procedures" and " long waiting time for bed" .Conclusions:From 2016 to 2021, the satisfaction of hospitalized patients has been consistently improved, but there is still room for improvement in non-medical services. Hospital meals for inpatient and relief of inpatient healthcare financial burden are the priorities for healthcare improvement and raising hospitalization satisfaction in the next stage.

Satisfaction analysis on outpatient experience in 136 tertiary public hospitals in China / 中华医院管理杂志

Objective:To summarize the progress and achievement of outpatient experience improvement in tertiary public hospitals from 2016 to 2021, so as to provide basis for further improving outpatient experience and raising outpatient satisfaction.Methods:Based on 5 round third-party evaluations of the China Healthcare Improvement Initiative from 2016 to 2021, descriptive trend analysis was conducted on the outpatient process and outpatient satisfaction, and stratified analysis was conducted on patient satisfaction in different regions and different types of institutions.Results:One hundred and thirty-six core sample hospitals were included in the 5 round evaluation, and 30 153 valid questionnaires were collected in the fifth evaluation in 2021.From 2016 to 2021, the overall satisfaction of outpatients in the 5 round evaluations was 91.4%, 87.3%, 90.1%, 91.1% and 95.4%, respectively. The satisfaction of outpatients to the medical services continued to improve. Outpatient treatment process has been continuously optimized, appointment registration has become the most commonly used way of outpatient registration. The satisfaction of outpatients to the process and environment of treatment in the western region was significantly improved.Conclusions:From 2016 to 2021, the overall satisfaction of outpatients has been consistently improved. Informatization helps to optimize the treatment process, but it is recommended that hospitals should provide special support for elderly outpatients.

Investigation and analysis of patients′ subjective feelings of medical reform effect under the background of the China Healthcare Improvement Initiative / 中华医院管理杂志

Objective:To explore the change trend of patients′ recognition of the medical reform effect and medical staff′s occupation and its relationship with medical experience, since the implementation of the China Healthcare Improvement Initiative(CHII), so as to provide reference for exploring the breakthrough point of consolidating the reform effect.Methods:Four indicators of the third-party assessment of patients were selected, which were " I think the medical reform has benefited patients" , " I think the doctor-patient relationship is improving in the past three years" , " I think medical personnel deserve social respect and recognition" , and " I am willing to let my children join the medical profession" . Descriptive and trend analysis were carried out on the survey results, and correlation analysis was carried out between the survey results and patients′ medical experience.Results:Compared with the baseline evaluation results(76.9% and 69.9%for outpatients, 87.3% and 85.6%for inpatients), the patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship in the fifth evaluation(86.2% and 89.1%for outpatients, 91.4% and 92.6%for inpatients)were significantly improved. The proportion of patients who thought the medical staff was worthy of respect and willing to let their children work in the hospital in the fifth evaluation(97.4%, 79.1%for outpatients, 98.7%, 85.1%for inpatients)were higher than the baseline evaluation results(92.3%, 71.0%for outpatients, 98.1%, 81.6%for inpatients). The above indicators were positively correlated with the patient′s medical experience.Conclusions:Since the implementation of CHII, patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship has been continuously improved, and patients′ respect and recognition of professional identity of medical personnel is at a high level and continues to improve. Improving medical experience has a positive effect on the improvement of patients′ sense of medical reform.

Clinical efficacy of HDR brachytherapy with concomitant complementary IMRT boost for bulky uterine cervical cancer / 中华放射肿瘤学杂志

Objective To investigate the clinical outcomes of patients with locally advanced uterine cervical cancer (UCC) treated by 3-dimensional high dose rate-intracavitary brachytherapy (3D HDR-ICBT) combined with complementary applicator-guided external beam radiotherapy (EBRT).Methods A total of 120 patients pathologically diagnosed with locally advanced UCC (tumors with a maximum diameter≥6 cm or ≥5 cm complicated with eccentric tumor growth) treated with concurrent chemoradiotherapy (CCRT) from June 2010 to June 2015 were recruited.Five fractions of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy were performed.The prescribed dose for HR-CTV and IR-CTV was 7 Gy (D9o) and 5-6 Gy (D90).The rectum,sigmoid colon,bladder and adjacent small intestine were delineated as the organs at risk.Intensity-modulated radiation therapy (IMRT) was used for EBRT (45 Gy/ 25f) combined with cisplatin-based chemotherapy every three weeks (75 mg/m2).Results The median follow-up time was 46 months (14-96 months).The 5-year local control rate (LCR),disease-free survival (DFS),and overall survival (OS) were 92.8％,76.6％ and 81.0％,respectively.The incidence rate of grade Ⅰ-Ⅱ genitourinary and gastrointestinal acute toxicities were 57.8％ and 14.6％,whereas 8.1％ and 2.9％ for grade Ⅲ toxicities.The incidence rate of later grade Ⅰ-Ⅱ genitourinary and gastrointestinal toxicities were 8.4％ and 5.3％,and 0.97％ and 1.3％ for grade Ⅲ late toxicities.Conclusions The combination of HDR-ICBT with an applicator-guided IMRT (ICBT+IMRT) yields low incidence of severe adverse events,relatively high LC and OS rate for locally advanced UCC.It is an efficacious comprehensive treatment of locally advanced bulky UCC.

Long-term results and prognostic factors in 582 nasopharyngeal carcinoma treated by intensitymodulated radiotherapy / 中华放射肿瘤学杂志

Objective To evaluate the long-term results and prognostic factors in 582 nasopharyngeal carcinoma ( NPC ) patients treated by intensity modulated radiotherapy ( IMRT ) . Methods 582 newly diagnosed NPC patients treated by IMRT in Sichuan cancer hospital from Jan. 2001 to Dec. 2004were reviewed. According to 2002UICC staging system, there were 36 stage Ⅰ , 144 stage Ⅱ , 224 stage Ⅲ, 178 stage Ⅳa. The Kaplan-Meier method was used to calculate the survival rate.Acute and late toxicities were graded according to the radiation therapy oncology group (RTOG) radiation morbidity scoring criteria. Results The follow up rate was 93.5％. The 5-year local control, regional control, distant metastasis-free survival, disease free survival, disease specific survival and overall survival rate was 89. 8％,95. 2％, 74. 1％, 69.6％, 83.2％ and 77. 1％. There were 29, 13 and 117 patients who had developed local, regional and distant recurrence respectively. The incidence of grade 3 acute ( salivary gland、 oral mucosa and skin) and late toxicity was 44. 5％ and 4. 2％. No grade 4 acute and late toxicity reaction was found. Multivariate analysis showed that clinical stage, N stage, radiotherapy interruption, age, HGB and weight loss were the independent prognostic factors for the overall survival. ConclusionsNPC treated with IMRT could get good long-term survival with high quality of life. The clinical stage and N stage were the main prognostic factors for the overall survival. The acute and late toxicities were mainly grade 1 and 2.Distant metastasis is the main cause of treatment failure.