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Objective@#To carry out the 4th round of third-party evaluation on the implementation and effect of the 1st year of the 2nd Phase National Healthcare Improvement Initiative(abbreviated as Initiative)since 2015.@*Methods@#The 4th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations.@*Results@#The 4th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces(autonomous regions, municipalities directly under the Central Government)and Xinjiang Production and Construction Corps.Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1%, 96.7%for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved.@*Conclusions@#The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction.
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Objective To carry out the 4th round of third-party evaluation on the implementation and effect of the 1st year of the 2nd Phase National Healthcare Improvement Initiative ( abbreviated as Initiative) since 2015. Methods The 4th round of the evaluation survey adopted the same methods, organization and execution, and technical roadmap as the former three rounds of evaluations.Results The 4th round of evaluation was carried out from 18 March to 9 April, 2019 at 185 public hospitals in 31 provinces ( autonomous regions, municipalities directly under the Central Government ) and Xinjiang Production and Construction Corps. Facility survey, health professional survey and patient survey were conducted at each of the sample health facilities. A total of 120 782 valid questionnaires were collected from 144 non-psychiatric health facilities, 16 246 valid questionnaires were obtained from 41 psychiatric health facilities, and 252 cases of outstanding departments/hospitals in healthcare improvement were also collected. The average overall scoring of the 12 dimensions to assess Initiative implementation at 144 non-psychiatric health facilities was 84.4%. The overall outpatient satisfaction scoring was 91.1% , 96.7% for the inpatients. The overall inpatient satisfaction(family members inclusive) at 41 psychiatric health facilities was 93%. Areas remaining to be improved include day-surgery, telemedicine and medical social work. Compared with technical services, non-technical care should be further strengthened. The compensation, workload and work environment of the healthcare providers are still to be improved. Conclusions The implementation of the Initiative by health facilities has been greatly improved. The percentage of health facilities and patients who had positive perceptions of improved doctor-patient relationship has been increasing. Patient care experiences at public hospitals have been generally improved, and the implementation of promoting traditional Chinese Medicine practices also made progress. However, work satisfaction of healthcare providers was found to be rather low, compared to the high level of patient satisfaction.
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Objective To investigate the associations between lifestyle factors and social network and cognitive impairment among the elderly in three communities in China.Methods From November 2017 to May 2018,1 200 elderly individuals were selected from three Chinese communities (Beijing,Hefei,and Lanzhou) using a random cluster sampling method.Data were collected on lifestyle,social network,and cognition.A conditional logistic regression analysis was conducted to identify the associations between lifestyle and social network and cognitive impairment.Results A total 1 115 participants (92.9％) were administered both social network and cognition questionnaires.After adjustment by age,sex,education,marital status,health,and living status,only low participation in physical activity was found to be associated with cognitive impairment (OR=0.65,95％ CI=0.45-0.93,P=0.019).A larger social network (OR=0.50,95％ CI=0.29-0.85,P=0.010),especially more friends (0R=0.44,95％ CI=0.29-0.65,P＜0.001),may decrease the risk of cognitive impairment.The interactions between lifestyle factors and social network were not associated with cognitive impairment.Conclusion Our findings suggest that larger social networks and physical activity are associated with cognitive function among the elderly.Identification and intervention of risk factors are crucial in the delay and prevention of cognitive impairment and the improvement of quality of life among the elderly.
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Objective To understand the current situation of doctors and nurses perceptions on doctor-patient relationship and its main influencing factors, and to make recommendations for further healthcare improvement. Methods Based on the survey results of the third-party evaluation of the National Healthcare Improvement Initiative of 136 public tertiary hospitals, we analyzed the doctors' and nurses' perceptions on doctor-patient relationship and the influencing factors. SAS 9.4 software was used to conduct variance test of doctors' and nurses' basic information and multivariate logistic regression analysis of the influencing factors of doctors' and nurses' perceptions on doctor-patient relationship. Results The recognition of doctors and nurses on the statement of "doctor-patient relationship has been getting better", their career identity and hoping children to study medicine varied significantly (P <0.05) with hospital type,age, department, academic rank, and annual income. The main influencing factors were patients' satisfactions and medical liability insurance (OR>1, P<0.05). Another main positive influencing factor was the communication duration between the doctor and outpatient(OR>1,P<0.05). Conclusions It is imperative to protect rights of doctors and nurses by enforcing relevant laws and regulations, and improving existing medical dispute handling mechanism. Other measures to this end include higher pay for medical workers equivalent to their value and career identity;media guidance by the government,which will all help create a better medical environment and doctor-patient relationship.
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Objective To learn the current situation and influencing factors of outpatients′perceptions of doctor-patient relationship,and to generate evidence for effective improvement of outpatients′perceptions of doctor-patient relationship.Methods Based on the results of the third party evaluation of the National Healthcare Improvement Initiative(2016-2017)in 136 hospitals, we analyzed the outpatients′perceptions of doctor-patient relationship and its influencing factors.Univariate analysis of the outpatients′perceptions of doctor-patient relationship(Chi-square test and Wilcoxon rank sum test),and binary logistic regression were conducted to analyze the influencing factors of the outpatients′perceptions of doctor-patient relationship.Results A total of 29 105 out-patients were included in this study.The average outpatient perception score of doctor-patient relationship was 3.88 ±0.99, and the median was 4.00.The perception score of outpatients pertaining to doctor-patient relationship was the highest in the eastern regions and lowest in the western regions.That of outpatients from general hospitals was highest than that of those in maternal and child hospitals and traditional Chinese medicine hospitals.Patients′waiting time for consultation,having a fixed physician or general practitioner before visiting, contracting with a community doctor or not, the overall satisfaction,and the household income and insurance coverage were all the influencing factors of the outpatients′perceptions of doctor-patient relationship(P<0.05).Conclusions There is still a long way to go before the patients can agree with the perception of a better doctor-patient relationship.The critical points for improvement include reducing waiting time for consultation, allocation of more medical resources to the western regions,improving humane care to patients and raising outpatients′overall satisfactions, especially in the departments of obstetrics and gynecology,and pediatrics.
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Objective To understand the current situation of inpatients′perceptions of doctor-patient relationship and its influencing factors, and to make policy recommendations for further targeted healthcare improvement.Methods Based on the survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals,we analyzed the inpatients′perceptions of doctor-patient relationship.SPSS 22.0 software was used to conduct Kruskal-Wallis test and Dunn-Bonferroni test,and SAS 9.4 was used to conduct multivariate logistic regression to analyze the influencing factors of inpatients′perceptions of doctor-patient relationship.Results The mean perception score of the inpatients pertaining to doctor-patient relationship was 4.34 ±0.84,and the median was 5.00.The perception score of the male inpatients pertaining to doctor-patient relationship was significantly higher than that of the female respondents(P<0.05),that of the inpatients who had fixed physicians or general practitioners before visiting was higher than that of the inpatients who did not have(P <0.05).The overall satisfaction of inpatients during hospitalization(P <0.01, OR =2.73)and doctors′satisfaction to have enough communication time with patients(P <0.01, OR =1.84)were the most significant protection factors to inpatients′perceptions of doctor-patient relationship.The process and structure evaluation results of hospitals in harmonization of doctor-patient relationship was a significant risk factor.Inpatients who had fixed physicians or general practitioners before visiting(P<0.01, OR=1.31)was another statistically significant positive influencing factor of inpatients′perceptions of doctor-patient relationship.Conclusions It is imperative to strengthen communications between doctors and patients and to improve healthcare service, in order to raise patients′satisfactions for a harmonized doctor-patient relationship.In addition to establish a working mechanism for medical disputes as a post-incident strategy, hospitals are recommended to take proactive and preventive measures.In addition,measures like integration of family doctor system and medical alliance system,as well as encouraging patients to contract their family doctors will help to harmonize the doctor-patient relationship.
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Objective To learn the satisfaction influencing factors of outpatients with different registration approaches, in order to improve outpatient registration and appointment services at hospitals. Methods The composition of outpatients with different registration approaches was analyzed based on the outpatient survey results of the third party evaluation of the National Healthcare Improvement Initiative(2016-2017).Binary multivariate logistic regression analysis was conducted for outpatients with appointment and service counter registration approaches respectively, to analyze the influencing factors of outpatient satisfaction.Results Among the validated respondents, 16 588 cases(56.99%)were registered at the service counter, only 12 517 cases(43.01%)had prior appointment.Outpatients in eastern region hospitals had a higher rate of appointment registration than in western regions.Except in maternal and child hospitals,the outpatients in general hospitals,traditional Chinese medicine hospitals and specialty hospitals still tend to register at the service counter.The satisfaction of outpatients registered at service counters was significantly lower than those with appointment(P<0.05).With control of the social and demographic characteristics of outpatients, medical experiences were the common statistically significant positive influencing factor of the overall satisfaction for outpatients registered via both service counters and appointment(P <0.001), while waiting time ranked their common statistically significant negative satisfaction influencing factor(P<0.001).Conclusions The overall satisfaction of the outpatients with appointment was higher than that of the outpatients registered at service counters.Appointment registration is to be further promoted at large tertiary hospitals in China.
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Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system.Methods Based on the outpatient satisfaction survey results of the National Healthcare Improvement Initiative Third Party Assessment(2016-2017),the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred.Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower(P<0.01,95%CI=-0.17, -0.06).The patient experience satisfaction score of the referred outpatients was 0.06 points lower than that of the non-referred(P=0.03,95%CI=-0.11,-0.01).Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction.To further improve the referral system and to raise patient satisfaction,there is a need to take following actions,to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system,to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system.In addition, it is critical to further regulate and optimize the referral procedures,so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy.Finally,it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system.
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Objective To explore the influencing factors of outpatients′satisfaction in different types of hospitals,and to generate evidence for further healthcare improvement in different types of hospitals. Methods Based on the inpatient satisfaction survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals,we divided the outpatients in four groups according to the hospital types as general, traditional Chinese medicine, maternal and child and specialty hospitals.SPSS 22.0 and SAS 9.4 were used to conduct the Pearson Chi-square test, variance analysis, Bonferroni test for univariate analysis, and multiple stepwise logistic regression analysis of the influencing factors of outpatients′satisfaction in different types of hospitals.Results A total of 29 105 complete questionnaires were collected from the outpatients.There were statistically significant differences between the overall outpatient satisfactions of different types of hospitals(P <0.01).Hospital experience was the common most significant positive factors affecting the overall satisfaction of outpatients in all types of hospitals(P<0.01,OR=4.10,4.39,3.83,4.36).Waiting time for consultation was the common most significant negative influencing factor of the overall outpatient satisfaction of all types of hospitals(P<0.01, OR=0.99).Conclusions In the next round of healthcare improvements, all types of hospitals should focus on shortening outpatient waiting time.In a short run, hospitals can address this issue through more appropriate allocation of resources within hospitals.In a longer run, there is a need to rationalize the allocation of multiple resources within the overall health service delivery system.It is necessary to strengthen patient centered humane care,and to meet diverse healthcare needs.Western areas are called for enhanced investment and strengthened healthcare improvements.
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The 2nd round of the third-party evaluation of the National Healthcare Improvement Initiative was made during Dec 2016 and Jan 2017.The methods, organization and implementation of the survey and the technical roadmap were the same as those of the 1st round of evaluation.The total number of respondents was 94 218,including 19 773 doctors,24 315 nurses,29 105 outpatients and 21 025 inpatients. 142 typical cases were collected from sample hospitals.The key findings showed that, the National Healthcare Improvement Initiative has been implemented quite well in the 2nd year, achievements and challenges exist side by side.The overall satisfaction rate of both outpatients and inpatients was good, both were about 90%.Further improvement is expected.Hospital staff have been actively involved in this Initiative,but they are not satisfied with their working environments and compensations.
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Objective To test the effect of an APP in the adherence of inhalation medicines for children with asthma,improve the rate of inhalation medicines compliance,self management ability and the quality of life of children with asthma.Methods The research use self-control study.We use Medication Adherence Report Scale for Asthma (MARS-A) to test the adherence of inhalation medicines for children with asthma in outpatient department.After 2 months using the APP,the children with asthma may be re-tested by the MARS-A to compare the differences in medication adherence,asthma knowledge,use method and pulmonary function,etc.Finally,data analysis using paired t test.Results After using the APP,the inhalation medicines adherence rate is increased from 25.78 ％ to 68.75 ％,the awareness rate of patients and their caregivers are increased from 25 ％ to 65 ％,and the APP usage rate is 42.18％,there was significant difference (P＜0.01).Conclusion The APP can effectively improve the adherence of inhalation drugs,standardized medication management,guarantee treatment effect and improve the quality of life of children with asthma.It could also reducing medical costs and improving work efficiency and service quality,thus deserves promotion.
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Objective To investigate the health-related quality of life and its relative factors in children with leukemia during maintenance treatment period. Therefore, the basis for effective individualization intervention can be provided. Methods A total of 224 leukemia children in maintenance treatment were collected in Affiliated Children′s Hospital of Chongqing Medical University from October 2015 to January 2016 by convenience sampling methods, questionnaire was used to assess the physical status, emotional status, social status, school status of the children. Results Single factor and generalized linear regression analysis were used to conclude that patient′s age (F=5.841-36.343, all P<0.01), parenting pattern (F=4.006-4.288, all P<0.05), family economic status (F=3.277-15.865, P<0.05 or 0.01) and the caregivers′information mastery level household location (F=2.044-2.661, P<0.05 or 0.01) had significant influence on the quality of life of children with leukemia in maintenance treatment. Conclusions The health-related quality of life and its relative factors in children with leukemia during maintenance treatment period should be analysis comprehensively. At the same time, take intervention should be taken from physiology, psychology, society, and school, to improve the social adaptability of children with leukemia and help them return to society as soon as possible.
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The present paper consults the concept of clinical competence, cultivation actuality, examination and assessment system of master of nursing specialist (MNS) at home and aboard based on literature analysis.Currently there is neither unified concept of master nursing specialist clinical competence, nor a unique clinical ability training mode of MNS.This paper mainly expounds the differences of the nursing professional master degree graduate students clinical ability evaluation system at home and abroad in the assessment methods, assessment tools, assessment agencies and assessment index, pointing out that our country should make a unified concept of the clinical competence.We should develop a flexible, diverse clinical competency assessment method, establish specialized evaluation agencies which are independent of the government, and implement 3 level quality monitoring system-graduate school of the university, clinical college graduate school and nursing department of, to ensure the training quality.