Modelos de medición de la calidad de atención en salud / Health care quality measurement models

Una aproximación para medir el nivel de atención expresada en la calidad de servicio que se presta al paciente en los establecimientos de salud está referida al uso de modelos de medición, que en este artículo se describen desde la propuesta por Donabedian basado en la teoría general de sistemas evaluando estructura, proceso y resultado, pasando a segundo plano la percepción del paciente. Este modelo contrasta con el modelo Nórdico que enfatiza la imagen corporativa, con un balance entre el servicio esperado y la percepción del servicio, basado en el paradigma de la desconfirmación al igual que el modelo presentado por Nguyen. En esta última línea paradigmática se encuentra el modelo más notorio, SERVQUAL que contrasta las expectativas y la precepción del usuario de un servicio identificando brechas en base a las 5 dimensiones propuestas fiabilidad, seguridad, elementos tangibles, capacidad de respuesta, y la empatía, posteriormente basado en este modelo se propone el modelo SERVPERF, basada exclusivamente en la valoración de las percepciones. Posteriormente, se describen el modelo de Desempeño Evaluado que surge como un modelo alternativo al SERVQUAL sustituyendo las expectativas por el concepto de punto ideal; el Modelo Jerárquico Multidimensional que desarrolla una solución tridimensional para completar la modelización de la calidad de servicio. De igual manera el modelo multietapa de valoraciones de la calidad que identifica la disconformidad que existe las expectativas del cliente en relación al servicio y las percepciones de las características por niveles de componente

One approach to measuring the level of care expressed in the quality of service provided to the patient in health facilities is referred to as the use of measurement models described in this paperstarting with the one proposed by Donabedian based on the general theory of systems evaluating structure, process and outcome, with the patient's perception taking second place. In contrast, the Nordic model emphasizes the corporate image, with a balance between the expected service and the perception of the service, based on the paradigm of disconfirmation as well as the model presented by Nguyen. In this paradigmatic line the most notorious model, SERVQUAL, contrasts the expectations and the user's perception of a service identifying gaps based on the 5 proposed dimensions reliability, security, tangible elements, responsiveness, and empathy, later based on this model the SERVPERF model is proposed, based exclusively on the valuation of perceptions. In addition, the Evaluated Performance model, which emerges as an alternative model to SERVQUAL, replaces expectations with the concept of ideal point. And the Multidimensional Hierarchical Model develops a three-dimensional solution to complete the modeling of service quality, as well as the multi-stage model of quality assessments that identifies the non-conformity that exists between customer expectations in relation to the service and the perceptions of the characteristics by component levels

Bases teóricas sobre la evaluación de la calidad del servicio en salud / Theoretical bases on health service quality assessment

Exponer las diferentes conceptualizaciones y los modelos de evaluación de la calidad de servicio en salud, respecto a sus características, fundamentos, y diferencias a través del análisis y síntesis de los aspectos más significativos encontrados en la literatura. Se realizó una revisión bibliográfica, bajo el sustento teórico de los siguientes métodos teóricos: Análisis, síntesis, histórico lógico y análisis documental de 19 artículos completos, accesibles en el idioma español e inglés, recolectados de bases de datos académicos como Google Académico, Research Gate, PubMed, Cochrane Library, Scielo Salud pública. Destacar que la búsqueda, recolección y análisis se realizó en los meses de mayo a julio. Tras la revisión bibliográfica pone en manifiesto la falta de consenso entre los expertos en el tema de calidad respecto a su conceptualización, misma que ha evolucionado conforme al contexto, social, tecnológico y científico. En definitiva, las bases teóricas para la evaluación de la calidad de atención en el servicio de salud, el primer modelo específico aplicado a salud fue el modelo de Abedis Donabedian, continuando las bases teóricas con el paradigma de la desconfirmación liderada por el modelo nórdico de Grönroos, el modelo de Parasumaran, Berry y Zeithaml respecto a la brecha que existe entre las expectativas y percepción; y el modelo de Cronin Taylor respecto a la valoración de las percepciones. Así mismo, se concluye, que el constructo de calidad está en evolución y su interpretación depende del observador y sus prioridades en base a la adaptación del instrumento respecto al contexto de aplicabilidad.

To expose the different conceptualizations and models of health service quality evaluation, regarding their characteristics, foundations, extension and differences through the analysis and synthesis of the most significant aspects found in the literature. A bibliographic review was carried out under the theoretical support of the following theoretical methods: analysis, synthesis, logical history and documentary analysis of 18 complete articles, accessible in Spanish and English, collected from academic databases such as Google Scholar, Research Gate, PubMed, Cochrane Library, Scielo Public Health, the search, collection and analysis was carried out from May to July. The bibliographic review reveals the lack of consensus among experts on the subject of quality with respect to its conceptualization, which has evolved according to the social, technological and scientific context. In short, the theoretical bases for the evaluation of the quality of care in the health service, the first specific model applied to health was the Abedis Donabedian model, continuing the theoretical bases with the paradigm of disconfirmation led by the Nordic model of Grönroos, the model of Parasumaran, Berry and Zeithaml regarding the gap that exists between expectations and perception; and the Cronin Taylor model regarding the assessment of perceptions. It is also concluded that the quality construct is evolving and its interpretation depends on the observer and his or her priorities based on the adaptation of the instrument to the context of applicability

Completeness of informed consent in supporting national standard accreditation of patient and family rights 5 hospitals at Ropanasuri surgical special hospital in Padang

Background: Completeness of informed consent is one indicator in supporting the accreditation of national hospital standards through the assessment of patient and family rights (PFR) assessment standards 5. In the health service process, informed consent can also be used as evidence and has a strong legal value in the form of a sheet of paper containing the doctor’s explanation about the diagnosis of the disease and the actions that will be performed on the patient.Methods: This research uses descriptive method with a qualitative approach. The population used was the entire patient medical record file in 2018, which was 3.093 medical record files. Sampling was done by random sampling using a formula according to Notoatmodjo for the calculation of the number of samples and obtained 355 files of medical records. Data processing using Microsoft Excel computer programs. For observing the completeness of the standard rights of patients and families using national standards for hospital accreditation.Results: Based on the analysis of 355 medical record files at Ropanasuri specialty hospital it is known that 296 pieces of informed consent were filled in with a percentage of 83.38%, 59 sheets of informed consent were incomplete with a percentage of 16.62%. The results showed the greatest incompleteness found in filling the informed consent items of witness signatures of 2.81%, providing information on the completeness of filling the doctor's identity by 2.54% and the name of the witness 1.70% on filling the authentication.Conclusions: 296 pieces of informed consent were filled in with a percentage of 83.38%, 59 sheets of informed consent were incomplete with a percentage of 16.62%.

Percepciones y expectativas del usuario respecto a la calidad del servicio en un Hospital de Chile / Perceptions and expectations of the user regarding the quality of service in a Hospital

Resumen Introducción: Actualmente, la calidad de servicio es un pilar fundamental en los sistemas sanitarios, ya que permite garantizar a los usuarios externos un conjunto de condiciones mínimas en las prestaciones de salud. Objetivo: Evaluar las percepciones y expectativas del usuario externo respecto a la calidad del servicio del Hospital Comunitario de Salud Familiar de Quirihue. Material y Método: Estudio descriptivo comparativo, transversal, basado en modelo SERVQUAL. Las variables sociodemográficas fueron analizadas mediante estadística descriptiva, las brechas se calcularon mediante la diferencia existente entre las percepciones y expectativas, las que se analizaron con las pruebas T pareada y Wilcoxon. Resultados: La variable con mayor insatisfacción en Atención Abierta (AA) fue "difícil acceso a horas médicas o de otro profesional"; en Atención Cerrada (AC) "personal no orienta ni explica de manera clara y adecuada la atención durante la hospitalización"; y en Atención de Urgencia "demora en la atención en el box de admisión". Conclusión: El tipo de atención con menor calidad de servicio fue la AA, le sigue AU y finalmente la AC. En la AA los mayores problemas se presentaron en la obtención de horas para atenderse con médico y también en el NO cumplimiento de los horarios programados. En la AU los usuarios refieren mayor insatisfacción en la atención inmediata a su llegada al servicio. En la AC los pacientes señalan que los funcionarios NO brindan el tiempo necesario para contestar las dudas o preguntas sobre el problema de salud por el cual se encuentran hospitalizados.

Abstract Introduction: Currently, quality of service is fundamental in healthcare systems, since it allows external users to be guaranteed a set of minimum conditions in health services. Objective: To evaluate the perceptions and expectations of the external user regarding the quality of the service of the Community Health Family Hospital of Quirihue. Material and Method: Cross-sectional descriptive study, based on the SERVQUAL model. The sociodemographic variables were analyzed by means of descriptive statistics, the gaps were calculated by means of the difference between perceptions and expectations, and those were tested with paired T and Wilcoxon. Results: The variable with the greatest dissatisfaction in Open Care (OC) it was "difficult access to medical or other profesional appointment "; in Closed Care (CC) "personnel without orientation or explanation in a clear and adequate manner during hospitalization"; and in Emergency Care (EC) "delay in attention in the admission box". Conclusion: The type of care with the lowest quality of service was OC, followed by EC and finally CC. In the OC, the greatest problems arise in obtaining an appointment to be seen by the doctor and also in the NO fulfillment with the scheduled appointments. In the EC, users refer to great discontent with the immediate attention to their arrival at the service. In the CC, the patients pointed out that the staff DO NOT provide the necessary time to answer the questions or clarify doubts about the health problem for which they are hospitalized.

Using the ServQual scale to measure client satisfaction in a rehabilitation teaching clinic in the Philippines

@#<p><strong>BACKGROUND</strong>: Teaching clinics provide low-cost health programs while offering valuable learning opportunities for student clinicians, which then contributes to increasing health care accessibility. To date, there is a paucity of literature exploring the satisfaction of patient seen in rehabilitation teaching clinics in developing countries. Thev Service Quality (ServQual) Scale is a valid and reliable tool that has been used to measure client satisfaction in different work settings and industries.</p><p><strong>OBJECTIVES</strong>: The aim of this study was to demonstrate the usefulness of ServQual in measuring the satisfaction of clients in a rehabilitation teaching clinic in a developing country.</p><p><strong>METHODOLOGY</strong>: A cross-sectional survey was conducted for three months among CTS-AA (Clinic for Therapy Services- Adult and Adolescent Section) clients who are at least 18 years old; have attended at least three sessions; and can read. Prior to administration in CTS-AA, the ServQual scale was translated to Filipino, validated and pilot tested for reliability.</p><p><strong>RESULTS</strong>: Thirty-two respondents were included in the analysis. there was no statistically significant difference between the expectation and the perceptions of the clients for the domains of reliability (z=1.799, p=0.0721), responsiveness (z=0.839, p=0.4013), assurance (z=1.914, p=0.0556) and empathy (z=1.772, p=0.0764). However, there was a statistically significant difference between the clients' perception and expectation for tangibles (z=4.117, p<0.0001) and between the overall client perception and expectation (z=4.086, p<0.0001).The overall ServQual score for CTS-AA is -0.3782.</p><p><strong>CONCLUSION</strong>: The ServQual has been shown to be useful in assessing the satisfaction of clients in rehabilitation clinics and the specific areas that needs improvement. The tool can still be further improved by including items on cost, relationship of students with supervisors and outcomes of treatment.</p>

Modelo de evaluación de requerimientos de privacidad, seguridad y calidad de servicio para aplicaciones médicas móviles / Model of assessment of requirements of privacy, security and quality of service for mobile medical applications

Resumen Introducción: El desarrollo de tecnologías móviles ha facilitado la creación de aplicaciones mHealth, las cuales son consideradas herramientas clave para la atención segura y de calidad a los pacientes de poblaciones apartadas y con carencia de infraestructura para la prestación de servicios de salud. El artículo considera una propuesta de un modelo de evaluación que permite determinar las debilidades y vulnerabilidades a nivel de seguridad y calidad de servicio (QoS) en aplicaciones mHealth. Objetivo: Realizar una aproximación de un modelo de análisis que apoye la toma de decisiones referentes al uso y producción de aplicaciones seguras, minimizando el impacto y la probabilidad de ocurrencia de los riesgos de seguridad informática. Materiales y métodos: El tipo de investigación aplicada es de tipo descriptivo, debido a que se detallan cada una las características que deben tener las aplicaciones móviles de salud para alcanzar un nivel de seguridad óptimo. La metodología utiliza las normas que regulan las aplicaciones y las mezcla con técnicas de análisis de seguridad, empleando la caracterización de riesgos planteadas por Open Web Application Security Project -OWASP y las exigencias de QoS de la Unión Internacional de Telecomunicaciones -UIT. Resultados: Se obtuvo un análisis efectivo en aplicaciones reales actuales, lo que muestra sus debilidades y los aspectos a corregir para cumplir con parámetros de seguridad adecuados. Conclusiones: El modelo permite evaluar los requerimientos de seguridad y calidad de servicio (QoS) de aplicaciones móviles para la salud que puede ser empleado para valorar aplicaciones actuales o generar los criterios antes de su despliegue.

Abstract Introduction: The development of mobile technologies has facilitated the creation of mHealth applications, which are considered key tools for safe and quality care for patients from remote populations and with lack of infrastructure for the provision of health services. The article considers a proposal for an evaluation model that allows to determine weaknesses and vulnerabilities at the security level and quality of service (QoS) in mHealth applications. Objective: To carry out an approximation of a model of analysis that supports the decision making, concerning the use and production of safe applications, minimizing the impact and the probability of occurrence of the risks of computer security. Materials and methods: The type of applied research is of a descriptive type, because each one details the characteristics that the mobile health applications must have to achieve an optimum level of safety. The methodology uses the rules that regulate applications and mixes them with techniques of security analysis, using the characterization of risks posed by Open Web Application Security Project-OWASP and the QoS requirements of the International Telecommunication Union-ITU. Results: An effective analysis was obtained in actual current applications, which shows their weaknesses and the aspects to be corrected to comply with appropriate security parameters. Conclusions: The model allows to evaluate the safety and quality of service (QoS) requirements of mobile health applications that can be used to evaluate current applications or to generate the criteria before deployment.

Architecture of Telemedicine Based on P2P Cloud Hybrid Network / 医学信息学杂志

The paper analyzes the problems existing in the architecture of traditional telemedicine based on cloud computing,puts forward a kind of telemedicine architecture that adopts Peer to Peer (P2P) Cloud hybrid network by referring to relevant researches,states the architecture characteristics and operation process,and provides several application cases of telemedicine.

Ananalysis on Runtime Associated QOS-Based Proficient Web Services Discovery Optimization

ABSTRACT In today's web world, Service-oriented architectures represent the main standard for IT infrastructures. Certainly, with the initiation of service oriented architecture, Web services have gained incredible growth. Web service discovery has become increasingly more significant as the existing use of web service. Discovering most appropriate web service from vast collection of web services is very decisive for successful execution of applications. In automation of web service discovery, there is always a need to deem Quality of Service (QoS) attributes during matching. A study of literature concerning the evolution of different web service discovery optimization methods with unique prominence to quality motivated service discovery have been carried out in this work. This paper depicts Bio-inspired algorithms optimizing the discovery process for semantic web services. Bio-inspired algorithm is a metaheuristics method that mimics the nature in order to unravel optimization difficulty and evaluates the analysis of some popular bio-inspired optimization algorithm systematically. This paper also focused on the principle of each algorithm and their application with respect to run time oriented QoSattributes and from result the best suitable bio-inspired optimization algorithm is been deployed.

CONTINUOUS IMPROVEMENT OF SCIENCE OF TCM--COMBINED WITH THE USE AND QUALITY OF SERVICE PERCEIVED GAP ANALYSIS MODEL / 现代医院

This paper takes the Traditional Chinese Medicine health population science as a social service . From the theoretical perspective .There's a clue that using the models of Perceived Service Quality , Determinants of Quality of Service , 5 Gaps Mode to find out the invisible zone of the continuous improvement of TCM populational sci -ence services.With the further analysis , this zone refers to the 5 gaps of the recognition differential .By minimizing the recognition differential , we form up a strategic program package for TCM populational science , which makes it dif-ferent.Besides, the real case of Guangdong Provincial hospital of TCM has verified that the good TCM populational Science service had demonstrated a positive influence to the Harmonious Relationship of doctor -patient.

The application of Kano model analysis in midwife outpatient service quality management / 中国实用护理杂志

Objective To explore the Kano model analysis in the application of midwife outpatient service quality management. Methods Kano questionnaire was consisted of 24 items, including five parts, environment facilities, service evaluation, service technology, the team service, delivery service′quality. Using the Kano model analysis, the impact factors of the midwife outpatient service quality in five different quality attributes were determined. It included property and had the opposite answer to the question, charisma, essential properties and one property. Results By identifing the quality index classification of the pregnant women with satisfactory service quality to midwife outpatient service, attributable to a property were 1,2,3,4,8,9,10,14,20,21;attributable to mandatory attributes were 13, belonging to the charm of the property had 5,6,7,11,12,15,16,17,18,19,22,23,24. Midwives outpatient had most of charisma attribute, 54.2%(13/24) of the total;The second was one attribute, 41.7% (10/24) of the total. The technology level of midwife was essential attribute. Conclusions Kano mode analysis technology will be introduced to the midwife outpatient service quality management to provide decision reference for improving the quality of the hospital management level, improve maternal satisfaction, improve the obstetric operation efficiency.

Escala para la calidad de los servicios y lealtad del consumidor en tiendas de alimentación / Scale for Service Quality and Customer Loyalty in Groceries

Actualmente el comercio local está amenazado por la competencia de las grandes superficies, siendo crucial apostar por la satisfacción y lealtad. El objetivo del estudio fue elaborar un instrumento para evaluar la satisfacción y la lealtad en tiendas de alimentación y estudiar la influencia de variables sociodemográficas. Se aplicó una entrevista personal compuesta por 36 ítems agrupados en seis dimensiones: trato-clientela, instalaciones, producto, servicios, fidelidad y valor añadido, a 712 participantes. Las puntuaciones globales fueron positivas y homogéneas, destacando las escalas de producto, lealtad y trato-clientela, y siendo este último el factor más explicativo de la satisfacción. Los hombres y el grupo de 21-35 años presentan una menor satisfacción. Tres escalas se asocian positivamente con la escala de lealtad.

Local trade is currently under the threat of competition from department stores; thus, it is crucial to concentrate on satisfaction and loyalty. To develop an instrument to evaluate satisfaction and loyalty in delicatessens and to study the influence of socio-demographic variables on these aspects. A personal interview was applied that was composed of 36 items grouped into six dimensions: treatment of costumers, facilities, product, services, loyalty and value added, conducted with 712 participants. Positive and homogenous overall scores were obtained, specially product, loyalty and handling of customer scales, the latter being the most explicative factor of satisfaction. Men and the 21-35 year age group show low satisfaction. Three scales are positively associated with the loyalty scale.

Effect of Health Insurance on the Use and Provision of Maternal Health Services and Maternal and Neonatal Health Outcomes: A Systematic Review.

Financial barriers can affect timely access to maternal health services. Health insurance can influence the use and quality of these services and potentially improve maternal and neonatal health outcomes. We conducted a systematic review of the evidence on health insurance and its effects on the use and provision of maternal health services and on maternal and neonatal health outcomes in middle- and low-income countries. Studies were identified through a literature search in key databases and consultation with experts in healthcare financing and maternal health. Twenty-nine articles met the review criteria of focusing on health insurance and its effect on the use or quality of maternal health services, or maternal and neonatal health outcomes. Sixteen studies assessed demand-side effects of insurance, eight focused on supply-side effects, and the remainder addressed both. Geographically, the studies provided evidence from sub-Saharan Africa (n=11), Asia (n=9), Latin America (n=8), and Turkey. The studies included examples from national or social insurance schemes (n=7), government-run public health insurance schemes (n=4), community-based health insurance schemes (n=11), and private insurance (n=3). Half of the studies used econometric analyses while the remaining provided descriptive statistics or qualitative results. There is relatively consistent evidence that health insurance is positively correlated with the use of maternal health services. Only four studies used methods that can establish this causal relationship. Six studies presented suggestive evidence of overprovision of caesarean sections in response to providers’ payment incentives through health insurance. Few studies focused on the relationship between health insurance and the quality of maternal health services or maternal and neonatal health outcomes. The available evidence on the quality and health outcomes is inconclusive, given the differences in measurement, contradictory findings, and statistical limitations. Consistent with economic theories, the studies identified a positive relationship between health insurance and the use of maternal health services. However, more rigorous causal methods are needed to identify the extent to which the use of these services increases among the insured. Better measurement of quality and the use of cross-country analyses would solidify the evidence on the impact of insurance on the quality of maternal health services and maternal and neonatal health outcomes.

Calidad de la rotación de pediatría comunitaria, desde la percepción del estudiante / Student’s perception on community pediatric rotation quality

Introducción: Las investigaciones publicadas sobre la calidad de servicio de la educación superior universitaria se han concentrado en el contenido del curso y su entrega y no en la calidad del servicio. El instrumento utilizado para la medición de la calidad ha sido el modelo ServQual. Objetivos: Evaluar la calidad de servicio educativo en la rotación de Pediatría Comunitaria desde la perspectiva del estudiante. Diseño: Estudio transversal, descriptivo, de diseño cuantitativo. Lugar: Departamento de Pediatría, Facultad de Medicina San Fernando, UNMSM. Participantes: Alumnos de la rotación de Pediatría Comunitaria. Intervenciones: Aplicación de la encuesta ServQual antes y después de la rotación. Resultados: La satisfacción global para todas las dimensiones fue de satisfacción y el nivel insatisfacción severa fue mínimo. En las dimensiones clases, profesores, instalaciones, personal administrativo, información, comunicación con la universidad y entorno institucional se observó que la satisfacción media fue de insatisfacción con la importancia que se le da al servicio educativo. En las otras dimensiones fue de satisfacción. Las dimensiones instalaciones, vida social, personal administrativo, comunicación con la universidad, situación financiera y entorno institucional presentaron niveles bajos de insatisfacción severa. Conclusiones: La satisfacción global, la satisfacción media, la permanencia, la elección de la rotación, el funcionamiento y la salud durante la rotación de Pediatría Comunitaria para la mayoría de los estudiantes fueron de satisfacción, y los atributos a los cuales los alumnos les dieron mayor importancia fueron calidad de las clases y capacidad de los profesores por la enseñanza.

Introduction: Published research on university education quality of service has focused on course content and submission and not on the quality of service. The instrument used for measuring quality is the SERVQUAL model. Objectives: To determine the quality of education in Community Pediatrics rotation from the student’s perspective. Design: Cross-sectional, descriptive, quantitative study. Location: Department of Pediatrics, San Fernando School of Medicine, Universidad Nacional Mayor de San Marcos. Participants: University Pediatrics rotation students. Interventions: SERVQUAL survey application before and after rotation. Results: Overall satisfaction for all dimensions was found and severe unsatisfaction was minimal. In size classes, teachers, facilities, staff, information, communication with the university and institutional environment unsatisfaction was median with importance given to educational service. Satisfaction was encountered in the other dimensions. Dimensions facilities, social life, administrative personal, communication with the university, financial and institutional environment showed low levels of severe unsatisfaction. Conclusions: Most students had overall satisfaction, median satisfaction, with satisfaction in permanency, rotation, performance and health during rotation of Community Pediatrics; more important attributes given by the pupils were quality of classes and teachers’ capacity for teaching.

Calidad de servicio en la consulta externa de un hospital octubre de la región Lambayeque 2010 / Quality of service in the external consultation of a hospital of the region Lambayeque. October 2010

Objetivo: Evaluar la calidad de servicio según el grado de satisfacción percibido por las personas de la consulta externa en el hospital nacional Almanzor Aguinaga Asenjo. Estudio Descriptivo, Transversal y Observacional. Se M étodos: aterial y Mseleccionó de manera no probabilística una muestra de 106 personas (proporción de 44,36%), constituida por los usuarios de los consultorios externos del Hospital Nacional Almanzor Aguinaga Asenjo en Octubre de 2010. Se utilizó muestreo no probabilístico, empleándose la encuesta SERVQUAL modificada a 19 pares. (Aspectos tangibles, Confiabilidad, Respuesta rápida, Seguridad y Empatía). El nivel de satisfacción se determinó calculando la diferencia entre las respuestas para las expectativas y las percepciones; < 0= satisfacción amplia; 0= satisfacción; > 0 y 2= insatisfacción leve/moderada; > ≤ 2= insatisfacción severa. Los datos fueron analizados con el SPSS. Se utilizó estadística descriptiva; análisis bivariado de las medias, test T de Student y test de Anova; chi2; y un análisis multivariado aplicando la regresión lineal múltiple. Luego de evaluar Resultados: a las personas de la consulta externa en el hospital nacional Almanzor Aguinaga Asenjo, se halló una insatisfacción global de 89,80% e insatisfacción en la dimensión confiabilidad 88%; las dimensiones tangibles (81,50%), seguridad (47,66%), respuesta rápida (84,30%) y empatía (80,50%). Conclusión: Existe insatisfacción en cuanto a la calidad de servicio de consulta externa, según la percepción de las personas.(AU)

Objective: To evaluate the service quality according to the degree of satisfaction perceived by the persons of the external consultation in the Almanzor Aguinaga Asenjo National Hospital. descriptive, Material and Methods: Atransversal and observational study. Using a nonprobability sampling, 106 persons (proportion of 44.36 %) were selected, constituted by the users of the external consults of the Almanzor Aguinaga Asenjo National Hospital between October - November, 2010. There was a simple random sampling, using the survey SERVQUAL modified to 19 couples. (Tangible aspects, Reliability, rapid Response, Security and Empathy). The level of satisfaction was determined by calculating the difference between the answers for the expectations and the perceptions; <0 = wide satisfaction; 0 = satisfaction; > 0 and = 2 = slight / moderate dissatisfaction;> 2 = severe dissatisfaction. The information was analyzed using SPSS. Descriptive statistics were used; bivariate analysis of the mean, Student's T-test and ANOVA test; chi square; and a multivaried analysis applying the linear multiple regression. Results: After evaluating the people of the external consults in the Almanzor Aguinaga Asenjo National Hospital, is was found a global dissatisfaction of 89,80 % and dissatisfaction in the dimension reliability 88 %; the tangible dimensions (81.50 %), safety (47.66 %), rapid response (84.30 %) and empathy (80.50 %). Conclusion: There is dissatisfaction as for the quality of service of external consults, according to the perception of the people.(AU)

Satisfacción laboral del personal de enfermería en el Hospital General de México / Working fulfillment of the nursing personnel in the Hospital General de México

Introducción: Mantener niveles altos de satisfacción laboral permite mejorar los procesos, fomenta el trabajo en equipo, aumenta la calidad de la atención de enfermería y el rendimiento de su productividad; así como la satisfacción de los usuarios. Objetivo: Conocer el grado de satisfacción laboral del personal de enfermería del Hospital General de México. Metodología: Se realizó estudio transversal, en una muestra aleatoria de 159 enfermeras que representan 10% del total del personal del Hospital General de México, la recolección de la información fue a través de un cuestionario ex profeso que contempló el modelo desarrollado por Herzberg. Resultados: La edad promedio fue de 36 años, 63% tiene una escolaridad de nivel técnico, los hechos que le produjeron mayor satisfacción son: sanar y apoyar a los pacientes, reconocimiento de su trabajo por sus superiores, ingresar y pertenecer al Hospital General de México. Los factores de ambiente de trabajo y capacitación fueron satisfactorios; no así para el salario. Discusión: La satisfacción del trabajador en el desempeño de sus funciones es un factor determinante de la calidad de la atención; en este trabajo faltó profundizar en los aspectos extrínsecos de la satisfacción. Conclusiones: La satisfacción laboral intrínseca demostró estrecha relación con los principales factores que la originaron.

Introduction: Maintaining high levels of working fulfillment leads to improved processes, fosters teamwork, and increases the quality of nursing care and the performance of its productivity, as well as patients' satisfaction. Objective: Knowing the level of working fulfillment in nurses from the Hospital General de México. Methodology: We performed a cross-sectional study in a sample of 159 nurses randomly selected representing 10% of the total staff of the Hospital General de México, the information was recollected through a questionnaire that was specially developed following the model developed by Herzberg. Results: The average age was 36 years old, 63% had a technical education level, events that granted more satisfied to the nurses: were healing and supporting the patients; the recognition of their work by their superiors; working and being part of the Hospital General de México. The working environment and training were satisfactory, but not the wages. Discussion: Working fulfillment of the nurses is a determinant factor in the quality of the attention to patients. We need to deepen our study in the extrinsic aspects of this fulfillment. Conclusions: The intrinsic working fulfillment demonstrated a close relation among the principal factors that originate.

Transcoder based on Proxy for Transmitting Patients' Video Stream / 대한의료정보학회지

OBJECTIVE: The progress in computer and communication technologies is making the Internet increasingly heterogeneous in terms of network, hardware and software capacities. Moreover, this has made it possible for emergency telemedicine services to provide high quality medical services. However, resource availability on the Internet varies unexpectedly. Thus, providing an efficient access to emergency telemedicine services requires that medical multimedia streams be adapted according to the environment constraints. One approach to this issue is based on the use of intermediate nodes within the network to perform such adaptations (media transformations and data transcoding). For this purpose, we have designed and implemented a proxy server for Quality of Service adaptations of medical multimedia streams. METHODS: We have organized a new emergency telemedicine system by designing a proxy server to execute transcoding. The proxy server is located between a patient system and a doctor system over heterogeneous networks. Before a patient system can deliver medical video streams to a doctor system, the proxy server measures uplink bandwidth which is one of the Quality of Service factors, from the proxy server to the doctor system. At this moment, frame rates are determined according to the measured bandwidth, and the proxy server transmits medical video streams modified for new frame rates to the doctor system. We describe the implementation of this proxy server on top of the Microsoft DirectShow(R) environment and report on a performance evaluation which demonstrates the effectiveness of the approach. RESULTS: The quality of requested medical video streams can be predicted when they are adapted to the receiver. With this prediction, adapted medical video streams which meet the frame rates constraints of the receiver can be delivered without additional measurements of bandwidth. CONCLUSION: This study represents a proxy server of a hybrid multimedia telemedicine system over heterogeneous networks. We expect that the designed proxy server can provide not only dynamic Quality of Service monitoring functions along bandwidth measurement, but also medical video adaptations to the receiver in heterogeneous network environments.