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Based on the documents issued by the General Office of the State Council, the authors took system innovation, technological innovation, mode innovation and management innovation as the general principles of development, took safety, effectiveness, patient centered, fairness, economy and timeliness as the goal of high-quality development of outpatient services, and combined the three attributes of " medical quality management path" to explore the improvement path and specific practice of high-quality development from three aspects of technical quality, service quality and management quality for reference of peers.
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OBJECTIVE To evalu ate the effects of perimenopausal one-day outpatient multidisciplinary model on the cognition of women to menopause hormone therapy （MHT）. METHODS The perimenopausal one-day outpatient service opened by the Third Affiliated Hospital of Chongqing Medical University in 2017 was introduced ，which was participated by doctors ，pharmacists， nutritionists，music psychotherapists ，nurses and other multidisciplinary members to provide systematic ，all-round，humanistic and face-to-face group science popularization and education ，practical experience and Q&A for women in perimenopause or about to enter perimenopause （called“students”）. The students who participated in one-day outpatient service in 2020 were selected as the survey object ， and the questionnaire was CMEI2020KPYJ（ZAMM）00206] designed to analyze the understanding of perimenopausal syndrome，awareness rate of MHT ，willingness to use and concerns. RESULTS A total of 295 students completed the questionnaire. Compared with before participation ， after participated in one-day outpatient service ，the cognition level of the students were all improved significantly ，including perimenopausal age （96.61％ vs. 99.32％，P＝0.037），the importance of perimenopausal health care knowledge （91.19％ vs. 96.95％，P＜0.001），whether the perimenopausal syndrome needs treatment （88.47％ vs. 99.32％，P＜0.001），willingness to use MHT （70.59％ vs. 94.48％ ，P＜0.001），MHT treatment timing （60.50％ vs. 95.17％ ，P＜0.001），reducing the risk of cardiovascular disease （51.68％ vs. 96.55％ ，P＜0.001），delaying aging （69.75％ vs. 97.59％ ，P＜0.001），preventing osteoporosis（65.13％ vs. 97.59％），P＜0.001）；the medical staff were higher than the non-medical staff （P＜0.05）. Totally 90％ of the students said they had gained knowledge about the prevention and treatment of common diseases ，nutrition and guidance， psychological regulation guidance hormone therapy related knowledges and exercise methods ；the proportion of the students who were willing to use MHT for 1 to 5 years（31.09％ vs. 47.93％）increased significantly. The proportion of the students who concerned about the risk of thrombosis （60.24％ vs. 36.81％），weight gain （59.64％ vs. 14.84％）and life-long dependence （52.41％ vs. 18.13％）was significantly reduced ，but that of the students who concerned about cancer risk was not diminished. From 2017 to 2020，the utilization rate of MHT was increased from 2.22％ to 62.16％ in non-medical staff among the students. CONCLUSIONS The multidisciplinary model of perimenopausal one-day outpatient service can improve the awareness of MHT among perimenopausal women ，eliminate misunderstandings ，and increase the utilization rate of MHT.
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Objective:To explore the pain points of outpatient service in hospital from the patient′s perspective, and to provide new ideas for optimizing management of service quality.Methods:Ten top hospitals in China were selected to collect the poor evaluation texts of outpatient services published by patients on the Dianping.com from January 1, 2017 to December 31, 2019. The user′ pain-point analysis model was introduced, the pain-point index word collection was constructed according to the word frequency, the pain-point index was quantitatively analyzed combined with the sentimental value, and the content of the index words was analyzed through conceptual annotation.Results:The analysis of 1 259 poor evaluation texts showed that patients′ poor evaluation of outpatient service quality mainly focused on four aspects: interpersonal interaction, process factors, human-computer interaction and environmental factors. The poor attitude of medical staff in interpersonal interaction and the long queuing time and short treatment time in process factors were the most prominent.Conclusions:Online patient comment analysis is suitable for the identification and perception of pain points in outpatient service, and is helpful for the hospital to choose the direction and items of service improvement.
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Objective:To build a comprehensive clinical management of outpatient with orthotopic neobladder based on doctor-nurse cooperation to provide overall service to patients.Methods:The comprehensive clinical management was established in October 2018, 32 patients were collected retrospectively from January 2009 to before the establishment of the clinic, and 14 patients were collected from the establishment of the clinic to January 2020. After the establishment of the clinic, the comprehensive management mode was adopted, including the medical team implementing management from the aspects of implementing doctor-patient joint decision-making, guiding patients to carry out pelvic floor muscle rehabilitation training, teaching family members to carry out new bladder irrigation, and establishing patients′ records. Before the establishment of the clinic, there was no specialized personnel for unified management, and the doctor for new bladder irrigation and so on.Results:The rate of complete urinary control in the 46 patients with orthotopic neobladder was 82.6%(38/46) in the day and 71.7%(33/46) in the night. The rates of complete urine control of patients in the day and night were 12/14 and 9/14 after the establishment of the clinic. The length of stay which was (13.36 ± 9.44) d, and feeding time which was (5.00 ± 2.11) d of the patients after the establishment of the clinic were both less than those of the patients before the establishment of the clinic, which were (17.28 ± 9.98) d and (5.78 ± 2.90) d, but the differences were not statistically significant ( t values were -1.247 and -0.905 respectively, both P>0.05). However, for diurnal and night-time urine control, the proportion of people with more than one diaper was better after the establishment of outpatient clinic than before. Conclusions:The establishment of the comprehensive clinical management meets the needs of patients with orthotopic neobladder, enables patients to get the function of continence and urination sooner, and contributes to improve the clinical outcome of patients.
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Objective To fully understand the actual situation and existing problems in vaccination outpatient services, which will provide information to support and improve the standardized construction of vaccination outpatient service and the whole-process vaccination management. Methods Cross-sectional study was conducted among all the vaccination outpatient services in Huangpu District of Shanghai.Data were collected by self-examination and health supervision.Analysis was focused on the conformance with the six aspects of management requirements, which included institution and personnel management, layout of facilities, vaccine and cold-chain management, vaccination management, disinfection and isolation management and medical waste management. Results Twenty-one vaccination clinics were included in the study.There were significant differences for conformance between self-examination and health supervision, public and private medical institutions (P < 0.05).There was no significant difference in the overall compliance rate among six aspects of management requirement (P > 0.05), indicating that they were relatively balanced.On analysis within the 6 aspects, there were significant differences in the indicator compliance rate for 4 aspects of management requirement, including institution and personnel management, layout of facilities, vaccine and cold-chain management, disinfection and isolation management (P < 0.05). Conclusion The standardized construction of vaccination outpatient service should be strengthened with the emphasis on the following: implementation and consolidation of management requirements, enhancement of responsibility consciousness in vaccination outpatient service, construction of special-need vaccination outpatient service in private medical institutions, and improvement of publicity and guidance education.
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To preliminarily analyze the prevention and control of COVID-19, a general hospital outpatient service took six management measures, including setting up a leading group, building rules and regulations, infection control and supervision, special training, humanized service, public opinion propaganda. After nearly two months, the rates of both body temperature monitoring and epidemiological history screening are 100%, the medical staff infection rate is zero, and no cross infection between the patients due to adopting outpatient service comprehensive management measures which had strong organization and leadership, effective targeted training, effective control of all links in epidemic prevention and control work. During the fight against COVID-19, outpatient management played an important role in hospital management. The above approaches provide valuable experience for preventing the spread of infectious diseases effectively and winning the biological weapon wars in the future.
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Objective To study the current situation and predilection of the annual outpatient services as used by rural residents in China ,and the characteristics and regional differences .Methods A stratified random sampling survey was adopted to extract 12 villages out of 6 counties across China , and the outpatients′personal clinical records were merged from all levels of local medical institutions . Descriptive statistics andχ2 test were employed to analyze their utilization .Results The survey showed that Huangzhong ,Xixian and Huzhou counties had lower access to health resources per thousand peoples than the other 3 counties ,as the outpatient visits were also lower than the latter .50％ of the outpatient services of the six counties in 2014 (217881/403707)were used by 20％ of the rural residents(23326/109058) .In most counties ,service utilization of primary institutions accounted for over 65％ (299228/371623)of the county .Conclusions The utilization of outpatient service in these counties presents aggregation effect to some extent.Irrational utilization was found in some areas and hierarchical medical system needs to be improved .
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Objective To evaluate the effects of medical social workers on the service efficiency and patient satisfaction in general practice outpatient service . Methods A randomized controlled intervention study was conducted at general practice department of Shanxi Dayi Hospital in June 2017.Three hundred and thirty patients were randomly selected and assigned into two groups : 159 patients received intervention with medical social work service package ( intervention group ) and 163 patients served as controls.The service package included advising service , counseling service, accompanying service, comfort service, intervention guidance service , etc.The average time per visit and patient satisfaction were compared between two groups and the effectiveness of intervention was evaluated by interview of doctors .Results There were no statistically significant differences in gender , age, occupation and insurance categories between the two groups (P ＞0.05).The average time per visit patients in the intervention and control groups were 18 (15,22) min and 21 (15,25) min, respectively (Z＝2.364, P＝0.018).The highest degree of patient satisfaction in the control group was the attitude of doctors (36/40, 90.0%), and the lowest was in the setting of consulting room (20/40, 50.0%).The highest degree of satisfaction in the intervention group was the "comfortable with doctors" (40/40, 100.0%), followed by the affinity nature of social workers ( 38/40, 95.0%), and the lowest was the environmental satisfaction index ( 32/40, 80.0%).The satisfaction of comfortableness with doctors , clinic environment and consultation process in intervention group [(40/40,100.0%)、(32/40,80.0%)、(37/40,92.5%)] was higher than that in control group [(29/40,72.5%)、(20/40,50.0%)、(30/40,75.0%)] (χ2＝12.754, 7.912, 4.501, P＜0.05).Conclusion Intervention provided by medical social workers can improve the efficiency of general practice outpatient service and improve the satisfaction of patients .
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The particularity of healthcare markets made the pricing of medical services a contentious issue.It reviewed the characteristics,technical and institutional arrangements for the outpatient service price setting across Organization for Economic Co-operation and Development(OECD) countries,aiming at providing international experiences for medical service pricing reform in China.
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From October 2014 to June 2015, among 5 800 pediatric patients underwent outpatient sedation in MRI and Special Inspection Departments at our hospital, the incidence of sedation-related ad-verse events was 272%(158 cases), and the mortality rate was 003%(2 cases)in pediatric outpa-tients. The common adverse events were nausea and vomiting(constituent ratio 3214%), regurgitation and aspiration(constituent ratio 2443%), respiratory depression(constituent ratio 2928%), agitation (constituent ratio 1571%)and delayed recovery(constituent ratio 143%). When chloral hydrate was used for sedation, it should be mixed with sugar to prevent the occurrence of nausea and vomiting; young age(especially preterm infant), diseases of respiratory system or nervous system and congenital heart dis-ease were the possible inducements to sedation-related adverse events, and intervention strategy should be performed to decrease the occurrence of adverse events and to improve the quality of sedation in pediatric outpatients.
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Objective:To investigate the characteristics of seeking behavior and medical expense of outpatients in the New Rural Cooperative Scheme,and provide suggestions and theoretical basis for the implementation and pro-motion of hierarchical medical policy systems.Methods:In this study,13 counties in the eastern part of China were selected.By using data about diabetes mellitus distribution and medical expense of outpatient service reimbursement database in Beijing New Rural Cooperative Medical Scheme from 2009 to 2013,the diabetes mellitus were divided in-to two groups:with complications and without complications; the number of visits and proportion of the first-class, secondary-and tertiary-level medical institutions and the average annual growth rate of the five-year were calculated and the total expense,the average cost,the individual burden and the annual growth rate of the two types of diabetes mellitus were statistically analyzed.Results:The visits in the tertiary medical institutions of diabetes mellitus without complications decreased from 1895 to 661 and the proportion decreased from 3.05% to 0.6% from 2009 to 2013, while the visits in the tertiary medical institutions of diabetes mellitus with complications increased year by year and the proportion increased from 3.27%~4.24% since 2010.Outpatient medical expenses varied widely between pa-tients with and without complications and the higher the level,the greater the difference between the two.At the first-class,secondary-and tertiary-level institutions,the average expenses per time of diabetes mellitus with complications were 2.50,3.34 and 3.75 times higher than the diabetes mellitus without complications and the average out-of-pock-et expenses per time were 2.62,3.66 and 3.96 times higher than the latter respectively.Conclusions:From 2009 to 2013,the utilization of primary outpatient service in the region achieved some success while there were still some problems including unreasonable outpatient distribution, and more diabetic patients with complications went to the tertiary-level institutions than those without complications.Compared with outpatients without complications,patients with complications face up to a larger direct-economic burden of disease.The construction and the ability to prevent and control diabetes mellitus of basic medical institutions should be further strengthened,and the distribution of pa-tient needs to be reasonably led to enhance the service quality and ability of preventing,treating and controlling dia-betes and complications,and to guide patients with diabetes to seek medical treatment in primary healthcare institu-tions.
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The current problem with the hospital registration system in our country is that many patterns among different hospi -tals are not standard which leads to poor efficiency and makes patients inconvenient .We analyzed these mussy patterns and suggested some solutions in combination with the practical situation in our hospital and finally designed a new registration booking system which solves the problem of "long time for payments , registration and treatment waiting"by providing online registration and payment in order to simplify the medical procedures .
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Objective To analyze family clustering of outpatient service utilization in rural areas of China.Method Outpatient service information of all families in rural area of sample county was obtained on the basis of new cooperative medical system (NCMS) outpatient database,and family outpatient service utilization database was cleared out with the help of functions like IF,LOOKUP and so on in Excel 2010.Lorentz curve was drawn by area graph and scatter diagram with Excel 2010,so was Gini coefficient.Descriptive statistic,variance analysis and so on were carried by IBM SPSS Statistic 20.0.Result 20％ family takes up 53％ of outpatient service,and rural family's Gini coefficient of outpatient service utilization is 0.516.Members of high outpatient service utilization family (HOUF) used (17.7) more outpatient service than other families (10.4,4.2).HOUF were mainly distributed in towns with high capability of township hospital and low capability of township hospital.Conclusion Great family clustering of outpatient service utilization exists in rural areas.Family homogenization is distinct,in which irrationality exists.The capability of primary medical institutions influences the outpatient service utilization of residents in rural area.
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Objective:To create a convenient, quick and personalized upgrade application (APP) based on current Pocket Shengjing hospital mobile medical APP.Methods: To establish the best suitable mobile terminal APP to patient by using smartphone and mobile internet technique.Result: A series of new function, such as appointed register at any time before diagnosis, anticipated waiting time during diagnosis, enquiry of detection after diagnosis, different kind of payment during diagnosis, healthy information net among family members and effective control for broken appointment of patient, were achieved by the upgrade mobile medical APP. It also can optimize the process of diagnosis, reduce waiting time, increase outpatient service effective and improve satisfaction of patient for outpatient serviceConclusion: The upgrade mobile medical APP is a more practical and convenience software, and it can improve medical treatment process and provide convenient condition for medical service based on the perspective of patient.
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The current problem with the hospital registration system in our country is that many patterns among different hospi -tals are not standard which leads to poor efficiency and makes patients inconvenient .We analyzed these mussy patterns and suggested some solutions in combination with the practical situation in our hospital and finally designed a new registration booking system which solves the problem of "long time for payments , registration and treatment waiting"by providing online registration and payment in order to simplify the medical procedures .
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Taking the Second Affiliated Hospital of Zhejiang University School of Medicine as an example,the paper discussed its practices in optimizing outpatient service process.These practices include innovating convenient outpatient service process,establishing a coordination center of hospital's beds to strengthen pre-hospital one-stop management,implementing day surgery to improve inpatient service,implementing professional and humanized hospital clinical care,introducing the concept of fast tract surgery to promote accelerated rehabilitation after surgery,and establishing a follow-up center for inpatients discharged.Such efforts have improved the medical services' efficiency and quality,and improved the patients' satisfaction.
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Objective To learn the applications and patient experience of mobile payment technology as used in the hospital outpatient service.Methods 342 outpatients using mobile technology (APP)were chosen from the hospital information system for survey,and 300 outpatients registering in the conventional process were chosen as a control.Data of the doctor-seeing experiences of the two groups were analyzed statistically.Results Waiting queue reminder function is found with the highest patient usage among the three officially launched APPs,accounting for 83.6%.The appointment and cellphone payment functions exert the greatest impact on patient experience,boasting a patient satisfaction of 90%. All these functions can save totally one hour for an outpatient.Conclusions The mobile payment technology can significantly reduce outpatient waiting time,and improve outpatient experiences.Such technology therefore needs more promotions and connection with medical insurance system for the sake of outpatients.
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Objective Characterize the social profile and the need of information from patients with refractory epilepsy. Method A semi-structured questionnaire was applied to 103 patients to investigate sociodemographic aspects, pharmacotherapy and any doubts about epilepsy. Results Patients were highly dependent on having a free and accessible supply of antiepileptic drugs. Sixty-eight percent of the population was unemployed, and 26% confirmed receiving social security benefits due to epilepsy. Twenty-nine percent of the population reached high school. Eighty-five percent of the patients had at least one doubt about epilepsy; treatment and epilepsy aspects in general were the main topics. Conclusion : As observed in developed countries, patients with refractory epilepsy from a developing country also have high rates of unemployment and low educational levels. The results raise a concern about the need of information about epilepsy by patients and their families, urging the necessity to invest in strategies to solve this deficiency in knowledge. .
Objetivo : Caracterizar o perfil social e a necessidade de informações por parte de pacientes com epilepsia refratária. Método Um questionário semi-estruturado foi aplicado a 103 pacientes para investigar aspectos sociodemográficos, farmacoterapia e quaisquer dúvidas sobre epilepsia. Resultados Os pacientes mostraram-se altamente dependentes de um fornecimento gratuito e acessível de drogas antiepilépticas. Sessenta e oito por cento da população estava desempregada, e 26% confirmaram receber algum benefício social devido à epilepsia. Vinte e nove por cento da população alcançou ensino médio. Oitenta e cinco por cento dos pacientes tinha ao menos uma dúvida sobre epilepsia; tratamento e aspectos gerais da epilepsia foram os principais temas. Conclusão Tal qual observado em países desenvolvidos, pacientes com epilepsia refratária em países em desenvolvimento também apresentam altas taxas de desemprego e baixos níveis educacionais. Os resultados são preocupantes no que diz respeito à necessidade de informações sobre epilepsia por parte dos pacientes e seus familiares, apontando a necessidade de se investir em estratégias que solucionem esta deficiência de conhecimento. .
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Adult , Female , Humans , Male , Middle Aged , Epilepsy/epidemiology , Health Knowledge, Attitudes, Practice , Tertiary Care Centers/statistics & numerical data , Anticonvulsants/therapeutic use , Brazil/epidemiology , Epilepsy/psychology , Social Security , Socioeconomic Factors , Surveys and Questionnaires , Unemployment/statistics & numerical dataABSTRACT
The influences of medicine by the rapid development of economy are at least reflected on the following three as-pects: dramatically increasing awareness of health and medical demand of the majority and the serious “five long one short” phenome-non in outpatient clinic.This paper is based on the medical data of Nanfang Hospital.We analyzed the problems in the five links of appointed registration, visiting the doctors, taking examination and treatment, charging medical fees and medicine -claiming, putting forward four suggestions including updating concept for outpatients , emphasizing the application of information equipment and popular-ization of mobile device, such as WeChat guidance, in order to enhance the hospital networking mechanism , realize the synchronous transfer of information, introduce high-technology, and finally perfect the e-record of patients.
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The traditional independent methods can not solve the prominent problems of long waiting time in registration , paying and drug obtaining and short time in diagnosis and treatment .After the application of the mobile internet technology , it′s highly possible that outpatients′queuing congestion can be drastically alleviated .The paper investigates the outpatient registration and queuing data of our hospital over 9 weeks, and presents key requirements and system architecture of an outpatient service system based on mo -bile internet.To achieve the target, the hospital must make great efforts to improve online experience , optimize offline outpatient process, promote mobile internet service , and cultivate outpatient internet habits .