Epidemic characteristics and trend analysis of heart failure in Guangzhou in 2017-2021 / 公共卫生与预防医学

Objective To understand the epidemic characteristics of heart failure in Guangzhou, and to provide a basis for the prevention and control of heart failure. Methods The information of patients hospitalized for heart failure in Guangzhou from January 1, 2017 to December 31, 2021 was collected, and t test, rank sum test, and χ2 test were used to analyze the differences of central tendency and composition ratio. Results From 2017 to 2021, there were 6 823 hospitalized patients with heart failure in Guangzhou, with 8,716 hospitalizations and 849 deaths. The average age of hospitalization was 78.50 ±10.48 years old. Male patients were younger than female patients (P<0.001), and females died 3.86 years later than males on average (P<0.001). The number of hospitalizations for males (4 251 person times, accounting for 48.77%) was less than that for females (4 465 person times, accounting for 51.23%), and the number of hospitalizations for urban registered residence (7 346 person times, accounting for 84.28%) was much more than that for rural registered residence (1 370 person times, accounting for 15.72%). The number of hospitalizations in the fourth quarter was the largest. The combined rates of coronary heart disease, hypertension, type 2 diabetes, chronic obstructive pulmonary disease and hyperlipidemia were 58.65%, 69.52%, 34.92%, 10.69% and 10.23% respectively. There were differences in age, registered residence, residential area and complications among patients with acute and chronic heart failure (P<0.05). Conclusion The mortality of patients with heart failure in Guangzhou is high, and the distribution characteristics of acute and chronic heart failure is different. Corresponding preventive measures should be taken for different groups to reduce the disease burden and improve the quality of life.

Checklist de cirurgias seguras: percepção da equipe de saúde / Safe surgery checklist: perception of the health team / Lista de verificación de cirugía segura: percepción del equipo de salud

Objetivo: analisar a percepção dos profissionais de saúde do centro cirúrgico acerca do uso do checklist de cirurgias seguras. Método: estudo descritivo-exploratório, com abordagem qualitativa, realizado com 29 profissionais da equipe cirúrgica de um hospital universitário do Centro-Oeste brasileiro. Dados obtidos por meio de entrevistas individuais, entre fevereiro e março de 2019, norteadas por instrumento semiestruturado. Realizada análise de conteúdo. Resultados: emergiram as categorias temáticas 'Prática e importância atribuída ao uso do checklist de cirurgias seguras pela equipe de saúde' e 'Perspectivas para o uso efetivo do checklist de cirurgias seguras na prática profissional'. Conclusão: Revelou-se uma prática incipiente do uso do checklist de cirurgias seguras, apesar de compreenderem sua importância, e verificou-se o reconhecimento de aspectos profissionais e organizacionais que precisam ser trabalhados para tornar a incorporação dessa ferramenta mais assertiva no processo de trabalho da instituição.

Objective: to analyze the perception of health professionals in the operating room regarding the use of the safe surgeries checklist. Method: descriptive-exploratory study, with a qualitative approach, carried out with 29 professionals from the surgical team of a university hospital in the Brazilian Midwest. Data obtained through individual interviews, between February and March 2019, guided by a semi-structured instrument. Content analysis performed. Results: thematic categories 'Practice and importance attributed to the use of the safe surgeries checklist by the health team' and 'Perspectives for the effective use of the safe surgeries checklist in professional practice' emerged. Conclusion: It was revealed an incipient practice of using the safe surgeries checklist, despite understanding its importance, and there was recognition of professional and organizational aspects that need to be worked on to make the incorporation of this tool more assertive in the work process of institution.

Objetivo: analizar la percepción de los profesionales de la salud en centro quirúrgico sobre el uso del checklist de cirugías seguras. Método: estudio descriptivo-exploratorio, con abordaje cualitativo, realizado con 29 profesionales del equipo quirúrgico de un hospital universitario del Medio Oeste brasileño. Datos obtenidos a través de entrevistas individuales, entre febrero y marzo de 2019, guiadas por un instrumento semiestructurado. Análisis de contenido realizado. Resultados: surgieron categorías temáticas 'Práctica e importancia atribuida al uso de la lista de verificación de cirugías seguras por parte del equipo de salud' y 'Perspectivas para el uso efectivo de la lista de verificación de cirugías seguras en la práctica profesional'. Conclusión: Se reveló una práctica incipiente de utilizar el checklist de cirugías seguras, a pesar de comprender su importancia, y se reconocieron aspectos profesionales y organizacionales que deben ser trabajados para hacer más asertiva la incorporación de esta herramienta en el proceso de trabajo de la institución.

Assistência de enfermagem no âmbito hospitalar: a experiência de pessoas privadas de liberdade / Nursing care in the hospital environment: the experience of people deprived of liberty / La atención de enfermería en el ámbito hospitalario: la experiencia de las personas privadas de libertad

Objetivo: Descrever a avaliação de pessoas privadas de liberdade sobre a assistência de enfermagem recebida no ambiente hospitalar. Métodos: Pesquisa qualitativa realizada em unidades de clínica médica e cirúrgica de três hospitais públicos, de capitais da região Nordeste do Brasil, referência em atendimento de urgência e emergência. A partir da aplicação técnica de exaustão, a amostra foi composta por 17 custodiados, do sexo masculino, em internação hospitalar. Para a coleta de dados, utilizou-se entrevistas semiestruturadas. Submeteu-se os dados à metodologia da análise de conteúdo proposta por Bardin. Resultados: Emergiram três categorias de análise: Percepção sobre o cuidado, Protocolo de segurança e Direitos das pessoas privadas de liberdade. Os sujeitos relataram insatisfação na garantia dos seus direitos, especificamente quando se referem à autorização de visitas; descrevem a realização de cuidados com distinção e preconceitos evidentes e reconhecem que o uso da algema e a presença do policial penal geram uma atmosfera de medo entre os profissionais e os demais pacientes na ala hospitalar. Conclusão: A avaliação sobre a prática assistencial hospitalar é positiva embora seja evidente a necessidade de refletir sobre a (re)organização do processo de trabalho, afinal a qualidade da assistência de enfermagem não se refere exclusivamente a habilidades técnicas. (AU)

Objective: To describe the assessment of people deprived of liberty on the nursing care received in the hospital environment. Methods: Qualitative research carried out in medical and surgical clinic units of three public hospitals, in capitals of the Northeast region of Brazil, reference in urgent and emergency care. From the technical application of exhaustion, the sample consisted of 17 male custodians in hospital. For data collection, semi-structured interviews were used. Data were submitted to the content analysis methodology proposed by Bardin. Results: Three categories of analysis emerged: Perception of care, Safety protocol and people deprived of liberty rights. The subjects reported dissatisfaction with the guarantee of their rights, specifically when referring to authorization for visits; describe the performance of care with distinction and evident prejudices and recognize that the use of handcuffs and the presence of the criminal policeman generate an atmosphere of fear among professionals and other patients in the hospital wing. Conclusion: The assessment of hospital care practice is positive, although the need to reflect on the (re)organization of the work process is evident, after all, the quality of nursing care does not refer exclusively to technical skills. (AU)

Objetivo: Describir la valoración de las personas privadas de libertad sobre los cuidados de enfermería recibidos en el ámbito hospitalario. Métodos: Investigación cualitativa realizada en unidades clínicas médico-quirúrgicas de tres hospitales públicos, en capitales de la región Nordeste de Brasil, referencia en atención urgente y de emergencia. A partir de la aplicación técnica del agotamiento, la muestra estuvo compuesta por 17 custodios masculinos en el hospital. Para la recolección de datos se utilizaron entrevistas semiestructuradas. Los datos fueron sometidos a la metodología de análisis de contenido propuesta por Bardin. Resultados: Surgieron tres categorías de análisis: Percepción del cuidado, Protocolo de seguridad y Derechos de las personas privadas de libertad. Los sujetos informaron descontento con la garantía de sus derechos, específicamente al referirse a la autorización de visitas; describir el desempeño de la atención con distinción y prejuicios evidentes y reconocer que el uso de esposas y la presencia del policía criminal generan un ambiente de miedo entre los profesionales y otros pacientes en el ala del hospital. Conclusion: La valoración de la práctica asistencial hospitalaria es positiva, si bien es evidente la necesidad de reflexionar sobre la (re) organización del proceso de trabajo, al fin y al cabo, la calidad de la atención de enfermería no se refiere exclusivamente a las habilidades técnicas. (AU)

El análisis de la calidad asistencial desde la perspectiva de la satisfacción y la experiencia del paciente: una mirada enfermera / An analysis of assistance quality from the perspective of patience satisfaction and experience: A nursing view

Este artículo pretende describir dos grandes aspectos: la satisfacción y la experiencia del paciente, y cómo medirlos y analizarlos en los campos de la gestión sanitaria, la gestión clínica y los servicios sanitarios. Dichos elementos están inmersos en el abordaje en seguridad del paciente y permiten que la enfermería se relacione con temas como la calidad de los cuidados, la satisfacción del usuario, su experiencia dentro del sistema, los cambios y la implementación de mejoras así como sus formas de medición y análisis dentro del vasto campo de la gestión clínica y sanitaria. Aunque se trata de un tema ampliamente explorado y complejo, susceptible de ser abordado por métodos cuantitativos y cualitativos, en el que la encrucijada entre calidad total, calidad percibida, satisfacción y experiencia parece conformar la hoja de ruta, el artículo aporta conceptos de reciente aparición como Healthcare Improvement Science (mejora de la ciencia de la salud), centrado en la mejora de la calidad del cuidado de la salud y la reducción de daños a los usuarios de los servicios y sus familias; Magnet Hospital (hospital magnético), que relaciona la satisfacción de los profesionales con la calidad de los cuidados, y Patient Experience Officer (director de la experiencia del paciente), nuevo perfil laboral creado en Estados Unidos, centrado en la mejora continua de la calidad a partir de la experiencia del paciente. Todos estos conceptos han sido desarrollados por instituciones e investigadores reconocidos en la materia. En conclusión, en este artículo se resumen algunas de las cuestiones clave que se deben tener en cuenta a la hora de analizar la experiencia del paciente, que es un elemento importante para la mejora y el mantenimiento de la calidad en la atención sanitaria.

This article aims to describe two major aspects: patient satisfaction and experience and the way these are measured and analyzed within health management, clinical management, and health services. These elements are immersed within processes of patient safety and assume a motive for nursing of interweaving issues such as quality of care, user satisfaction, user experience within the system, change and the implementation of improvements, as well as ways of measuring and analyzing these issues within the vast field of clinical and health management. This is a widely explored and complex topic where total quality, perceived quality, satisfaction, and experience appear to make up a crossroad that needs to be taken into account and whose engagement is susceptible to qualitative and quantitative measurements. This article, however, contributes new concepts like Healthcare Impro-vement Science, centered on the improving the quality of health care and reducing harm to users of services and their families, Magnet Hospital, where the satisfaction of employed professionals is related with quality of care, and Patient Experience Officer, a new job profile created in the United States focused on the continuous improvement of patient experience quality. All these concepts were developed by recognized institutions and researchers in the field. In conclusion, this article summarizes some of the key issues that must be taken into account when analyzing the patient's experience, which is an important element for the improvement and maintenance of quality in health care.

Cultura de segurança do paciente em organização hospitalar / Patient safety culture in hospital organization / Cultura de seguridad del paciente en organización hospitalaria

Estudo do tipo survey realizado em maio de 2015 que descreveu a cultura de segurança do paciente em organização hospitalar. Do total de 511 profissionais de enfermagem, 267 pessoas compuseram a amostra aleatória, 128 atenderam aos critérios de inclusão e responderam ao Questionário "Pesquisa sobre Segurança do Paciente em Hospitais", perfazendo taxa de resposta de 47,94%. Das dimensões da cultura de segurança, destacaram-se com respostas negativas, "Trabalho em equipe na unidade" com 67% (338), "Expectativas sobre o seu supervisor/chefe e ações promotoras da segurança do paciente" com 66,3% (330), "Aprendizado organizacional ­ melhoria contínua", 53,8% (198) e "Transferências internas e passagens de plantão" com 50,9% (255), representando as principais áreas com potencial de melhoria. Não houve dimensões com respostas globais positivas definidas com área de força. Urge responsabilidade compartilhada em implementar estratégias que visem corrigir as fragilidades encontradas em prol de uma assistência qualificada, eficaz, efetiva e segura (AU).

Survey study conducted in May 2015 that described patient safety culture in hospital organization. Of the total 511 nursing professionals, 267 individuals composed the random sample, 128 met the inclusion criteria and answered the questionnaire "Pesquisa sobre Segurança do Paciente em Hospitais" (Survey on Patient Safety in Hospitals), totaling a response rate of 47.94%. Of the safety culture dimensions, the ones which stood out with negative answers were: "Team work in the unit" with 67% (338), "Expectations on your supervisor/boss and actions promoting patient safety" with 66.3% (330), "Organizational learning ­ continuous improvement" with 53.8% (198) and "Internal transfers and shift changes" with 50.9% (255), representing the main areas with potential for improvement. There were no dimensions with positive overall answers defined with area of strength. It is of utmost importance to share responsibility in implementing strategies aiming to correct weaknesses found to promote qualified, effective and safe health care (AU).

Estudio tipo survey realizado en mayo de 2015, describiendo la cultura de seguridad del paciente en organización hospitalaria. Del total de 511 profesionales de enfermería, 267 individuos compusieron la muestra aleatoria; 128 cumplieron los criterios de inclusión y respondieron el Cuestionario "Investigación sobre Seguridad del Paciente en Hospitales", ofreciendo tasa de respuesta del 47,94%. De las dimensiones de la cultura de seguridad, obtuvieron respuestas negativas: "Trabajo en equipo en la unidad", 67% (330), "Expectativas sobre su supervisor/jefe y acciones promotoras de seguridad del paciente", 66,3% (330), "Aprendizaje organizacional ­ capacitación continua", 53,8% (198) y "Transferencias internas y cambios de guardia", 50,9% (255); representando las principales áreas con potencial de mejora. No hubo dimensiones con respuestas globales positivas definidas con área de fuerza. Urge responsabilidad compartida para implementar estrategias de corrección de debilidades encontradas, en pro de una atención calificada, eficaz, efectiva y segura (AU).

Data Mining Application in Customer Relationship Management for Hospital Inpatients / 대한의료정보학회지

OBJECTIVES: This study aims to discover patients loyal to a hospital and model their medical service usage patterns. Consequently, this study proposes a data mining application in customer relationship management (CRM) for hospital inpatients. METHODS: A recency, frequency, monetary (RFM) model has been applied toward 14,072 patients discharged from a university hospital. Cluster analysis was conducted to segment customers, and it modeled the patterns of the loyal customers' medical services usage via a decision tree. RESULTS: Patients were divided into two groups according to the variables of the RFM model and the group which had significantly high frequency of medical use and expenses was defined as loyal customers, a target market. As a result of the decision tree, the predictable factors of the loyal clients were; length of stay, certainty of selectable treatment, surgery, number of accompanying treatments, kind of patient room, and department from which they were discharged. Particularly, this research showed that when a patient within the internal medicine department who did not have surgery stayed for more than 13.5 days, their probability of being a classified as a loyal customer was 70.0%. CONCLUSIONS: To discover a hospital's loyal patients and model their medical usage patterns, the application of data-mining has been suggested. This paper suggests practical use of combining segmentation, targeting, positioning (STP) strategy and the RFM model with data-mining in CRM.

O hospital-escola de São Carlos: análise do funcionamento por meio da satisfação dos usuários / The São Carlos Hospital School: assessment of its functioning by means of user satisfaction

O objetivo deste estudo é avaliar a satisfação dos usuários com o hospital-escola de São Carlos nos seis primeiros meses de funcionamento. Amostra é composta por 137 usuários divididos pelo serviço utilizado (internação hospitalar, internação domiciliar, emergência SAMU, emergência demanda espontânea e acolhimento) no hospital. Os usuários foram entrevistados quanto ao perfil sociodemográfico e clínico e avaliação da satisfação com o hospital. A maioria dos usuários era do sexo feminino e na faixa etária de 18 a 45 anos. Os usuários ficaram "muito satisfeitos" (46,2 por cento) com a agilidade no atendimento e com a equipe (52,6 por cento). 59,2 por cento dos usuários ficaram muito satisfeitos com o hospital e 68,6 por cento o consideraram melhor do que imaginavam. Não houve diferença entre serviços na satisfação com a agilidade, ambiente físico e equipe. Houve menor "esclarecimento sobre a saúde" no acolhimento em relação à internação hospitalar e domiciliar (p<0,05). Os usuários da internação hospitalar apresentaram maior satisfação e melhor expectativa do que o acolhimento e emergência SAMU (p<0,05). As características do perfil do usuário com diferenças estatísticas quanto à satisfação foram "a cor da pele" e "plano de saúde". O estudo demonstra que a adoção do modelo de assistência humanizada à saúde, como a proposta do hospital-escola, resulta em satisfação dos seus usuários.

This research assessed the satisfaction of the users of São Carlos Hospital School in its first six months of functioning. A sample of 137 users was grouped according to the service used: hospital admittance, home care, emergency medical assistance, spontaneous emergency and shelter. Inferential statistics were realized by Chi-Square and Fischer Exact tests. The majority of users were women and aged 18 to 45 years-old. The users were "very satisfied" (46.2 percent) with attendance agility and with the team (52.6 percent). A number of 59.2 percent of the users were very satisfied with the hospital and 68.8 percent considered the service better than expected. Less "clarity concerning health" was reported for shelter regarding hospital admittance and home care (p<0.05). Users under hospital admittance presented greater satisfaction and better expectation compared to acceptance and emergency medical assistance (p<0.05). User profile characteristics as "skin color" and "health plan" presented statistical differences regarding general satisfaction. The study showed that the adoption of a humanized model of assistance in healthcare as the proposal of this Hospital resulted in user satisfaction.

O papel do aluno de graduação em Medicina no atendimento a pacientes de enfermarias de longa permanência de um hospital-escola / The role of the graduation Medical student in the care of patients in long permanence ward of a medical school hospital

Verificar a percepção que os pacientes internados em um Hospital Escola (HC-UFG) têm da presença dos alunos de medicina no atendimento prestado a eles e observar outros fatores relacionados à satisfação com o atendimento. MÉTODO: Critério de inclusão: internação há menos de um ano em outro Hospital não Escola. Excluídos: Menores de 18 anos e incapazes de colaborar. Aplicado questionário, por alunas da Faculdade de Medicina da UFG, com informações sobre a internação, privacidade, comparação com outros hospitais e avaliação da presença dos alunos. Utilizados estatística descritiva, teste de Wilcoxon, c² e Regra de Sinais de Descartes. RESULTADOS: Avaliados 96 pacientes. A média das notas do HC-UFG foi 9,01±1,5, a dos outros hospitais foi 5,67±3,38. A maioria (58,33 por cento) relatou mudança no conhecimento sobre sua doença após a internação no HC-UFG. A presença dos alunos foi avaliada como boa ou muito boa por 91,58 por cento e despertou sentimentos positivos em 84,54 por cento dos entrevistados. As aulas ao redor dos leitos foram consideradas agradáveis por 69,79 por cento deles. CONCLUSÃO: O aluno tem papel relevante no atendimento prestado no Hospital Escola. Contribui para maior confiança no serviço, desperta maior segurança e alegria nos pacientes, torna o ambiente mais acolhedor e atua como disseminador de conhecimentos.

To investigate the patients' perception of the students in their care in a long permanence ward of the School Hospital of the Federal University of Goiás (HC-UFG) and to observe another factors related to these patients' satisfaction. METHOD: Inclusion criterion: length of hospital stay of no longer than one and a half year at a non-school hospital. Individuals under 18 years of age and unable to collaborate were excluded. Participants responded to a questionnaire, applied by medical students of UFG, with information regarding hospitalization, privacy, comparison with other hospitals and evaluation of students' presence. Descriptive statistical analysis, Wilcoxon's Test, c² and Descartes' Rule of Sign were used. RESULTS: 96 patients were evaluated. The average grade for the HC-UFG was 9,01±1,5 while that of other hospitals was 5,67±3,38. Most participants (58,33 percent) reported a change regarding knowledge of their disease after hospitalization at the HC-UFG. The presence of students was deemed good or very good by 91,58 percent and yielded positive feelings in 84,54 percent of the interviewees. Bedside-held classes were considered pleasant by 69,79 percent of the participants. CONCLUSION: The student has a relevant role in caregiving at the School Hospital. It further contributes to more reliability on the service, gives rise to the more security and happiness among patients, makes the environment cozier and acts as knowledge disseminator.

Encontros de serviço e satisfação de clientes em hospitais / Service encouters and customer satisfaction in hospitals / Encuentros de los servicios y satisfación de los clientes en hospitales

A pesquisa realizada versa sobre os encontros de serviço e a satisfação de clientes em hospitais. O estudo é de natureza exploratória e teve por objetivo identificar os encontros de serviço que ocorrem no hospital e os atributos de satisfação a eles relacionados. Os dados foram coletados com profissionais e clientes de hospitais, no ano de 2003, por meio de entrevistas utilizando a técnica do incidente crítico. A análise de conteúdo evidenciou os atributos de satisfação dos encontros de serviço que compõem os processos de admissão, internação e alta. Os resultados fornecem importantes informações para ao gestor de serviços hospitalares, permitindo o delineamento de ações com foco no cliente.

This research is about service encounters and customer satisfaction in hospitals. The study is exploratory and was aimed at identifying the service encounters maintained in hospitals and the satisfaction attributes related to them. The data were collected with hospital professionals and customer, in 2003, by means of interviews using the critical incident technique. The content analysis evidentiated the satisfaction attributes of the service encounters regarding admission, hospitalization and discharge procedures. The results provide important information to hospital service managers, allowing for the planning of customer-focused actions.

La pesquiza realizada tratase sobre los encuentros de los servicios y la satisfación de los clientes en hospitales. El estudio es de naturaza exploratoria e tiene por objetivo identificar los encuentros de los servicios que acontecen en el hospital y los requisitos de la satisfación a estos relacionados. Los dados fueron coletados con profesionales y clientes de hospitales, em el año de 2003, por medio de entrevistas utilizando la tecnica del episodio crítico. La analisis del contenido resalto los requisitos de la satisfación de los encuentros de los servicios que componen los procesos de admisión, internación y baja del hospital. Los resultados fornecen importantes informaciones para el gestor de servicios hospitalares, permitiendo el delineamiento de las aciones con foco en el cliente.

Derechos del paciente hospitalizado: Responsabilidad en la práctica de enfermerías / Hospitalized patient's rights: A nursing practice responsibility

Introducción: los derechos humanos fundamentales los tiene cada persona por el simple hecho de serlo; protegen valores como la vida, la libertad, la integridad, la igualdad, la dignidad y principalmente la seguridad jurídica. Objetivo: identificar el conocimiento del personal de enfermería sobre los derechos humanos del paciente hospitalizado y su relación con la satisfacción del usuario en la atención de enfermería. Material y métodos: a través de un estudio descriptivo transversal, se estudió una muestra por conveniencia conformada por 50 enfermeras generales y 121 pacientes hospitalizados. Para las enfermeras se construyó una encuesta en escala dicotómica; y un cuestionario con 18 reactivos para evaluar la satisfacción de los pacientes en la atención de enfermería. Resultados: se encontró que el 100% del personal encuestado tiene conocí miento sobre el derecho a la salud. Derechos como la verdad, la vida, la libertad, la autonomía y la confidencialidad son conocidos por más de la mitad del personal encuestado; El 49% de los pacientes refiere no conocer el nombre de la enfermera que lo atiende en los diferentes turnos y en el 51% no se respeta su intimidad. En lo que concierne a la atención de enfermería más de la mitad de los pacientes, la refiere como buena, 28% excelente y 14% regular. Conclusiones: la despersonalización es evidente cuando se analiza el derecho del paciente a un trato digno. Aunque 69 y 55%de las enfermeras conoce que los pacientes tienen derecho a la autonomía e intimidad, resulta incongruente que más del 70% de estos refiera que no es respetada su decisión e intimidad respecto a su persona ofrecimientos diagnósticos y terapéuticos. Sin embargo más de la mitad de los pacientes encuestados refieren que la atención de enfermería que reciben es buena.

Introduction: protection to the human rights is a duty of society, the law to be guarded mayor attention is about children, illness and inability. Since the 50's decade, with the publication of Nuremberg's Code, it'd established the rights of the patient hospitalized. Objective: identify the degree of knowing in the nursery personal about the rights of patient hospitalized and if it has influencing in satisfactions with health attention. Material and methods: transversal, descriptive, and observational study with 50 general nurses from hospitalization and measured by an instrument with 20 items, previously valided by expert and the confidentiality with Cuter-Richardson's with value of 0.60 for ask positive, and of 0.23 for the ask negative. The items were about the right to health, autonomy, information, truth, confidentiality, freedom, intimacy, a deal with worthy best medical attention. An interview was applied to 121 hospitalized patients, questionaire related with satisfaction and a linker's scale, for classify nursery- attention. To associate the degree nurse's knowing a correlation by means of coefficient PHI. Results: the 100% knows the right to life, the 84% to health, the 69% about autonomy, the 55% knows what's the rights to information, the 95% to truth, 69% knows right to confidentiality, 74% to freedom, the 55% knows the right to intimacy, 50% to dignity, the 42% knows the right to a best medical attention. In relation to patients the 48.8% didn't know the name of nurse that assists, them 51.2% said intimacy wasn't respected, the 97.5% opined that the decisions for treatment or surgery are a direct medical responsibility, about the nursery attention, the patients were opinions 28% excellent, the 58% good and the 14% as regular. Conclusions: level of nurses knowing the hospitalized patient rights was, 42% of the nurses ignore the right to a best medical attention, the patient ignores the name of the nurses take care of them, and 14% of patients' opinion about attention was regular.

Construction of the Novel Value-Group Based Mode between Hospitals and Patients / 中国医学伦理学

In order to enhance their core competitiveness,hospitals will deal with medical service suppliers,patients,counterpart hospitals and other stakeholders constantly.Such multiple value activities constitute a patient-oriented and hospital-centered value group.Hospitals have to constantly meet the demand of patients in the provision of medical services,and patients will be satisfied through their own participation in medical activities,thus realize the increase of their value.The pattern of mutual value creation between hospitals and patients forms the new hospital-patient relationship.It is an important condition for the hospitals to gain competitive advantages in the medical service provision through the two models of value maximization and organization minimization,and is also profitable for the formation of a harmonious relationship between doctors and patients.

A Comparative Study on the Pattern of Outpatient Department Utilization at a Tertiary Level Hospital before and after Implementation of the Patient Referral System / 예방의학회지

This study was conducted to assess the effects of implementation of the patient referral system started July 1st, 1989. A comparison on the pattern of outpatient services of the Departments of Internal Medicine, General Surgery, and Pediatrics at the Yeungnam University Hospital was conducted for each one year period before and after implementation of the patient referral system. The pre-implementation period was from July 1. 1988 to June 30, 1989 and the post-implementation period was from July 1. 1989 to June 30, 1990. The information used for this study was obtained from official forms, prepared by the Yeungnam University Hospital, and submitted to the Korean Medical Insurance Cooperatives. After implementation of the patient referral system, the number of outpatient cases in the Department of Internal Medicine decreased 36.1% from 9,669 cases to 6,181 cases a year. Cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of Pediatrics decreased 36.9% from 3,372 cases to 2,128 cases a year. After implementation of the patient referral system, the average age of cases in the Departments of Internal Medicine and General Surgery was 52.5 and 49.7 years old, respcetively. This was a significant increase in comparison with the pre-implementation period. After implementation of patient referral system, the proportion of new outpatients in the Department of Internal Medicine decreased form 24.1% to 14.6%, the Department of General Surgery from 36.0% to 23.4%, and the Department of Pediatrics from 15.5% to 8.3%. The number of visits per case decreased significantly in the Department of Internal Medicine(from 1.74 to 1.61), but there was no significant change in the Department of General Surgery and Pediatrics. The length of treatment per case increased significantly in all three departments (form 16.1 days to 19.3 days in the Department of Internal Medicine, from 12.0 days to 15.2 days in the Department General Surgery, and 8.9 days to 11.2 days in the Department of Pediatrics). The number of clinical tests per case increased significantly in the Department of Internal Medicine (from 22. to 2.5), in the Department of Pediatrics(from 0.8 to 1.1) and increased in the Department of General Surgery(from 6.4 to 6.6). The average medical cost per case decreased form 43,900 Won to 42,500 Won in the Department of Internal Medicine, while the cost increased from 75,900 Won to 78,500 Won in the Department of General Surgery and from 12,700 Won to 13,500 Won in the Department of Pediatrics. In case-mix, the chronic degenerative disease(i. e. hypertension, diabetes mellitus, angina pectoris, malignant neoplasm, and pulmonary tuberculosis) ranked higher and acute infectious diseases and simple cases(i. e. gastritis and duodenitis, haemorrhoids, anal fissure, carbuncle, acute URI, and bronchitis) ranked lower after implementation of the patient referral system compared to before implementation.