Research on Satisfaction Degree of Doctor-patient Communication Quality based on Patient Perception / 中国医学伦理学

Objective sampling method was used to conduct a questionnaire survey on outpatients in two hospitals in Guangdong province in order to evaluate patients’ satisfaction with the quality of medical service. This paper explored the factors that affect patients’ evaluation of medical service quality, and found that patients’ age was negatively correlated with the evaluation of medical service quality. It is suggested that the establishment of friendly medical institutions should be carried out according to the national policy. At the same time, the management mechanism of hospital should be improved, the number of medical service centers for "efficient" should be increased, and the medical service personnel should be regularly trained; carry out medical knowledge education in community, improve the popularization of personal medical knowledge and close the cognitive gap between doctors and patients.

ASSESSING PUBLIC SERVICE QUALITY & SERVICE SATISFACTION:WITH REFERENCE TO GOVERNANCE IN KARNATAKA, INDIA

Being a democratic country India has brought in various acts and reforms to uphold citizen centricity. Right to service act has been one of such initiatives. As on 2023, the state of Karnataka has been able to provide highest number of services under this act. This study explores and investigates citizen's perspective of service quality & service satisfaction attained by availing the public services. A questionnaire survey was formulated and study found that the ve factors 'Reliability' 'Assurance', 'Empathy', 'Valence', and 'Waiting Time' are determinants of the quality of citizen/government services. The outcome indicate that overall service quality has signicantly positive impact on service satisfaction. This research is of greater value to scholars who are interested in the area of governance, administration, and service delivery.

Análise da correlação dos índices de estrutura e recursos humanos do serviço veterinário oficial em 2019 e as incidências acumuladas (2017 ­ 2019) de doenças de notificação obrigatória em bovinos e equinos no Brasil / Analysis of the correlation between the structure and human resources indexes of the official veterinary service in 2019 and the accumulated incidences (2017 ­ 2019) of notifiable diseases in cattle and horses in Brazil

As doenças de notificação obrigatória em bovinos podem gerar impactos sociais e econômicos significativos na cadeia pecuária brasileira, além de consequências negativas no mercado internacional devido a embargos sanitários. Para auxiliar no entendimento de como um sistema de vigilância epidemiológica com mais recursos pode gerar mais credibilidade para o país, foram realizadas análises de correlação entre a notificação de doenças e a estrutura veterinária disponível nos Órgãos Executores de Sanidade Agropecuária (OESAs), a partir dos dados contidos no Sistema Nacional de Informação Zoossanitária (SIZ), entre os anos de 2017 e 2019. Com base nos dados do serviço veterinário, foram produzidos o Índice de Estrutura Física Oficial (IEFO) e o Índice de Recursos Humanos do Serviço Oficial (IRHSO). Foi realizada análise de correlação entre a notificação de doenças de bovinos com a capacidade de estrutura física e recursos humanos de vigilância epidemiológica disponíveis no Serviço Veterinário brasileiro. Os estados AP, RR e SC foram os que mais notificaram brucelose e tuberculose no período e estão entre os melhores índices de estrutura e recursos humanos do país. A análise dos índices mostrou que a raiva não possui correlação significativa com estrutura e recursos humanos do serviço, entretanto, brucelose e tuberculose possuem correlação positiva com estrutura veterinária oficial disponível para a vigilância em bovinos. Portanto, melhorias na estrutura podem refletir no incremento dos índices de notificação das doenças de bovinos, assim como na qualidade de suas informações.

Notifiable diseases in cattle can generate significant social and economic impacts on the Brazilian livestock chain, in addition to impacts on the international market due to sanitary embargoes. To help understand how an epidemiological surveillance system with more resources can generate more credibility for the country, correlation analyzes were carried out between the notification of diseases and the veterinary structure available in the Executing Bodies of Agricultural Health (OESAs), based on the data contained in the National System of Zoosanitary Information (SIZ), between the years 2017 to 2019. Based on public data from the veterinary service, the Official Physical Structure Index (IEFO) and the Official Service Human Resources Index (IRHSO) were produced. Correlation analysis was performed between the notification of bovine diseases with the capacity of physical structure and human resources for epidemiological surveillance available in the Brazilian Veterinary Service. AP, RR and SC were the states that most notified brucellosis and tuberculosis in the period and are among the best indices of structure and human resources in the country. The analysis of correlation indices showed that the rabies disease does not have a significant correlation with the structure and the human resources of the service, however, brucellosis and tuberculosis does have a positive correlation with the official veterinary structure available for surveillance in cattle. Therefore, Improvements in the structure can reflect in the increase of the notification rates, as well as in the quality of its information.

HEALTHCARE SERVICE QUALITY- A REVIEW OF LITERATURE

Healthcare is a service sector with unique characteristics. Across the world public and private healthcare institutions have been the matter of priority. There are so many studies done on the various factors of hospital like assessing competition in hospital care market, performance relationship, and environment uncertainty in hospital, patient loyalty in India and outside India. Healthcare Service quality is a broad concept. This paper examines the review of literature on Healthcare Service Quality. Review of healthcare service quality was done by analysing 25 articles. The study investigates the factor of quality affecting the value care and patient satisfaction. Patient satisfaction is an important parameter to measure healthcare service quality level. This study is based on secondary data literature review and it explores the important factors on Healthcare Service Quality.

Patients' perception of service quality in a healthcare not-for-profit organisation

Service organisations should be aware of those elements that are perceived as excellent quality and incorporate these as part of their service offering. However, a not-for-profit (NPO) healthcare organisation consists of a diverse group of stakeholders who have different perspectives and interests. Service quality therefore requires a multidimensional definition that comprehends all their needs and expectations.Methods: Perceived service quality experienced by patients was measured by completion of the Service Performance (SERVPERF) questionnaire. A total of 111 patients completed the questionnaire across three mobile clinics supported by an NPO.Results: The research results suggested that service quality at the mobile clinics was of a very high standard, with no meaningful differences between clinics, age groups or gender. However, the responses had very little variance and could have been subjected to response bias or extreme bias. The absence of a comparator organisation could also have had an influence on responses given by respondents. Conclusion: Healthcare service organisations should strive towards maintaining high standards and engage in continuous measurement and improvement of their service quality as part of their quality management process. By measuring the current level of service experienced by patients, insights have been identified where adjustments might have a positive effect on perceived value. Future research recommendations include suggestions to increase the sample population, taking the service setting into account and further studies to confirm the validity and reliability of solicited service quality questionnaires in a NPO setting.

Study on the construction of the perceived service quality evaluation index system for Internet hospitals / 中华医院管理杂志

Objective:To construct an evaluation index system of perceived service quality for Internet hospitals, and to provide references for scientific evaluation and effective management of such hospitals′ service quality.Methods:Thanks to literature review and expert interviews, an index system was initially built based on the Brady and Cronin model.From August to November 2021, Delphi expert consultation method was used in three rounds of correspondence questionnaire survey, and experts were consulted to assess the importance, familiarity and judgment basis of these indexes. The importance of the indexes was expressed by ± s, and the weight value of each index was calculated using analytic hierarchy process fuzzy comprehensive evaluation method and SPSS Au software. Results:The evaluation index system of perceived service quality for such hospitals included 3 level-1 indexes, namely environmental quality, interaction quality and result quality; and 10 level-2 indexes, namely software platform, service support, social factors, attitude, behavior, professional quality, service effect, service efficiency, service cost, satisfaction; and 30 level-3 indexes. Among these indexes, result quality of level-1 indexes scored the highest weight value(0.337); Software platform, professional quality, service support and attitude of level-2 indexes scored a higher weight values, respectively 0.119, 0.119, 0.109 and 0.109. Of level-3 indexes, reputation of Internet hospitals, service attitude of their doctors and doctor-patient communication skills of doctors online scored a higher weight values, respectively 0.102, 0.057 and 0.055.Conclusions:The index system for Internet hospital perceived service quality evaluation built in this study proved scientific, contributing positively to guiding Internet hospitals to improve their quality and safety management.

Analysis of the medical complaint data in a district of Beijing during the COVID-19 epidemic / 中华医院管理杂志

Objective:To analyze the complaint data of medical institutions in a district of Beijing in 2021, discuss the patients′ demands for medical services under the background of epidemic normalizaed prevention and control, for reference to improve the service quality and quality management level of medical institutions.Methods:The data was from all patient complaints received by the Beijing Hospital Management Center in 2021 from medical institutions in a district of Beijing, and the information of confirmed cases of COVID-19 in Beijing in 2021 from Wind database. The time of complaint, the complained organization, the object of complaint, the content and reason, and the time distribution of epidemic related complaints and COVID-19 cases were analyzed. All data were analyzed by descriptive analysis.Results:A total of 2 408 valid complaints were included. The tertiary hospitals(1 175, 48.8%) and secondary hospitals(724, 30.1%) received more complaints; The complaints against to hospital managers were the most(1 470, 61.0%), followed by complaints against doctors(590, 24.5%); The number of complaints related to hospital management were the largest(776, 32.2%), followed by complaints related to diagnosis and treatment effects(623, 25.9%) and epidemic situation(431, 17.9%). The time distribution of epidemic related complaints was similar to the change trend of the number of confirmed COVID-19 cases in Beijing during the same period.Conclusions:Under the background of epidemic normalizaed prevention and control, the problems of hospital management in medical complaints were the most prominent, and epidemic related complaints accounted for a large proportion. Medical institutions should closely combine patients′ demands, optimize diagnosis and treatment procedures, unblock doctor-patient communication channels, promote hierarchical diagnosis and treatment, optimize resource allocation, and explore high-quality hospital operation and management mode.

Analysis of 388 telephone interview 12345 complaints based on patient perception quality / 中华医院管理杂志

Objective:To study the key factors that affect patients′ perception among the five dimensional factors of patients′ perceived service quality, and explore how to effectively rebuild patients′ confidence in the process of handling services with quality defects.Methods:A total of 388 12345 work orders from a Beijing stomatological hospital in 2021 were collected. The problems and solutions of patients′feedback were classified and standardized into tangibility, reliability, responsiveness, assurance and empathy. Chi-square test and logistic regression were used to analyze the relationship between relevant factors and problem solving rate, patient satisfaction.Results:There were 513 feedback questions in 388 return visit work orders, with 1.32 items for each. There were 83, 112, 126, 111 and 81 questions in the five dimensions of tangibility, reliability, responsiveness, assurance and empathy; 273 work orders had single-dimension problems, accounting for 70.4%, 105 work orders had two dimensional problems, and 10 work orders had three dimensional problems. Among them, the assurance dimension problem accounts for 47% and 100% of the work orders of two-dimension and three-dimension problems respectively; The proportion of unsolved responsiveness dimension problems was the highest, accounting for 31.7%, and there was a negative correlation between responsiveness dimension problems and patient satisfaction rate( r=-0.709). Conclusions:In the process of medical service, the basic quality and skills of medical staff are the basis of building patient trust. In the process of handling medical services with quality defects, it is most important that quickly respond to patients′ queries, which could help to rebuild patients′ confidence in the quality of services.

Evaluación psicométrica de la escala de calidad de servicios de atención en donantes de un banco de sangre en Medellín, Colombia, 2019 / Psychometric assessment of a quality scale perceived in blood bank donors of Medellín, Colombia, 2019 / Avaliação psicométrica de uma escala de qualidade percebida em doadores de um banco de sangue em Medellín, Colômbia, 2019

Resumen Objetivo: Evaluar la adaptabilidad del modelo Service Quality (servqual), con el fin de valorar la calidad del servicio en la atención de los donantes de un banco de sangre en la ciudad de Medellín. Metodología: Se llevó a cabo una evaluación psicométrica en 301 donantes de sangre, para determinar la calidad percibida. Se realizaron pruebas de consistencia interna con alpha de Cronbach e índice de discriminación, y se evaluó la validez de contenido de los dos cuestionarios y la estructura factorial, mediante análisis factorial exploratorio. Resultados: El alpha de Cronbach fue de 0,86; en las subescalas de expectativas, 0,87, y en percepciones, 0,77. Se observó una mayor consistencia interna en el cuestionario de expectativas que de percepciones. Aunque se obtuvo una baja consistencia interna en algunas dimensiones, no se afecta la escala de manera global. Conclusión: La escala servqual presenta un adecuado desempeño psicométrico y, por tanto, es útil para evaluar la calidad percibida en la atención en donantes de sangre, siempre y cuando sea abordada de forma unidimensional.

Abstract Objective: To assess the reproducibility and validity of the scale of perceived quality in donors from a blood bank in the city of Medellín. Methodology: Psychometric evaluation in 301 blood donors through internal consistency with Cronbach's alpha and discrimination index. Content validity of the polls and factorial structure were evaluated by means of exploratory factor analysis. Results: Cronbach's alpha was 0.86. For the expectations subscales, 0.87 and in perceptions 0.77. A greater internal consistency was observed in the poll of expectations rather than in that of perceptions. Although low internal consistency was obtained in some dimensions, this does not affect the scale globally. The use of the instrument should be approached in a unidimensional way. Conclusion: The servqual scale presents an adequate psychometric performance and, therefore, is useful to assess the perceived quality of care in blood donors in the Colombian context, as long as it is approached in a unidimensional way.

Resumo Objetivo: Avaliar a reprodutibilidade e validade da escala de qualidade percebida em doadores de um banco de sangue da cidade de Medellín. Metodologia: Avaliação psicométrica em 301 doadores de sangue, por meio da consistência interna com Alfa de Cronbach e índice de discriminação. A validade do conteúdo dos questionários e a estrutura fatorial foram avaliadas por meio de análise fatorial exploratória. Resultados: O Alfa de Cronbach foi de 0,86, nas subescalas de expectativas 0,87 e nas percepções 0,77. Foi observada maior consistência interna no questionário de expectativas do que de percepções. Embora tenha sido obtida baixa consistência interna em algumas dimensões, isso não afeta a escala globalmente; a utilização do instrumento deve ser abordada de uma forma unidimensional. Conclusão: A escala servqual apresenta um desempenho psicométrico adequado e, portanto, é útil para avaliar a percepção da qualidade do cuidado em doadores de sangue no contexto colombiano, desde que seja abordada de uma forma unidimensional.

La relación entre la calidad en el servicio, satisfacción del cliente y lealtad del cliente: un estudio de caso de una empresa comercial en México / The relationship between service quality, customer satisfaction, and customer loyalty: A case study of a trading company in Mexico

Resumen La calidad en el servicio se considera una alternativa para que las empresas puedan obtener una ventaja competitiva y sostenible en un entorno económico globalizado. Las pequeñas y medianas empresas deben ofrecer una mayor calidad en el servicio que las empresas grandes, y así obtener la preferencia de los clientes. El objetivo de este estudio fue identificar la relación entre la variable calidad en el servicio y las variables satisfacción del cliente y lealtad del cliente. Se utilizó el coeficiente de correlación de Spearman y un método estadístico basado en análisis factorial exploratorio que apunta a extraer la varianza máxima del conjunto de datos dentro de cada factor. Los resultados permitieron observar una correlación altamente significativa, positiva y fuerte de la variable de calidad en el servicio con satisfacción del cliente (r = 0.820) y lealtad del cliente (r = 0.803). Un hallazgo importante también fue la asociación entre la dimensión aspectos tangibles con las variables satisfacción del cliente (r = 0.910) y lealtad del cliente (r = 0.919). Por otro lado, en el análisis factorial, a través de la varianza total explicada, se observó que el autovalor es superior a 1 en los cinco primeros casos, donde el porcentaje de la varianza alcanza un valor máximo de 54.886 % en su primer factor. Entonces, con cinco factores se consigue explicar un 73.713 % de la varianza de todos los datos originales. El estudio presentó la limitación de su aplicación en solo una empresa. Se confirmó que a través de una mejor atención y servicio al cliente, la calidad en el servicio constituye una excelente herramienta para la rentabilidad y sostenibilidad de la empresa.

Abstract Service quality is considered an alternative for companies to obtain a competitive and sustainable advantage in a globalized economic environment. Small and medium-sized enterprises must offer a higher quality of service than large companies, and thus obtain customer preference. The objective of this study was to identify the relationship between service quality variable and the customer satisfaction and customer loyalty variables. Spearman's correlation coefficient was used, and a statistical method based on exploratory factor analysis, aiming to extract the maximum variance of the data set within each factor. The results allowed observing a highly significant, positive, and strong correlation, with values of r = 0.820 and r = 0.803, between the variables of service quality, customer satisfaction, and customer loyalty. An important finding was the association between the tangible aspects dimension with the customer satisfaction and customer loyalty variables, with values of r = 0.910 and r = 0.919, respectively. On the other hand, in the factor analysis, through the explained total variance, it was observed that the eigenvalue is greater than 1 in the first five cases, where the percentage of the variance reaches a maximum value of 54.886 % in its first factor. Then, with five factors, 73.713 % of the variance of all the original data is explained. The study presented the limitation of its application in only one company. It was confirmed that, through better customer care and service, service quality constitutes an excellent tool for the profitability and sustainability of the organization.

Pain-point analysis of outpatient service based on online patient comments / 中华医院管理杂志

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.

Investigation on inpatient service quality of general hospital based on SERVQUAL model / 中华医院管理杂志

Objective:To investigate the gap between the expectation and actual feeling of inpatients in general hospital, so as to provide reference for improving inpatient service quality.Methods:From October to November 2019, a questionnaire survey was conducted on the inpatient service quality with the revised SERVQUAL scale. The questionnaire included 20 items in 6 dimensions of reliability, assurance, responsiveness, economy, caring and tangibility. According to the gap between the expected service quality and the actual experience, improvement strategies were formulated.Results:Among the 211 inpatients investigated, the expected service quality was consistent with the actual experience in all dimensions. The quality value was ranked from the highest to the lowest as assurance, caring, reliability, responsiveness, tangible and economy. The gap between the expected value and actual value of economy was the largest and the gap between assurance was the smallest. The actual value was lower than the expected value of 20 items, among which the gap in the rationality of hospital diet, drugs and examination fees was the largest.Conclusions:There is a big gap between the expected service quality and the actual feeling of patients in tertiary general hospitals, and corresponding improvement measures should be taken, including moving forward the management port and improving the service quality.

An empirical study on the evaluation of the educational quality of clinical practice bases for master of nursing specialist / 中国实用护理杂志

Objective:To compile the evaluation scale of the quality of education in the clinical practice base of full-time Master of Specialist Nursing (MNS) based on student participation and the SERVQUAL model, evaluate the quality of clinical practice base, and provide reference for the evaluation of clinical practice base.Methods:Based on the theory of student participation and the SERVQUAL model, the evaluation scale of the educational quality of clinical practice base of MNS was constructed. By facilitating sampling methods, 176 MNS students from 11 universities in 6 provinces were selected, and a questionnaire of self-compiled general information and a survey of the evaluation scale of education quality of MNS clinical practice base were distributed.Results:The evaluation scale of education quality of clinical practice base of MNS contained 28 entries in five dimensions: tangibility, reliability, responsiveness, guarantee and empathy. The total Cronbach alpha coefficient of the scale was from 0.983 to 0.987, item level content validity index was from 0.92 to 0.96, scale level content validity index was 1 and the correlated coefficient of the structural validity Pearson was from 0.785 to 0.966. To explore factor analysis, the dimension value of the scale KMO value was greater than 0.7, and the expected part and the actual feel part KMO value were 0.956 and 0.963 respectively. The number of common factors was 2 and 3 respectively, and the cumulative interpretation variation was 79.1% and 78.4% respectively.The actual perception of the quality of education in the clinical practice base of MNS was lower than expected, and the differences in entries were statistically significant ( P<0.05). The analysis of multiple linear regression showed that the teaching time and level of clinical practice base undertaken by clinical practice base were the main factors affecting the expectation and actual feeling value ( P<0.05). The importance performance analysis analysis found that 11 entries were in the advantage zone, 3 entries were in the maintenance area, 12 entries were in the minor improvement area and 2 entries were in the priority improvement area. Conclusions:The evaluation scale of the quality of education of the clinical practice base of MNS have good confidence and validity. The actual degree of educational quality of the clinical practice base of MNS is lower than expected. The teaching time and level of clinical practice base undertaken by clinical practice base are the main factors that affect expectation and actual feeling. It is urgent to improve the theoretical knowledge and practice level of tutors and deal with occupational exposure experienced by MNS students.

Comprehensive Evaluation of Rehabilitation Medical Service Quality in Tertiary General Hospitals in Gansu, China / 中国康复理论与实践

Objective:To investigate the quality of rehabilitation medical service in tertiary general hospitals in Gansu Province. Methods:Stratified sampling was used to sample tertiary general hospitals in Gansu Province for on-site surveys in 2017. A quality evaluation index system was established in the view of medical service providers, including 17 indicators, based on Donabedian model and experts' opinions. Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) and Rank-sum Ratio were applied to make a comprehensive evaluation on the overall service quality of the hospital rehabilitation medical service. Results:A total of 27 tertiary general hospitals were sampled, in 13 cities/prefectures of Gansu Province. For the structure quality, the compliance rate of the business operation area and the number of beds in the rehabilitation medicine department were 77.78% and 51.85% respectively; while the compliance rates of the physicians, therapists and nurses were all less than 50%. For the process and results quality, the compliance rates were all more than 85%. For the overall quality of rehabilitation medical service, five hospitals were classified as Good, located in Lanzhou, Tianshui and Jiayuguan; 18 hospitals were classified as Medium, located in Longnan, Longdong, Lanzhou and surround, Linxia and Hexi regions; four hospitals classified as Poor, located in Lanzhou and Tianshui. Conclusion:The overall quality of rehabilitation services in the tertiary general hospitals of Gansu Province needs to be improved, and the development of rehabilitation services is uneven in various regions. Comprehensive evaluation provides an important reference to promote the rational distribution of rehabilitation medical resources and improve the quality of rehabilitation medical services.

Improving service performance in organizations for individuals with intellectual disability: an intervention focused on participation of families / A melhoria do desempenho do serviço em organizações para indivíduos com deficiência intelectual: uma intervenção com foco na participação das famílias / La mejora del desempeño del servicio en organizaciones para personas con discapacidad intelectual: una intervención centrada en la participación de las familias

To improve service performance in organizations for individuals with intellectual disability, the authors tested an intervention based on collaborative teams. Specifically, professionals and families cooperated in the design and implementation of projects to improve the quality of life of individuals with intellectual disability. We considered two service performance indicators reported by family members (N = 342; 78% women; and a mean age of 57.17 years): service quality and self-determination communication openness. Our results revealed that family members assigned to the experimental condition improved their service quality evaluations from pre-intervention to post-intervention, whereas family members assigned to the control condition did not change their evaluations. The intervention was not effective for communication openness. Perceptions remained stable in family members who participated in the teams (experimental condition), whereas communication openness decreased in family members in the control condition. We discuss the implications of our findings for service research.

Para melhorar o desempenho do serviço em organizações para indivíduos com deficiência intelectual, os autores testaram uma intervenção baseada em equipes colaborativas. Especificamente, profissionais e famílias cooperaram na concepção e implementação de projetos para melhorar a qualidade de vida das pessoas com deficiência intelectual. Foram considerados dois indicadores de desempenho do serviço relatados pelos familiares (N = 342; 78% mulheres; idade média de 57,17 anos): qualidade do serviço e abertura de comunicação autodeterminada. Nossos resultados revelaram que os membros da família atribuídos à condição experimental melhoraram suas avaliações de qualidade de serviço de pré-intervenção para pós-intervenção, enquanto os membros da família atribuídos à condição de controle não mudaram suas avaliações. A intervenção não foi eficaz para a abertura de comunicação. As percepções permaneceram estáveis ​​nos familiares que participaram das equipes (condição experimental), enquanto a abertura comunicativa diminuiu nos familiares na condição controle. Discutimos as implicações de nossas descobertas para a pesquisa de serviços.

Para mejorar el desempeño del servicio en organizaciones para personas con discapacidad intelectual, los autores pusieron a prueba una intervención basada en equipos colaborativos. En concreto, profesionales y familias colaboraron en el diseño e implementación de proyectos para mejorar la calidad de vida de las personas con discapacidad intelectual. Se consideraron dos indicadores de desempeño del servicio reportados por los miembros de la familia (N = 342; 78% mujeres; y una edad promedio de 57,17 años): calidad del servicio y apertura en comunicación sobre autodeterminación. Nuestros resultados revelaron que los miembros de la familia asignados a la condición experimental mejoraron sus evaluaciones de calidad del servicio desde la preintervención hasta la postintervención, mientras que los miembros de la familia asignados a la condición de control no cambiaron sus evaluaciones. La intervención no fue eficaz para la apertura en comunicación. Las percepciones se mantuvieron estables en los familiares que participaron en los equipos (condición experimental), mientras que la apertura en comunicación disminuyó en los familiares en la condición de control. Se analizan las implicaciones de nuestros hallazgos para la investigación de servicios.

Quality of routine immunization service: Perception of clients

Background: Immunization prevents over 2�million deaths each year worldwide. In India, even though vaccines are offered free of cost at public health facilities the coverage remains low. Limited scrutiny has been conducted at health service and client interface for routine immunization (RI) services, which may have been affecting the acceptance of vaccines. This emphasizes the importance of assessing the level of satisfaction and perceived quality of clients regarding RI services. Objectives: This study aimed to assess the perceived quality and level of overall general satisfaction with RI services of clients. In addition, determine the association of factors influencing clients perceived quality and overall general satisfaction with RI services. Methods: A community-based cross-sectional study was conducted in an urbanized village of Delhi from November 2015 to April 2017. A total of 279 RI visits were covered in the study, and the clients were interviewed at their residence using a pretested tool. Results: The dissatisfaction toward the domains of perceived quality of RI services was reported to be 3.2% for vaccine availability, 9.7% for vaccine information, 3.2% for staff behavior, 6.1% for doctor behavior, and 7.5% for infrastructure. Multivariable-regression analysis indicated that distance to health facility, literacy and age of the client, doctor behavior, staff behavior, and infrastructure had an effect on overall general satisfaction of client toward RI services. Conclusions: The client's perception is multidimensional; improvement in one domain is likely to strengthen the other. By understanding the client's perspective toward quality of RI service, the health-care mangers may improve the level of overall satisfaction.

Perception of type 2 diabetes mellitus clients on applications in Bima Regional General Hospital

Background:Repeat hospitalization is a process for a patient who needs to return to hospital as a result of inability to control and take care of their disease. The objective of study is to gather deeper understanding about the meaning experience of repeat hospitalization process among diabetes mellitus type 2 patients. The study is qualitative research within phenomenology method by using deep interview instruments. In this study, the research seeks the experience of diabetes mellitus type 2 patients who are being treated with repeat hospitalization process. Methods:The study applies descriptive phenomenology approach. By using the method, the subject could be explored, analyzed, and explained directly about their experience of repeat hospitalization. The size of sample, in descriptive study, is essential in order to reveal the saturation data. The participants collecting procedure is using the snowball sampling technique.Results:The age of participants are ranging from 40-79 years old. The level of education among participants are varies, from elementary schools to senior high schools. The occupation type are housewife, farmers or merchants.The participants’ income is ranging between 750.000-2.000.000 rupiah/month.Conclusions:The result reveals four findings among 10 participants: 1) the characteristics of participants 2) the lack of knowledge from diabetes mellitus(DM)management, 3) quality of service, 4) hope of recovery.

Profile and inspirations of hospital value-based purchasing of MS-DRG in the United States / 中华医院管理杂志

Pay-for-performance(P4P) is the third stage of payment evolution in the United States. As of 2010, the Centers for Medicare and Medicaid Services launched a series of P4P programs, including hospital value-based purchasing(HVBP) program. This paper introduced the background and eligibility of HVBP in the United States, focusing on the contents and calculation methods of HVBP as references for the reform of payment methods in China.

Demand analysis of Internet hospital service based on KANO Model / 医学研究生学报

ObjectiveAs a new mode and format of health care service, Internet hospital has created a convenient and efficient medical treatment channel for patients and promoted more access to high-quality medical resources. In order to better identify patients′ service demands of Internet hospitals and thus meet people′s diversified health needs, refined classification management of service demands of Internet hospitals is implemented by KANO model, so as to promote the improvement of service quality of Internet hospitals and enhance patient satisfaction as well.MethodsBased on the analysis ideas of KANO model, 300 patients were randomly selected from the social pharmacy of an Internet hospital for questionnaire survey and service demand survey.ResultsIn the KANO requirement attribute classification of Internet hospital service items, there were 6 items belonging to charm attribute, 10 items belonging to expectation attribute and 5 items belonging to necessity attribute. Service items corresponding to expected attributes and necessary attributes account for more than 70% of Internet hospital services.ConclusionThe application of KANO model to the service demand survey of Internet hospitals can effectively improve the service management level of Internet hospitals, and the continuous improvement of service quality of Internet hospitals requires regular monitoring of service demand changes.

Factors Associated with Rehabilitation Service Satisfaction in Convalescent Stroke Patients / The Japanese Journal of Rehabilitation Medicine

Purpose：This study investigated the factors associated with rehabilitation service satisfaction in convalescent stroke patients.Methods：This cross-sectional study included 41 participants (mean age 50.5 ± 9.3 years；73.2％ were male). Patients with severe cognitive impairment who were unable to respond to questionnaires were excluded from the study. At discharge, patient satisfaction was assessed using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS) tool. We also evaluated physical function using the Stroke Impairment Assessment Set-Motor (SIAS-M) gain tool, activities of daily living (ADL) using the Motor-Functional Independence Measure (M-FIM) effectiveness tool, depressive symptoms using the Japan Stroke Scale-Depression (JSS-D) tool, optimism using the revised Life Orientation Test (LOT-R), and service quality using the SERVPERF model. Stepwise regression analysis was performed to identify factors that were significantly associated with CSSNS scores.Results：The mean CSSNS score of participants was 55.5 ± 8.3 points. Stepwise multiple regression analysis showed that M-FIM effectiveness (β＝0.48, p＜0.01) and SERVPERF scores (β＝0.48, p＜0.01) were significantly associated with CSSNS scores.Conclusion：This study revealed that favorable improvements in ADL and better service quality were associated with higher rehabilitation service satisfaction in convalescent stroke patients.