【作者】 洪志莹；

【导师】 向月应；

【作者基本信息】 南方医科大学 ， 社会医学与卫生事业管理， 2011， 硕士

【摘要】 研究背景当今,全球医疗保障服务面临医疗公正与医疗费用快速上涨的难题,其中有卫生体制不健全的原因,也有医学自身发展的因素,社会医学与健康模式,医学服务体制、服务手段等都处于转型和整合过程中,医学学科建设与发展正面临着新的态势。我们都在探索如何从人人享有卫生保健目标出发来改革医疗服务体系,如何顺应当代医学发展进程中出现的整体化趋势,重新思考与定位医疗服务的模式与功能,整合现有的卫生资源,使之发挥更好的效益。医院分科越来越细的模式难以满足现代医疗服务的客观需求。因为许多疾病的诊疗需要多学科、多专业的融合方能取得更好的效果。以冠心病和先心病为例,既需要内科也需要外科相互配合的诊疗。物理学家、量子论的创始人M·普朗克指出：“科学史内在的整体,被分解为单独的部门不取决于事物的本质,而是取决于人类认识能力的局限性。”科学史表明科学经历了综合、分化、再综合的过程。医学科学也同样遵循这一规律。近些年来,许多医院特别是大型医院引入整合医学理念对学科进行了整合,取得了显著的社会、经济和技术效益。目前,医院的学科整合呈现出蓬勃发展之势。因此,对学科整合的有关问题进行研究,具有其重要性和必要性,对推动学科发展具有现实意义。研究目的1.通过对目前学科整合发展路径的论述,考察学科整合后所产生的经济效益及社会效益,进一步证明学科整合的必要性及重要性。2.对两家医院住院病人满意度情况进行总的评价,探讨如何有效利用满意度调查结果促进学科整合,为医院的管理者提出合理化建议,改进服务质量,提高服务意识,重新思考与定位医疗服务的模式。研究方法本研究以综合医院住院病人作为研究对象,采用《住院病人满意度问卷调查表》为测量工具,通过分层随机抽样的方法抽取共600位住院病人。调查表分为两部分,第一部分为患者的基本情况,用来了解患者在基本统计上的特征。第二部分为患者满意调查表,患者的总体满意度为一级指标,又分为8个二级指标,医疗设施病房环境、后勤服务、医疗技术、服务态度、医患沟通、医疗收费、医德医风、目前治疗效果8个项目共34个问题。统计分析2009年9月～2010年9月所发出的住院病人满意度调查问卷。问卷采用5级Likert标度法,应答由正向到负向分5个等级依次赋予分值5～1分。(完全满意5分、很满意4分、一般3分、不满意2分、很不满意1分)。研究结果1.被调查的600名住院病人中,有效问卷540份,其中学科整合后病人满意度的总体评价得分为4.29,总满意率为95.8%,未进行学科整合病人满意度的总体评价得分为3.77,总满意率为66.7%。2.以百分制计算调查表各二级指标的得分,学科整合后的病人调查问卷中,医疗设施病人环境得分80.2000,后勤服务得分79.7444,医疗技术得分80.2778,服务态度得分82.7222,医患沟通得分82.2937,医疗收费得分79.82,41,医德医风得分81.6944,目前治疗效果得分82.7500。未学科整合后的病人调查问卷中,医疗设施病人环境得分76.3555,后勤服务得分75.6444,医疗技术得分75.7778,服务态度得分79.2963,医患沟通得分78.9206,医疗收费得分74.0000,医德医风得分73.9444,目前治疗效果得分74.8333。多元线性回归分析结果显示：性别、年龄、婚姻、职业、文化程度、付费类别、家庭人均月收入均无统计学意义(P>0.05),组别有差异,有统计学意义(P<0.05)。结论1.学科整合后总满意率明显提高,总体评价得分也随之提高。2.学科整合后,住院病人对目前治疗效果得分最高(82.7500),对后勤服务得分最低(79.7444)。更多还原

【Abstract】 BackgroundNowadays, the world’s medical health care services faces the problems of medical justice and medical expense rising rapidly. including the reasons for the health system is not perfect,also there aremedical factors in their own development, social medical and health, medical service system, mode service method, etc are in transition and integration process, construction and development of medical disciplines are facing a new situation. We are exploring how from everyone to reform health care aim of medical service system, how to meet contemporary emerge in the process of the development of medicine intergration trend, rethinking and positioning medical service mode, function and integration of existing health resources, So as to reap better benefit.Hospital Division is getting thinner which is difficult to meet the objective demand of modern medical service.Because many diseases need multi-disciplinary and more professional fusion in order to obtain better results. For patients with coronary heart disease and congenital heart disease, we need medical diagnosis and also need surgical reciprocal treatment. Physicist, the founder of quantum theory M ·Planck said:" the whole History of Science, is broken into separate department does not depend on the nature of things, but on the limitations of human understanding ability." History shows that science has experienced comprehensive, differentiation, then integrated process.Medical science also follow this rule.Many hospitals, especially large hospitals introduced the concept of integrated medical to integrat disciplines and significant social, economic and technological benefits has been made in recent years. Currently, the hospital discipline integration presented with vigorous development potential. Therefore, studies on discipline integration are not only importance but also necessary, and have practical significance to promote the disciplinary development.Objectives1.Based on the discussion of discipline integration development path to study the combined disciplines of economic and social benefits, further proof of the necessity and importance of discipline integration.2.On the patients’satisfaction assessment of two hospitals,to discuss how to effectively use satisfaction survey results promoted disciplinary integration, make reasonable suggestions for hospital administrators to improve service quality, enhance service awareness, rethinking and positioning medical service mode.MethodsThe research objects of This study are comprehensive hospital patients, using the self-designed questionnaire survey of satisfaction of patients in hospital, through the stratified random sampling method extracting altogether 600 hospitalized patients.Questionnaire is divided into two parts, the first part is the basic conditions of patients to see the basic statistical characteristics of them. The second part is the satisfaction of inpatients, patients’ overall satisfaction questionnaire for one class index, and divided into eight secondary indexes, medical facilities ward environment, logistics service, medical technology, service attitude, doctor-patient communication, medical treatment charge, medical ethics, the current treatment,34 questions in total.Statistical analysis of the satisfaction questionnaires of hospitalized patients which are issued in September 2009-2010.Questionnaire Likert scale by 5 levels by the positive method, the response to the negative points 5 levels in turn give score 5 to 1 points. (completely satisfied with five points, very satisfied with four points, generally three points, not satisfied with 2 points, very dissatisfied 1 points).Results1.The survey 600 hospital patients,540 effective questionnaires, of which the combined disciplines of theoverall assessment of patient satisfaction score was 4.29, with a total satisfaction rate of 95.8%, the overall assessment without discipline of patient satisfaction score was 3.77 The total satisfaction rate of 66.7%.2.To calculate percentile questionnaire scores of the two indexes, medical facilities and environment scored 80.2000, logistics service scored 79.7444, medical technology scored 80.2778, the service attitude scored 82.7222, doctor-patient communication scored 82.2937, medical treatment charge scored 79.8241, medical ethics scored 81.6944, the current treatment scored 82.7500.In questionnaires of patients without discipline integration, medical facilities and environment scored 76.3555,logistics service scored 75.6444, medical technology scored 75.7778, the service attitude scored 79.2963,doctor-patient communication scored 78.9206, medical treatment charge scored 74.0000,medical ethics scored 73.9444, the current treatment scored 74.8333. Multiple linearregression analysis showed: gender, age, marital status, occupation, education level, pay category, family income was not statistically significant (P> 0.05), group has obvious difference between statistical significance (P<0.05).Conclusion1. Discipline obviously improve the total satisfaction after integration, overall evaluation score increases.2. After discipline integrated, the current treatment scored highest (82.7500), the logistics service scored lowest (79.7444)更多还原