Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.
Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.
复制标题
患者对医院住院护理的满意度：信任、医疗保险和感知护理质量的影响
DOI：
10.1371/journal.pone.0164366
复制
发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Ren J
中科院分区：
文献类型：
--
作者：
Shan L;Li Y;Ding D;Wu Q;Liu C;Jiao M;Hao Y;Han Y;Gao L;Hao J;Wang L;Xu W;Ren J
目的中国医患关系的恶化日益引起国际社会的关注。本研究旨在探讨信任在病人对医院住院服务满意度中的作用，以及如何从病人和提供者的角度塑造病人-提供者信任。方法我们采用混合方法的方法，包括使用二手数据的多变量logistic回归模型（过去一年有住院经历的1200人），来自第五次全国卫生服务调查（NHSS，2013），以确定患者满意度与信任、经济负担和感知护理质量之间的关系，随后对62名方便挑选的关键信息提供者（27名来自卫生部门，35名来自非卫生部门）进行了深入访谈。一个主题分析建立了一个概念框架，以解释恶化的病人-供应商的关系。结果约24%的受访者表示不满意医院的住院治疗。Logistic回归分析显示，患者满意度与患者对医院的信任度（OR = 14.995）、住院医疗费用（OR = 5.736-1.829）、医护人员态度（OR = 3.155）、病房环境（OR = 2.361）呈正相关。但患者满意度与城镇居民医疗保险及其他保险状况呈负相关（与城镇职工医疗保险相比，OR = 0.215-0.357）。定性分析表明，病人的信任，病人满意度的最重要的预测因素，是由感知的高质量的服务提供，同情和关怀的人际交往，以及设计更好的医疗保险，提供更强的经济保障，使更公平地获得医疗保健。结论患者对医院护理不满意的核心是缺乏信任。中国当前的医疗保健制度改革尚未解决制度中导致不信任的根本问题。如果不采取涉及所有利益攸关方的系统问责办法，只注重医患之间的人际互动，就无法成功解决医患关系恶化的问题。
Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.
登录
查看更多内容
影响因子：
3.3
作者：
Footman, Katharine;Roberts, Bayard;McKee, Martin
通讯作者：
McKee, Martin
影响因子：
9.7
作者：
Hsiao, William C.
通讯作者：
Hsiao, William C.
影响因子：
2.5
作者：
Cai, Wenzhi;Deng, Ling;Yu, Min
通讯作者：
Yu, Min
影响因子：
1.4
作者：
Feng, Zhihua;Li, Tiantian
通讯作者：
Li, Tiantian
影响因子：
5.4
作者：
Franco, LM;Bennett, S;Kanfer, R
通讯作者：
Kanfer, R