基于患者体验的公立医院改革绩效评估研究

The important standard to evaluate the achievement of public hospital reform is if it can ensure all people to accept satified and effective medical service or not. This project absorbes the advanced idea of patient's view of perception. Based on Donabedian's 'structure-process-results' model of medical care quality assessment, the project will contruct the performance indicator system of hospital service with combination of theoratical study and field survey and evaluate the public hospitals in pilot cities and counties for public hospital reform. The contents of the project include to establish a theoratical framework of hospital service performance, to build a performance indicator system of hospital service, to survey and evaluate performance of public hospital reform in China, and to propose policy recommendations to improve public hospital reform. The evaluation targets include pulic hospitals in cities and counties implementing public hospital reform pilots. The results wil be compared with those hospitals with similar conditions but not starting reform. Data envelope analysis (DEA) will be adopted to show the performances of hospitals in different reform models. And DEA index will be modelled with relevant factors such as reform policy and measures, resources input, etc to find the key factors influcing effects of reform. The findings and achievements of the project will provide theoratical and practical support to push on public hospital reform. And also it will provide government with a vigorous tool in medical service manamgement.

衡量公立医院改革成效的重要标准就是能否保证全体居民获得满意和有效的医疗服务。本项目借鉴国际先进理念，从患者体验的视角，以Donabedian提出的"结构-过程-结果"的医疗服务质量评价模式为基础，理论研究和现场调查相结合，构建医院服务绩效评估指标体系，并对开展不同模式公立医院改革的试点城市和县级公立医院进行调查评估。研究内容包括：建立医院服务绩效理论框架，构建医院服务绩效指标体系，评估研究我国公立医院改革绩效，提出完善公立医院改革的政策建议。评估对象包括开展公立医院改革试点的城市医院和县级公立医院改革试点医院，并与相应层次未开展试点的医院进行对比。采用DEA分析方法比较不同改革模式的医院绩效，并将DEA指数与改革政策和措施、资源投入等因素进行曲线拟合，从而总结改革成效，发现影响改革效果的关键因素，为完善我国医改政策，推进公立医院改革，提供理论和实证支持，为政府开展医疗服务监管提供有力工具。

本项目在充分学习国际上关于患者报告体验的测量与应用等相关研究的基础上，深入分析了我国深化医改的进展和问题，明确了患者报告体验对评价医改政策的重要性和可能性。基于这些理论研究，项目通过180名患者、40名医务人员、20名一般居民的深入访谈，并结合专家函询和座谈会，开发了我国公立医院患者报告就医体验的测量工具：公立医院患者报告体验量表。以此为工具，对我国东、中、西部4个省（江苏、福建、安徽、陕西）10个城市的10家城市公立医院和16家县级公立医院的门诊和住院患者进行了面对面询问调查，共完成了7856名患者调查。通过调查分析，初步证明项目开发的量表可以较为准确地反映医院的服务状况，对公立医院改革政策的效应可以做出较好的综合评价。经过4年的研究，本项目形成了一个患者体验量表，发表学术论文18篇，其中在SCI期刊发表论文1篇，中文核心5篇，参与2次国际交流，培养了4名硕士研究生。后续仍有部分成果在进一步整理中。本项目的成果，将为我国深化医改，尤其是公立医院改革的效果评价，提供一套更加实用的评价工具。