【摘要】 目的 研究一、二级医院门诊医疗服务过程质量、就诊时间和医疗费用,为改善医疗服务过程质量提供科学的决策依据。方法 采用模拟患者调查、门诊患者调查、门诊医生调查方法,对上海市区各20家一、二级医院的门诊医疗服务过程质量(包括病史采集、体格检查、实验室检查与辅助检查、诊断、处理、与患者的沟通能力和病史书写总体质量)、就诊时间、医疗费用和患者满意率进行评价。结果 一、二级医院门诊患者对门诊医生医疗服务过程质量的总体满意率为88.5％;模拟患者对门诊医生的医疗服务过程质量的评价总平均分为(67.4±6.8)分(满分100分),门诊医生对自我总体医疗服务过程质量满意者占83.1％,一、二级医院间差异无显著性(P>0.05);除诊疗时间外,一级医院门诊患者的人均挂号与候诊时间、人均付费与配药时间和人均就诊总时间均明显少于二级医院(均P<0.01);门诊患者的药费、实验室检查费、辅助检查费及诊疗总费用及模拟患者的人均门诊诊疗总费用在一、二级医院间差异无显著性(均P>0.05)。结论 一、二级医院门诊医生的医疗服务过程质量基本得到患者的肯定;总体上说,门诊患者就诊挂号与等待时间长、付费时间长、取药时间长、诊疗时间短的现象得到改善;一级医院的医生能够提供与二级医院基本无差异的常见病医疗保健服更多还原

【Abstract】 Objective In order to provide scientific basis in decision-making for improvement of quality of medical care, current quality of medical care service process, consultation time and medical care cost were studied in primary and secondary-care hospitals of Shanghai. Methods Quality in medical care service process, including history taking, physical examinations, lab tests and auxiliary examinations, diagnosis, treatment, ability of communication with patients, and medial history writing, consultation time, medical care cost and satisfaction of outpatients were studied in primary and secondary-care hospitals in Shanghai through investigations on simulated patients, outpatients and physicians. Results Overall, 88.5% of outpatients were satisfied with medical care service process quality in primary and secondary-care hospitals, average total quality score of medical doctors in outpatient departments evaluated by simulated patients was 67.4±6.8 (with a perfect score of 100) , and 83.1% of the investigated medical doctors in outpatient departments were satisfied with quality of medical care service process by themselves, without significant difference between primary and secondary-care hospitals(P>0.05) . Time consumed for registration and waiting for consultation, average medical care cost, time consumed for dispensing prescription and average total patients’ visit time except for diagnosis and treatment were significantly less in primary-care hospitals than those in secondary-care ones( P < 0.01). There were no significant difference in costs for drugs, lab test and auxiliary examinations and total cost of outpatients, as well as average cost for simulated outpatient visit in primary and secondary-care hospitals( P>0.05) . Conclusions Quality of medical care service process in primary and secondary-care hospitals was perceived good by the outpatients. In general, phenomena of long queues for registration, waiting for consultation, payment, getting drugs and short time for diagnosis and treatment in outpatient departments have been improved a little bit. Medical doctors in primary-care hospitals could provide medical care service as nearly the same as that in secondary-care ones, while time consumed for registration, waiting for consultation, payment and getting drugs, as well as for a total visit was much less in primary-care hospitals.更多还原