【作者】 杨娟；

【导师】 沈丽宁； 张晓祥；

【作者基本信息】 华中科技大学 ， 图书情报， 2019， 硕士

【摘要】 【目的】梳理医院信息化服务指标,构建三甲医院信息化服务质量评价指标体系;依据信息化服务指标作为题项设计医院儿科信息化的服务质量评价问卷,确定儿科患者及家属对各项信息化服务的期望-感知差异,了解医院信息化服务中存在的问题;基于卡诺(KANO)二维品质模型,对各项信息化服务进行需求属性的分类,识别患者核心信息化服务;结合改进的KANO与IPA综合模型确定信息化服务要素提升优先权,根据结果提出改进医院信息化服务建议,以提高医院整体服务质量,增加患者满意度,提升医院整体竞争力。【方法】(1)文献分析法:广泛查阅信息化服务或医院信息化相关文献,结合公立三甲医院信息化服务特点,整合梳理医院信息化服务项目。(2)深度访谈法:随机抽取武汉某三甲医院儿科4名科室主任、10名普通儿科医务人员和10名患者进行深度访谈,提出代表性不足、可操作性差和需要添加的信息化服务指标。(3)德尔菲专家咨询法:对任职于武汉某三甲医院信息科室、医院儿科科室主任、武汉某“双一流”高校卫生信息管理专业教授共15名专家进行两轮咨询,最终确立医院信息化服务指标评价体系。(4)问卷调查法:设计医院患儿及家属信息化服务感知-期望差异问卷,了解儿科患者及家属对服务期望和公立三甲医院提供儿科信息化服务的实际情况,并比较其差异;设计KANO问卷,对公立三甲医院信息化服务指标进行患者需求属性分类,明确患者核心信息化服务需求。【结果】(1)本文通过文献查阅、相关人员访谈构建了含3项一级指标,7项二级指标和24项三级指标项的三甲医院信息化服务评价指标体系,通过两轮德尔菲专家咨询,删除C-14手术室外电子屏播报进展、C-24出院随访(电话,上门)两项三级指标,最终构建了三甲医院信息化服务评价指标体系。(2)依据信息化服务指标体系构建题项,完成了医院儿科患者服务质量满意度调查问卷的设计,问卷的Cro nbach’s Alpha系数均在0.7以上,问卷因子分析的KMO值为0.832,Bartlett球形检验的显著概率低于0.05,问卷具有良好的信效度。(3)儿科患者及家属对医院信息化服务的感知(满意度)评分总体为82.74?15.73,对信息化服务的期望总分(总要性)为88.25?12.30。(4)对各信息化服务指标儿科患者及家属的期望值和感知值得分进行配对样本t检验,结果表明C1医生开具电子入院证、C5开具电子检查/检验申请单、C16 IPAD移动查房并开具相应医嘱、C17 PDA床旁生命体征采集、C18微信公众号线上答疑五项信息化服务的感知值与期望值得分差异没有统计学意义(P<0.05);(5)以儿科患者基本调查信息项为因素进行儿科信息化服务质量得分的单因素方差分析,结果表明患儿的年龄和家庭月均收入的P值<0.05,有统计学意义。【结论】(1)儿科患者及其家属对医院信息化服务的总体感知满意度小于感知重要性,医院提供的信息化服务整体上没有达到患者及其家属的期望;患儿的年龄和家庭月均收入是影响儿科信息化服务质量得分的因素。(2)22项信息化服务指标中有18项被纳入KANO调查问卷,结果有4项被归为“魅力需求”,7项被归于“期望需求”,其余7项为“无差异需求”的服务。(3)医院提供C2手机、自助机等方式自助入院和C23线上复查提示(微信、短信)2项服务能最大程度增加儿科患者及家属满意度及降低不满意度。(4)实践证明KANO-IPA综合服务质量优化方法能成功运用于医院信息化服务质量评价,最终可得11项医院信息化服务的优化改进顺序为:C23→C19→C21→C2→C18→C20→C7→C13→C6→C11→C17。更多还原

【Abstract】 [Purpose]Firstly,combating hospital information service indicators,constructing i nformation service evaluation index system of the third-grade class-A hospital;Second ly,designing the Service quality evaluation questionnaire based on the information s ervice indicators to determine the patient’s information services for pediatrics Expect ation-perceived differences,understanding the problems in pediatric informatization se rvices;Thirdly,based on the two-dimensional quality model of KANO to classify the attributes of various informatization services,to identify patient core information se rvices;Finally,combining improved KANO with The IPA comprehensive model deter mines the priority of the information service element,and proposes to improve the pediatric information service proposal according to the results,so as to improve the overall service quality of the hospital,increase patient satisfaction,and improve th e overall competitiveness of the hospital.[Methods] Literature analysis method: extensive access to information services o r hospital information services related literature,combined with the characteristics of information services in the third-grade class-A hospital,integrated and combined ho spital information services projects.In-depth interview method: Randomly selected 4department heads of pediatrics,10 general pediatric medical staff and 10 patients in a third-grade class-A hospital in Wuhan for in-depth interviews,proposing indicators with insufficient representation,poor operability and need to be added.Delphi expert consultation method: a total of 15 experts who served in the health information dep artment of a third-grade class-A hospital in Wuhan,the director of the hospital’s pe diatric department,and professor s of health information management in a “double-class” university in Wuhan,and finally established the hospital information service index evaluation system.Questionnaire method: designing the hospitalized children’s i nformation service perception-expectation difference questionnaire to understand the a ctual situation of pediatric patients’ service expectations and pediatric information ser vices provided by the public third-grade class-A hospitals,and compare the differences;The KANO questionnaire was designed to classify the patient demand attributes of the pediatric information service indicators of the public third-grade class-A hospita ls,and to clarify the patient’s core information service needs.[Results] Firstly,through literature review and related personnel interviews,the i ndex system of information system for the third-grade class-A hospitals with three fi rst-level indicators,seven second-level indicators and 24 third-level indicators was co nstructed.Through two rounds of Delphi expert consultation,two three-level indicato rs of C-14 surgical outdoor electronic screen broadcast progress,C-24 discharge fol low-up(telephone,door-to-door)were deleted,and the third-grade class-A hospital information service evaluation index system was finally built.Secondly,according to t he information service index system,the design of the questionnaire for the service quality satisfaction of hospital pediatric patients was completed.The Cronbach’s Alp ha coefficient of the questionnaire was above 0.7,the KMO value of the questionna ire factor analysis was 0.832,and the Bartlett spherical test had a low probability.At 0.05,the questionnaire has good reliability and validity.Thirdly,The sensation(sati sfaction)scores of pediatric patients and their families for hospital information servi ces were 82.74 ? 15.73,and the total score(total)of information services was 88.25? 12.30.Fourthly,A paired sample t test was conducted on the expected and perceive d scores of pediatric patients and their families.The results showed that C1 doctors issued an electronic admission card,C5 issued an electronic examination/inspection application form,C16 IPAD mobile rounds and issued corresponding medical orders,C17 PDA bedside vital sign collection and the C18 WeChat public online Q & A,the difference between the perceived value and the expected value score of the five information services is not statistically significant(P<0.05).Finally,The one-way an alysis of variance of pediatric informatization service quality scores was based on th e basic survey information items of pediatric patients.The results showed that the a ge of the children and the monthly average income of the family had a P value of<0.05,which was statistically significant.[Conclusions] Firstly,The overall perceived satisfaction of pediatric patients and their families to hospital pediatric informatization services is less than perceived imp ortance.The information services provided by hospitals do not meet the expectations of patients and their families as a whole;the age of children and the monthly ave rage income of families are affecting factors of pediatric information service quality score.Secondly,Of the 22 pediatric information service indicators,18 were included in the KANO questionnaire.Four of the results were classified as “glamour deman d”,7 were attributed to “expected demand”,and the remaining 7 were “no diff erence demand” services.Thirdly,The hospital provides self-service admission for C2 mobile phones,self-service machines,etc.and C23 online review tips(WeChat,SM S).The two services can maximize the satisfaction of pediatric patients and their fa milies and reduce dissatisfaction.Fourthly,Practice has proved that the KANO-IPA co mprehensive service quality optimization method can be successfully applied to hosp ital information service quality evaluation.Finally,the optimization and improveme nt order of 11 hospital information services can be obtained: C23→C19→C21→C2→C18→C20→ C7→C13→C6→C11→C17.更多还原