A Comparative Study Of Service Quality, Patient Satisfaction And Experience Under Two Modes Of Medical Consortium General Practice Alliance And Community Family Physician

BackgroundChina's medical service level has improved significantly after the adoption of open up policy,However,the allocation of health resources is still unreasonable,and the ability of primary health care services needs to be strengthened."Healthy China 2030"pointed out that it is necessary to adhere to the grassroots level and promote the equalization of basic public health services,establish an integrated medical and health service system with complete system,clear division of labor,complementary functions and efficient operation.The foundation of building an integrated medical and health service system is to consolidate the ability of primary health care services,and promoting family physicians'contract services is a feasible path to improve primary health care capacity.However,there is a contradiction between the rapid growth of the contracting rate and the insufficient provision of contracted services.exploring how to improve the ability of family physicians to sign services under the integrated health service system,guide residents to seek medical care rationally,and optimize the utilization of medical resources is the key work at this stage.The main path for China to implement an integrated health service system is to establish a medical and health service consortium.Relevant research shows that family physicians'signing services with the participation of the medical consortium general practice alliance can improve residents'recognition of primary health care capabilities.And whether this model can improve the services'quality,enhance patient satisfaction and patient experience,further research and analysis are needed.ObjectivesBy comparing the impact of two types of family physician contracting service on the utilization,service quality,patient satisfaction and patient experience of family physician contracting service between the medical consortium general practice alliance and the community family physician team,this paper explores the advantages and disadvantages of the medical consortium general practice allianceto community family physician contracting service,in order to provide theoretical references and suggestions for improving grass-roots health service capacity and enhancing patients'satisfaction and experience of contracted residents.MethodsThe Beixia Street Community Health Service Center in Guancheng District of Zhengzhou City and the Linke Community Health Service Center in Jinshui District were selected as the investigative institutions.Beixia Street Community Health Service Center,as a grass-roots unit supported by the medical consortium,received strong support and assistance from tertiary hospitals.The contracted residents who belongs to the Beixia Street Community Health Service Center as the medical consortium general practice alliance,and the contracted residents who belongs to the Linke Community Health Service Center as the community family physician group.Strictly selected according to the inclusion exclusion criteria from September 1,2018 to October 31,2018 were selected as the respondents,each group of surveyed family physicians and services signed 500 residents,a total of 1,000 people.The survey tool consists of five parts:the basic situation questionnaire of contracted residents,the questionnaire of the utilization of contracted services of family physicians,the questionnaire of the quality of contracted services of family physicians(SERVQUAL),the questionnaire of patients satisfaction of contracted residents(extended EUROPEP),and the questionnaire of patients'experience of contracted residents(Picker Patient Experience Scale-PPE15).Epidata 3.1 software was used for data double-entered and SPSS22.0 software was used for data processing and analysis.Comparison of two different modes,t-test and variance analysis were used for data normal distribution.Wilcoxon rank sum test was used when the data did not conform to normal distribution.?~2 test was used for comparison of count data.Fisher exact probability method was used when the minimum theoretical frequency was less than 5.The correlation analysis of indicators was evaluated by Gamma rank coefficient.Factor analysis was used to analyze the difference.The difference was statistically significant with P<0.05.Results1.Utilization of contracted services for family physiciansThe community family physicians group paid attention to the implementation of basic medical services.The top three in the ten basic services were"basic medical services","public health services"and"health education and consulting services".The lowest utilization rate was"Priority referral service".The top three services in satisfaction were"health management services","health education and counseling services"and"diagnosis services".The utilization rates of"basic medical services"and"public health services"were high but satisfaction is very low,and"priority referral services"were less satisfied.The utilization rate of the ten basic contracting services in the medical consortium general practice alliance had been much higher than that of the community family physicians in the past year.The three services with higher utilization rate were consistent with the community family physicians group.The lowest utilization rate was"long-term prescription service".The top three services in satisfaction were"basic medical services","public health services"and"health management".Satisfaction with"pharmaceutical distribution and guidance services"and"long-term prescription services"was low.Although there were significant differences in the changes in medical expenses between the two groups after signing the contract(P<0.001),most residents thought that the medical expenses after signing the contract did not change.The community family physicians accounted for 52.4%,and the medical consortium general practice alliance accounted for 63.4%.Although the changes in health care awareness were significantly different(P<0.001),most residents thought that the awareness of health protection after signing was improved.The community family physicians accounted for 82.6%,and the medical consortium general practice alliance accounted for 60.8%.The community family physician group accounted for 82.6%,and the medical consortium general practice alliance accounted for 60.8%.There was a significant difference in the number of visits to community health service centers(P<0.001).Most residents in the community family physicians group believed that the number of times after signing increased,accounting for 70.2%,while most residents of the medical consortium general practice alliance thought that they would remain unchanged,accounting for 51.0%.2.Family physicians contract service qualityAmong the 26 service quality indicators in the community family physician group,there was no significant difference between the 7 indicators'perception and expectation(P>0.05),7 indicators perceived greater than expected(P<0.05),and 12 indicators perceived less than Expectation(P<0.05).The 24indicators of the medical consortium general practice alliance were more than expected(P<0.001),and only 2 indicators were less than expected(P<0.001).In the quadrant analysis,26 indicators of each group fell in the first quadrant(holding area),and the actual perceived value of the contracted residents of the medical consortium general practice alliance was relatively higher.The total score of service quality and the scores of each dimension of the medical consortium general practice alliance were higher than those of the community family physicians(P<0.001).Different genders(P<0.01),health self-assessment(P<0.001)and the presence or absence of chronic disease(P<0.01)had significant differences in the quality of family physicians'contracted services.3.Patient satisfaction of the family physician contract serviceAmong the 30 indicators of family physicians'contract satisfaction,the community family physicians group"provides you with daily health care services"was very satisfied with the highest response rate(38.4%),However,"the best way to get you from a higher level hospital"was the lowest response rate(0.6%).The medical consortium general practice alliance"prepare for your referral to the superior hospital"was very satisfied with the highest response rate(63.2%),but"the waiting time in the waiting room"was the lowest response rate(2.4%).The scores of satisfaction scores and dimensions of the medical consortium general practice alliance were higher than those of the community family physicians(P<0.01).Different health self-assessment(P<0.05)and the presence or absence of chronic disease(P<0.01)had significant differences in the impact of patient satisfaction on family physician contracting services.4.Patient experience of the family physician contract serviceThe total score of patients in the medical consortium general practice alliance was higher than that of the community family physicians(P<0.001),and there was no significant difference between the two dimensions of"emotional support","respect for patient preference"and"physiological comfort"(P>0.05),the medical consortium general practice alliance scored higher in the two dimensions of"family or friend participation"and"continuity of medical services"than the community family physician group(P<0.001),but in the dimension of"information transmission and patient education"the score was lower than the community family physician group(P<0.01).Different ages(P<0.01),type of insured(P<0.05),and presence or absence of chronic disease(P<0.001)had significant differences in the impact of family doctor contracting services.8 of the 15 patient experience indicators were strongly correlated with the overall evaluation of patient experience(Gamma coefficient?0.5),which belong to the four dimensions of information transmission and patient education,emotional support,family or friend participation,and continuity of medical services;The difference of 15 patient experience indicators could be classified into five factors:communication,emotional support,service continuity,information transmission,and respect for patient rights.The cumulative variance contribution rate was 67.669%.Conclusions(1)The medical consortium general practice alliance service model could improve the quality of family physicians'contracting services,improve the satisfaction of contracted residents and patient experience.(2)The medical consortium general practice alliance service model focused on the implementation of basic medical services,enhanced the continuity and cooperation of medical services,and promoted a new pattern of orderly medical treatment at the grassroots level.(3)Although the medical consortium general practice alliance service model had achieved certain results,it need to be improved in improving service processes,cultivating service attitudes,and improving communication skills between doctors and patients.Policy Implications(1)Focus on experience and optimize medical service evaluation tools;(2)Resource integration and improve regional collaborative service mechanism;(3)Increase investment and improve grassroots health service capacity;(4)Information sharing to promote the interconnection of medical institutions;(5)Innovative ideas,summarizing and promoting experience in pilot areas;(6)People-oriented,respecting the rights of patients.