| BackgroundControl costs,improve the efficiency of the domestic medical industry has been the theme of reform,day surgery as a new operation mode,fit the development direction of domestic medical industry,in recent years is also reflected in the domestic health policy,its development and promotion has become an inevitable trend.The studies of day surgery in China stress on the macroscopic analysis,like policy,institution,quality,acceptance level,degree of recognition and so on.Nowadays,the difficulties of popularizing day surgery are the limited acceptance of patients,health insurance,standardization construction of day surgery center and cognition of its conception.The implementation of day surgery is taken as a result of the joint decisions between doctors and patients when digging into the process.There are kinds of factors that can influence the result interacting with each other in this period.However,there is a lack of specific analysis of the factors influencing the selection tendency of day surgery in the process of visiting doctors.The specific problems of doctors and patients have not been analyzed in detail,which will have certain influence on the further development of day surgery.ObjectivesTo understand day surgery status quo,analyze the influencing factors on day surgery's implementation of patients and doctors based on the case of tertiary hospital in Shandong Province,then explore the causes of issues and put forward the policy suggestions.(1)Describe and analyze the current status and development trend of ophthalmologic day surgery in hospitals,and understand the stakeholders who affect ophthalmic day surgery.(2)Understand the stakeholders' ability to gain benefits and resources,and analyze their tendency for day surgery.(3)Analyze the influencing factors affecting the patient's selection outcome and choice intention,analyze the causes of differences in patient's choice of day surgery outcomes,and the causes of medical personnel's day surgery choice tendency,and determine their influence on day surgery choices of patients..(4)Make suggestions for improvement and provide basis for the development of day surgery.MethodsThis study adopts quantitative analysis method and qualitative analysis method.Qualitative method analysis is mainly based on literature review and interview.Understanding the challenges and solutions in the process of day surgery in the world through literature reading.In addition,choosing 8 medical staffs and 1 manager in charge of day surgery management from the director to the department nurse using stratified sampling method,to know their cognition level and the influencing factors in the process of day surgery selection.And 10 in the ophthalmology patients were randomly selected to understand their views on day surgery and the reasons for their willingness of acceptance.Quantitative analysis was applied to select the patients'insurance information and medical records of 1 years of Ophthalmology day surgery to understand the diseases which are involved and to carry out the day surgery patient demographic information,health care and other related information.Then using the result of day surgery taking as the dependent variable,chi square analysis and logistic regression analysis to explore the influence of patient demography,medical insurance and other related information on day surgery through SPSS 20.0 software.Additionally,we used random sampling to understand the basic situation of patients,the cognition of day surgery and willingness to accept.By using SPSS 20.0 software and taking the degree of acceptability of patients as dependent variable,using chi square analysis and logistic regression analysis to explore the influence of basic factors and cognition level on their willingness to accept.Main results(1)both doctors and patients pay attention to the safety of medical quality.Medical staffs take the inclusion criteria as the premise of day operation.Among the patients,331 patients(98.22%),333(99.10%)and 328(98.20%)were selected for the importance of safety.(2)Day surgery is affected by many factors.First,the factors that affect the doctor's choice tendency of day surgery include the operation hardware,the related resources,the degree of cognition and the assessment system.Lack of construction in independent day surgery room,lack of various kinds of equipment needed for day surgery,and distribution of human resources of ophthalmologists generally appear in the form of inverted triangle,which has a negative impact on doctors deciding to use day surgery.There is still a lack of cognition in daytime surgery among doctors and also a contradiction between bed occupancy rate and turnover rate in the assessment system,which results in lack of motivation for doctors to promote daytime surgery.Secondly,the factors that affect the patient's choice of day surgery are mainly medical insurance,education level and occupation,and the degree of trust to the hospital.The importance of operating costs and reimbursement is one of the key factors for patients.Of the 334 and 336 patients who participated in the survey,257 in both group attached importance to it,accounting for 76.95%and 76.49%.In terms of education and occupation,patients with higher education and higher levels of work are more receptivity to daytime surgery.Finally,ophthalmology patients participated in a questionnaire survey,a total of 337 people,of which 97.92%were not very aware of and had not heard of day surgery,but 74.70%of them accept day surgery.According to the interview,the reason is patients have a high degree of tertiary public hospitals.The results showed that doctors played a decisive role in the decision process of day surgery,and the results were mostly related to the address of the patients and the number of operations.Medical insurance was not considered by doctors in the choice of operative mode.(3)According to the results,the improvement of medical quality is a continuing theme,and the process,the guarantee mechanism and the clinical path need to be deepened.Secondly,the medical insurance reimbursement system,the performance appraisal system and the allocation of human resources need to be further improved.The definition of medical insurance reimbursement coverage and the payment mode of medical insurance should be changed to meet the requirements of day surgery.The assessment system should take into account the performance of nursing staff,and the allocation of human resources should meet the needs of day surgery.In addition,the cognition degree of both doctors and patients and the propaganda work of the hospital need to be promoted.Finally,the patient's other related factors need to be paid attention to,taking into account the impact of individual patients' factors in the process of medical treatment.Policy suggestions(1)We should strengthen the government's investment in medical and health resources and strengthen the quality of day surgery.The allocation of resources in the health policy of government health departments should be offset to the construction of daytime surgery.Meanwhile,some supervision measures should be taken for medical institutions carrying out daytime operation.(2)Improve the medical insurance system.The medical insurance department should reasonably define the day surgery diseases according to the daily operation volume,day surgery and reimbursement problems,combined with the definition of international day surgery and the control of medical expenses,then establish the scope of the day surgery insurance.(3)Improve the human resources in the hospital.The government health related department should provide policy support to the staffing of the hospital with the progress of the day operation.In the hospital,the human resource allocation standards suitable for the development of day surgery should be formulated in combination with the feedback of the physician team.(4)Improve the distribution system of performance assessment.The government's health administration should increase its investment in day surgery in medical institutions.In the hospital,a good distribution mechanism of interest should be set up,and the performance of nursing staff should be taken into account.In addition,a new type of performance distribution model should also be adopted to promote the relatively complex operation under the day surgery mode.(5)Strengthen the propaganda work of the hospital.The hospital itself should start from the internal,according to the day surgery situation and the future development trend,take the Department as the unit to strengthen the daytime operation training.The hospital reservation platform,the official website and other new channels can be used to increase the publicity of the day surgery related information,in order to enhance the patient's understanding of the day operation. |
PDF Full Text Request