| Purpose:From the perspective of patients,this study analyzes the impact of Shanxi Province ’s integration reform on the service quality of township hospitals,summarizes the key links and elements of the reform that affect the service quality of township hospitals,analyzes its mechanism of action,and finds the existing problems.Deepen and continue to promote integrated reform policy recommendations,with a view to providing experience and reference for similar reforms in other regions.Method:In this study,a combination of typical sampling and multi-stage random sampling was used.Three counties with different degrees of progress in the integration reform of Yuncheng City were selected as sampling units.A total of 1050 patients over 18 years of age were selected as survey objects.Adopted the Primary Care Assessment Tools-Adult Edition(PCAT-AE)as an evaluation tool,and conducted a questionnaire survey on the research subjects through a one-to-one interview.A total of 971 valid questionnaires were recovered,and the effective recovery rate was It was 92.5%.The descriptive analysis was used for the basic characteristics of the three counties.The differences in the items,dimensions and total scores of the PCAT-AE scale were analyzed by a multiple linear regression analysis model to compare and analyze the differences in the items,dimensions and total scores of the three counties.Results:A total of 971 people were surveyed in this study,including 328 from County A,317 from County B,and 326 from County C.In terms of demographic characteristics,men in County A accounted for 45.43%,County B accounted for 44.16%,and County C accounted for 43.56%;County A patients aged 60 years and over accounted for 53.96%,County B accounted for 60.57%,and County C accounted for 50.31%.Mainly junior high school and below;the type of insurance is mainly medical insurance for urban and ruralresidents.In terms of health status,there are more patients with chronic diseases in the three counties,60.67% in county A,73.5% in county B,and 56.75% in county C.The majority of those who feel good about their health are the majority.In terms of service utilization,there were more patients in the three counties who had seen 5 or less in the past year,accounting for more than 75%;at the same time,only a small number of patients had received the services of county doctors when they visited the township health centers.County A It is 22.26%,County B is 20.5%,and County C is 23.01%.The results show that the scores of the three counties are different in many dimensions.The county A,which has made the most progress in the integration reform and has the highest degree of implementation,has the first diagnosis(utilization),continuity,coordination(referral),and extension of the medical culture in the core dimension.These dimensions of communication and communication have the highest scores,and the integration of reforms has the highest score in the first dimension(utilization)of the core dimension and the extended dimension of medical culture and communication.The scores are higher than that of county C.After multiple linear regression analysis,the scores are different.All of them were statistically significant(P <0.05).The three counties were in the first consultation(accessible),coordination(information system),comprehensive(available services),comprehensive(actually provided),patient-and family-centered and The scores for these dimensions for the community are not significantly different and have no statistical significance(P> 0.05).Among all the dimensions of the three counties,the score for the comprehensive(actually provided)dimension is the highest,and the score for the community-oriented dimension is the lowest.The three counties also showed differences in PCAT-AE total scores,with County A being the highest(21.65),County B being the second(20.74),and County C being the lowest(20.01).The difference in scores was statistically significant(P <0.05).In terms of the first consultation(utilization)dimension,County A and County B have higher scores in the three items of “Conventional Physical Examination”,“Preferred for Medical Treatment” and “Referral Approval”,and County A has “Preferred Medical Treatment”,The referral approval scores were higher than those of county B.In terms of continuity,county A was ranked in terms of “seeing the same doctor”,“understanding health problems”,“can consult smoothly”,and “understand health status comprehensively”.The scores are higher than those of counties B and C.In terms of coordination(referral),County A has “recommended hospitals or doctors”,“contact hospitals”,“fill in the reasonfor referrals”,and “understand the situation after referral” The scores of these items are higher than those of counties B and C.County B has higher scores on the two items of“contact hospital” and “understand situation after referral”.After multiple linear regression analysis,the score differences are both Statistical significance(P <0.05).Conclusion:County A,which has the longest progress and the highest degree of implementation of the integration reform,is better than the counties B and C in the core dimensions of the first consultation(utilization),continuity,and coordination(referral).The quality is also higher than that of the other two counties;the county B,which has the second most advanced integration reform,is the first to diagnose(use)the core patient’s perceived service quality better than that of county C,and the overall perceived service quality is also higher than that of county C.County A,based on the integration reform,promoted the first consultation at the grassroots level by improving the grass-roots software and hardware facilities,implementing the "five-unification" policy for medicines,and implementing informatization construction with the grass-roots level;through the formation of “1 + 1 +X” families Doctors sign a team and rely on the information platform to improve work efficiency,effectively improve the experience of patients and improve the continuity of patient visits;through the establishment of a barrier-free two-way referral green channel,and the use of information to support the referral,strengthen The coordination between primary medical institutions and county-level hospitals.The long-term and in-depth promotion of integrated reforms and the implementation of various reform measures can achieve significant results in improving the quality of medical services.Therefore,we should continue to push forward the integration reform and strive to form a demonstration effect to provide a reference for reform in other regions. |
