Zhang Xinli, Wang Tianjin, Yu Yu, Zhao Shuzhen
Business School of Sichuan University, Chengdu, 610065, China.
West China Hospital of Sichuan University, Chengdu, 610041, China.
BMC Health Serv Res. 2018 Nov 7;18(1):840. doi: 10.1186/s12913-018-3460-8.
The referral service is a significant component of healthcare reform in China, and the measurement of patient satisfaction with the referral service process will help to improve the quality of referral medical delivery. Furthermore, the referral service in China includes inter-institutional collaborations between hospitals at different levels and multi-nodes throughout the referral process. It is therefore necessary to identify the key nodes that affect patient satisfaction during the referral service process.
This study conducted a questionnaire survey of 110 patients to collect data regarding patient satisfaction at the following healthcare nodes: primary-level hospital, referral appointment registration, claim of appointment number in the outpatient department, examination service, admission service, and overall satisfaction during the referral service process. Correlation analysis and logistic regression methods were used to establish a mathematical model of patient satisfaction between five nodes and overall satisfaction. Additionally, a peak-end model was formed to identify the peak node impacting overall patient satisfaction during the referral service based on the sample data.
Over 80% of referral patients rated the overall referral service as 'good'. The correlation analysis revealed that there was a significant correlation between the satisfaction of each node and the overall satisfaction (P < 0.05). The results of the regression model showed that the satisfaction of five nodes determined the overall satisfaction and that "admission service at the higher-level hospital" exerted the greatest impact on overall satisfaction (β = 0.312), while "referral appointment registration" had the lowest influence on overall satisfaction (β = 0.177). The peak-end model also revealed that "admission service at the higher-level hospital" had a greater effect on overall satisfaction.
Our study showed that the key nodes affecting patient satisfaction were "transferring service at the primary-level hospital" and "admission service at the higher-level hospital". Furthermore, the efficacy of the referral services is determined by the gatekeepers' management of the referral system at the primary-level hospital and the allocation and management of bed resources at the higher-level hospital. These findings can serve as a science-based guidance for them to improve their performance in inter-regional healthcare collaborations in the referral service process.
转诊服务是中国医疗改革的重要组成部分，衡量患者对转诊服务流程的满意度有助于提高转诊医疗服务质量。此外，中国的转诊服务包括不同级别医院之间的机构间合作以及转诊过程中的多个节点。因此，有必要确定转诊服务过程中影响患者满意度的关键节点。
本研究对110名患者进行了问卷调查，以收集以下医疗节点的患者满意度数据：基层医院、转诊预约挂号、门诊取号、检查服务、入院服务以及转诊服务过程中的总体满意度。采用相关性分析和逻辑回归方法建立五个节点与总体满意度之间的患者满意度数学模型。此外，基于样本数据形成了一个峰终模型，以确定转诊服务期间影响患者总体满意度的峰值节点。
超过80%的转诊患者将总体转诊服务评为“良好”。相关性分析显示，每个节点的满意度与总体满意度之间存在显著相关性（P < 0.05）。回归模型结果表明，五个节点的满意度决定了总体满意度，其中“上级医院入院服务”对总体满意度的影响最大（β = 0.312），而“转诊预约挂号”对总体满意度的影响最小（β = 0.177）。峰终模型还显示，“上级医院入院服务”对总体满意度的影响更大。
我们的研究表明，影响患者满意度的关键节点是“基层医院转诊服务”和“上级医院入院服务”。此外，转诊服务的效果取决于基层医院转诊系统守门人的管理以及上级医院床位资源的分配和管理。这些发现可为他们在转诊服务过程中改善区域间医疗合作绩效提供科学指导。
