School of Public Health, Fudan University, Shanghai, China.
Department of Health Policy Research, Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China.
Int J Health Plann Manage. 2019 Jul;34(3):1036-1054. doi: 10.1002/hpm.2873. Epub 2019 Jul 31.
To understand the effect of the health institution combinative contracting mechanism (which make participating residents make a "combinative contracting" involving family doctor of community health center, one secondary hospital, and one tertiary hospital) on community residents' patient experiences in Shanghai, China.
We conducted two questionnaire surveys (2016 and 2018) on the patient experiences of 1200 permanent residents of 12 subdistricts of Shanghai, who were selected via stratified random sampling. Of these, 926 participants were included after propensity score matching. We compared five dimensions of patient experience-accessibility, environment and facilities, service attitude and emotional support, communication and patient engagement, and service integration-before and after implementation of the health institution combinative contracting mechanism in June 2016. Furthermore, logistic regression analysis was used to explore the factors related to residents' overall experience.
The health institution combinative contracting mechanism influenced most dimensions of residents' patient experience, such as accessibility, service attitude and emotional support, communication and patient participation, and service integration. The mechanism in general helped contracted residents obtain a better patient experience than before its implementation. Referral had a significant effect on participants' overall experience.
Contracted family doctors play active roles in improving nearly every dimension of residents' service experience, as well as their overall experience of services. The health institution combinative contracting mechanism not only increases interaction and strengthens trust between doctors and patients but also makes it possible for residents to obtain integrated health services.
了解医疗机构组合签约机制（使参与居民与社区卫生服务中心的家庭医生、一家二级医院和一家三级医院进行“组合签约”）对中国上海社区居民就医体验的影响。
我们对通过分层随机抽样选择的上海 12 个街道的 1200 名常住居民进行了两次问卷调查（2016 年和 2018 年）。经过倾向评分匹配，共纳入 926 名参与者。我们比较了 2016 年 6 月实施医疗机构组合签约机制前后，在可及性、环境和设施、服务态度和情感支持、沟通和患者参与以及服务整合五个方面的患者体验。此外，我们还采用逻辑回归分析探讨了与居民整体体验相关的因素。
医疗机构组合签约机制影响了居民就医体验的大多数方面，如可及性、服务态度和情感支持、沟通和患者参与以及服务整合。该机制总体上帮助签约居民获得了比实施前更好的就医体验。转诊对参与者的整体体验有显著影响。
签约家庭医生在改善居民服务体验的几乎所有方面，以及他们对服务的整体体验方面发挥了积极作用。医疗机构组合签约机制不仅增加了医患之间的互动，增强了信任，还使居民能够获得整合的医疗服务。
