Rhodes L E, Gawkrodger D J
Dermatology Department, Royal Liverpool University Hospital Trust, UK.
Clin Exp Dermatol. 1995 Mar;20(2):132-5. doi: 10.1111/j.1365-2230.1995.tb02670.x.
Most hospitals now have acquired trust status and managers have started the process of setting contracts with purchasers. In order to assess quality content of contracts for dermatology services, a survey was performed on behalf of the British Association of Dermatologists' (BAD) Audit Subcommittee. A letter was sent to 278 consultant members of the BAD, requesting a copy of their contract: 171 (62%) replies were received. Seventy-four consultants had formal contracts with purchasers, but only 25 (34%) of these had been involved in contract preparation. Several consultants were unsure whether formal contracts existed and many had difficulty in obtaining the documents. The 20 contracts received were highly variable, with a median of 13 (range 0-89) quality clauses per contract. These mostly related to the process of care, particularly waiting times and communication with general practitioners (GPs). Sometimes the structure for delivering care was specified, but only occasionally were outcome measures mentioned. The specified maximum waiting time for a new patient appointment ranged between 4 and 30 weeks (median 13). GPs were to be sent out-patient letters within 3-10 days (median 10) of patient attendance. Following in-patient care a notification was to be sent within 1-3 days (median 2) of discharge and a full summary within 7-21 days (median 12). A requirement for patient satisfaction surveys was included in only six contracts. Greater involvement of consultant dermatologists in setting contracts with purchasers should lead to the inclusion of more consistent and appropriate quality clauses.(ABSTRACT TRUNCATED AT 250 WORDS)
现在大多数医院已获得信托地位，管理人员也已开始与采购方签订合同。为评估皮肤科服务合同的质量内容，代表英国皮肤科医师协会（BAD）审计小组委员会开展了一项调查。向BAD的278名顾问成员发送了一封信，索要他们的合同副本：共收到171份（62%）回复。74名顾问与采购方签订了正式合同，但其中只有25名（34%）参与了合同起草。有几位顾问不确定是否存在正式合同，许多人在获取文件时遇到困难。收到的20份合同差异很大，每份合同的质量条款中位数为13条（范围为0 - 89条）。这些条款大多与护理流程相关，尤其是等待时间以及与全科医生（GP）的沟通。有时会明确护理提供的结构，但提及结果指标的情况很少。新患者预约的规定最长等待时间在4至30周之间（中位数为13周）。患者就诊后，应在3至10天内（中位数为10天）向全科医生发送门诊信件。住院护理后，应在出院后1至3天内（中位数为2天）发送通知，并在7至21天内（中位数为12天）发送完整总结。只有六份合同包含患者满意度调查的要求。皮肤科顾问医生更多地参与与采购方签订合同，应能促使纳入更一致、恰当的质量条款。（摘要截取自250字）
