目的

建立适用于中国患者的医疗服务患者体验评价工具，开展系统性和标准化的医疗服务患者体验评价实践，探索医疗服务舆情评价的前沿方法，通过医疗服务的患者体验和舆情评价定量分析结果，为推进医疗机构以患者为中心的持续性医疗服务改善提供外部评估参考，为政府医疗服务监管部门的政策制定和完善提供循证决策依据。

内容

1、 医疗服务患者体验评价工具研制开发。包括医疗服务患者体验问卷开发和现场调查工具开发。

2、 患者体验的现况水平分布和影响因素。开展全国性患者体验现况调查，了解中国患者体验的现状水平分布。分析全国分区域、分类型的医疗机构患者体验差异，分析不同环节和领域患者体验差异，研究影响患者体验的相关因素，分析患者体验存在的重点问题。

3、 社会公众对于医疗服务的认知和评价。基于信息流行病学视角，建立分析框架，分析互联网舆情对于医疗服务相关话题的关注和评价。

方法

1、 患者体验评价工具开发：研究构念定义、构念评价框架的确定，采用回顾性文献研究；医疗服务关键环节识别、备选条目编制，以现场访谈为主，结合使用归纳法和演绎法；评价工具最终形成，以专家咨询法和预试研究为基础，分别采用信度分析、效度分析、可接受性分析进行效果评价。

2、 现况调查：采用配额抽样选择样本医院，采用方便抽样采集患者样本。患者体验现况水平研究采用描述性分析，结合数据可视化方法展现。logistic回归分析、平滑曲线拟合、阈值效应分析、分段线性回归等方法将被用于定量数据分析。

3、 信息流行病学研究：利用社会化媒体数据抓取、文本内容分析、自然语言处理等技术和方法，探索性分析以社会化媒体用户数据为来源的互联网舆情中有关医疗服务的相关话题内容，提出研究框架，建立研究指标和方法。

结果

1、 开发出了分别包含32个和28个条目的门诊患者体验问卷（CPEQ-A）和住院患者体验问卷（CPEQ-I），作为适用于中国患者的患者体验评价工具。两类问卷总体信度系数分别为0.952和0.950，调查时间分别为10分钟和8分钟左右，同时配套开发了基于移动互联网的现场调查工具。

2、 全国136家样本医院的门诊和住院医疗服务患者体验总体平均分数为4.37±0.67分和4.66±0.51分。诊疗行为和人文关怀是门诊和住院患者体验较好的领域。

3、 环境设施和流程效率的医疗服务患者体验评分水平偏低；候诊时间和膳食服务，分别是门诊和住院医疗服务患者体验评分水平最低的环节。

4、 西部医院医疗服务的患者体验与东、中部医院差距较大；综合、中医、妇幼、专科医院的患者体验薄弱环节各有所异。

5、 人文关怀是影响门诊和住院医疗服务患者体验总体评价最为敏感的作用因素，OR值分别为6.06（96%CI：5.51-6.67）和6.75（96%CI：5.91-7.72）。

6、 挂号等候超过16分钟、候诊时间超过26分钟、检查等候时间超过36分钟、缴费时间超过13分钟后，患者对相应环节的感受体验和评价降幅趋缓；诊疗沟通时间患者接受度的饱和效应出现在8分钟。

7、 本研究提出并使用了话题关注率（TI）和话题声量比（TOR）两个指标，诊疗行为、信息技术应用、医疗服务效率是互联网舆情关注较多的话题，TI强度分别为30.1%、22.2%、17.9%。

8、 社会化媒体用户有关医疗服务话题的舆情中，总体水平上情感倾向为正面的占36.1%，中立的占16.4%，负面的占47.4%。 的占36.1%，中立的占16.4%，负面的占47.4%。

结论

1、 本研究开发的医疗服务患者体验评价工具适用性较好，基于该工具评价的全国136家公立医院医疗服务患者体验处于较好水平。

2、 环境设施和流程效率是医疗服务患者体验有待改善的重点领域，整体水平而言，门诊医疗服务患者体验有待改进的重点环节是候诊时间，住院医疗服务患者体验有待改进的重点环节是膳食服务。

3、 西部地区医院是政府卫生行政部门推进医疗服务改善工作落实需要重点关注的对象。改善医疗服务提供过程中的人文关怀，可有效提升患者体验的总体评价。

4、 医疗服务的互联网舆情关注焦点在于服务提供的技术性要素，对诊疗行为的感受和评价以正面为主，对医疗服务效率的感受和评价偏负面。

5、 研究的创新在于同时开发了门诊和住院医疗服务患者体验评价工具，定量化揭示了医疗服务患者体验改善优先领域和标准，探索出了基于信息流行病学视角的医疗服务评价新方法。

6、 患者体验是医疗服务获得感的直观体现，医疗服务改善应以患者体验评价为参考，应推动患者体验监测评价的制度化常态化。

7、 专项患者体验评价工具的开发、患者体验评价结果的标化与校正、与临床医疗质量安全评价的结合、创新性医疗服务评价方法的探索、患者体验评价在医保支付中的应用是未来研究可考虑的重要方向。

Objective

The study intends to develop the patient experience measure instrument in China and conduct a systematic and standardized survey of Chinese patient experience. Also, the research tries to explore the frontier methods of public opinion analysis of healthcare services and utilize the method to conduct quantitative analysis of patients experience to provide external reference for the promotion of continuous patient-centered care improvement in medical facilities, furthermore, the study intends to provide evidence-based decision-making basis for policy formulation of the national official medical service supervision departments.

Content

1. The development of a set of Chinese patient experience measure instruments. It includes the development of patient experience questionnaires and field survey tools based on the internet.

2. The distribution of the current status of patient experience in China and its influencing factors. Conduct a nationwide survey of patient experience to understand the current status of patient experience in China. Analyze patient experience distribution differences among medical institutions in different regions and types across the country, analyze patient experience differences in different aspect of healthcare services, study relevant factors affecting patient experience, and explore the key issues from the patient experience survey results.

3. The public opinion on healthcare services. From the perspective of infodemiology, an analytical framework will be established to analyze the public's concerns about healthcare services related topics.

Methods

1. Development of patient experience measure instruments: definition of research construct and the design of its evaluation framework are based on the retrospective literature study. Identification of critical process in healthcare services and preparation of a survey items pool are based on field study from the medical facilities combined with inductive approach and deductive approach. The final formation of the questionnaires is determined though expert consultation and pilot study. The effectiveness of the questionnaires was evaluated using reliability analysis, validity analysis, and acceptability analysis.

2. Cross-sectional study: Select sample hospitals with quota sampling and use convenience sampling to recruit patient survey samples. A descriptive analysis combined with the data visualization method was used in the study of the current status of patient experience. Logistic regression was used to analyze the influence factors. Smooth curve fitting, threshold effect analysis, piecewise linear regression and other methods will also be used for quantitative data analysis.

3. Infodemiology research: Using social media data fetching, text content analysis, natural language processing and related technologies to explore the public opinion on healthcare services from social media user data. New research framework and analysis indicators also will be proposed for the exploratory study.

Results

1. The Chinese Patient Experience Questionnaire for Ambulatory care（CPEQ-A）and Chinese Patient Experience Questionnaire for Inpatient care（CPEQ-I）,which included 32 and 28 survey items, were developed as Chinese patient experience evaluation tools. The reliability coefficients of the questionnaires have a general Cronbach’s α of 0.952 and 0.950 respectively. Survey length was about 10 minutes and 8 minutes respectively. The field study electronic survey application based on the mobile Internet also developed.

2. On the overall level, average scores of patient experience for outpatient and inpatient services in 136 sample hospitals were 4.37±0.67 points and 4.66±0.51 points. The diagnosis and treatment behavior and humanistic care have a positive and favorite survey results for both outpatient and inpatient experience.

3. The patient experience score for environmental facilities and service efficiency of the hospital is relative lower than the other aspects. Waiting time and hospital food have the lowest score of patient experience for outpatient and inpatient respectively.

4. The patient experience in western hospitals is far from the gap between eastern and central hospitals. Different types of hospitals have different priority areas for improving patient experience.

5. Humanistic care for patient is the most sensitive factor influencing the overall level of patient experience with the odds ratio of 6.06（96%CI：5.51-6.67）for outpatient and 6.75（96%CI：5.91-7.72）for inpatient respectively.

6. If the patient registered waits for more than 16 minutes, the waiting time to see a doctor exceeds 26 minutes, waits for inspection and examination time exceeds 36 minutes, and the payment time exceeds 13 minutes, the decrease for the patient experience score of the corresponding stages will slow down. And it’s also observed that, there is a saturation effect of the patient experience if consultation length is more than 8 minutes.

7. Two indicators of Topic Incidence（TI）and Topic Occurrence Ratio（TOR）were proposed and used in this study. The TI intensity of diagnosis and treatment behavior, information technology application, and medical service efficiency were 30.1%, 22.2%, and 17.9%, respectively from the social media contents.

8. On the overall level, among the public opinion on healthcare services from the social media users’ related topics, 36.1% of the content had a positive emotion, 16.4% of neutral, and 47.4% of negative.

Conclusions

1. The CPEQ-A and CPEQ-I developed by this research have an acceptable practicability in Chinese patient survey. As the survey results of the tools, healthcare services for 136 sample hospitals have favorable patient experience.

2. Environmental facilities and service efficiency of the hospital are key healthcare domains for improving patient experience. Patient experience of waiting time and hospital food are key issues to be improved for outpatient and inpatient respectively.

3. The hospital in western region of China should be paid more attention by the government healthcare regulation sectors to promote the improvement of healthcare service. To enhance the patient experience of humanistic care could be effectively improving the overall level of patient experience.

4. The public opinion’s focus on healthcare services related topics are technique issues during the service delivery process. The public’s perception of the behavior of medical treatment are positive, while the perception and evaluation of hospital service efficiency are negative.

5. The innovation of the research was developed both ambulatory service and inpatient service measure instruments in this research, thus enable the research quantitatively revealed the priority aspects and standards of patient experience improvement in hospital. A new approach to healthcare services evaluation based on the perspective of infodemiology has been proposed and used.

6. The patient experience is an intuitive representation of the feeling of healthcare services. The improvement of healthcare services should be based on the regular evaluation of patient experience. Institutionalization and normalization of patient experience monitoring and evaluation scheme should be considered by the government.

7. Development of special patient experience of care measure, Standardization of patient experience evaluation results, integration with clinical quality and safety assessment, exploration of innovative evaluation methods, and design of medical insurance payment plans included the patient experience would be of benefit in future research.