基于现实主义评估方法的改善医疗服务政策执行机制构建研究  

Research on The Construction of a Policy Implementation Mechanism of Healthcare Improvement Based on Realism Evaluation

作　　者：朱拓东 吴昊 Zhu Tuodong;Wu Hao(Southwest Hospital,Army Medical University,Chongqing,400038,China;不详)

机构地区：[1]陆军军医大学西南医院,重庆400038 [2]重庆医科大学第一附属医院,重庆400016

出　　处：《中国医院管理》2025年第3期36-39,共4页Chinese Hospital Management

基　　金：重庆市技术创新与应用发展专项重点项目(cstc2020jscx-dxwtBX0055)。

摘　　要：目的探索患者体验在改善医疗服务政策执行中发挥作用的情况,构建患者体验视角下改善医疗服务政策执行机制。方法采用现实主义评估方法,首先以史密斯政策执行模型和政策反馈理论为指导,提出改善医疗服务政策执行的初始项目理论。其次收集访谈与文献数据,反复测试和修订初始理论,深度分析改善医疗服务政策可持续执行的背景、机制和结果,形成完善的改善医疗服务政策执行机制项目理论,构建改善医疗服务政策执行机制。结果完善的改善医疗服务政策执行机制包含了7个现实主义项目理论要素,涉及患者体验评估设计、患者体验反馈收集、患者体验反馈处理和患者体验改善行动4个主要阶段的背景、机制和结果元素。结论患者体验在改善医疗服务政策执行中尚存在一定挑战,政策执行与政策反馈理论能够提供理论保障,未来需要进一步利用政策引领、患者参与、改良导向评估、组织协同、问责与激励、人才发展、健康素养提升等机制保障改善医疗服务政策执行路径的畅通。Objective By exploring the role of patient experience in policy implementation of healthcare improvement,this paper aimed to construct a policy implementation mechanism of healthcare improvement from the perspective of patient experience.Methods To adopt a realist evaluation method,we first proposed an initial program theory(PT)for policy implementation of healthcare improvement,guided by the Smith policy-implementationprocess framework and policy feedback theory.Secondly,it collected interview and literature data,iteratively tested and refined the initial PT,profoundly analyzing the context-mechanism-outcome of the sustainable implementation of healthcare improvement policies.Finally,it arrived at a refined PT and constructed the policy implementation mechanism.Results The refined policy implementation mechanism included seven realist theoretical elements involving the context-mechanism-outcome elements of four main stages:evaluation and design,feedback collection,feedback processing,and improvement action.Conclusion In the future,it is necessary to further use mechanisms such as policy guidance,patient participation,improvement-oriented evaluation,organizational coordination,accountability and incentives,talent development,and health literacy improvement to ensure the smooth implementation path of improving medical service policies.

关 键 词：改善医疗服务政策 患者体验 政策执行 现实主义评估 

分 类 号：R197.1[医药卫生—卫生事业管理]