published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

Background Patient satisfaction is an important assessment of hospital’s service quality. Patients from emergency department (ED) usually have high expectation on receiving timely and high quality medical service. They generally have low patient satisfaction. Patient satisfaction has been identified to be associated with willingness to return and recommendation of the medical service to others. Therefore, to identify the factors associated with patient satisfaction in ED is important. Factors associated with patient satisfaction could vary by different ED systems. This project aimed at synthesizing factors associated with patient satisfaction in ED in Mainland China, Hong Kong and Taiwan, and comparing the different factors associated with patient satisfaction among the three areas and make recommendations on interventions to improve patient satisfaction in ED. Methods This review retrieved published literatures from PubMed, CNKI, and Taiwan electronic periodical services (TEPS). There is no restriction on study design, study population and measurements of patient satisfaction. Studies reporting factors associated with patient satisfaction in ED, and studies reporting effective interventions of improving patient satisfaction in ED were included. A total of 20 including 12 studies about Mainland China, two studies about Hong Kong and six studies about Taiwan were included. Results Common factors associated with patient satisfaction in emergency services have been identified in Mainland China, Hong Kong and Taiwan as well as other countries. These common factors included patients' characteristics, technical skills of medical staff, service attitudes, communication skills, professional ethics, provision of sufficient information, waiting time, allocation of resources and physical environment of ED. Different health systems can explain some unique factors identified in different areas. Satisfaction with medical expenses has been identified as a factor associated with overall patient satisfaction of ED in Mainland China, which could be due to that patients in Mainland have higher out-of-pocket share. Hong Kong has a gate keeper system which results in a large number of inappropriate ED users and thereby increases the waiting time and causes the ED crowding. Conclusion On the basis of the identified factors, potential interventions such as providing patients with sufficient information and improving medical staff’s technical skills, service attitude and communication skills can be implemented to increase patient satisfaction. Future studies should focus more on the evaluation of specific interventions. / published_or_final_version / Medicine / Master / Master of Public Health

Objectives: This study has been conducted to determine the levels of inappropriate use of the A&E for conditions that could be treated by GPs, the nature of the morbidity pattern of those conditions, the reasons why primary care services were not being utilized, and also examined the validity (i.e. sensitivity and specificity) of patient classifications undertaken by nurses at the time of admission within this local context. Study design and setting: A cross sectional study was conducted over a one year period and subjects were randomly selected from four A&E departments located across the four principle geographic regions of Hong Kong by stratified, two-stage sampling. Main outcome measure: The gold standard in differentiating true emergency cases and GP cases was based on a retrospective record review conducted independently by a panel of emergency physicians. A random sub-sample of those classified as GP cases was interviewed and compared to a matched (via morbidity status) sample of primary care patients who had attended a hospitals' GOPC in order to determine factors distinguishing these two patient groups. Multiple Logistic Regression was used to distinguish the difference between GP cases and matched GOPC primary care patients on significance and odds ratios of the variables. The morbidity pattern according to ICPC was tabulated and analysed for the 'true' A&E cases and non-urgent cases. Sensitivity, specificity and positive predictive values were computed for both non-weighted and weighted conditions. Results: The level of GP cases was found to be 57% with a significant higher proportion of patients in younger age group, and late evening. The morbidity pattern of those top 10 diagnoses of non-urgent cases was very similar to the Hong Kong general practice morbidity pattern for self limiting conditions. Closure of the clinic was the main reason for GP cases attending A&E. Other major reasons were deterioration of symptoms, GPs' inability to diagnose efficiently and patients' wish to continue medical treatment in the same hospital. Affordability was the most pronounced reason for utilising the GOPC, but did not apply to the A&E GP patients. The most accurate weighted nurses' triage classification had the average sensitivity of 75%, specificity of 65.7%, and positive predictive value of 54%. The most accurate weighted patients' self-triage classification yielded a sensitivity of 43.3%, specificity of 49.2%, and a positive predictive value of 38.6%. Conclusion: The reasons for high level of utilisation of A&E services are complex and reflect problems of delivery of GP services. There is an urgent need for the GPs to set up a network system to provide out of hours services, and also for a better interfacing between primary and secondary care, and between public and private sectors, so that patients can be referred back to GPs. The design and measures chosen for this study will help provide A&E policy makers and planners with relevant information for better addressing practical solutions. / Albert Lee. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 137-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Appendix 4 in Chinese.