公立医院诊疗行为对患者信任影响:基于PZB模型的实证研究

The project utilizes the patients trust and the physician behavior as a break through point, PZB model as a theoretical foundation, and studies the relationship between clinic diagnosis treatment and perception, satisfaction and trust of the patients, by using combination method of qualitative, quantitative and multi-center empirical research. The detail content includes: 1. Using situational observation method to describe and analyze the physician beha viors. Analyzing the physician behavior based on the contact and treatment process through third party observer. 2. Utilizing PZB gaps model to analyze the perception difference between patients and third party observer. Using the evaluation results of the treatment from pati ents and third party observer, and the difference analysis between them to have th e real patient perception of the treatment behavior. 3. Using the patient trust gauge to measure the level of patient trust. By measuri ng the patient trust during the treatment behavior, analyzing the influence of pa tient trust to treatment behavior. 4. By using system dynamics model and structural formula, analyzing the relations hip between treatment behavior in public hospital, patient trust and compensation mechanism. 5. By utilizing the combination method of qualitative, quantitative and multi-cent er empirical research, demonstrating the relationship between patient perception, patient satisfaction and patient trust, and providing policy suggestions. The project provides theoretical basis and empirical reference to improve the pat ient-physician relationship, enhance the quality of medical service and promote th e reform of public hospitals.

课题以患者信任和医生诊疗行为相互关系为切入点，PZB（服务质量差距模型）为理论支撑，定性、定量和多中心现场实证研究方法相结合，研究诊疗行为与患者感知、患者满意和患者信任之间的关系。具体内容：（1）情景观察法描述并分析诊疗行为。通过第三方观察医生与患者接触诊疗过程,并分析其行为内容。（2）PZB差距理论分析患者与第三方对诊疗相互行为的感知差异。通过诊疗过程中患者和第三方对诊疗行为的评价以及两者间差异分析，获得患者对诊疗行为的真实感知水平。（3）患者信任度量表衡量患者信任水平。通过患者在诊疗行为中信任度测量，分析患者信任对诊疗行为的影响。（4）系统动力学模型和结构方程分析公立医院诊疗行为、患者信任、补偿机制等因素的相互关系。（5）运用定性、定量和多中心现场实证研究方法，论证诊疗行为与患者感知、患者满意和患者信任之间的关系，提出政策建议。为改善医患关系、提高医疗服务质量促进公立医院改革提供参考。

课题以患者信任和医生诊疗行为相互关系为切入点，PZB（服务质量差距模型）为理论支撑，定性、定量和多中心现场实证研究方法相结合，研究诊疗行为与患者感知、患者满意和患者信任之间的关系。具体内容：（1）情景观察法描述并分析诊疗行为。通过第三方观察医生与患者接触诊疗过程,并分析其行为内容。（2）PZB差距理论分析患者与第三方对诊疗相互行为的感知差异。通过诊疗过程中患者和第三方对诊疗行为的评价以及两者间差异分析，获得患者对诊疗行为的真实感知水平。（3）患者信任度量表衡量患者信任水平。通过患者在诊疗行为中信任度测量，分析患者信任对诊疗行为的影响。（4）系统动力学模型和结构方程分析公立医院诊疗行为、患者信任、补偿机制等因素的相互关系。（5）运用定性、定量和多中心现场实证研究方法，论证诊疗行为与患者感知、患者满意和患者信任之间的关系，提出政策建议。为改善医患关系、提高医疗服务质量促进公立医院服务质量. 主要研究结论有：. （1）通过问卷调查和分析表明，调研样本中患者目前的信任度和满意度较低，有很大的提高空间。. （2）中文修订版的医生诊疗行为量表（LCSAS）具有良好信效度，适用于我国医生诊疗行为评估。. （3）医生的诊疗行为能够影响患者对医疗服务质量的认知，进而影响信任程度。诊疗行为和患者. 信任是直接相关关系和间接相关关系（通过患者满意的中介效应）。

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