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Article(id=1241522848108434080, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202306396, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1687104000000, receivedDateStr=2023-06-19, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931713367, onlineDateStr=2026-03-19, pubDate=1707494400000, pubDateStr=2024-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931713367, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931713367, creator=13701087609, updateTime=1773931713367, updator=13701087609, issue=Issue{id=1241522846384583426, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931712956, creator=13701087609, updateTime=1773931842201, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523388544504301, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523388544504302, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=552, endPage=556, ext={EN=ArticleExt(id=1241522848456561319, articleId=1241522848108434080, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Evaluation survey and influencing factors of integrated care management services in patients with pulmonary nodules and lung cancer in a tertiary hospital in Sichuan Province, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the evaluation of integrated care management in patients with pulmonary nodule lung cancer and to provide basis for improving the service quality of integrated care management of chronic disease.

Methods

From January 2021 to December 2022, electronic questionnaires were distributed to patients with lung nodule lung cancer who met the inclusion criteria, and an anonymous survey was conducted. The chi-square test was used to compare the evaluation differences among different groups.

Results

A total of 130 valid questionnaires were collected. The overall satisfaction evaluation, recommendation intention, and improvement evaluation of the integrated care management were 95.72, 94.66, and 79.89, respectively. There were significant differences (P<0.05) in satisfaction evaluation among different ethnic groups (χ2=16.788, P=0.010), education level (χ2=24.339, P=0.042), and management time (χ2=19.277, P=0.013). There were significant differences (P<0.05) in recommendation intention among patients of different ethnic groups (χ2=15.943, P=0.0144), occupation (χ2=37.265, P=0.011), and management time (χ2=9.536, P=0.049). There was a significant positive correlation among patient satisfaction evaluation, recommendation intention, and improvement evaluation, and the correlation coefficients were 0.581, 0.723, and 0.538,respectively.

Conclusion

The integrated care management model of pulmonary nodule lung cancer is widely recognized by patients, with high level of satisfactory evaluation, and patients have strong willingness to recommend. This model can significantly improve the medical service experience and treatment effect.

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目的

调查肺结节肺癌患者对全程管理评价情况，为提升慢病全程管理服务质量提供依据。

方法

于2021年1月—2022年12月通过对符合纳入标准的肺结节肺癌全程管理患者发放电子问卷，开展匿名调查，并采用χ2检验比较不同组别的评价差异。

结果

共回收有效问卷130份，130名调查对象对全程管理的整体满意评价95.72分，推荐意愿94.66分，改善评价79.89分。不同民族（χ2=16.788，P=0.010）、文化程度（χ2=24.339，P=0.042）、纳入管理时间（χ2=19.277，P=0.013）间满意评价的差异有统计学意义（P<0.05)。推荐意愿在不同民族（χ2=15.943，P=0.014）、职业（χ2=37.265，P=0.011）、纳入管理时间（χ2=9.536，P=0.049）的患者间存在统计学差异（P<0.05)。患者满意评价、推荐意愿、改善评价三者之间存在显著正相关（P<0.05)，三者间的相关系数分别为0.581、0.723、0.538。

结论

肺结节肺癌全程管理模式获得患者的广泛认可，满意评价水平高，推荐意愿强，该模式可以显著提高患者的就医体验和诊疗效果。

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朱梦蓉，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=P5vcQmef0GJsccJRRUeDjw==, magXml=M8+LpsGF8nYNK9hNqecqSg==, pdfUrl=null, pdf=cTb3J0wTdI7xdJMR2B9UqA==, pdfFileSize=741484, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=ctcd2CSEhVg5oJZBilXYxg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=3hvt1a5B8c6x1oMFMTiqhA==, mapNumber=null, authorCompany=null, fund=null, authors=

杨先碧（1994—），女，硕士，研究实习员，研究方向：卫生政策及全程管理的研究

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杨先碧（1994—），女，硕士，研究实习员，研究方向：卫生政策及全程管理的研究

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Chin J Lung Dis, 2021, 14(6): 729-733., articleTitle=Investigation on psychological and health status and influencing factors of patients with pulmonary nodules, refAbstract=null), Reference(id=1241680466948976649, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, doi=null, pmid=null, pmcid=null, year=2021, volume=20, issue=6, pageStart=17, pageEnd=19, url=null, language=null, rfNumber=[22], rfOrder=36, authorNames=邬玉琳, journalName=安徽医专学报, refType=null, unstructuredReference=邬玉琳.400例肺结节体检检出者近5年内随访复查依从性分析[J].安徽医专学报，2021，20（6）：17-19., articleTitle=400例肺结节体检检出者近5年内随访复查依从性分析, refAbstract=null), Reference(id=1241680467058028556, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, doi=null, pmid=null, pmcid=null, year=2021, volume=20, issue=6, pageStart=17, pageEnd=19, url=null, language=null, rfNumber=[22], rfOrder=37, authorNames=Wu YL, journalName=Journal of Anhui Medical College, refType=null, unstructuredReference=Wu YL. 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Journal of Anhui Medical College, 2021, 20(6): 17-19., articleTitle=Compliance analysis of 400 patients with pulmonary nodules in recent 5 years, refAbstract=null), Reference(id=1241680467167080461, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, doi=null, pmid=null, pmcid=null, year=2023, volume=58, issue=6, pageStart=682, pageEnd=688, url=null, language=null, rfNumber=[23], rfOrder=38, authorNames=江淀淀, 崔妙玲, 黄维, journalName=中华护理杂志, refType=null, unstructuredReference=江淀淀，崔妙玲，黄维，等.肺癌患者就医延迟风险预测模型的构建及验证[J].中华护理杂志，2023，58（6）：682-688., articleTitle=肺癌患者就医延迟风险预测模型的构建及验证, refAbstract=null), Reference(id=1241680467263549455, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, doi=null, pmid=null, pmcid=null, year=2023, volume=58, issue=6, pageStart=682, pageEnd=688, url=null, language=null, rfNumber=[23], rfOrder=39, authorNames=Jiang DD, Cui ML, Huang W, journalName=Chinese Journal of Nursing, refType=null, unstructuredReference=Jiang DD, Cui ML, Huang W, et al. Construction and validation of a risk predictive model for treatment delay of patients with lung cancer[J].Chinese Journal of Nursing, 2023, 58(6): 682-688., articleTitle=Construction and validation of a risk predictive model for treatment delay of patients with lung cancer, refAbstract=null), Reference(id=1241680467351629840, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, doi=null, pmid=null, pmcid=null, year=2023, volume=null, issue=3, pageStart=32, pageEnd=33, url=null, language=null, rfNumber=[24], rfOrder=40, authorNames=李为民, journalName=健康中国观察, refType=null, unstructuredReference=李为民.从"小切口"入手守护人民群众的"大健康[J].健康中国观察，2023,（3）：32-33., articleTitle=从"小切口"入手守护人民群众的"大健康, refAbstract=null), Reference(id=1241680467443904529, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, doi=null, pmid=null, pmcid=null, year=2023, volume=null, issue=3, pageStart=32, pageEnd=33, url=null, language=null, rfNumber=[24], rfOrder=41, authorNames=Li WM, journalName=Healthy China Observation, refType=null, unstructuredReference=Li WM. Starting from "small incisions" to safeguard the "great health" of the People[J]. Healthy China Observation, 2023, (3): 32-33., articleTitle=Starting from "small incisions" to safeguard the "great health" of the People, refAbstract=null)], funds=[Fund(id=1241680459520865153, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, awardId=2022YFC2406804, language=CN, fundingSource=国家重点研发计划项目(2022YFC2406804), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241680451878842962, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, xref=1., ext=[AuthorCompanyExt(id=1241680451891425877, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, companyId=1241680451878842962, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241680451904008790, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, companyId=1241680451878842962, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西医院呼吸与危重症医学科，四川 成都 610041)]), AuthorCompany(id=1241680453418152543, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, xref=2., ext=[AuthorCompanyExt(id=1241680453430735455, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, companyId=1241680453418152543, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西医院全程管理中心，四川 成都 610041)]), AuthorCompany(id=1241680453523010151, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, xref=3., ext=[AuthorCompanyExt(id=1241680453531398759, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, companyId=1241680453523010151, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.四川大学华西公共卫生学院/华西第四医院卫生政策与管理学系，四川 成都 610041)])], figs=[ArticleFig(id=1241680458216436548, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, language=EN, label=Figure 1, caption=The relationship between patients’ satisfaction, recommendation, and improvement evaluation, figureFileSmall=8fvHQZRI3bPmkbYMu8ZQWw==, figureFileBig=eJF6xMQIaxyywme8mqj4iA==, tableContent=null), ArticleFig(id=1241680458333877064, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, language=CN, label=图1, caption=患者满意、推荐及改善评价关系图

注： *表示P<0.05。

, figureFileSmall=8fvHQZRI3bPmkbYMu8ZQWw==, figureFileBig=eJF6xMQIaxyywme8mqj4iA==, tableContent=null), ArticleFig(id=1241680458463900495, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, language=EN, label=Table 1, caption=

Score of evaluation item ()

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类别条目得分（分）
满意评价总计得分95.76±11.39
就医指导94.35±13.42
挂号预约93.79±16.97
检查预约96.13±11.72
随访管理94.96±14.54
人员态度96.64±9.00
改善评价总计得分79.89±20.10
流程便捷83.05±23.73
费用减少66.26±27.30
依从性84.58±22.95
就医综合85.65±21.52
推荐意愿推荐意愿94.66±12.61
), ArticleFig(id=1241680458602312532, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, language=CN, label=表1, caption=

各评价条目得分情况（）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别条目得分（分）
满意评价总计得分95.76±11.39
就医指导94.35±13.42
挂号预约93.79±16.97
检查预约96.13±11.72
随访管理94.96±14.54
人员态度96.64±9.00
改善评价总计得分79.89±20.10
流程便捷83.05±23.73
费用减少66.26±27.30
依从性84.58±22.95
就医综合85.65±21.52
推荐意愿推荐意愿94.66±12.61
), ArticleFig(id=1241680458702975835, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, language=EN, label=Table 2, caption=

The most satisfactory and least satisfactory management items

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管理内容最满意选项最不满意选项
频数百分比（%）频数百分比（%）
就医指导3527.5064.60
预约挂号3022.902216.80
预约检查1813.7021.50
定期随访及提醒2922.1010.80
人员态度1813.7000.00
总计131100.003123.70
), ArticleFig(id=1241680458866553697, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, language=CN, label=表2, caption=

最满意与最不满意管理内容情况

, figureFileSmall=null, figureFileBig=null, tableContent=
管理内容最满意选项最不满意选项
频数百分比（%）频数百分比（%）
就医指导3527.5064.60
预约挂号3022.902216.80
预约检查1813.7021.50
定期随访及提醒2922.1010.80
人员态度1813.7000.00
总计131100.003123.70
), ArticleFig(id=1241680458988188521, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, language=EN, label=Table 3, caption=

Distribution and differences of scores of satisfaction evaluation, recommendation intention, and improvement evaluation［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
类别不满意满意χ2值P值不推荐推荐χ2值P值无变化有变化χ2值P值
性别男3480.1060.7444470.3310.56528231.6200.203
女7734763347
年龄(岁)18～25147.6810.6602315.1080.128417.2560.701
26～30060624
31～401212201012
41～503352361622
51～602311321518
>603241261413
民族汉族911916.7880.010712115.9430.01458703.5230.741
回族010110
彝族010110
其他101010
婚姻状况未婚1710.3800.239267.1410.521354.0830.850
已婚810961115463
离婚120321
丧偶020211
其他010110
文化程度小学0324.3390.0420311.0990.678218.1220.883
初中022220616
高中270954
技工学校020211
中专或中技151524
大专3292301715
大学3453452424
硕士及以上180945
职业国家公务员11412.7610.88701537.2650.0118716.0970.711
企业管理人员191955
专业技术人员2322321420
个体经营者183645
离退休人员2281291515
自由职业者140532
职员180954
农民150624
无业060624
学生011010
其他060624
您的家庭月收入(元)<1 0001016.6430.0830112.5090.2521010.6090.389
>1 000～3 00011121066
>3 000～5 0003283281813
>5 000～10 0002512512429
>10 0003301321221
其他010101
医疗保险支付方式全公费0415.5330.114044.1210.942316.7230.751
全自费151515
城镇职工基本医疗保险7915934652
新型农村合作医疗01111056
城乡居民基本医疗保险2911065
商业医疗保险010101
加入全程疾病类别肺结节5934.3890.1117911.6290.44343551.6950.428
肺癌5281321815
加入全程管理时间(月)1～635419.2770.0133549.5360.04922357.4070.493
>6～124463472228
>12～182911083
>18～24050532
>24161652
), ArticleFig(id=1241680459193709426, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522848108434080, language=CN, label=表3, caption=

患者满意评价、推荐意愿、改善评价得分情况［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
类别不满意满意χ2值P值不推荐推荐χ2值P值无变化有变化χ2值P值
性别男3480.1060.7444470.3310.56528231.6200.203
女7734763347
年龄(岁)18～25147.6810.6602315.1080.128417.2560.701
26～30060624
31～401212201012
41～503352361622
51～602311321518
>603241261413
民族汉族911916.7880.010712115.9430.01458703.5230.741
回族010110
彝族010110
其他101010
婚姻状况未婚1710.3800.239267.1410.521354.0830.850
已婚810961115463
离婚120321
丧偶020211
其他010110
文化程度小学0324.3390.0420311.0990.678218.1220.883
初中022220616
高中270954
技工学校020211
中专或中技151524
大专3292301715
大学3453452424
硕士及以上180945
职业国家公务员11412.7610.88701537.2650.0118716.0970.711
企业管理人员191955
专业技术人员2322321420
个体经营者183645
离退休人员2281291515
自由职业者140532
职员180954
农民150624
无业060624
学生011010
其他060624
您的家庭月收入(元)<1 0001016.6430.0830112.5090.2521010.6090.389
>1 000～3 00011121066
>3 000～5 0003283281813
>5 000～10 0002512512429
>10 0003301321221
其他010101
医疗保险支付方式全公费0415.5330.114044.1210.942316.7230.751
全自费151515
城镇职工基本医疗保险7915934652
新型农村合作医疗01111056
城乡居民基本医疗保险2911065
商业医疗保险010101
加入全程疾病类别肺结节5934.3890.1117911.6290.44343551.6950.428
肺癌5281321815
加入全程管理时间(月)1～635419.2770.0133549.5360.04922357.4070.493
>6～124463472228
>12～182911083
>18～24050532
>24161652
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全程管理医疗模式下四川省某三甲医院肺结节肺癌患者就医体验及影响因素分析
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杨先碧 1, 2 , 陈凤 2 , 刘青 2 , 周永召 1, 2 , 朱梦蓉 3
现代预防医学 | 临床与预防 2024,51(3): 552-556
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现代预防医学 | 临床与预防 2024, 51(3): 552-556
全程管理医疗模式下四川省某三甲医院肺结节肺癌患者就医体验及影响因素分析
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杨先碧1, 2, 陈凤2, 刘青2, 周永召1, 2, 朱梦蓉3
作者信息
  • 1.四川大学华西医院呼吸与危重症医学科，四川 成都 610041
  • 2.四川大学华西医院全程管理中心，四川 成都 610041
  • 3.四川大学华西公共卫生学院/华西第四医院卫生政策与管理学系，四川 成都 610041

    • 杨先碧（1994—），女，硕士，研究实习员，研究方向：卫生政策及全程管理的研究

通讯作者:

朱梦蓉，E-mail:
Evaluation survey and influencing factors of integrated care management services in patients with pulmonary nodules and lung cancer in a tertiary hospital in Sichuan Province
Xian-bi YANG1, 2, Feng CHEN2, Qing LIU2, Yong-zhao ZHOU1, 2, Meng-rong ZHU3
Affiliations
  • Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2024-02-10 doi: 10.20043/j.cnki.MPM.202306396
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摘要
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目的

调查肺结节肺癌患者对全程管理评价情况，为提升慢病全程管理服务质量提供依据。

方法

于2021年1月—2022年12月通过对符合纳入标准的肺结节肺癌全程管理患者发放电子问卷，开展匿名调查，并采用χ2检验比较不同组别的评价差异。

结果

共回收有效问卷130份，130名调查对象对全程管理的整体满意评价95.72分，推荐意愿94.66分，改善评价79.89分。不同民族（χ2=16.788，P=0.010）、文化程度（χ2=24.339，P=0.042）、纳入管理时间（χ2=19.277，P=0.013）间满意评价的差异有统计学意义（P<0.05)。推荐意愿在不同民族（χ2=15.943，P=0.014）、职业（χ2=37.265，P=0.011）、纳入管理时间（χ2=9.536，P=0.049）的患者间存在统计学差异（P<0.05)。患者满意评价、推荐意愿、改善评价三者之间存在显著正相关（P<0.05)，三者间的相关系数分别为0.581、0.723、0.538。

结论

肺结节肺癌全程管理模式获得患者的广泛认可，满意评价水平高，推荐意愿强，该模式可以显著提高患者的就医体验和诊疗效果。

肺结节  /  肺癌  /  全程管理  /  评价反馈  /  影响因素
Objective

To investigate the evaluation of integrated care management in patients with pulmonary nodule lung cancer and to provide basis for improving the service quality of integrated care management of chronic disease.

Methods

From January 2021 to December 2022, electronic questionnaires were distributed to patients with lung nodule lung cancer who met the inclusion criteria, and an anonymous survey was conducted. The chi-square test was used to compare the evaluation differences among different groups.

Results

A total of 130 valid questionnaires were collected. The overall satisfaction evaluation, recommendation intention, and improvement evaluation of the integrated care management were 95.72, 94.66, and 79.89, respectively. There were significant differences (P<0.05) in satisfaction evaluation among different ethnic groups (χ2=16.788, P=0.010), education level (χ2=24.339, P=0.042), and management time (χ2=19.277, P=0.013). There were significant differences (P<0.05) in recommendation intention among patients of different ethnic groups (χ2=15.943, P=0.0144), occupation (χ2=37.265, P=0.011), and management time (χ2=9.536, P=0.049). There was a significant positive correlation among patient satisfaction evaluation, recommendation intention, and improvement evaluation, and the correlation coefficients were 0.581, 0.723, and 0.538,respectively.

Conclusion

The integrated care management model of pulmonary nodule lung cancer is widely recognized by patients, with high level of satisfactory evaluation, and patients have strong willingness to recommend. This model can significantly improve the medical service experience and treatment effect.

Lung nodule  /  Lung cancer  /  Integrated care management  /  Evaluation feedback  /  Influencing factors
杨先碧, 陈凤, 刘青, 周永召, 朱梦蓉. 全程管理医疗模式下四川省某三甲医院肺结节肺癌患者就医体验及影响因素分析. 现代预防医学, 2024 , 51 (3) : 552 -556 . DOI: 10.20043/j.cnki.MPM.202306396
Xian-bi YANG, Feng CHEN, Qing LIU, Yong-zhao ZHOU, Meng-rong ZHU. Evaluation survey and influencing factors of integrated care management services in patients with pulmonary nodules and lung cancer in a tertiary hospital in Sichuan Province[J]. Modern Preventive Medicine, 2024 , 51 (3) : 552 -556 . DOI: 10.20043/j.cnki.MPM.202306396
正文
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在中国，慢性非传染疾病的高发病率、高死亡率已成为影响人民生活健康质量的重要因素，但其诊疗管理仍集中在院中，尚未形成规范的全程慢病防治体系，院前、院后的连续性专业管理处于真空地带。以我国发病率死亡率均居首位的肺癌为例[1-2]，其早期的生存率可高达80%[3]，现实却因缺乏肺癌筛查和规范治疗导致75%的患者在诊断时已属晚期[4]，五年生存率仅5.2%，而肺结节作为肺癌在胸部CT影像上的主要表现，随着胸部CT广泛运用，其检出率大幅增加，按肺结节检出率54%估计我国肺结节人数已超3亿[5]，规律随访及全程管理是提高肺癌早诊率的有效手段。
全程管理是以患者为中心，进行多学科诊疗和护理相结合的、连续的、整体的医护服务模式。笔者所在医院与其他大型三甲医院情况一样，诊疗疾病范围广、复杂、重症病人多，但慢性病、常见病占比仍较高[6-7]，“一号难求”“随意复诊”的现象依然普遍存在，慢病管理亟需改进。四川省是全国肺癌负担最高的省份之一，以提高肺癌生存率、降低肺癌死亡率为总目标，我院于2019年对自愿加入的肺结节肺癌患者进行全程管理，全程管理提高肺结节肺癌患者随访依从率、诊疗完成率[8]、早筛早诊率、诊断恶性率等[9]成效显著。
目前全程管理的评价多集中于诊疗效果，针对患者的管理需求和感受的研究较少[10-12]，本研究基于肺结节肺癌患者视角，通过构建管理内容、过程、结果评价指标，探讨患者对全程管理的真实感受和管理需求，分析全程管理模式的运行效果，为肺结节肺癌全程管理工作改进提供建议，也为全程管理的模式推广至其他慢病中提供参考和依据。
1　资料与方法
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1.1　研究对象
调查对象纳入条件：（1）明确有肺结节或病理诊断为肺癌；（2）纳入全程管理时间≥1月；（3）至少体验过1次管理服务。排除条件：（1）文化差异，不能理解问卷内容；（2）神智异常，不能自主填写问卷。
1.2　肺结节肺癌全程管理内容
肺结节肺癌全程管理内容为：（1）线上线下健康教育（普及相关知识、心理疏导、戒烟指导）；（2）就医指导（挂号、预约检查、手术准备、用药指导等）；（3）建立个性化健康档案及随访方案；（4）全程主动随访管理（诊前短信和电话提醒、诊中督促与引导、诊后随访及关怀）；（5）就医协助（协助预约挂号、预约检查、转诊等）。
1.3　问卷调查
自制肺结节及肺癌患者评价问卷，问卷内容包括性别、年龄等一般情况、对全程管理内容的满意、推荐意愿、改善评价、需求建议等内容，共25个条目。其中患者对满意度评价分为全程管理服务类别评价、自我改善评价两大类，按照Likert 5级评分，“非常满意”“比较满意”“一般满意”“不太满意”“很不满意”分别赋值5、4、3、2和1分。“非常”“比较”“一般”“很小”“几乎没有”原始分值分别为5、4、3、2和1分。对问卷中题目进行信效度分析，结果显示Cronbach α系数为0.837，KMO=0.877，问卷信效度良好。总的满意度和改善情况计分规则采用累计百分制，分类将“非常满意”和“比较满意”当作满意，其他为不满意。问卷填写方式为门诊随访时扫描问卷二维码填写。满意度调查时间为2021年1月—2022年12月。
1.4　统计学方法
计量资料采用（），计数资料采用频数和百分比描述，采用χ2检验对患者满意度、推荐情况、加入后变化基本情况做组间比较，并采用相关分析探索患者满意评价、推荐意愿和改善评价之间的关系。所以统计分析均基于SPSS 23.0完成，以α=0.05作为检验水准。
2　结果
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2.1　患者基本情况
共回收问卷131份，有效问卷130份，有效问卷回收率达99.24%。调查对象130人中，女性80人，占比61.50%，与现有总的全程管理肺结节肺癌性别分布一致；年龄以41～50岁为主，38人，41岁及以上累积占比75.4%；汉族为主，非汉族患者仅3人；89.2%患者为已婚状态；整体文化程度较高，以大专及本科为主；其中肺结节患者97人，肺癌患者33人；全程管理时间上有23人超过1年。
2.2　各评价条目得分情况
从各评价条目得分情况可见，患者满意总得分为95.76分，单项满意得分最高为96.64分，条目为“人员态度”，其次是“检查预约”的96.13分，“挂号预约”得分最低，为93.79分，见表1。“最满意和最不满意的管理内容”的结果显示，患者提及最多的最满意的管理内容是“就医指导”和“预约挂号”，最不满意管理内容提及最多的是“预约挂号”，见表2。
2.3　患者满意评价、推荐意愿、改善评价影响因素分析
由于满意评价、推荐意愿、改善评价三个总计得分均不服从正态分布，χ2检验结果显示，满意评价在民族（χ2=16.788，P=0.010）、文化程度（χ2=24.339，P=0.042）、加入全程管理时间（χ2=19.277，P=0.013）三个组内差异有统计学意义；推荐意愿在民族（χ2=15.943，P=0.014）、职业（χ2=37.265，P=0.011）、纳入管理时间（χ2=9.536，P=0.049）三个组内差异有统计学意义。改善评价组内差异结果均无统计学意义(P>0.05)。见表3。
2.4　患者对全程管理满意评价、改善评价、推荐意愿的相关分析
患者满意评价、推荐意愿和改善评价三部分之间均具有正相关关系，见图1。通过分析综合类别内部的相互关系显示，在满意评价类别，挂号预约与总体相关性最强，r=0.949，其次是检查预约，r=0.898；改善评价类别，就医综合体验的相关系数最大，为0.905。针对各组成部分对其他类别的相互关系分析发现，就医综合体验对推荐意愿和满意评价的相关系数最高（r=0.543、r=0.600），挂号预约与推荐意愿和改善评价的相关性最大（r=0.544、r=0.685），见图1。
3　讨论
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3.1　肺结节肺癌患者对全程管理满意评价高、推荐意愿强
全程管理模式是现代医院医疗服务模式变革，提升医疗服务质量水平的重要创新尝试。本研究发现，肺结节肺癌患者对全程管理总体满意度较高，总得分为95.76分，5个管理内容满意得分均在93分以上，全程管理患者满意程度远高于普通门诊患者满意度水平[13]，全程管理模式得到了肺结节肺癌患者较高的认可度，对全程管理的推荐意愿也较强。
3.2　肺结节肺癌患者对全程管理综合评价的人群差异
肺结节肺癌患者对全程管理的满意得分受人口学特征影响较少，受管理内容影响为主，这一结果与既往研究结果吻合[14]。全程管理满意得分在民族、文化程度和加入管理时间三个组中的差异有统计学意义，与国内外研究发现的影响满意度的因素类似[15-17]，汉族满意度低于少数民族，但本调查研究中，少数名族患者不足5人，因此可能存在选择偏倚，民族差异的准确性需较大样本的数据进一步证明。虽然满意度得分和推荐得分在性别和年龄组别中显示均无统计学意义，但目前我国肺癌患病人群呈年轻化趋势[18]，且非吸烟女性的患病率逐年增加，肺结节肺癌全程管理需根据女性的生理特点、生活方式、情绪疏导等多个方面进行个性化管理，更好的提升肺癌早期诊断率及五年生存率。
3.3　“预约挂号”是影响患者对全程管理评价的最重要因素和核心管理需求
从满意度、推荐程度、改善评价相关关系研究显示，改善评价与满意评价之间存在较高的正向关系。“预约挂号”的满意得分，在满意评价内的相关性最高，同时与推荐意愿和改善评价的相关系数也最高。在患者“最不满意的的全程管理内容”中，“预约挂号”占比也最高。根据问卷中“最需要的帮助”和“对全程管理建议”两个开放性题目的结果统计来看，在62人“最需要的帮助”回答中，“挂号”帮助提及35次，占比56.45%，在59人“对全程管理的建议”回答中，14人表示希望“挂号”内容更好。由此可见，“预约挂号”是影响肺结节肺癌患者对全程管理评价的最核心的内容，也是患者针对全程管理内容的核心需求。
3.4　建议
首先，肺结节患者爆发性增长导致就医需求快速增长[19]；其次，肺结节肺癌难以诊断和需要长期随访的特点进一步增加高水平的诊疗需求；最后，患者认知不足而焦虑、恐惧带来的反复就医导致部分医疗资源浪费。所以现在肺结节肺癌患者在三甲医院“一号难求”的现象突出[20-21]。为通过全程管理途径进一步解决肺结节肺癌患者“预约挂号”就医难题和需要，提出两点建议。
3.4.1　实现全程管理的分级分层，加强健康教育
全程管理中心可联合临床多学科团队，按照临床指南，对检出的肺结节患者进行危险程度分级，再按照分级结果进行诊疗指导，避免患者盲目挂号、挂错号、浪费号，让低危患者不再挤占高危结节的号源，同时高危患者得到有效、及时的治疗，实现就医流程通畅，缓解挂号难的问题。
目前国内肺结节的管理大多无系统性，均靠患者的“自觉性”和医师的“再三叮嘱”[22]，由于疾病感知水平低、社会支持水平低、未健康体检、健康素养低等多因素导致患者就医延迟情况多发[23]，同时过度诊断、手术等比例较高。依托全程管理模式，加强对肺结节肺癌患者的健康教育干预，将极大提高患者的依从性，并进而有效提高肺结节肺癌的规范就诊比例。
3.4.2　建立以影像云为基础的肺结节肺癌全程管理专病联盟
肺结节及肺癌的诊断过程需要连续性、长期性、规律性的随访，当病情变化时还需要内、外、肿瘤、影像、病理等多科协作，单个医疗机构不能满足区域肺结节肺癌患者就医需求。建立以影像云平台为支撑的紧密的全程管理肺结节肺癌联盟[24]，搭建数据共享的影像云平台，患者可以不用重复检查，就医更加便捷。践行肺结节肺癌患者低风险在基层、中风险在县市医院、高风险在三级医院的分级诊疗理念，让全程管理中心与各分中心结对子，协助专病全程管理患者路径实施、上下转诊、疑难会诊、康复随访等事务性工作，促进优质医疗资源扩容和区域均衡布局，加强重大慢性病管理的重要实现途径。
基金
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  • 国家重点研发计划项目(2022YFC2406804)
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2024年第51卷第3期
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doi: 10.20043/j.cnki.MPM.202306396
  • 接收时间：2023-06-19
  • 首发时间：2026-03-19
  • 出版时间：2024-02-10
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  • 收稿日期：2023-06-19
基金
国家重点研发计划项目(2022YFC2406804)
作者信息
    1.四川大学华西医院呼吸与危重症医学科，四川 成都 610041
    2.四川大学华西医院全程管理中心，四川 成都 610041
    3.四川大学华西公共卫生学院/华西第四医院卫生政策与管理学系，四川 成都 610041

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2种不同金属材料的力学参数
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species		 占总种数比例
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total species (%)		 属
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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