Application of “Structure-process-result” Three-dimensional Quality Evaluation Model in the Prevention and Treatment of VTE in Surgical Inpatients
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摘要:
目的 探讨“结构-过程-结果”三维质量评价模式在外科住院患者VTE防治工作的应用效果。 方法 将2020年7月至2021年6月入住昆明市延安医院普外二科病房400例患者为研究对象，按照随机数字表法分为对照组200例，实验组200例，对照组按医院规定流程进行院内VTE防治护理。实验组将“结构-过程-结果”三维质量评价模式应用于院内VTE防治和管理体系，从结构、过程、结果3个维度进行优化，比较2组的VTE发生率、患者满意度、患者服务感知及护士护理质量得分情况。 结果 实验组VTE发生率显著小于对照组（χ2 = 4.592，P < 0.05），实验组与对照组在患者满意度（t = -8.811.91，P < 0.001）和服务感知（t = -11.813，P < 0.001）上差异有统计学意义，其中实验组和对照组在服务感知的5个维度上，服务体系（t = -7.401，P < 0.001）、护理专业性（t = -8.347，P < 0.001）、执行能力（t = -5.73，P < 0.001）、需求反馈（t = -8.024，P < 0.001）、护患关系（t = -9.799，P < 0.001）均存在差异。实验组在患者满意度和服务感知上的得分显著高于对照组。并且实验组护士护理质量差异有统计学意义，护士护理质量SD分数逐渐降低，护理质量逐渐趋于稳定。 结论 应用“结构-过程-结果”三维质量评价模式可降低外科住院患者VTE发生率，促进护理团队高质量发展。 Abstract:Objective To explore the application effect of “structure-process-outcome” three-dimensional quality evaluation model in the prevention and treatment of surgical inpatients with VTE. Methods A total of 400 patients admitted to Department of General Surgery in Yan’an Hospital of Kunming City from July 2020 to June 2021 were selected as research subjects, and were divided into control group and experimental group using random number table method, with 200 patients in each group. The control group received hospital VTE prevention and treatment nursing following the hospital regulations. The experimental group received the “structure-process-result” three-dimensional quality evaluation model, which was applied to the prevention and management system of VTE in the hospital, and was optimized from three dimensions: structure, process and result. The incidence of VTE, patient satisfaction, patient service perception and nursing quality score of the two groups were compared. Results The incidence of VTE in the experimental group was significantly lower than that in the control group （χ2 = 4.592, P < 0.05）. There were significant differences in patient satisfaction （t = -8.811.91, P < 0.001） and service perception （t = -11.813, P < 0.001） between experimental group and control group. There were differences in five dimensions of service perception between the experimental group and the control group, namely, service system （t = -7.401, P < 0.001）, nursing professionalism （t = -8.347, P < 0.001）, executive ability （t = -5.73, P < 0.001）, demand feedback （t = -8.024, P < 0.001）, nurse-patient relationship （t = -9.799, P < 0.001）. The experimental group scored significantly higher on patient satisfaction and service perception than the control group. In addition, the nursing quality of the experimental group showed statistically significant differences, SD scores of nursing quality gradually decreased, and nursing quality gradually stabilized. Conclusion The application of the “structure-process-result” three-dimensional quality evaluation model can reduce the incidence of VTE in surgical inpatients and promote the high-quality development of nursing teams. -
Key words:
- Quality evaluation system /
- Venous thromboembolism /
- VTE prevention
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表 1 2组基线资料比较（n = 400）
Table 1. Comparison of the baseline data between experimental group and control group （n = 400）
项目 对照组 实验组 χ2/t P 性别 男 127（0.635） 129（0.645） 0.043 0.835 女 73（0.365） 71（0.355） 年龄（岁） 60.64 ± 9.37 60.8 ± 9.338 −0.166 0.868 风险等级 中风险 146 137 0.979 0.323 高风险 54 63 注：表中性别、风险等级用卡方检验，年龄用t检验。 
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表 2 2组VTE发生率[n（%）]
Table 2. Incidence of VTE in 2 groups [n（%）]
分组 VTE发生率 χ2 P 未发生 发生 对照组 193（96.5） 7（3.5） 4.592 < 0.05* 实验组 199（99.5） 1（0.5） 与对照组比较，*P < 0.05。
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表 3 2组满意度、服务感知测评[（
$\bar x \pm s $ ），分]Table 3. Satisfaction and service perception evaluation in 2 groups [（
$\bar x \pm s $ ），scores]项目 对照组（n = 200） 实验组（n = 200） t P 满意度 81.97 ± 8.051 87.63 ± 4.209 −8.811 0.000 服务体系 91.26 ± 4.911 97.03 ± 3.238 −7.401 0.000 护理专业性 13.29 ± 5.359 16.84 ± 4.159 −8.347 0.000 执行能力 16 ± 6.261 20.75 ± 5.056 −5.73 0.000 需求反馈 13.72 ± 5.607 16.56 ± 4.207 −8.024 0.000 护患关系 12.72 ± 5.752 16.76 ± 4.175 −9.799 0.000 服务感知总分 15.34 ± 6.853 21.2 ± 4.968 −11.813 0.000
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表 4 实验组对照组护理质量考核秩和检验[分]
Table 4. Mann-Whitney Test of nursing quality evaluate in experimental group and control group [scores]
月份 对照组（n = 6） 实验组（n = 6） Z P 等级平均值 等级的和 等级平均值 等级的和 1月 5.42 32.5 7.58 45.5 −1.058 0.31 2月 7.75 46.5 5.25 31.5 −1.231 0.24 3月 5 30 8 48 −1.506 0.18 4月 6.25 37.5 6.75 40.5 −0.25 0.818 5月 4.17 25 8.83 53 −2.295 0.026 6月 4.33 26 8.67 52 −2.115 0.041 7月 4.33 26 8.67 52 −2.127 0.041 8月 4.08 24.5 8.92 53.5 −2.372 0.015 9月 4.25 25.5 8.75 52.5 −2.317 0.026 10月 4.33 26 8.67 52 −2.179 0.041 11月 3.5 21 9.5 57 −2.934 0.002 12月 3.58 21.5 9.42 56.5 −2.863 0.002
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表 5 实验组单样本SD数值
Table 5. SD value of experimental group
月份 N 平均数 标准差 一月 6 91.67 1.751 二月 6 93 1.673 三月 6 93.33 1.366 四月 6 94.67 1.211 五月 6 94.67 1.033 六月 6 95.33 1.211 七月 6 95.83 1.329 八月 6 96 1.095 九月 6 96.83 0.983 十月 6 97.33 1.033 十一月 6 97.5 0.548 十二月 6 98 0.632
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