Results from the pile sorting (n = 42).

Background
Patient perspectives have received increasing importance within health systems over the past four decades. Measures of patient experience and satisfaction are commonly used. However, these measures do not capture all the information that is available through engaging with patients. An improved understanding of the various types of patient perspectives and the distinctions between them is needed. The lack of such knowledge limits the usefulness of including patient perspectives as components within pay-for-performance initiatives. This study aimed to explore patient perspectives on hospital care in Lebanon. It also aimed to contribute insights that may improve the national pay-for-performance initiative and to the knowledge on engaging patients towards person-centered health systems.
Methods
We conducted a qualitative study using focus group discussions with persons recently discharged after hospitalization under the coverage of the Lebanese Ministry of Public Health. This study was implemented in 2017 and involved 42 participants across eight focus groups. Qualitative content analysis was used to analyze the information provided by participants.
Results
Five overall themes supported by 17 categories were identified, capturing the meaning of the participants’ perspectives: health is everything; being turned into second class citizens; money and personal connections make all the difference; wanting to be treated with dignity and respect; and tolerating letdown, for the sake of right treatment. The most frequently prioritized statement in a ranking exercise regarding patient satisfaction was regular contact with the patient’s doctor.
Conclusions
Patient perspectives include more than what is traditionally incorporated in measures of patient satisfaction and experience. Patient valuing of health and their perceptions on each of the health system, and access and quality of care should also be taken into account. Hospital pay-for-performance initiatives can be made more responsive through a broader consideration of these perspectives. More broadly, health systems would benefit from wider engagement of patients. We propose a framework relating patient perspectives to value-based healthcare and health system performance.

研究背景
过去四十年来，患者视角在卫生系统中的重要性与日俱增。当前临床实践中，患者体验与满意度评价指标被广泛应用，但此类手段无法涵盖通过与患者互动所能获取的全部信息。学界亟需深化对不同类型患者视角及其相互差异的认知，当前该领域的认知缺口，限制了将患者视角纳入按绩效付费（pay-for-performance）项目组件的应用价值。本研究旨在探讨黎巴嫩患者对医院诊疗服务的视角，同时期望为优化该国国家按绩效付费项目、丰富以患者为中心的卫生系统（person-centered health systems）患者参与相关认知提供参考见解。

研究方法
本研究采用定性研究方法，招募受黎巴嫩公共卫生部医保覆盖的近期出院住院患者开展焦点小组讨论（focus group discussions）。本研究于2017年实施，共开展8组焦点小组讨论，纳入42名参与者。研究采用定性内容分析（qualitative content analysis）法对参与者提供的信息进行编码与分析。

研究结果
本研究共识别出5个核心主题，涵盖17个子类别，完整呈现了参与者的视角内涵，分别为：健康至上；被视作二等公民；金钱与人脉决定一切；渴望获得有尊严与尊重的对待；为获得恰当诊疗甘愿忍受落差。在针对患者满意度的排序练习中，优先级最高的表述为"与接诊医生保持定期沟通"。

研究结论
患者视角的内涵远超传统患者满意度与体验测评所覆盖的范畴。卫生系统在开展相关评估时，还应纳入患者对健康的重视程度、对卫生系统本身的认知，以及对诊疗可及性与服务质量的看法。若能更全面地考量此类患者视角，医院按绩效付费项目的响应性可得到进一步提升。从更宏观的层面而言，扩大患者参与将使卫生系统整体获益。本研究提出了一套将患者视角与价值医疗（value-based healthcare）及卫生系统绩效相关联的分析框架。