Rubin H R
Department of Medicine, University of California, San Francisco.
Med Care Rev. 1990 Fall;47(3):267-326. doi: 10.1177/107755879004700302.
We have found that patients have distinct opinions about many components of hospital care, but that little recent work has identified those components important to today's patients in the United States. Investigators have constructed reproducible scales to obtain evaluations. Patient evaluations of the interpersonal features of hospital care are influenced by interventions that physicians or nurses identify as "higher" quality of care. We do not know if patient reports and ratings of specific aspects of care accurately reflect the effects of hospital care on health outcomes--the quality standard that public agencies and payers may consider the most important. However, patient evaluations of nursing care and medical care are independently related to patients' overall satisfaction, overall assessments of quality, and intentions to recommend and return to the same hospital. More studies are needed to clarify whether other components of hospital care also contribute to these ratings and intentions and, if so, how much. Nonresponse bias affects patient surveys, making patient ratings of care in each sample more favorable than the population mean; we do not know how this affects conclusions of surveys that compare hospitals or treatments. Few studies have compared how different methods affect the reproducibility and accuracy of patient reports and ratings. Practical issues may be the most important obstacles for users of patient ratings, particularly regarding whether potential users will be able to interpret results and accept them. Finally, no comprehensive instrument or survey method in the published literature has been tested enough to be recommended as a reproducible, accurate, and interpretable quality measure: a few do, however, appear worthy of further testing.
我们发现，患者对医院护理的许多方面都有不同的看法，但最近几乎没有研究确定哪些方面对美国当今的患者很重要。研究人员构建了可重复的量表来获取评估结果。患者对医院护理人际特征的评估会受到医生或护士认为是“更高”质量护理的干预措施的影响。我们不知道患者对护理特定方面的报告和评分是否准确反映了医院护理对健康结果的影响——公共机构和付款人可能认为这是最重要的质量标准。然而，患者对护理和医疗的评估与患者的总体满意度、对质量的总体评估以及推荐和返回同一家医院的意愿独立相关。需要更多的研究来阐明医院护理的其他方面是否也对这些评分和意愿有贡献，如果有，贡献程度如何。无应答偏差会影响患者调查，使每个样本中的患者护理评分比总体均值更有利；我们不知道这如何影响比较医院或治疗方法的调查结论。很少有研究比较不同方法如何影响患者报告和评分的可重复性和准确性。实际问题可能是患者评分使用者面临的最重要障碍，尤其是潜在使用者是否能够解释结果并接受它们。最后，已发表文献中没有一种综合工具或调查方法经过充分测试，足以被推荐为可重复、准确且可解释的质量衡量标准：不过，有一些似乎值得进一步测试。
