Finkelstein B S, Harper D L, Rosenthal G E
Case Western Reserve University, USA.
Health Serv Res. 1999 Jun;34(2):623-40.
To examine three issues related to using patient assessments of care as a means to select hospitals and foster consumer choice-specifically, whether patient assessments (1) vary across hospitals, (2) are reproducible over time, and (3) are biased by case-mix differences.
DATA SOURCES/STUDY SETTING: Surveys that were mailed to 27,674 randomly selected patients admitted to 18 hospitals in a large metropolitan region (Northeast Ohio) for labor and delivery in 1992-1994. We received completed surveys from 16,051 patients (58 percent response rate).
Design was a repeated cross-sectional study.
Surveys were mailed approximately 8 to 12 weeks after discharge. We used three previously validated scales evaluating patients' global assessments of care (three items)as well as assessments of physician (six items) and nursing (five items) care. Each scale had a possible range of 0 (poor care) to 100 (excellent care).
Patient assessments varied (p<.001) across hospitals for each scale. Mean hospital scores were higher or lower (p<.01) than the sample mean for seven or more hospitals during each year of data collection. However, within individual hospitals, mean scores were reproducible over the three years. In addition, relative hospital rankings were stable; Spearman correlation coefficients ranged from 0.85 to 0.96 when rankings during individual years were compared. Patient characteristics (age, race, education, insurance status, health status, type of delivery) explained only 2-3 percent of the variance in patient assessments, and adjusting scores for these factors had little effect on hospitals' scores.
The findings indicate that patient assessments of care may be a sensitive measure for discriminating among hospitals. In addition, hospital scores are reproducible and not substantially affected by case-mix differences. If our findings regarding patient assessments are generalizable to other patient populations and delivery settings, these measures may be a useful tool for consumers in selecting hospitals or other healthcare providers.
探讨与利用患者护理评估作为选择医院及促进消费者选择相关的三个问题，具体而言，即患者评估（1）在不同医院之间是否存在差异，（2）随时间推移是否具有可重复性，以及（3）是否因病例组合差异而存在偏差。
数据来源/研究背景：对1992 - 1994年在俄亥俄州东北部一个大都市地区的18家医院因分娩入院的27,674名随机选取的患者进行邮寄调查。我们收到了16,051名患者填写完整的调查问卷（回复率为58%）。
设计为重复横断面研究。
出院后约8至12周邮寄调查问卷。我们使用了三个先前经过验证的量表，分别评估患者对护理的总体评价（三个项目）以及对医生护理（六个项目）和护士护理（五个项目）的评价。每个量表的评分范围为0（护理差）至100（护理优）。
每个量表的患者评估在不同医院之间存在差异（p <.001）。在数据收集的每年中，七家或更多医院的平均得分高于或低于样本均值（p <.01）。然而，在各医院内部，平均得分在三年间具有可重复性。此外，医院的相对排名稳定；将各年份的排名进行比较时，斯皮尔曼相关系数范围为0.85至0.96。患者特征（年龄、种族、教育程度、保险状况、健康状况、分娩类型）仅解释了患者评估中2% - 3%的变异，对这些因素进行得分调整对医院得分影响不大。
研究结果表明，患者对护理的评估可能是区分不同医院的一项敏感指标。此外，医院得分具有可重复性，且受病例组合差异的影响不大。如果我们关于患者评估的研究结果能够推广到其他患者群体和医疗服务环境，这些指标可能是消费者选择医院或其他医疗服务提供者的有用工具。
