Macario A, Weinger M, Carney S, Kim A
Department of Anesthesia, Stanford University Medical Center, California 94305-5115, USA.
Anesth Analg. 1999 Sep;89(3):652-8. doi: 10.1097/00000539-199909000-00022.
Healthcare quality can be improved by eliciting patient preferences and customizing care to meet the needs of the patient. The goal of this study was to quantify patients' preferences for postoperative anesthesia outcomes. One hundred one patients in the preoperative clinic completed a written survey. Patients were asked to rank (order) 10 possible postoperative outcomes from their most undesirable to their least undesirable outcome. Each outcome was described in simple language. Patients were also asked to distribute $100 among the 10 outcomes, proportionally more money being allocated to the more undesirable outcomes. The dollar allocations were used to determine the relative value of each outcome. Rankings and relative value scores correlated closely (r2 = 0.69). Patients rated from most undesirable to least undesirable (in order): vomiting, gagging on the tracheal tube, incisional pain, nausea, recall without pain, residual weakness, shivering, sore throat, and somnolence (F-test < 0.01).
Although there is variability in how patients rated postoperative outcomes, avoiding nausea/vomiting, incisional pain, and gagging on the endotracheal tube was a high priority for most patients. Whether clinicians can improve the quality of anesthesia by designing anesthesia regimens that most closely meet each individual patient's preferences for clinical outcomes deserves further study.
通过了解患者偏好并定制护理以满足患者需求，可以提高医疗质量。本研究的目的是量化患者对术后麻醉结果的偏好。术前门诊的101名患者完成了一份书面调查。要求患者将10种可能的术后结果按从最不理想到最理想的顺序进行排序。每个结果都用简单的语言描述。还要求患者在这10种结果之间分配100美元，将更多的钱按比例分配给更不理想的结果。美元分配用于确定每个结果的相对价值。排序和相对价值得分密切相关（r2 = 0.69）。患者从最不理想到最理想的排序（按顺序）为：呕吐、气管导管呛咳、切口疼痛、恶心、无痛回忆、残余无力、寒战、咽痛和嗜睡（F检验<0.01）。
尽管患者对术后结果的评分存在差异，但对大多数患者来说，避免恶心/呕吐、切口疼痛和气管导管呛咳是高度优先事项。临床医生是否可以通过设计最符合每个患者对临床结果偏好的麻醉方案来提高麻醉质量，值得进一步研究。
