Jacobi Catharina E, Boshuizen Hendriek C, Rupp Ines, Dinant Huibert J, van den Bos Geertrudis A M
Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Int J Qual Health Care. 2004 Feb;16(1):73-81. doi: 10.1093/intqhc/mzh009.
To identify health care aspects of inadequate quality in rheumatoid arthritis (RA) care from the perspective of patients, and to study to what extent patients' perspectives on quality of care are associated with patient characteristics.
Cross-sectional questionnaire survey performed in 1999.
Secondary and tertiary rheumatology outpatient clinics.
A random sample (n = 683) of patients diagnosed with rheumatoid arthritis according to the 1987 revised American College of Rheumatology criteria. Patients varied widely with respect to age (mean 61.5 years) and disease duration (mean 10.7 years).
Using the method of the QUOTE-questionnaire, patients' were asked to rate the importance to them of 29 aspects of care, and to rate the performance of five different health care providers [i.e. rheumatologist, general practitioner (GP), physiotherapist, home nurse, and formal home help] relating to these aspects. To identify aspects of inadequate quality, patients' performance ratings were weighted by importance ratings within each health care service. Inadequate performance on an extremely important aspect was found to be a more serious quality problem than an inadequate performance on an aspect that was less important to patients. Using regression analyses, the association between patients' quality ratings and patient characteristics was assessed.
Several aspects of inadequate quality were identified, namely in the field of knowledge of rheumatism and particularly for GPs, physiotherapists, home nurses, and formal home help, and in the field of information on medication and treatment for rheumatologists and GPs. Furthermore, for the majority of the importance and performance ratings, we found no association with patient-related characteristics.
Our study demonstrated that the quality of care could be improved further from the perspective of patients. These findings may be used for making health care more responsive to patients' needs.
从患者角度识别类风湿关节炎（RA）护理中质量不足的医疗保健方面，并研究患者对护理质量的看法在多大程度上与患者特征相关。
1999年进行的横断面问卷调查。
二级和三级风湿病门诊。
根据1987年修订的美国风湿病学会标准诊断为类风湿关节炎的患者随机样本（n = 683）。患者在年龄（平均61.5岁）和病程（平均10.7年）方面差异很大。
使用QUOTE问卷法，要求患者对29个护理方面对他们的重要性进行评分，并对五名不同医疗保健提供者[即风湿病学家、全科医生（GP）、物理治疗师、家庭护士和正规家庭护理人员]在这些方面的表现进行评分。为了识别质量不足的方面，在每个医疗保健服务中，患者的表现评分根据重要性评分进行加权。发现在极其重要的方面表现不足比在对患者不太重要的方面表现不足是更严重的质量问题。使用回归分析评估患者质量评分与患者特征之间的关联。
识别出几个质量不足的方面，即在风湿病知识领域，特别是对于全科医生、物理治疗师、家庭护士和正规家庭护理人员，以及在风湿病学家和全科医生的药物和治疗信息领域。此外，对于大多数重要性和表现评分，我们发现与患者相关特征没有关联。
我们的研究表明，从患者角度来看，护理质量可以进一步提高。这些发现可用于使医疗保健更能响应患者需求。
