Yi Michael S, Luckhaupt Sara, Mrus Joseph M, Tsevat Joel
Department of Internal Medicine, Division of General Internal Medicine, Section of Outcomes Research, University of Cincinnati Medical Center, USA.
Health Qual Life Outcomes. 2004 Apr 7;2:19. doi: 10.1186/1477-7525-2-19.
Little information is available regarding medical residents' perceptions of patients' health-related quality of life. Patients cared for by residents have been shown to receive differing patterns of care at Veterans Affairs facilities than at community or university settings. We therefore examined: 1) how resident physicians value the health of patients; 2) whether values differ if the patient is described as a veteran; and 3) whether residency-associated variables impact values.
All medicine residents in a teaching hospital were asked to watch a digital video of an actor depicting a 72-year-old patient with mild-moderate congestive heart failure. Residents were randomized to 2 groups: in one group, the patient was described as a veteran of the Korean War, and in the other, he was referred to only as a male. The respondents assessed the patient's health state using 4 measures: rating scale (RS), time tradeoff (TTO), standard gamble (SG), and willingness to pay (WTP). We also ascertained residents' demographics, risk attitudes, residency program type, post-graduate year level, current rotation, experience in a Veterans Affairs hospital, and how many days it had been since they were last on call. We performed univariate and multivariable analyses using the RS, TTO, SG and WTP as dependent variables.
Eighty-one residents (89.0% of eligible) participated, with 36 (44.4%) viewing the video of the veteran and 45 (55.6%) viewing the video of the non-veteran. Their mean (SD) age was 28.7 (3.1) years; 51.3% were female; and 67.5% were white. There were no differences in residents' characteristics or in RS, TTO, SG and WTP scores between the veteran and non-veteran groups. The mean RS score was 0.60 (0.14); the mean TTO score was 0.80 (0.20); the mean SG score was 0.91 (0.10); and the median (25th, 75th percentile) WTP was 10,000 dollars (7600 dollars, 20,000 dollars) per year. In multivariable analyses, being a resident in the categorical program was associated with assigning higher RS scores, but no residency-associated variables were associated with the TTO, SG or WTP scores.
Physicians in training appear not to be biased either in favor of or against military veterans when judging the value of a patient's health.
关于住院医师对患者健康相关生活质量的看法，目前可用信息较少。研究表明，在退伍军人事务机构接受住院医师治疗的患者，其护理模式与社区或大学环境中的患者不同。因此，我们进行了以下研究：1）住院医师如何评估患者的健康状况；2）如果将患者描述为退伍军人，评估结果是否会有所不同；3）与住院医师相关的变量是否会影响评估结果。
要求一家教学医院的所有内科住院医师观看一段数字视频，视频中一名演员饰演一名患有轻中度充血性心力衰竭的72岁患者。住院医师被随机分为两组：一组中，患者被描述为朝鲜战争退伍军人；另一组中，患者仅被称为男性。受访者使用四种方法评估患者的健康状况：评分量表（RS）、时间权衡法（TTO）、标准博弈法（SG）和支付意愿（WTP）。我们还确定了住院医师的人口统计学特征、风险态度、住院医师培训项目类型、研究生年级、当前轮转科室、在退伍军人事务医院的工作经验，以及距离他们上次值班过去了多少天。我们以RS、TTO、SG和WTP作为因变量进行单变量和多变量分析。
81名住院医师（占符合条件者的89.0%）参与了研究，其中36人（44.4%）观看了退伍军人患者的视频，45人（55.6%）观看了非退伍军人患者的视频。他们的平均（标准差）年龄为28.7（3.1）岁；51.3%为女性；67.5%为白人。退伍军人组和非退伍军人组在住院医师特征以及RS、TTO、SG和WTP评分方面均无差异。RS评分的平均值为0.60（0.14）；TTO评分的平均值为0.80（0.20）；SG评分的平均值为0.9(0.10)；WTP的中位数（第25、75百分位数）为每年10,000美元（7600美元，20,000美元）。在多变量分析中，参加分类培训项目的住院医师与较高的RS评分相关，但没有与住院医师相关的变量与TTO、SG或WTP评分相关。
在判断患者健康价值时，接受培训的医生似乎对退伍军人不存在偏袒或偏见。
