Harriott Erica M, Williams Thomas V, Peterson Michael R
Center for Health Care Management Studies, Office of the Assistant Secretary of Defense, Health Affairs, TRICARE Management Activity, Falls Church, Virginia 22041-3206, USA.
Birth. 2005 Mar;32(1):4-10. doi: 10.1111/j.0730-7659.2005.00342.x.
The U.S. Department of Defense provides medical services for approximately 9.1 million beneficiaries, one-half of whom are women. Information is lacking about how well the military health system has adopted patient-centered approaches for promoting individual choice and preference in a bureaucratically structured military hospital. The purpose of this study was to examine women's evaluations of maternity care with respect to decision-making, confidence, trust in health care providers, and treatment within the military hospital.
The Department of Defense Inpatient Childbirth Survey was mailed to a simple stratified random sample of beneficiaries who received maternity care at a military hospital between July 1 and September 30, 2001. Data for 11 dimensions of women's care and experiences were examined from self-reported assessments of 2,124 respondents who gave birth at one of 44 military hospitals. A multiple logistic regression model was estimated to determine which dimensions of care predicted beneficiaries' likelihood to recommend the military hospital to family and friends.
Less than 50 percent of respondents would recommend the military hospital to family and friends. Significantly associated with women's willingness to recommend their specific military hospital to others were courtesy and availability of staff, confidence and trust in provider, treatment with respect and dignity, information and education, physical comfort, involvement of friends and family, continuity and transition, and involvement in decision-making.
In a military population, obstetric patients who are treated with respect, courtesy, and dignity, are involved in decisions about their care, and have established trusting relationships with their practitioners are significantly more likely to recommend the military hospital to others. It is important for military health care leaders to establish a proactive program of patient-centered maternity care. Continuous care, education, support services, and a multidisciplinary approach should be integrated to retain and recapture obstetric patients who are served in military hospitals in the United States.
美国国防部为大约910万受益人提供医疗服务，其中一半为女性。关于军事卫生系统在官僚结构的军事医院中采用以患者为中心的方法以促进个人选择和偏好方面的情况，目前缺乏相关信息。本研究的目的是考察女性对军事医院产科护理在决策、信心、对医疗服务提供者的信任以及治疗方面的评价。
向2001年7月1日至9月30日期间在军事医院接受产科护理的受益人简单分层随机样本邮寄了国防部住院分娩调查问卷。从2124名在44家军事医院之一分娩的受访者的自我报告评估中，考察了女性护理和经历的11个维度的数据。估计了一个多元逻辑回归模型，以确定护理的哪些维度能够预测受益人向家人和朋友推荐军事医院的可能性。
不到50%的受访者会向家人和朋友推荐该军事医院。与女性向他人推荐其所在特定军事医院的意愿显著相关的因素包括工作人员的礼貌和可及性、对提供者的信心和信任、受到尊重和有尊严的治疗、信息和教育、身体舒适度、朋友和家人的参与、连续性和过渡以及参与决策。
在军人群体中，受到尊重、礼貌和有尊严对待、参与护理决策并与从业者建立了信任关系的产科患者向他人推荐军事医院的可能性显著更高。军事医疗保健领导者建立一个积极主动的以患者为中心的产科护理项目非常重要。应整合持续护理、教育、支持服务和多学科方法，以留住和重新吸引在美国军事医院接受服务的产科患者。
