Chang John T, Hays Ron D, Shekelle Paul G, MacLean Catherine H, Solomon David H, Reuben David B, Roth Carol P, Kamberg Caren J, Adams John, Young Roy T, Wenger Neil S
the David Geffen School of Medicine at UCLA and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California; RAND Health, Santa Monica, California; and RAND Health, Arlington, Virginia.
Ann Intern Med. 2006 May 2;144(9):665-72. doi: 10.7326/0003-4819-144-9-200605020-00010.
Patient global ratings of care are commonly used to assess health care. However, the extent to which these assessments of care are related to the technical quality of care received is not well understood.
To investigate the relationship between patient-reported global ratings of health care and the quality of providers' communication and technical quality of care.
Observational cohort study.
2 managed care organizations.
Vulnerable older patients identified by brief interviews of a random sample of community-dwelling adults 65 years of age or older who received care in 2 managed care organizations during a 13-month period.
Survey questions from the second stage of the Consumer Assessment of Healthcare Providers and Systems program were used to determine patients' global rating of health care and provider communication. A set of 236 quality indicators, defined by the Assessing Care of Vulnerable Elders project, were used to measure technical quality of care given for 22 clinical conditions; 207 quality indicators were evaluated by using data from chart abstraction or patient interview.
Data on the global rating item, communication scale, and technical quality of care score were available for 236 vulnerable older patients. In a multivariate logistic regression model that included patient and clinical factors, better communication was associated with higher global ratings of health care. Technical quality of care was not significantly associated with the global rating of care.
Findings were limited to vulnerable elders who were enrolled in managed care organizations and may not be generalizable to other age groups or types of insurance coverage.
Vulnerable elders' global ratings of care should not be used as a marker of technical quality of care. Assessments of quality of care should include both patient evaluations and independent assessments of technical quality.
患者对医疗护理的总体评价常用于评估医疗保健服务。然而，这些护理评估与所接受护理的技术质量之间的关联程度尚未得到充分理解。
探讨患者报告的医疗保健总体评价与医疗服务提供者的沟通质量及护理技术质量之间的关系。
观察性队列研究。
2家管理式医疗组织。
通过对年龄在65岁及以上的社区居住成年人随机抽样进行简短访谈确定的弱势老年患者，这些患者在13个月期间在2家管理式医疗组织接受护理。
使用医疗服务提供者和系统消费者评估计划第二阶段的调查问题来确定患者对医疗保健的总体评价以及与医疗服务提供者的沟通情况。由弱势老年人护理评估项目定义的一组236项质量指标用于衡量针对22种临床病症所提供护理的技术质量；通过病历摘要或患者访谈数据对207项质量指标进行评估。
236名弱势老年患者有关于总体评价项目、沟通量表和护理技术质量得分的数据。在包含患者和临床因素的多变量逻辑回归模型中，更好的沟通与更高的医疗保健总体评价相关。护理技术质量与护理总体评价无显著关联。
研究结果仅限于参加管理式医疗组织的弱势老年人，可能不适用于其他年龄组或保险覆盖类型。
弱势老年人对护理的总体评价不应用作护理技术质量的指标。护理质量评估应包括患者评价和对技术质量的独立评估。
