HSR&D Center for Organization, Leadership & Management Research, VA Boston Healthcare System (152-M), Boston, MA, USA.
Health Serv Res. 2010 Oct;45(5 Pt 1):1188-204. doi: 10.1111/j.1475-6773.2010.01138.x.
Recent studies have suggested that there is a positive impact of patient-centered care (PCC) on both the patient-physician relationship and subsequent patient health-related behaviors. One recent prospective study reported a significant relationship between the degree of PCC experienced by patients during their hospitalization for acute myocardial infarction (AMI) and their postdischarge cardiac symptoms. A limitation of this study, however, was a lack of information regarding the technical quality of the AMI care, which might have explained at least part of the differences in outcomes. The present study was undertaken to test the influence of both PCC and technical care quality on outcomes among AMI patients.
We analyzed data from a national sample of 1,858 veterans hospitalized for an initial AMI in a Department of Veterans Affairs medical center during fiscal years 2003 and 2004 for whom data had been compiled on evidence-based treatment and who had also completed a Picker questionnaire assessing perceptions of PCC. Cox proportional hazards models were used to estimate the relationship between PCC and survival 1-year postdischarge, controlling for technical quality of care, patient clinical condition and history, admission process characteristics, and patient sociodemographic characteristics. We hypothesized that better PCC would be associated with a lower probability of death 1-year postdischarge, even after controlling for patient characteristics and the technical quality of care.
Better PCC was associated with a significantly but modestly lower hazard of death over the 1-year study period (hazard ratio 0.992, 95 percent confidence interval 0.986-0.999).
Providing PCC may result in important clinical benefits, in addition to meeting patient needs and expectations.
最近的研究表明，以患者为中心的护理（PCC）对医患关系以及患者随后的健康相关行为都有积极影响。最近的一项前瞻性研究报告称，患者在因急性心肌梗死（AMI）住院期间经历的 PCC 程度与出院后心脏症状之间存在显著关系。然而，这项研究的一个局限性是缺乏有关 AMI 护理技术质量的信息，这至少可以部分解释结果的差异。本研究旨在检验 PCC 和技术护理质量对 AMI 患者结局的影响。
我们分析了 2003 年至 2004 年期间在退伍军人事务部医疗中心因初次 AMI 住院的 1858 名退伍军人的全国样本数据，这些患者接受了基于证据的治疗，并完成了评估患者对以患者为中心护理的看法的 Picker 问卷。我们使用 Cox 比例风险模型来估计 PCC 与出院后 1 年生存率之间的关系，控制了护理技术质量、患者临床状况和病史、入院过程特征以及患者社会人口统计学特征。我们假设，即使在控制了患者特征和护理技术质量后，更好的 PCC 与出院后 1 年死亡的可能性降低相关。
更好的 PCC 与 1 年研究期间死亡的风险显著降低相关，但幅度较小（风险比 0.992，95%置信区间 0.986-0.999）。
提供以患者为中心的护理可能除了满足患者的需求和期望外，还会带来重要的临床益处。
