Cydulka Rita K, Tamayo-Sarver Joshua, Gage Anita, Bagnoli Dominic
Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
J Emerg Med. 2011 Oct;41(4):405-11. doi: 10.1016/j.jemermed.2010.10.021. Epub 2011 Jan 7.
Patient-physician interactions in the emergency department (ED) are unique in that prior relationships may not exist; interactions are brief, and the environment is hectic.
The research hypotheses were that patient satisfaction scores on a commonly used national satisfaction survey are associated with patient complaints and risk management file openings or lawsuits (risk management episodes).
Administrative databases from an emergency physician management group that staffs 34 EDs in 8 states were merged with patient satisfaction data. Dates of inclusion were January 2002-April 2006. Estimates of physician contribution to satisfaction utilized a multi-level mixed-effects linear regression with a random-effect for practice site and physician, and fixed-effect adjustments for patient factors, time pressures, acuity mix, and physician productivity. Adjusted satisfaction scores were used to explore the relationship with complaints and risk management episodes.
Association of patient satisfaction scores with risk of complaint and risk management episodes.
There were 3947 physician-quarters of practice data analyzed, representing 2,462,617 patient visits. There were 375 complaints and 61 risk management episodes. Those in the lowest quartile of satisfaction were nearly twice as likely to have a complaint (adjusted odds ratio 1.84; 95% confidence interval [CI] 1.29-2.63) as those in the highest quartile. Satisfaction was not directly related to risk management episodes. Complaints were more strongly associated with risk management episodes than other variables: those receiving ≥ 2 complaints in a quarter were 4.13 (95% CI 1.12-15.2) times more likely to have a risk management episode.
Patient satisfaction scores are not associated with increased risk management episodes but are closely related to receiving complaints. Receiving complaints is a strong marker for increased risk management episodes and should prompt early corrective action.
急诊科医患互动具有独特性，因为此前可能不存在医患关系；互动时间短暂，且环境繁忙。
研究假设为，在一项常用的全国性满意度调查中，患者满意度得分与患者投诉以及风险管理档案开启或诉讼（风险管理事件）相关。
将来自一个为8个州34家急诊科配备人员的急诊医生管理小组的行政数据库与患者满意度数据合并。纳入日期为2002年1月至2006年4月。对医生满意度贡献的估计采用多层次混合效应线性回归，对执业地点和医生采用随机效应，对患者因素、时间压力、病情严重程度组合和医生工作效率采用固定效应调整。调整后的满意度得分用于探究与投诉和风险管理事件的关系。
患者满意度得分与投诉风险和风险管理事件的关联。
共分析了3947个医生季度的执业数据，代表2462617次患者就诊。有375起投诉和61起风险管理事件。满意度处于最低四分位数的患者出现投诉的可能性几乎是最高四分位数患者的两倍（调整后的优势比为1.84；95%置信区间[CI]为1.29 - 2.63）。满意度与风险管理事件无直接关联。投诉与风险管理事件的关联比其他变量更强：在一个季度内收到≥2起投诉的患者发生风险管理事件的可能性是其他患者的4.13倍（95%CI为1.12 - 15.2））。
患者满意度得分与风险管理事件增加无关，但与收到投诉密切相关。收到投诉是风险管理事件增加的一个强烈标志，应促使尽早采取纠正措施。
