在比较过医院的患者中，医院绩效数据的影响是否更大？
Is the impact of hospital performance data greater in patients who have compared hospitals?
机构信息
Department of Medical Decision Making, Leiden University Medical Center, The Netherlands.
出版信息
BMC Health Serv Res. 2011 Sep 9;11:214. doi: 10.1186/1472-6963-11-214.
BACKGROUND
Public information on average has limited impact on patients' hospital choice. However, the impact may be greater in consumers who have compared hospitals prior to their hospital choice. We therefore assessed whether patients who have compared hospitals based their hospital choice mainly on public information, rather than e.g. advice of their general practitioner and consider other information important than patients who have not compared hospitals.
METHODS
337 new surgical patients completed an internet-based questionnaire. They were asked whether they had compared hospitals prior to their hospital choice and which factors influenced their choice. They were also asked to select between four and ten items of hospital information (total: 41 items) relevant for their future hospital choice. These were subsequently used in a hospital choice experiment in which participants were asked to compare hospitals in an Adaptive Choice-Based Conjoint analysis to estimate which of the hospital characteristics had the highest Relative Importance (RI).
RESULTS
Patients who have compared hospitals more often used public information for their hospital choice than patients who have not compared hospitals (12.7% vs. 1.5%, p < 0.001). However, they still mostly relied on their own (47.9%) and other people's experiences (31%) rather than to base their decision on public information. Both groups valued physician's expertise (RI 20.2 [16.6-24.8] in patients comparing hospitals vs. 16.5 [14.2-18.8] in patients not comparing hospitals) and waiting time (RI 15.1 [10.7-19.6] vs. 15.6 [13.2-17.9] respectively) as most important public information. Patients who have compared hospitals assigned greater importance to information on wound infections (p = 0.010) and respect for patients (p = 0.022), but lower importance to hospital distance (p = 0.041).
CONCLUSION
Public information has limited impact on patient's hospital choice, even in patients who have actually compared hospitals prior to hospital choice.
背景
公众信息对患者的医院选择的影响有限。然而，对于那些在选择医院之前已经对医院进行过比较的消费者来说，这种影响可能更大。因此，我们评估了那些基于公众信息而不是例如他们的全科医生的建议来做出医院选择的患者，是否比那些没有比较过医院的患者更看重这些信息，并考虑了其他比没有比较过医院的患者更重要的信息。
方法
337 名新的外科患者完成了一项基于互联网的问卷调查。他们被问到是否在选择医院之前进行过比较，以及哪些因素影响了他们的选择。他们还被要求从与未来医院选择相关的 41 项医院信息中选择 4 到 10 项（总计：41 项）。这些信息随后被用于医院选择实验中，参与者被要求在自适应选择基于联合分析中比较医院，以估计医院特征的相对重要性（RI）。
结果
与没有比较过医院的患者相比，那些比较过医院的患者更经常使用公众信息来做出医院选择（12.7%对 1.5%，p < 0.001）。然而，他们仍然主要依赖于自己的（47.9%）和他人的经验（31%），而不是基于公众信息做出决定。两组患者都认为医生的专业知识（RI 20.2 [16.6-24.8]在比较过医院的患者中，RI 16.5 [14.2-18.8]在没有比较过医院的患者中）和等待时间（RI 15.1 [10.7-19.6]在比较过医院的患者中，RI 15.6 [13.2-17.9]在没有比较过医院的患者中）是最重要的公众信息。比较过医院的患者更重视有关伤口感染（p = 0.010）和对患者的尊重（p = 0.022）的信息，但对医院距离的重视程度较低（p = 0.041）。
结论
即使在那些在选择医院之前已经实际比较过医院的患者中，公众信息对患者的医院选择的影响也有限。
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