1 Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada 2 Hamilton Health Sciences, Hamilton, Ontario, Canada 3 Strategic Market Leadership and Health Services Management, DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada 4 Institute for Knowledge Innovation and Technology (IKIT), University of Toronto, Toronto, Ontario, Canada.
Patient. 2008 Dec 1;1(4):317-30. doi: 10.2165/1312067-200801040-00013.
A consensus regarding the components of a patient-centered approach to healthcare does not exist. Although patient-centered care should be predicated on patient preferences, existing models provide little evidence regarding the relative importance of different care processes to patients themselves.
To involve patients in the design of a model of patient-centered care for a corporation of Canadian teaching hospitals.
Using themes from focus groups and interviews, a conjoint survey was developed comprising 14 four-level patient-centered care attributes. Sawtooth Software's Choice Based Conjoint module (version 2.6.7) was used to design the survey. Each participant completed 15 choice tasks, each task presenting a choice between three hospitals described by a different combination of patient-centered care attribute levels. Latent class analysis was used to identify segments of participants with similar patient-centered care choice patterns. Randomized First Choice simulations were used to predict the percentage of participants in each segment who would choose different approaches to improving patient-centered care.Representative hospital service users were recruited from a corporation of five Canadian teaching hospitals serving a regional population of 2.2 million.
A total of 508 patients and family members of children completed a choice-based conjoint survey. Latent class analysis revealed two segments: an informed care segment and a convenient care segment. Participants in the informed care segment (71.3% of the sample) were more likely to have higher education, be non-immigrants, speak English as a first language, and be outpatients or family members.The information needed to understand health concerns, an opportunity to learn health improvement skills, teams that communicated effectively, short waiting times, and collaborative treatment planning were more important to the informed care segment than to the convenient care segment. Convenient settings, a welcoming environment, and ease of internal access exerted a greater influence on the choices made by the convenient care segment. Both segments preferred hospitals that provided health information and gave prompt feedback on patient progress.
This study suggests that many patients would exchange an increase in waiting times for prompt feedback, information, and the skills to improve their health.
目前尚未就以患者为中心的医疗保健方法的组成部分达成共识。尽管以患者为中心的护理应该基于患者的偏好，但现有的模式几乎没有提供关于不同护理过程对患者本身相对重要性的证据。
让患者参与设计加拿大教学医院集团以患者为中心的护理模式。
使用焦点小组和访谈的主题，开发了一个包含 14 个四级以患者为中心的护理属性的联合调查。Sawtooth Software 的基于选择的联合模块（版本 2.6.7）用于设计调查。每个参与者完成了 15 项选择任务，每项任务都在三个由不同的以患者为中心的护理属性水平组合描述的医院之间进行选择。潜在类别分析用于识别具有相似以患者为中心的护理选择模式的参与者细分。随机第一选择模拟用于预测每个细分市场中会选择不同方法来改善以患者为中心的护理的参与者的百分比。
共有 508 名儿童的患者和家属完成了基于选择的联合调查。潜在类别分析揭示了两个细分市场：知情护理细分市场和便利护理细分市场。知情护理细分市场（样本的 71.3%）的参与者更有可能接受过高等教育、是非移民、将英语作为第一语言，并且是门诊患者或家属。了解健康问题所需的信息、学习健康改善技能的机会、有效沟通的团队、短的等待时间和协作的治疗计划对知情护理细分市场比对便利护理细分市场更为重要。便利的环境、欢迎的环境和内部访问的便利性对便利护理细分市场的选择产生了更大的影响。两个细分市场都更喜欢提供健康信息并及时反馈患者进展的医院。
这项研究表明，许多患者愿意等待时间更长，以换取及时的反馈、信息和改善健康的技能。
