Department of Nursing, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
J Hosp Med. 2012 May-Jun;7(5):370-5. doi: 10.1002/jhm.1931. Epub 2012 Feb 29.
Despite government investment in public reporting of hospital quality data, patients still rely on recommendations from their primary care physicians (PCPs). Little is known about how physicians make hospital referrals.
To characterize factors that influence PCPs' hospital referral choices.
Web-based physician survey.
PCPs affiliated with 3 Massachusetts hospitals.
Physician demographics, familiarity with public reporting, and opinions about which factors would influence hospital referral decisions for an elderly patient with pneumonia.
Of 194 PCPs who received invitations, 92 (47%) responded. Although 93% maintained admitting privileges, only 20% admitted patients. The following were considered "very" important in referral decisions: "familiarity with the hospital" (70%), "patient preference" (62%), and "admitting arrangements with a hospitalist group" (62%). "Publicly available quality measures" were "not at all" important to 42%. Only 61% were aware of hospital quality reporting; 16% were familiar with Hospital Compare, a Centers for Medicare and Medicaid Services (CMS) Web site. No physicians reported ever using quality information to make a referral decision or discussing it with patients. No physician factors were associated with awareness of publicly reported data. PCPs identified the following factors as being "very" important in determining the quality of pneumonia care: antibiotics within 6 hours of arrival (66%), appropriate initial antibiotic (63%), and blood cultures performed prior to the administration of antibiotics (51%).
Although PCPs most valued the information available through Hospital Compare, only 16% were aware of it, and none used publicly reported quality data in referral decisions. Medicare and high-performing hospitals should consider marketing Hospital Compare to PCPs.
尽管政府对医院质量数据的公开报告进行了投资，但患者仍然依赖于他们的初级保健医生（PCP）的建议。对于医生如何进行医院转诊，知之甚少。
描述影响 PCP 医院转诊选择的因素。
基于网络的医生调查。
隶属于马萨诸塞州 3 家医院的 PCP。
医生的人口统计学特征、对公开报告的熟悉程度以及对哪些因素会影响老年肺炎患者的医院转诊决策的看法。
在收到邀请的 194 名 PCP 中，有 92 名（47%）做出了回应。尽管 93%的人保留了收治权，但只有 20%的人收治患者。在转诊决策中被认为“非常”重要的因素包括：“对医院的熟悉程度”（70%）、“患者的偏好”（62%）和“与医院医生组的收治安排”（62%）。“公开可获得的质量指标”对 42%的人来说“一点也不重要”。只有 61%的人知道医院质量报告；16%的人熟悉医疗保险和医疗补助服务中心（CMS）网站 Hospital Compare。没有医生报告曾经使用过质量信息来做出转诊决定或与患者讨论过。没有医生因素与对公开报告数据的了解有关。PCP 确定了以下因素在确定肺炎护理质量方面“非常”重要：到达后 6 小时内使用抗生素（66%）、使用适当的初始抗生素（63%）以及在使用抗生素前进行血培养（51%）。
尽管 PCP 最看重通过 Hospital Compare 提供的信息，但只有 16%的人知道这一点，而且没有人在转诊决策中使用公开报告的质量数据。医疗保险和高绩效医院应考虑向 PCP 推销 Hospital Compare。
