Serious Mental Illness Treatment Resource and Evaluation Center, Health Services Research and Development Service, Department of Veterans Affairs Ann Arbor Healthcare System, North Campus Research Complex, Ann Arbor, MI 48109, USA.
Psychiatr Serv. 2013 Jun;64(6):554-62. doi: 10.1176/appi.ps.002342012.
This study used factor analysis of a Veterans Health Administration (VHA) survey to identify factors that measure satisfaction with inpatient treatment and to examine the factors' utility in evaluating treatment participation following discharge.
The Survey of Healthcare Experiences of Patients (inpatient version) (I-SHEP) was mailed to 34,237 veterans who were discharged from inpatient to outpatient care in the VHA during fiscal year 2009 and was completed by 7,408 patients. A factor analysis of survey responses identified underlying I-SHEP factors and evaluated relationships between the factors, patient characteristics, and attendance at VHA mental health appointments within seven and 30 days of discharge.
The factor analysis identified three domains of satisfaction: respect and caring by nurses-overall hospital impression; involvement and information about care; and respect and caring by doctors. These factors demonstrated good internal consistency (Cronbach's α=.93, .90, and .94, respectively) and accounted for a moderate amount of variance in patient responses (r2=.167). Only the care involvement and information factor was associated with participation in follow-up care: increased satisfaction (one standard deviation change in scale score) was associated with improved odds of a mental health visit within seven and 30 days of discharge (odds ratio=1.14 and 1.17, respectively, p<.01).
After discharge, persons may not generalize satisfaction about the respect and caring shown by inpatient treatment teams toward their decision to attend outpatient care. Providing patients with information about treatment and involving them in care decisions during inpatient care may help facilitate the transition to outpatient settings.
本研究通过对退伍军人健康管理局（VHA）调查进行因子分析，确定衡量患者对住院治疗满意度的因素，并检验这些因素在评估出院后治疗参与度方面的效用。
2009 财年期间，在退伍军人健康管理局接受住院治疗转为门诊治疗的 34237 名退伍军人收到了患者医疗体验调查（住院版）（I-SHEP），并由 7408 名患者完成了调查。对调查结果进行因子分析，以确定 I-SHEP 的潜在因素，并评估这些因素与患者特征以及出院后 7 天和 30 天内参加退伍军人健康管理局心理健康预约之间的关系。
因子分析确定了三个满意度领域：护士的尊重和关怀-整体医院印象；护理的参与和信息；医生的尊重和关怀。这些因素表现出良好的内部一致性（Cronbach's α 分别为.93、.90 和.94），并能很好地解释患者反应的变异性（r2=.167）。只有护理参与和信息因素与随访护理的参与度相关：在规模评分上增加一个标准差的满意度（一个标准差变化）与出院后 7 天和 30 天内心理健康就诊的可能性增加相关（优势比分别为 1.14 和 1.17，p<.01）。
出院后，患者可能不会将对住院治疗团队表现出的尊重和关怀的满意度普遍推广到他们参加门诊护理的决定。在住院治疗期间为患者提供治疗信息并让他们参与护理决策，可能有助于促进向门诊环境的过渡。
