Hewitson Paul, Skew Alex, Graham Chris, Jenkinson Crispin, Coulter Angela
Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, Headington, England.
BMC Health Serv Res. 2014 Jan 23;14:33. doi: 10.1186/1472-6963-14-33.
Long-term conditions have a significant impact on individuals, their families, and the health service. As people with these conditions represent a high proportion of hospital admissions, investigating their experiences of inpatient care has become an important area of investigation. We conducted a secondary analysis of the NHS adult inpatient survey for England to compare the hospital experiences of three groups of patients: those without long-term conditions, those with a single long-term condition, and those with multiple long-term conditions. We were particularly interested in the extent to which these patients received self-management support from hospital staff, so we developed a brief summary tool drawn from salient questions in the survey to aid the comparison.
Analysis of data from the 2011 national adult inpatient survey (n = 65,134) to compare the experiences of three groups of patients: those with no limiting long-term conditions (No-LLTC), those with one limiting long-term condition (S-LLTC), and those with two or more limiting long-term conditions (M-LLTC). The main outcome measure was patients' self-reports of their experience of inpatient care, including staff-patient interactions, information provision, involvement in decisions and support for self-care and overall ratings of care. A short form scale, the Oxford Patient Involvement and Experience scale (OxPIE) was developed from the adult inpatient survey and used to compare the groups using logistic regression.
There were significant differences between the No-LLTC group in comparison to both the S-LLTC and M-LLTC groups. Patients with limiting long-term conditions reported significantly worse hospital experiences than those without, as measured by OxPIE: S-LLTC odds ratio = 1.23, 95% CI 1.03-1.48; M-LLTC odds ratio = 1.64, 95% CI 1.19-2.26. Responses to a single global rating question were more positive but not strongly correlated with OxPIE.
Patients with LLTCs were more critical of their inpatient care than those with no LLTCs. Those with more than one long-term condition reported worse experiences than those with a single limiting condition. Simple rating questions may not be sufficiently sensitive to reflect important aspects of patients' experience.
慢性病对个人、其家庭及医疗服务有着重大影响。由于患有这些疾病的人群在住院患者中占比很高，调查他们的住院护理体验已成为一个重要的研究领域。我们对英国国民医疗服务体系（NHS）的成人住院患者调查进行了二次分析，以比较三组患者的住院体验：无慢性病患者、患有一种慢性病患者和患有多种慢性病患者。我们尤其关注这些患者从医院工作人员那里获得自我管理支持的程度，因此我们从调查中的关键问题开发了一个简短的总结工具，以帮助进行比较。
分析2011年全国成人住院患者调查的数据（n = 65134），以比较三组患者的体验：无限制性慢性病患者（No - LLTC）、患有一种限制性慢性病患者（S - LLTC）和患有两种或更多种限制性慢性病患者（M - LLTC）。主要结局指标是患者对其住院护理体验的自我报告，包括医患互动、信息提供、参与决策以及自我护理支持和总体护理评分。从成人住院患者调查中开发了一个简短量表，即牛津患者参与和体验量表（OxPIE），并用于通过逻辑回归比较各组。
No - LLTC组与S - LLTC组和M - LLTC组相比存在显著差异。通过OxPIE衡量，患有限制性慢性病的患者报告的住院体验明显比没有慢性病的患者差：S - LLTC优势比 = 1.23，95%置信区间1.03 - 1.48；M - LLTC优势比 = 1.64，95%置信区间1.19 - 2.26。对单个总体评分问题的回答更积极，但与OxPIE的相关性不强。
患有慢性病的患者对其住院护理比没有慢性病的患者更为挑剔。患有多种慢性病的患者报告的体验比患有一种限制性疾病的患者更差。简单的评分问题可能不够敏感，无法反映患者体验的重要方面。
