*Yale School of Public Health, Yale School of Medicine, New Haven, CT †HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (152-M) ‡Department of Health Policy & Management, Boston University School of Public Health, Boston, MA §VA Office of Analytics and Business Intelligence, Washington, DC ∥Department of Health Care Policy, Harvard Medical School, Boston, MA.
Med Care. 2014 Jul;52(7):619-25. doi: 10.1097/MLR.0000000000000144.
Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients.
To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information.
We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI.
Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were >0.97 across 9 dimensions of inpatient experience.
This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics.
调查越来越多地被用于评估患者对医疗保健的体验。基于患者体验调查的医院评分比较应该针对可能影响调查结果的患者特征进行调整。这些特征通常来自于收集很少或没有临床信息的患者调查。因此，一些医院，尤其是那些治疗特别复杂患者的医院，一直担心标准调整方法不能充分反映治疗患者的挑战。
仅使用调查报告的患者特征和更完整的临床和医院信息进行调整后，比较不同类型医院的评分。
我们使用了来自退伍军人事务部（VA）医疗中心 2003 年和 2004 年财政年度初次急性心肌梗死（AMI）住院的 1858 名退伍军人的全国样本的临床和调查数据。我们使用 VA 行政数据来描述医院。调查询问了患者对医院护理的体验。临床数据包括从预测 AMI 后生存的医疗记录中提取的 14 个指标。
仅根据患者报告的健康状况和社会人口特征调整的医院评分比较与同时根据患者临床特征调整的评分比较相似；2 组调整后评分之间的斯皮尔曼等级相关系数在住院体验的 9 个维度中均>0.97。
这项研究不支持这样的观点，即患者护理体验的衡量标准是不公平的，因为常用模型不能充分调整可能影响患者临床特征的因素。
