Anhang Price Rebecca, Elliott Marc N, Cleary Paul D, Zaslavsky Alan M, Hays Ron D
RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202, USA,
J Gen Intern Med. 2015 Feb;30(2):253-6. doi: 10.1007/s11606-014-3111-7. Epub 2014 Nov 22.
Measures of patients' care experiences are increasingly used as quality measures in accountability initiatives. As the prominence and financial impact of patient experience measures have increased, so too have concerns about the relevance and fairness of including them as indicators of health care quality. Using evidence from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, the most widely used patient experience measures in the United States, we address seven common critiques of patient experience measures: (1) consumers do not have the expertise needed to evaluate care quality; (2) patient "satisfaction" is subjective and thus not valid or actionable; (3) increasing emphasis on improving patient experiences encourages health care providers and plans to fulfill patient desires, leading to care that is inappropriate, ineffective, and/or inefficient; (4) there is a trade-off between providing good patient experiences and providing high-quality clinical care; (5) patient scores cannot be fairly compared across health care providers or plans due to factors beyond providers' control; (6) response rates to patient experience surveys are low, or responses reflect only patients with extreme experiences; and (7) there are faster, cheaper, and more customized ways to survey patients than the standardized approaches mandated by federal accountability initiatives.
患者护理体验的衡量指标在问责制举措中越来越多地被用作质量衡量标准。随着患者体验指标的重要性和财务影响不断增加,人们对将其作为医疗质量指标的相关性和公平性也越来越担忧。我们利用美国使用最广泛的患者体验衡量指标——医疗服务提供者与系统消费者评估(CAHPS®)调查的证据,回应了对患者体验指标的七种常见批评:(1)消费者没有评估护理质量所需的专业知识;(2)患者“满意度”是主观的,因此无效或无法采取行动;(3)对改善患者体验的日益重视促使医疗服务提供者和计划满足患者的需求,导致护理不适当、无效和/或低效;(4)提供良好的患者体验与提供高质量的临床护理之间存在权衡;(5)由于提供者无法控制的因素,患者评分在不同医疗服务提供者或计划之间无法进行公平比较;(6)患者体验调查的回复率很低,或者回复仅反映有极端体验的患者;(