Xu Xiao, Buta Eugenia, Anhang Price Rebecca, Elliott Marc N, Hays Ron D, Cleary Paul D
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
Department of Biostatistics and the Yale Center for Analytic Studies, Yale School of Public Health, New Haven, CT.
Health Serv Res. 2015 Aug;50(4):1146-61. doi: 10.1111/1475-6773.12264. Epub 2014 Dec 7.
To illustrate methodological considerations when assessing the relationship between patient care experiences and mortality.
Medical Expenditure Panel Survey data (2000-2005) linked to National Health Interview Survey and National Death Index mortality data through December 31, 2006.
We estimated Cox proportional hazards models with mortality as the dependent variable and patient experience measures as independent variables and assessed consistency of experiences over time.
We used data from respondents age 18 or older with at least one doctor's office or clinic visit during the year prior to the round 2 interview. We excluded subjects who died in the baseline year.
The association between overall care experiences and mortality was significant for deaths not amenable to medical care and all-cause mortality, but not for amenable deaths. More than half of respondents were in a different care experience quartile over a 1-year period. In the five individual experience questions we analyzed, only time spent with the patient was significantly associated with mortality.
Deaths not amenable to medical care and the time-varying and multifaceted nature of patient care experience are important issues to consider when assessing the relationship between care experience and mortality.
阐述评估患者护理体验与死亡率之间关系时的方法学考量。
医疗支出面板调查数据（2000 - 2005年），通过2006年12月31日与国民健康访谈调查及国家死亡指数死亡率数据相链接。
我们以死亡率为因变量、患者体验指标为自变量估计了Cox比例风险模型，并评估了体验随时间的一致性。
我们使用了在第二轮访谈前一年至少有一次去医生办公室或诊所就诊的18岁及以上受访者的数据。我们排除了在基线年份死亡的受试者。
总体护理体验与死亡率之间的关联对于不可治疗死亡和全因死亡率具有显著性，但对于可治疗死亡则不然。超过一半的受访者在1年期间处于不同的护理体验四分位数区间。在我们分析的五个个人体验问题中，只有与患者相处的时间与死亡率显著相关。
不可治疗死亡以及患者护理体验的时变和多面性是评估护理体验与死亡率之间关系时需要考虑的重要问题。
