Reeves Rachel, West Elizabeth
Principal Research Fellow, School of Health and Social Care, University of Greenwich, England, UK
Professor of Applied Social Science, School of Health and Social Care, University of Greenwich, England, UK.
J Health Serv Res Policy. 2015 Jul;20(3):131-7. doi: 10.1177/1355819614564256. Epub 2014 Dec 21.
Adult inpatient surveys generate approximately 70,000 responses per year about patients' experiences of National Health Service hospital care in England. We examine historical data to assess change between 2002 and 2013 and consider the factors that may have stimulated any change.
Archived national data from National Health Service Inpatient Surveys between 2002 and 2013 (comprising 840,077 patient responders) were obtained. Questions were selected for inter-year analysis if they had been replicated for at least seven years. The percentage of responses in the most positive category was compared for each question's earliest and most recent year. The statistical significance of differences was tested using chi-square. Also, since such large sample sizes mean that even 1% differences are statistically significant, effect sizes were used to assess the practical significance of those differences.
There were statistically significant (p < .001) increases in positive responses to 35 questions, a significant deterioration for 8 questions and no change for 7 questions. There was one 'moderate' improvement (ϕ = 0.3), six 'small' improvements (ϕ > 0.1) and one 'small' decline, but differences were not meaningful for 42 questions. The greatest improvements were for patients receiving copies of doctors' letters; single sex ward areas; clinicians' hand washing; ward cleanliness and planned admission waiting times. The greatest decline was that fewer responders said their call bells were usually answered within 2 min.
More aspects of care have improved than have deteriorated. This study highlights the need for a consistent repeated survey programme to detect changes over the long term, since year-to-year changes tend to be small. The greatest improvements are in areas that can be influenced by organisation-wide interventions and many are associated with top-down government policies, targets or media campaigns. Patients' evaluations of many aspects of their interactions with clinicians are unchanged or have declined. Further research could test whether ward-specific facilitated communication of survey results to clinicians could drive improvements in clinician-patient interactions.
成人住院患者调查每年能收到约7万份关于英格兰国民医疗服务体系（NHS）医院护理患者体验的回复。我们通过审查历史数据来评估2002年至2013年期间的变化，并考虑可能引发任何变化的因素。
获取了2002年至2013年期间国民医疗服务体系住院患者调查的存档全国数据（包括840,077名患者回复者）。如果问题被重复提出至少七年，则选择这些问题进行跨年分析。比较每个问题最早和最近一年中最积极类别回复的百分比。使用卡方检验差异的统计学显著性。此外，由于如此大的样本量意味着即使1%的差异在统计学上也是显著的，因此使用效应量来评估这些差异的实际显著性。
对35个问题的积极回复有统计学显著增加（p <.001），8个问题显著恶化，7个问题无变化。有1项“中等”改善（ϕ = 0.3），6项“小”改善（ϕ > 0.1）和1项“小”下降，但42个问题的差异无意义。最大的改善在于患者收到医生信件副本、单性别病房区域、临床医生洗手、病房清洁度和计划入院等待时间方面。最大的下降是表示呼叫铃通常能在2分钟内得到回应的回复者减少。
护理改善的方面多于恶化的方面。本研究强调需要一个持续重复的调查计划来长期检测变化，因为逐年变化往往较小。最大的改善在于可受全组织干预影响的领域，许多改善与自上而下的政府政策、目标或媒体宣传活动相关。患者对与临床医生互动的许多方面的评价没有变化或有所下降。进一步的研究可以测试病房特定的向临床医生传达调查结果的便利方式是否能推动临床医生与患者互动的改善。
