Johnson David P, Browning Whitney L, Gay James C, Williams Derek J
Divisions of Hospital Medicine and
Divisions of Hospital Medicine and.
Hosp Pediatr. 2015 Apr;5(4):211-8. doi: 10.1542/hpeds.2014-0086.
To determine pediatric hospitalists' perceptions about residents' effects on cost and quality of care and their own ability to provide and teach cost-effective, high-quality care.
A 15-item survey assessing hospitalist perceptions of resident impact on costs/quality and their role in teaching cost-effectiveness was developed and sent to 180 hospitalists from 113 institutions in the United States.
Of 180 hospitalists surveyed, 127 completed surveys (71%). Overall, 76 (60%) and 91 (72%) hospitalists believed that residents increase quality and cost of care, respectively. Respondents who worked with residents all the time were more likely to state that residents increase quality (50 of 70 [71%]) compared with those who worked with residents sometimes (18 of 42 [43%]) or never (8 of 15 [53%]; P=.01). Similarly, academic hospitalists were more likely than community hospitalists to believe that residents increase quality (67 of 103 [65%] vs 9 of 24 [38%]; P=.03). Although only 28 (22%) respondents reported receiving formal cost-effectiveness training, 116 (91%) believed that they provided cost-effective care, and 103 (81%) believed that they were qualified to teach this topic. Most respondents (n=115 [91%]) believed that residents should participate in a cost-effectiveness curriculum.
Most respondents felt trainees increase both the costs and quality of care for hospitalized children. The perception of increased quality was associated with increased resident interaction, whereas cost perceptions were similar across groups. Pediatric hospitalists report a lack of formal cost-effectivesness training, but nearly all respondents supported the incorporation of such training into graduate medical education programs.
确定儿科住院医师对住院医师对医疗成本和质量的影响以及他们自身提供和教授具有成本效益的高质量医疗服务能力的看法。
设计了一项包含15个条目的调查问卷，评估住院医师对住院医师对成本/质量的影响及其在教授成本效益方面作用的看法，并将其发送给来自美国113家机构的180名住院医师。
在接受调查的180名住院医师中，127人完成了调查（71%）。总体而言，分别有76名（60%）和91名（72%）住院医师认为住院医师提高了医疗质量和成本。与有时（42人中有18人[43%]）或从不（15人中有8人[53%]）与住院医师共事的人相比，一直与住院医师共事的受访者更有可能表示住院医师提高了医疗质量（70人中有50人[71%]；P = 0.01）。同样，学术型住院医师比社区型住院医师更有可能认为住院医师提高了医疗质量（103人中有67人[65%]对24人中有9人[38%]；P = 0.03）。尽管只有28名（22%）受访者报告接受过正式的成本效益培训，但116名（91%）认为他们提供了具有成本效益的医疗服务，103名（81%）认为他们有资格教授这一主题。大多数受访者（n = 115 [91%]）认为住院医师应该参加成本效益课程。
大多数受访者认为住院医师会增加住院儿童的医疗成本和质量。对医疗质量提高的认知与住院医师互动增加有关，而不同群体对成本的认知相似。儿科住院医师报告缺乏正式的成本效益培训，但几乎所有受访者都支持将此类培训纳入毕业后医学教育项目。
