Schmocker Ryan K, Holden Sara E, Vang Xia, Lumpkin Stephanie T, Cherney Stafford Linda M, Leverson Glen E, Winslow Emily R
Department of Surgery, University of Wisconsin Clinical Science Center, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
Department of General Surgery, University of North Carolina, Chapel Hill, NC, USA.
Am J Surg. 2016 Aug;212(2):282-8. doi: 10.1016/j.amjsurg.2015.10.017. Epub 2015 Dec 13.
Patient satisfaction is often measured using the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Our aim was to examine the structural and clinical determinants of satisfaction among inpatients with prolonged lengths of stays (LOS).
Adult patients who were admitted between 2009 and 2012, had a LOS of 21 days or more, and completed the Hospital Consumer Assessment of Healthcare Providers and Systems survey, were included. Univariate analyses assessed the relationship between satisfaction and patient/system variables. Recursive partitioning was used to examine the relative importance of the identified variables.
One hundred one patients met inclusion criteria. The average LOS was 35 days and 58% were admitted to a surgical service. Satisfaction with physician communication was significantly associated with fewer consultations (P < .01), nonoperative admission (P < .001), no intensive care unit stay (P < .01), nonsurgical service (P < .01), and non-emergency room admissions (P = .03). Among these, having fewer consultations had the highest relative importance.
In long stay patients, having fewer inpatient consultations was the strongest predictor of patient satisfaction with physician communication. This suggests that examination of patient-level data in clinically relevant subgroups may be a useful way to identify targets for quality improvement.
患者满意度通常使用医疗服务提供者与系统消费者评估调查来衡量。我们的目的是研究住院时间延长（LOS）的住院患者满意度的结构和临床决定因素。
纳入2009年至2012年间入院、住院时间为21天或更长且完成了医疗服务提供者与系统消费者评估调查的成年患者。单因素分析评估了满意度与患者/系统变量之间的关系。递归划分用于检验所确定变量的相对重要性。
101名患者符合纳入标准。平均住院时间为35天，58%的患者入住外科服务科室。对医生沟通的满意度与会诊次数较少（P <.01）、非手术入院（P <.001）、未入住重症监护病房（P <.01）、非外科服务科室（P <.01）以及非急诊室入院（P =.03）显著相关。其中，会诊次数较少的相对重要性最高。
在长期住院患者中，住院会诊次数较少是患者对医生沟通满意度的最强预测因素。这表明在临床相关亚组中检查患者层面的数据可能是确定质量改进目标的有用方法。
