Figueroa Jose F, Schnipper Jeffrey L, McNally Kelly, Stade Diana, Lipsitz Stuart R, Dalal Anuj K
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
J Hosp Med. 2016 Sep;11(9):615-9. doi: 10.1002/jhm.2569. Epub 2016 Feb 29.
To deliver high-quality, patient-centered care during hospitalization, healthcare providers must correctly identify the patient's primary recovery goal.
To determine the degree of concordance between patients and key hospital providers.
A validated questionnaire administered to a random sample of hospitalized patients alongside their nurse and physician provider. Goals included: "be cured," "live longer," "improve/maintain health," "be comfortable," "accomplish a particular life goal," or "other."
Major academic hospital in Boston, Massachusetts.
Adult patients admitted for more than 48 hours from November 2013 to May 2014 were eligible. When a patient was incapacitated, a legal proxy was interviewed. The nurse and physician provider were then interviewed within 24 hours.
Frequencies of responses for each recovery goal and the rate of concordance among the patient, nurse, and physician provider were measured. The frequency of responses across groups were compared using adjusted χ(2) analyses. Inter-rater agreement was measured using 2-way Kappa tests.
All 3 participants were interviewed in 109 of the 181 (60.2%) patients approached (or with proxy available). Significant differences in selected goals were observed across respondent groups (P < 0.001). Patients frequently chose "be cured" (46.8%). Nurses and physician providers frequently selected "improve or maintain health" (38.5% and 46.8%, respectively). All 3 participants selected the same goal in 22 cases (20.2%). Inter-rater agreement was poor to slight for all pairs (kappa 0.09 [-0.03-0.19], 0.19 [0.08-0.30], and 0.20 [0.08-0.32] for patient-physician, patient-nurse, and nurse-physician, respectively).
We observed poor to slight concordance among hospitalized patients and key medical team members with regard to the patient's primary recovery goal. Journal of Hospital Medicine 2016;11:615-619. © 2016 Society of Hospital Medicine.
为在住院期间提供高质量的、以患者为中心的护理，医疗服务提供者必须正确识别患者的主要康复目标。
确定患者与关键医院提供者之间的一致程度。
对随机抽取的住院患者及其护士和医生提供者进行一份经过验证的问卷调查。目标包括：“治愈”、“活得更长”、“改善/维持健康”、“舒适”、“实现特定生活目标”或“其他”。
马萨诸塞州波士顿的一家大型学术医院。
2013年11月至2014年5月入院超过48小时的成年患者符合条件。当患者无行为能力时，对法定代理人进行访谈。然后在24小时内对护士和医生提供者进行访谈。
测量每个康复目标的回答频率以及患者、护士和医生提供者之间的一致率。使用校正χ(2)分析比较各组的回答频率。使用双向Kappa检验测量评分者间的一致性。
在181例（60.2%）被接触的患者（或有代理人）中，109例患者的所有三方参与者都接受了访谈。在不同回答者组中观察到选定目标存在显著差异（P < 0.001）。患者经常选择“治愈”（46.8%）。护士和医生提供者经常选择“改善或维持健康”（分别为38.5%和46.8%）。在22例（20.2%）中，所有三方参与者选择了相同的目标。所有配对的评分者间一致性均为差到一般（患者与医生、患者与护士、护士与医生的kappa值分别为0.09[-0.03 - 0.19]、0.19[0.08 - 0.30]和0.20[0.08 - 0.32]）。
我们观察到住院患者与关键医疗团队成员在患者主要康复目标方面的一致性为差到一般。《医院医学杂志》2016年；11:615 - 619。©2016医院医学协会。
