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突破叙事领域:严格引出和评估患者叙事的创新方法。

Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives.

作者信息

Grob Rachel, Schlesinger Mark, Parker Andrew M, Shaller Dale, Barre Lacey Rose, Martino Steven C, Finucane Melissa L, Rybowski Lise, Cerully Jennifer L

机构信息

Center for Patient Partnerships, UW Law School, University of Wisconsin-Madison, Madison, WI.

Department of Family Medicine, UW Medical School, University of Wisconsin-Madison, Madison, WI.

出版信息

Health Serv Res. 2016 Jun;51 Suppl 2(Suppl 2):1248-72. doi: 10.1111/1475-6773.12503. Epub 2016 Apr 29.

Abstract

OBJECTIVE

To design a methodology for rigorously eliciting narratives about patients' experiences with clinical care that is potentially useful for public reporting and quality improvement.

DATA SOURCES/STUDY SETTING: Two rounds of experimental data (N = 48 each) collected in 2013-2014, using a nationally representative Internet panel.

STUDY DESIGN

Our study (1) articulates and operationalizes criteria for assessing narrative elicitation protocols; (2) establishes a "gold standard" for assessment of such protocols; and (3) creates and tests a protocol for narratives about outpatient treatment experiences.

DATA COLLECTION/EXTRACTION METHODS: We randomized participants between telephone and web-based modalities and between protocols placed before and after a closed-ended survey.

PRINCIPAL FINDINGS

Elicited narratives can be assessed relative to a gold standard using four criteria: (1) meaningfulness, (2) completeness, (3) whether the narrative accurately reflects the balance of positive and negative events, and (4) representativeness, which reflects the protocol's performance across respondent subgroups. We demonstrate that a five-question protocol that has been tested and refined yields three- to sixfold increases in completeness and four- to tenfold increases in meaningfulness, compared to a single open-ended question. It performs equally well for healthy and sick patients.

CONCLUSIONS

Narrative elicitation protocols suitable for inclusion in extant patient experience surveys can be designed and tested against objective performance criteria, thus advancing the science of public reporting.

摘要

目的

设计一种方法,用于严格收集有关患者临床护理体验的叙述,这可能对公开报告和质量改进有用。

数据来源/研究背景:2013 - 2014年使用全国代表性的互联网面板收集的两轮实验数据(每组N = 48)。

研究设计

我们的研究(1)明确并实施评估叙述引出方案的标准;(2)建立此类方案评估的“金标准”;(3)创建并测试关于门诊治疗体验叙述的方案。

数据收集/提取方法:我们将参与者随机分配到电话和基于网络的方式之间,以及在封闭式调查之前和之后放置的方案之间。

主要发现

可以使用四个标准相对于金标准评估引出的叙述:(1)意义性,(2)完整性,(3)叙述是否准确反映正负事件的平衡,以及(4)代表性,这反映了方案在各受访者亚组中的表现。我们证明,与单个开放式问题相比,经过测试和完善的五个问题的方案使完整性提高了三到六倍,意义性提高了四到十倍。它对健康患者和患病患者的表现同样良好。

结论

可以根据客观性能标准设计和测试适合纳入现有患者体验调查的叙述引出方案,从而推动公开报告科学的发展。

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