Cohen Justin B, Myckatyn Terence M, Brandt Keith
St. Louis, Mo.
From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine.
Plast Reconstr Surg. 2017 Jan;139(1):257-261. doi: 10.1097/PRS.0000000000002848.
New regulations require that physician performance must be evaluated and graded in both objective and subjective ways. This represents a novel factor in American health care delivery driven by the reality that the United States spends more than any other nation on health care yet still lags behind in key outcome measures. Patient satisfaction has been established as a core component of physician rankings and reimbursement. In fact, it already has acted as both a powerful motivator and stressor. Patient feedback has driven hospital administrators' agendas to improve facilities and provide relative luxuries to inpatients, and individual providers have been tempted to ignore sound medical judgment by relenting to patient requests to increase their satisfaction scores. Unfortunately, there is little high-level evidence to support that patient satisfaction will improve medical outcomes, and there are plenty of contradictory data in smaller studies. Part of the difficulty of these studies may lie in the diversity of patient expectations, which are dependent on the disease process and the inherently subjective and labile nature of people's responses. Reliable tools are needed that will take into account what constitutes a superior quality of patient care in a more systematic, meaningful, and validated way.
新规定要求，必须以客观和主观两种方式对医生的表现进行评估和分级。这在美国医疗服务中是一个新因素，其背后的现实是，美国在医疗保健方面的支出比其他任何国家都多，但在关键成果指标上仍落后。患者满意度已被确立为医生排名和报销的核心组成部分。事实上，它已经既是一个强大的激励因素，也是一个压力源。患者反馈推动了医院管理人员改善设施、为住院患者提供相对豪华待遇的议程，而个别医护人员则因迁就患者要求以提高满意度评分而倾向于忽视合理的医疗判断。不幸的是，几乎没有高级证据支持患者满意度会改善医疗结果，而且在较小规模的研究中有大量相互矛盾的数据。这些研究的部分困难可能在于患者期望的多样性，这取决于疾病过程以及人们反应固有的主观性和易变性。需要可靠的工具，以更系统、有意义和经过验证的方式考虑什么构成优质的患者护理。
