Sullivan Paul, Bell Derek
NIHR CLAHRC for Northwest London, Imperial College, London, UK.
BMJ Open. 2017 Jan 18;7(1):e012133. doi: 10.1136/bmjopen-2016-012133.
Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital.
Acute medical admission units in all NHS Acute Trusts in England.
We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1-2 nights, so as to isolate the experience delivered during the acute admission process.
We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected 'being treated with respect and dignity' and 'pain control' as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters.
The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors.
When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between Trusts and should prompt further research to explore if more discriminant surveys can be developed.
既往研究发现，医院和专科对患者体验评分的影响有限，患者层面的因素更为重要。这可能是由于组织内各亚单位在提供体验方面存在异质性。我们旨在确定，如果对每家医院同一亚专科微观系统的评分进行分析，组织层面的因素是否具有更大影响。
英格兰所有国民保健服务急性信托基金中的急性内科住院病房。
我们分析了来自英国成人住院患者调查的患者体验数据，该调查每年在英格兰的每个国民保健服务急性信托基金中对850名患者进行。我们选取了所有8753名回复调查的患者，这些患者均为急诊内科住院患者，且在其住院病房停留1 - 2晚，以便分离出急性住院过程中提供的体验。
我们使用多水平逻辑回归来确定主办组织、组织层面因素（规模和教学地位）以及患者层面因素（人口统计学特征、长期疾病和残疾情况）的分摊影响。我们选取“受到尊重和有尊严的对待”以及“疼痛控制”作为主要结局参数。其他皮克领域问题得分作为次要参数进行分析。
组织层面可归因的总体方差比例较小；“受到尊重和有尊严的对待”方面为0.5%（无统计学意义），“疼痛控制”方面为0.4%（无统计学意义）。长期疾病及由此导致的残疾与低分相关。其他项目得分也表明，大多数影响来自患者层面因素。
当分离出单个微观系统，即急性内科住院过程时，体验评分的方差主要可由患者层面因素解释，组织层面影响有限。这对使用通用的患者体验调查进行信托基金之间的比较具有启示意义，并应促使进一步研究，以探索是否能够开发出更具区分性的调查。
