Seiler Adrianne, Knee Alexander, Shaaban Reham, Bryson Christine, Paadam Jasmine, Harvey Rohini, Igarashi Satoko, LaChance Christopher, Benjamin Evan, Lagu Tara
Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, United States of America.
Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America.
PLoS One. 2017 Jul 5;12(7):e0180294. doi: 10.1371/journal.pone.0180294. eCollection 2017.
Excellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients' perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication.
We designed a comprehensive physician-training module focused on improving specific "etiquette-based" physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent "always" scores for questions related to patients' perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists.
A total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent "always" responses, for the HCAHPS questions of doctors "treating patients with courtesy" "explaining things in a way patients could understand," and "overall teamwork" showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors "keeping patient informed" (adjusted intercept shift 9.9% P = 0.019), "overall teamwork" (adjusted intercept shift 11%, P = 0.037), and "using words the patient could understand" (adjusted intercept shift 14.8%, p = 0.001).
A simulation based physician communication coaching method focused on specific "etiquette-based" communication behaviors through a deliberate practice framework was not associated with significantly improved HCAHPS physician communication patient experience scores. Further research could reveal ways that this model affects patients' perceptions of physician communication relating to specific physicians or behaviors.
良好的沟通是高质量医疗保健的必要组成部分。我们旨在确定一个培训模块是否能改善患者对医生沟通行为的认知，这通过与医生沟通相关的患者体验评分领域随时间的变化来衡量。
我们设计了一个全面的医生培训模块，通过标准化模拟和提供结构化反馈的医生指导，专注于提高特定的“基于礼仪”的医生沟通技巧。我们采用了准实验前后设计，干预组由内科住院医师和实习医生组成，对照组由外科医生组成。结果是使用医疗服务提供者和系统消费者评估（HCAHPS）调查以及对住院医生护理的患者进行的非HCAHPS医生特定患者体验调查（NHPPES）中，与患者对医生沟通的认知相关问题的“总是”得分百分比。
共有128名医生参与了模拟。使用HCAHPS调查数据对5020名患者的回答进行了分析，使用NHPPES调查数据对1990名患者的回答进行了分析。对于医生“礼貌对待患者”“以患者能理解的方式解释事情”和“整体团队合作”的HCAHPS问题，干预前“总是”回答百分比的截距变化，即变化程度，在外科对照组和住院医生干预组患者之间没有显著差异。干预后，对于特定个体医生“让患者了解情况”（调整后的截距变化9.9%，P = 0.019）、“整体团队合作”（调整后的截距变化11%，P = 0.037）和“使用患者能理解的语言”（调整后的截距变化14.8%，P = 0.001）的问题，调整后的NHPPES优秀调查结果显著增加。
一种通过刻意练习框架专注于特定“基于礼仪”沟通行为的基于模拟的医生沟通指导方法，与HCAHPS医生沟通患者体验评分的显著改善无关。进一步的研究可能会揭示该模型影响患者对与特定医生或行为相关的医生沟通认知的方式。
