从患者角度看德国的医院选择：一项横断面研究。
Hospital choice in Germany from the patient's perspective: a cross-sectional study.
作者信息
de Cruppé Werner, Geraedts Max
机构信息
Institute for Health Systems Research, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany.
Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Karl-von-Frisch-Strasse 4, 35043, Marburg, Germany.
出版信息
BMC Health Serv Res. 2017 Nov 13;17(1):720. doi: 10.1186/s12913-017-2712-3.
BACKGROUND
In many countries health policy encourages patients to choose their hospital, preferably by considering information of performance reports. Previous studies on hospital choice mainly have focused on patients undergoing elective surgery. This study examined a representative sample of hospital inpatients across disciplines and treatment interventions in Germany. Its research questions were: How many patients decide where to go for hospital treatment? How much time do patients have before admission? Which sources of information do they use, and which criteria are relevant to their decision?
METHODS
Cross-sectional observational study covering 1925 inpatients of 46 departments at 17 hospitals in 2012. The stratified survey comprised 11 medical disciplines (internal medicine, gynaecology, obstetrics, paediatrics, psychiatry, orthopaedics, neurology, urology, ENT and geriatrics) on 3 hospital care levels representing 91.9% of all hospital admissions to inpatient care in Germany in 2012. The statistical analysis calculated the frequency distributions and 95% confidence intervals of characteristics related to the hospital choice.
RESULTS
63.0% [60.9-65.2] of patients in Germany chose the hospital themselves, but only 21.1% [19.3-22.9] had more than one week to decide prior to admission. Major sources of information were personal knowledge of hospitals, relatives, outpatient health professionals and the Internet. Main criteria for the decision were personal experience with a hospital, recommendations from relatives and providers of outpatient services, a hospital's reputation and distance from home. Specific quality information as provided by performance reports were of secondary importance.
CONCLUSIONS
A majority of patients in the German health system choose their hospital freely. Providers of outpatient health care can have an important "agent" function in the quality-oriented hospital choice especially for patients with little time prior to admission and those who do not decide themselves. Hospitals have an impact on patients' future hospital choices by the treatment experience they provide to patients.
背景
在许多国家，卫生政策鼓励患者选择医院，最好是通过参考绩效报告信息来进行选择。以往关于医院选择的研究主要集中在接受择期手术的患者身上。本研究对德国各学科和治疗干预措施的住院患者进行了代表性抽样调查。其研究问题为：有多少患者决定前往何处接受住院治疗？患者在入院前有多少时间来做决定？他们使用哪些信息来源，以及哪些标准与他们的决定相关？
方法
2012年对17家医院46个科室的1925名住院患者进行横断面观察研究。分层调查涵盖11个医学学科（内科、妇科、产科、儿科、精神病科、骨科、神经科、泌尿科、耳鼻喉科和老年医学科），涉及3个医院护理级别，占2012年德国所有住院护理入院人数的91.9%。统计分析计算了与医院选择相关特征的频率分布和95%置信区间。
结果
德国63.0%[60.9 - 65.2]的患者自行选择医院，但只有21.1%[19.3 - 22.9]的患者在入院前有超过一周的时间来做决定。主要信息来源是对医院的个人了解、亲属、门诊医疗专业人员和互联网。决定的主要标准是对医院的个人体验、亲属和门诊服务提供者的推荐、医院的声誉以及与家的距离。绩效报告提供的具体质量信息重要性次之。
结论
德国医疗体系中的大多数患者可自由选择医院。门诊医疗服务提供者在以质量为导向的医院选择中可发挥重要的“代理”作用，特别是对于入院前时间较少以及那些不自行做决定的患者。医院通过为患者提供的治疗体验对患者未来的医院选择产生影响。
Zotero 插件