From the Department of Surgery (J.L.D., J.A.W., P.W.G., D.J.S., S.I., J.V.J., T.L.G., T.M.T., S.R.P.), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
J Trauma Acute Care Surg. 2018 Jul;85(1):193-197. doi: 10.1097/TA.0000000000001934.
Although physician-patient communication and health literacy (HL) have been studied in diverse patient groups, there has been little focus on trauma patients. A quality improvement project was undertaken at our Level I trauma center to improve patient perception of physician-patient communication, with consideration of the effect of HL. We report the first phase of this project, namely the reference level of satisfaction with physician-patient communication as measured by levels of interpersonal care among patients at an urban Level I trauma center.
Level I trauma center patients were interviewed during hospitalization (August 2016 to January 2017). Short Assessment of Health Literacy tool was used to stratify subjects by deficient versus adequate HL. Interpersonal Processes of Care survey was administered to assess perception of physician-patient communication. This survey allowed patients to rate physician-patient interaction across six domains: "clarity," "elicited concerns," "explained results," "worked together (on decision making)," "compassion and respect," and "lack of discrimination by race/ethnicity." Each is scored on a five-point scale. Frequencies of "top-box" (5/5) scores were compared for significance (p < 0.05) between HL-deficient and HL-adequate patients.
One hundred ninety-nine patients participated. Average age was 42 years, 33% female. Forty-nine (25%) patients had deficient HL. The majority of patients in both groups rated communication below 5/5 across all domains except "compassion and respect" and "lack of discrimination by race/ethnicity." Health literacy-deficient patients were consistently less likely to give physicians top-box scores, most notably in the "elicited concerns" domain (35% vs. 54%, p = 0.012).
Health literacy-deficient patients appear relatively less satisfied with physician communication, particularly with respect to perceiving that their concerns are being heard. Overall, however, the majority of patients in both groups were unlikely to score physician communication in the "top box." Efforts to improve physician-trauma patient communication are warranted, with attention directed toward meeting the needs of HL-deficient patients.
Prognostic/Epidemiologic, level I.
尽管医患沟通和健康素养（HL）在不同的患者群体中得到了研究，但对创伤患者的关注甚少。我们在一级创伤中心开展了一项质量改进项目，以提高患者对医患沟通的感知，同时考虑 HL 的影响。我们报告了该项目的第一阶段，即在城市一级创伤中心测量患者的人际关怀水平，以确定医患沟通满意度的参考水平。
一级创伤中心的患者在住院期间接受了访谈（2016 年 8 月至 2017 年 1 月）。使用简短健康素养评估工具对患者进行 HL 不足和 HL 充足的分层。医患沟通满意度调查评估了患者对医患沟通的感知。该调查允许患者在六个领域对医患互动进行评分：“清晰度”、“引出关注”、“解释结果”、“共同决策（决策制定）”、“同情和尊重”以及“种族/民族歧视缺乏”。每个领域的评分都在五分制上。对 HL 不足和 HL 充足患者的“最高分箱”（5/5）评分的频率进行了比较（p < 0.05）。
共有 199 名患者参与。平均年龄为 42 岁，女性占 33%。49 名（25%）患者的 HL 不足。两个组的大多数患者在所有领域的评分都低于 5/5，除了“同情和尊重”和“种族/民族歧视缺乏”。HL 不足的患者给予医生最高分箱的可能性始终较低，在“引出关注”方面最为明显（35%比 54%，p = 0.012）。
HL 不足的患者似乎对医生的沟通相对不满意，尤其是在他们认为自己的担忧得到倾听方面。然而，总体而言，两个组的大多数患者都不太可能对医生的沟通进行“最高分箱”评分。需要努力改善医生与创伤患者的沟通，关注满足 HL 不足患者的需求。
预后/流行病学，I 级。
