Flott Kelsey, Darzi Ara, Mayer Erik
NIHR Imperial Patient Safety Translational Research Centre (PSTRC), Imperial College London, London, UK.
Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK.
BMJ Open. 2018 Jul 7;8(7):e020411. doi: 10.1136/bmjopen-2017-020411.
The aim of this study was to identify the care pathway and organisational factors that predict patient experience.
Statistical analysis of large National Health Service (NHS) datasets.
England; acute NHS organisational-level data.
The relationship of care pathway and organisational variables to organisation-level patient experience.
A framework of 18 care pathway and organisational variables were created based on the existing literature. 11 of these correlated to patient experience in univariate analyses. Multicollinearity tests resulted in 1 of the 11 variables holding a correlation to another variable larger than r=0.70. A significant multilinear regression equation, including the final 10 variables, was found (F(10,108)=6.214, p<0.00), with an [Formula: see text] of 0.365. Two variables were significant in predicting better in patient experience: Amount of support to clinical staff (beta=0.2, p=0.02) and the proportion of staff who would recommend the trust as a place to work or receive treatment (beta=0.26, p=0.01). Two variables were significant in predicting a negative impact on the patient's rating of their experience: Number of patients spending over 4 hours from decision to admit to admission (beta=-1.99, p=0.03) and the percentage of estates and hotel services contracted out (beta=-0.23, p=0.01).
These results indicate that augmenting clinical support and investing in the mechanisms that facilitate positive staff experience is essential to delivering appropriate, informative and patient-centric care. Reducing wait times and the extent of external contracting within hospitals is also likely to improve patient ratings of experience. Understanding the relationship between patient experience and objective, measurable organisational features promote a more patient-centric interpretation of quality and compel a better use of patient experience feedback to drive improvement.
本研究旨在确定预测患者体验的护理路径和组织因素。
对大型国家医疗服务体系（NHS）数据集进行统计分析。
英格兰；NHS急性组织层面数据。
护理路径和组织变量与组织层面患者体验的关系。
基于现有文献创建了一个包含18个护理路径和组织变量的框架。其中11个在单变量分析中与患者体验相关。多重共线性检验导致11个变量中的1个与另一个变量的相关性大于r = 0.70。发现了一个包含最终10个变量的显著多元线性回归方程（F(10,108)=6.214，p<0.00），[公式：见正文]为0.365。两个变量在预测更好的患者体验方面具有显著性：对临床工作人员的支持量（β=0.2，p=0.02）以及会推荐该信托机构作为工作或接受治疗场所的工作人员比例（β=0.26，p=0.01）。两个变量在预测对患者体验评分的负面影响方面具有显著性：从决定入院到实际入院花费超过4小时的患者数量（β=-1.99，p=0.03）以及外包的房地产和酒店服务百分比（β=-0.23，p=0.01）。
这些结果表明，增加临床支持并投资于促进积极员工体验的机制对于提供适当、信息丰富且以患者为中心的护理至关重要。减少等待时间以及医院内部的外部承包范围也可能提高患者的体验评分。理解患者体验与客观、可测量的组织特征之间的关系，有助于以更以患者为中心的方式解读质量，并促使更好地利用患者体验反馈来推动改进。
