用患者自己的话记录从入院到出院的住院旅程体验：一项定性研究。
Capturing the experience of the hospital-stay journey from admission to discharge using diaries completed by patients in their own words: a qualitative study.
机构信息
Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand.
Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
出版信息
BMJ Open. 2019 Mar 12;9(3):e027258. doi: 10.1136/bmjopen-2018-027258.
OBJECTIVE
To capture and better understand patients' experience during their healthcare journey from hospital admission to discharge, and to identify patient suggestions for improvement.
DESIGN
Prospective, exploratory, qualitative study. Patients were asked to complete an unstructured written diary expressed in their own words, recording negative and positive experiences or anything else they considered noteworthy.
PARTICIPANTS AND SETTING
Patients undergoing vascular surgery in a metropolitan hospital.
PRIMARY OUTCOME MEASURES
Complete diary transcripts underwent a general inductive thematic analysis, and opportunities to improve the experience of care were identified and collated.
RESULTS
We recruited 113 patients in order to collect 80 completed diaries from 78 participants (a participant response rate of 69%), recording patients' experiences of their hospital-stay journey. Participating patients were a median (range) age of 69 (21-99) years and diaries contained a median (range) of 197 (26-1672) words each. Study participants with a tertiary education wrote more in their diaries than those without-a median (range) of 353.5 (48-1672) vs 163 (26-1599) words, respectively (Mann-Whitney U test, p=0.001). Three primary and eight secondary themes emerged from analysis of diary transcripts-primary themes being: (1) communication as central to care; (2) importance of feeling cared for and (3) environmental factors shaping experiences. In the great majority, participants reported positive experiences on the hospital ward. However, a set of 12 patient suggestions for improvement were identified, the majority of which could be addressed with little cost but result in substantial improvements in patient experience. Half of the 12 suggestions for improvement fell into primary theme 1, concerning opportunities to improve communication between healthcare providers and patients.
CONCLUSIONS
Unstructured diaries completed in a patient's own words appear to be an effective and simple approach to capture the hospital-stay experience from the patient's own perspective, and to identify opportunities for improvement.
目的
从患者入院到出院的整个医疗过程中，捕捉并更好地理解患者的体验，并确定患者的改进建议。
设计
前瞻性、探索性、定性研究。患者被要求使用自己的语言完成一份非结构化的书面日记，记录负面和正面的体验或他们认为值得注意的任何其他事情。
参与者和地点
在一家大都市医院接受血管外科治疗的患者。
主要结果测量
完整的日记转录进行了一般归纳主题分析，并确定和整理了改善护理体验的机会。
结果
我们招募了 113 名患者，以便从 78 名参与者中收集 80 份完成的日记（参与者响应率为 69%），记录患者住院期间的体验。参与研究的患者年龄中位数（范围）为 69（21-99）岁，日记中位数（范围）为 197（26-1672）个单词。具有高等教育背景的研究参与者在日记中写的内容多于没有高等教育背景的参与者——中位数（范围）分别为 353.5（48-1672）和 163（26-1599）个单词（Mann-Whitney U 检验，p=0.001）。对日记转录本的分析产生了三个主要和八个次要主题-主要主题是：（1）沟通是护理的核心；（2）关怀的重要性；（3）环境因素塑造体验。在绝大多数情况下，参与者报告了在医院病房的积极体验。然而，确定了 12 项患者改进建议，其中大多数可以通过低投入实现，但会极大地改善患者体验。这 12 项改进建议中有一半属于主要主题 1，涉及改善医护人员与患者之间沟通的机会。
结论
使用患者自己的语言完成的非结构化日记似乎是一种从患者自身角度捕捉住院体验并确定改进机会的有效且简单的方法。
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