患者对医疗保健的体验得到改善与腕管松解术后临床转归的改善相关。
Better Patient-Reported Experiences with Health Care Are Associated with Improved Clinical Outcome after Carpal Tunnel Release Surgery.
机构信息
From the Department of Orthopedic Surgery, Mayo Clinic; the Departments of Plastic, Reconstructive and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Department of Plastic and Reconstructive Surgery, Radboudumc University Hospital; and the Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School.
出版信息
Plast Reconstr Surg. 2019 Jun;143(6):1677-1684. doi: 10.1097/PRS.0000000000005516.
BACKGROUND
In hand surgery, and specifically carpal tunnel syndrome, it is currently unknown whether experiences with health care influence surgical outcome. To investigate whether there is an association between patient-reported experience measures and symptom relief, data were gathered using a cohort of patients undergoing surgical treatment for carpal tunnel syndrome.
METHODS
Patient-reported experience measures and patient-reported outcome measures were registered in a national database of 16 hand surgery practices. The experience measure data were gathered at 3 months after surgery and included six subscales on different health care delivery aspects (e.g., provided information, communication, facility, operative care). The outcome measure data were acquired before and 3 months after surgery with the Boston Carpal Tunnel Assessment Questionnaire. The association was tested using linear regression analyses.
RESULTS
A total of 1607 patients were included in the analysis. The experience measure scores were good to excellent, with a median value between 8.0 and 8.5 on a 10-point scale. Regression analyses showed a significant (p < 0.001) association with the Boston Carpal Tunnel Assessment Questionnaire for all individual patient-reported experience measure subscales. The greatest effects were found in physician communication and treatment information. Patient-reported experience measures accounted for more than 5 percent of the explained variance, with patient characteristics explaining an approximately additional 3 percent.
CONCLUSIONS
In this large data set of carpal tunnel syndrome patients who underwent surgical release, a significant impact of health care experiences on self-reported clinical outcome was found. This is relevant information, not only for directing care providers in improving health care experiences as a quality-of-health care measure but now also potentially to achieve better clinical outcome.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
在手部外科领域，特别是腕管综合征，目前尚不清楚患者的就医经历是否会影响手术效果。为了研究患者报告的体验测量结果与症状缓解之间是否存在关联，本研究通过对接受手术治疗的腕管综合征患者进行队列研究收集了数据。
方法
患者报告的体验测量结果和患者报告的结局测量结果在 16 家手部外科实践的全国数据库中进行登记。体验测量数据在术后 3 个月采集，包括 6 个关于不同医疗服务提供方面的子量表（如提供的信息、沟通、设施、手术护理）。结局测量数据在术前和术后 3 个月采集，采用波士顿腕管评估问卷进行评估。采用线性回归分析检验关联。
结果
共纳入 1607 例患者进行分析。体验测量评分良好至优秀，10 分制的中位数在 8.0 至 8.5 之间。回归分析显示，所有患者报告的体验测量子量表与波士顿腕管评估问卷均存在显著相关性（p < 0.001）。在医生沟通和治疗信息方面的影响最大。患者报告的体验测量结果解释了超过 5%的方差，患者特征解释了大约额外的 3%。
结论
在接受手术松解的大量腕管综合征患者的这组数据中，发现医疗体验对自我报告的临床结局有显著影响。这不仅为指导护理人员改善医疗体验作为医疗质量措施提供了相关信息，而且现在可能还可以实现更好的临床结局。
临床问题/证据水平：治疗性，III 级。
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