患者是否愿意接受更长的旅行时间来降低与手术相关的风险？一项系统评价。
Are patients willing to accept longer travel times to decrease their risk associated with surgical procedures? A systematic review.
机构信息
Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, University Witten/Herdecke, Ostmerheimer Str. 200, Building 38, D-51109, Cologne, Germany.
Central Research Institute of Ambulatory Health Care in Germany (Zi), Salzufer 8, D-10587, Berlin, Germany.
出版信息
BMC Public Health. 2020 Feb 19;20(1):253. doi: 10.1186/s12889-020-8333-5.
BACKGROUND
Distance to a hospital is an influencing factor for patients´ decision making when choosing a hospital for surgery. It is unclear whether patients prefer to travel further to regional instead of local hospitals if the risk associated with elective surgery is lower in the farther hospital. The aim of our systematic review was to investigate patient preferences for the location of care, taking into consideration surgical outcomes and hospital distance.
METHODS
MEDLINE (PubMed), EconLit, PsycInfo and EMBASE were searched until November 2019. We included experimental choice studies in which participants were asked to make a hypothetical decision where to go for elective surgery when surgical risk and/or distance to the hospitals vary. There was no restriction on the type of intervention or study. Reviewers independently extracted data using a standardized form. The number and proportion of participants willing to accept additional risk to obtain surgery in the local hospital was recorded. We also extracted factors associated with the decision.
RESULTS
Five studies exploring participants´ preferences for local care were included. In all studies, there were participants who, independently of a decreased mortality risk or a higher survival benefit in the regional hospital, adhered to the local hospital. The majority of the patients were willing to travel longer to lower their surgical risk. Older age and fewer years of formal education were associated with a higher risk tolerance in the local hospital.
CONCLUSIONS
Whether patients were willing to travel for a lower surgery-associated risk could not be answered in a straightforward manner. The studies we identified showed that decision making also relies on factors other than on rational information on risk or distance to hospital.
TRIAL REGISTRATION
International prospective register of ongoing systematic reviews (PROSPERO): CRD42016033655. Registered 1 January 2016.
背景
医院距离是患者选择手术医院时决策的一个影响因素。如果较远的医院的手术风险较低，患者是否更愿意选择去区域医院而不是当地医院，这一点尚不清楚。我们系统评价的目的是调查患者对护理地点的偏好，同时考虑手术结果和医院距离。
方法
截至 2019 年 11 月，我们在 MEDLINE（PubMed）、EconLit、PsycInfo 和 EMBASE 中进行了检索。我们纳入了实验性选择研究，这些研究要求参与者在手术风险和/或医院距离不同的情况下做出假设性的手术地点选择决策。干预措施或研究类型没有限制。审查员使用标准化表格独立提取数据。记录愿意接受额外风险以在当地医院接受手术的参与者的数量和比例。我们还提取了与决策相关的因素。
结果
纳入了 5 项探索患者对当地护理偏好的研究。在所有研究中，都有一些参与者独立于区域性医院死亡率降低或生存获益更高，坚持选择当地医院。大多数患者愿意长途旅行以降低手术风险。年龄较大和受正规教育年限较少与在当地医院的风险容忍度较高相关。
结论
患者是否愿意为降低手术相关风险而长途旅行，不能简单地给出答案。我们确定的研究表明，决策制定还依赖于风险或医院距离等理性信息以外的因素。
试验注册
国际前瞻性正在进行的系统评价登记册（PROSPERO）：CRD42016033655。注册于 2016 年 1 月 1 日。
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