美国急症护理医院非临床服务与患者体验结果之间的关联
Associations Between Nonclinical Services and Patient-Experience Outcomes in US Acute Care Hospitals.
作者信息
Schiaffino Melody K, Suzuki Yukari, Ho Tarryn, Finlayson Tracy L, Harman Jeffrey S
机构信息
University of California San Diego Moores Cancer Center, San Diego State University, CA, USA.
San Diego State University, School of Public Health, CA, USA.
出版信息
J Patient Exp. 2020 Dec;7(6):1086-1093. doi: 10.1177/2374373519892770. Epub 2019 Dec 11.
BACKGROUND
Patient experience is an important measure of hospital quality and performance. Since the passage of the Affordable Care Act, patient experiences with their care encounters are embedded into the framework of payment incentives. However, drivers of patient experience in the context of the supportive, nonclinical, services that relate to patient care have not been as well understood.
AIMS
To assess the role of organizational factors on patient experience.
METHODS
This cross-sectional analysis integrates hospital patient-experience scores from Hospital Consumer Assessment of Healthcare Providers and Systems, and Centers for Medicaid and Medicare Service data from 2013 to 2015 (N = 3392). Based on hospitals with "top-box" responses, the aggregate proportion of hospital patients responding "always" on a Likert scale represented a top-box hospital. Domains were split at the mean for analysis (above average = 1). Multivariable logistic regression models for each domain were analyzed against hospital factors and services, including offering a patient education center, patient-enabling services, and language services.
RESULTS
Most hospitals reported a full-time hospitalist (64.4%) and a patient education center (60.4%), while fewer provided enabling/support services (33.7%). In multivariable models, small and medium hospitals performed better compared to the largest hospitals (300+ beds; < .0001). Structurally, medium and small hospitals reported significantly greater odds of top-box patient-experience versus large hospitals. Across all domains, only hospitals with patient education centers returned better performance (adjusted odds ratio: 1.27-1.64; = .0002-.0166).
DISCUSSION/CONCLUSION: Patient education centers provide relevant information at the point of service and may improve overall patient experience of care. Given the growing reliance on accountable care delivery models, opportunities to partner with community health education partners may be profitable.
背景
患者体验是衡量医院质量和绩效的重要指标。自《平价医疗法案》通过以来，患者在就医过程中的体验已被纳入支付激励框架。然而，在与患者护理相关的支持性、非临床服务背景下，患者体验的驱动因素尚未得到充分理解。
目的
评估组织因素对患者体验的作用。
方法
本横断面分析整合了来自医疗服务提供者和系统的医院消费者评估的医院患者体验分数，以及2013年至2015年医疗保险和医疗补助服务中心的数据（N = 3392）。基于给出“最高分”回复的医院，在李克特量表上回答“总是”的医院患者总体比例代表了一家高分医院。各领域在均值处进行划分以进行分析（高于平均水平 = 1）。针对每个领域的多变量逻辑回归模型针对医院因素和服务进行了分析，包括提供患者教育中心、患者支持服务和语言服务。
结果
大多数医院报告有全职住院医师（64.4%）和患者教育中心（60.4%），而提供支持/辅助服务的医院较少（33.7%）。在多变量模型中，与最大的医院（300张及以上床位）相比，中小型医院表现更好（< .0001）。在结构上，中小型医院报告的患者体验获得最高分的几率明显高于大型医院。在所有领域中，只有设有患者教育中心的医院表现更好（调整后的优势比：1.27 - 1.64； = .0002 - .0166）。
讨论/结论：患者教育中心在服务点提供相关信息，并可能改善患者的整体护理体验。鉴于对可问责医疗服务提供模式的依赖日益增加，与社区健康教育伙伴合作的机会可能会带来收益。
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