Moreau Jessica L, Hamilton Alison B, Yano Elizabeth M, Rubenstein Lisa V, Stockdale Susan E
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System at Sepulveda, North Hills, CA, USA.
Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, CA, USA.
J Patient Exp. 2020 Dec;7(6):1634-1641. doi: 10.1177/2374373520910335. Epub 2020 Mar 13.
While patient-centered care (PCC) is a widely accepted aspect of health-care quality, its definition is still the subject of debate. We investigated health-care workers' definitions of PCC by level of patient contact in job roles. Our qualitative study involved semi-structured interviews with key stakeholder employees (n = 66) at 6 Veterans' Affairs health-care locations in Southern California. Interviews were recorded, transcribed, coded for definitions of PCC, and analyzed by participants' self-described level of patient contact. Stakeholders whose role primarily involved patient contact tended to define PCC through: patient as a person, patient preferences, and shared decision-making. Stakeholders whose role did not primarily involve patient contact tended to define PCC through: patient-centered redesign, customer service, and access to services. Stakeholders with more patient contact emphasized patient-level and interpersonal concepts, while those with less patient contact emphasized system-level and business-oriented concepts. The focus on PCC-as-access may reflect influence of changing institutional climate on definitions of PCC for some stakeholders. To facilitate successful PCC efforts, health-care systems may need to leverage differing but complementary definitions of PCC within its workforce.
虽然以患者为中心的护理(PCC)是医疗质量中一个被广泛接受的方面,但其定义仍存在争议。我们按工作角色中与患者接触的程度,调查了医护人员对PCC的定义。我们的定性研究包括对南加州6个退伍军人事务医疗地点的关键利益相关员工(n = 66)进行半结构化访谈。访谈进行了录音、转录,对PCC的定义进行编码,并根据参与者自述的与患者接触程度进行分析。主要涉及患者接触的利益相关者倾向于通过以下方式定义PCC:将患者视为人、患者偏好和共同决策。主要不涉及患者接触的利益相关者倾向于通过以下方式定义PCC:以患者为中心的重新设计、客户服务和服务可及性。与患者接触较多的利益相关者强调患者层面和人际概念,而与患者接触较少的利益相关者强调系统层面和商业导向概念。对PCC即可及性的关注可能反映了机构氛围变化对一些利益相关者PCC定义的影响。为推动成功的PCC工作,医疗系统可能需要在其员工队伍中利用不同但互补的PCC定义。