Department of Hospital Management, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, No. 138, Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China.
Shanghai Medical Ethos Association, Jiangan District, No. 328, Huashan Road, Shanghai, 200040, People's Republic of China.
BMC Med Inform Decis Mak. 2021 Jan 25;21(1):25. doi: 10.1186/s12911-021-01385-1.
We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.
A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models.
The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to "My physician informed me of different treatment alternatives" was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals).
Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.
我们评估了住院患者的共同决策感知，并在中国上海的公立三甲医院中检验了共同决策与住院患者满意度之间的关联。
2018 年 7 月至 8 月，我们对上海 47 家公立三甲医院的 2585 名住院患者进行了横断面调查。我们评估了整体共同决策以及共同决策的 4 个方面，并通过线性或两层回归模型检验了影响共同决策的因素以及共同决策与患者满意度（患者对医生服务、医疗费用、结果和整体住院护理的满意度）之间的关联。
上海公立三甲医院住院患者对整体共同决策的正向反应率（PRR）和高度正向反应率（HPRR）均较高（分别为 95.30%和 87.86%），但“医生向我告知了不同的治疗方案”的 HPRR 较低（80.09%）。此外，与未接受手术的患者相比，接受手术的患者对整体共同决策的 HPRR 和调整后 HPRR 更高。研究表明，在高度重视整体共同决策的患者中，对医生服务、医疗费用、结果和整体住院护理的高度满意度（HSR）更高（分别为 96.50%、68.44%、89.50%和 92.60%），而在整体共同决策水平较低的患者中则较低（分别为 71.77%、35.19%、57.30%和 67.49%）。在有和没有高度共同决策的患者之间，调整后的 HSR 差异最大的是对医疗费用和共同决策中的知情同意的住院患者满意度。此外，医院类型（综合医院与专科医院）解释了整体住院护理 HSR 医院间差异的 46.22%。
上海公立三甲医院住院患者对共同决策的 PRR 和 HPRR 总体上较高，但对替代方案的信息较低。共同决策可能受到患者和医生的共同决策偏好以及医疗状况的影响。通过更好的共同决策可以提高患者满意度，并且应该在医院层面上加以重视。
