Covinsky K E, Rosenthal G E, Chren M M, Justice A C, Fortinsky R H, Palmer R M, Landefeld C S
Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland Veterans Affairs Medical Center, Ohio 44016-4961, USA.
J Gen Intern Med. 1998 Apr;13(4):223-9. doi: 10.1046/j.1525-1497.1998.00071.x.
To examine the relation between two patient outcome measures that can be used to assess the quality of hospital care: changes in health status between admission and discharge, and patient satisfaction.
Prospective cohort study.
Subjects were 445 older medical patients (aged > or =70 years) hospitalized on the medical service of a teaching hospital.
We interviewed patients at admission and discharge to obtain two measures of health status: global health and independence in five activities of daily living (ADLs). At discharge, we also administered a 5-item patient satisfaction questionnaire. We assessed the relation between changes in health status and patient satisfaction in two sets of analyses, that controlled for either admission or discharge health status. When controlling for admission health status, changes in health status between admission and discharge were positively associated with patient satisfaction (p values ranging from .01 to .08). However, when controlling for discharge health status, changes in health status were no longer associated with patient satisfaction. For example, among patients independent in ADLs at discharge, mean satisfaction scores were similar regardless of whether patients were dependent at admission (i.e., had improved) or independent at admission (i.e., remained stable) (79.6 vs 81.2, p = .46). Among patients dependent in ADLs at discharge, mean satisfaction scores were similar regardless of whether they were dependent at admission (i.e., remained stable) or independent at admission (i.e., had worsened) (74.0 vs 75.7, p = .63). These findings were similar using the measure of global health and in multivariate analyses.
Patients with similar discharge health status have similar satisfaction regardless of whether that discharge health status represents stable health, improvement, or a decline in health status. The previously described positive association between patient satisfaction and health status more likely represents a tendency of healthier patients to report greater satisfaction with health care, rather than a tendency of patients who improve following an interaction with the health system to report greater satisfaction. This suggests that changes in health status and patient satisfaction are measuring different domains of hospital outcomes and quality. Comprehensive efforts to measure the outcomes and quality of hospital care will need to consider both patient satisfaction and changes in health status during hospitalization.
研究两种可用于评估医院护理质量的患者结局指标之间的关系，即入院与出院之间的健康状况变化以及患者满意度。
前瞻性队列研究。
研究对象为445名年龄在70岁及以上、因内科疾病入住一家教学医院内科病房的老年患者。
我们在患者入院和出院时进行访谈，以获取两种健康状况指标：整体健康状况以及日常生活五项活动（ADL）的自理能力。出院时，我们还发放了一份包含5个条目的患者满意度调查问卷。我们在两组分析中评估了健康状况变化与患者满意度之间的关系，这两组分析分别对入院或出院时的健康状况进行了控制。在控制入院健康状况时，入院与出院之间的健康状况变化与患者满意度呈正相关（p值范围为0.01至0.08）。然而，在控制出院健康状况时，健康状况变化与患者满意度不再相关。例如，在出院时能够自理ADL的患者中，无论患者入院时是否需要依赖他人（即有所改善）或入院时能够自理（即保持稳定），平均满意度得分相似（79.6对81.2，p = 0.46）。在出院时需要依赖他人进行ADL的患者中，无论他们入院时是否需要依赖他人（即保持稳定）或入院时能够自理（即有所恶化），平均满意度得分相似（74.0对75.7，p = 0.63）。使用整体健康状况指标以及在多变量分析中，这些结果相似。
出院时健康状况相似的患者满意度相似，无论该出院健康状况代表的是健康稳定、改善还是健康状况下降。先前描述的患者满意度与健康状况之间的正相关关系更可能代表健康状况较好的患者对医疗保健报告更高满意度的一种倾向，而不是与医疗系统互动后病情改善的患者报告更高满意度的一种倾向。这表明健康状况变化和患者满意度衡量的是医院结局和质量的不同领域。全面衡量医院护理结局和质量的努力需要同时考虑患者满意度和住院期间的健康状况变化。
