Chung K C, Hamill J B, Kim H M, Walters M R, Wilkins E G
Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Medical Center, Ann Arbor, MI 48109-0340, USA.
Ann Plast Surg. 1999 Jan;42(1):56-60. doi: 10.1097/00000637-199901000-00010.
Although outcome measurement in medical care has traditionally included various aspects of clinical and functional status, patient satisfaction is another important metric in the assessment of health care quality. Determining which factors contribute most to patient satisfaction can assist health care providers in improving care. In an era of diminishing resources, satisfaction ratings can further aid third-party payers in determining who provides those services. The authors used the ordinal logistic regression method to develop a predictive model for patient satisfaction in an outpatient plastic surgery clinic. Consecutive patients who attended a university outpatient plastic surgery clinic were asked to complete the Visit Specific Patient Satisfaction Questionnaire (VSQ) after their clinic visit. Type of clinic (e.g., hand clinic, aesthetic clinic, breast clinic) and demographic variables like age, gender, race, and education were added to the questionnaire to control for possible confounding effects. The authors constructed an ordinal logistic regression model using the overall visit response as the dependent variable and the eight other response categories as independent variables. A total of 345 patients completed the VSQ, which takes each patient less than 2 minutes to complete. The patient response rate was more than 95%. Statistically significant predictors included (1) personal manner of physician (odds ratio [OR], 18.0; p = 0.0002), (2) time spent with physician (OR, 4.7; p = 0.0099), (3) length of time to get an appointment (OR, 4.6; p = 0.0055), and (4) explanation of what was done (OR, 3.9; p = 0.0263). There was no statistically significant association between overall satisfaction scores and the following factors: (1) length of wait in the clinic (OR, 2.7; p = 0.0747), (2) getting through to the clinic by phone (OR, 0.71; p = 0.5439), (3) convenience of the clinic's location (OR, 2.3; p = 0.1368), and (4) technical skills of the physician (OR, 1.0; p = 0.9974). The predictive model was adjusted for possible confounding due to the type of clinic and demographic variables. In this study the most important predictors of patient satisfaction were those related to efficient clinic operation (scheduling of appointments and clinic waiting time) and the quality of the patient-physician interaction. Clinic facilities (like clinic location and ease of phone contact) were not significant predictors. Because patients often have difficulty assessing the technical skills of physicians, this variable was not a significant predictor. To improve patient satisfaction in plastic surgery outpatient clinics, efforts and resources should be directed toward expedient and empathic delivery of care.
尽管医疗保健中的结果测量传统上包括临床和功能状态的各个方面，但患者满意度是评估医疗保健质量的另一个重要指标。确定哪些因素对患者满意度贡献最大有助于医疗保健提供者改善护理。在资源日益减少的时代，满意度评级可以进一步帮助第三方支付者确定谁提供这些服务。作者使用有序逻辑回归方法为门诊整形手术诊所的患者满意度建立了一个预测模型。要求在大学门诊整形手术诊所就诊的连续患者在就诊后完成特定就诊患者满意度问卷（VSQ）。问卷中增加了诊所类型（如手部诊所、美容诊所、乳房诊所）以及年龄、性别、种族和教育程度等人口统计学变量，以控制可能的混杂效应。作者构建了一个有序逻辑回归模型，将总体就诊反应作为因变量，其他八个反应类别作为自变量。共有345名患者完成了VSQ，每位患者完成问卷的时间不到2分钟。患者回复率超过95%。具有统计学意义的预测因素包括：（1）医生的个人态度（优势比[OR]，18.0；p = 0.0002），（2）与医生相处的时间（OR，4.7；p = 0.0099），（3）预约所需时间（OR，4.6；p = 0.0055），以及（4）对所做事情的解释（OR，3.9；p = 0.0263）。总体满意度得分与以下因素之间无统计学意义的关联：（1）在诊所等待的时间（OR，2.7；p = 0.0747），（2）通过电话联系到诊所的情况（OR，0.71；p = 0.5439），（3）诊所位置的便利性（OR，2.3；p = 0.1368），以及（4）医生的技术技能（OR，1.0；p = 0.9974）。针对诊所类型和人口统计学变量可能造成的混杂进行了预测模型调整。在本研究中，患者满意度最重要的预测因素是与高效诊所运营（预约安排和诊所等待时间）以及医患互动质量相关的因素。诊所设施（如诊所位置和电话联系的便捷性）不是显著的预测因素。由于患者通常难以评估医生的技术技能，该变量不是显著的预测因素。为提高整形手术门诊诊所的患者满意度，应将努力和资源导向便捷且富有同理心的护理服务提供。
