Peering inside the black box of patient-centered care.
Peering inside the black box of patient-centered care.
复制标题
窥探以患者为中心的护理的黑匣子。
DOI：
10.1161/circoutcomes.114.001038
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Naik,AanandD
中科院分区：
文献类型：
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作者：
Naik,AanandD
2014年5月348例循环血管质量结局患者，他们的医生是否为心力衰竭提供指南一致的护理。相比之下，使用标准化的措施来收集在临床接触期间与医疗保健提供者的具体沟通的主观评级，通常会预测与这些接触相关的健康结果。11例如，患者认为他们的医生给了他们与糖尿病护理相关的选择，这可能预示着自我护理行为和血压控制的改善。9以病人为中心的主观衡量标准还包括那些旨在捕捉病人护理经验的指标。11患者体验包括情绪、身体感受、社会互动以及与特定遭遇、互动和医疗程序相关的判断。[11]对病人经历的描述存在可用性偏差，这是一项经验发现，即容易想到的认知对我们的规范性判断和决策产生了不成比例的影响。12鉴于这种偏见，患者经验的主观报告可能与客观事实不完全一致，或者他们可能过分强调医疗保健经验的特定方面。例如，最近一项关于患者上消化道内窥镜检查经历的定性研究发现，对手术的满意度集中在围手术期经历的一些突出记忆上（例如，在候诊室的时间、与手术相关的不适、受手术人员尊重的感觉以及术后对医生的信任）。[13]这些记忆定义了医疗保健体验，并塑造了患者对所接受护理的判断;因此，它们影响了随后的健康行为，尽管存在缺陷，但值得衡量。13，14 Ottenberg等人的新研究，15也在这一期的
348 Circ Cardiovasc Qual Outcomes May 2014 patients whether their physician is providing guidelines-concordant care for heart failure. In contrast, using standardized measures to gather subjective ratings of specific communication with healthcare providers during clinical encounters will often predict health outcomes related to those encounters. 11 For example, patient perceptions that their doctors gave them choices related to their diabetes mellitus care are likely to predict improved self-care behaviors and blood pressure control. 9 Subjective measures of patient centeredness also include those designed to capture patients’ experiences of care. 11 Patient experiences include emotions, bodily feelings, social interactions, and judgments associated with specific encounters, interactions, and procedures comprising health care. 11 Accounts of patient experiences suffer from availability bias, an empirical finding that cognitions that come readily to mind have a disproportionate influence on our normative judgments and decision making. 12 Given this bias, subjective reports of patient experiences may not be completely consistent with objective facts or they may overemphasize a particular aspect of the healthcare experience. For example, a recent qualitative study of patients’ experiences with upper endoscopy found that satisfaction with the procedure centered on a few salient memories of the periprocedure experience (eg, time in waiting room, discomfort associated with the procedure, feeling respected by procedure staff, and trust in physician postprocedure). 13 These are the memories that come to define a healthcare experience and shape a patient’s judgment of the care received; therefore, they influence subsequent health behaviors and are worth measuring despite their flaws. 13, 14 The novel study by Ottenberg et al, 15 also in this issue of