Investigation of the degree of organisational influence on patient experience scores in acute medical admission units in all acute hospitals in England using multilevel hierarchical regression modelling
Investigation of the degree of organisational influence on patient experience scores in acute medical admission units in all acute hospitals in England using multilevel hierarchical regression modelling
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DOI：
10.1136/bmjopen-2016-012133
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发表时间：
2017-01-01
期刊：
影响因子：
2.9
通讯作者：
Bell, Derek
中科院分区：
文献类型：
--
作者：
Sullivan, Paul;Bell, Derek
目的以往的研究发现，医院和专业对患者体验得分的影响有限，患者层面的因素更为重要。这可能是由于组织内的子单元之间的体验交付的异质性。我们的目的是确定是否组织水平的因素有更大的影响，如果分数相同的亚专科微系统进行分析，在每个hospital. Set急性医疗入院单位在所有NHS急性trustsinEngland.Participants我们分析了英国成人住院调查，这是管理到850例患者，每年在每个急性NHS信托在英格兰的患者经验数据。我们选择了所有8753名返回调查的患者，他们是急诊入院并在他们的入院单位停留1-2晚，以分离急性入院过程中提供的经验。主要和次要结果测量我们使用多水平logistic回归来确定主办机构和组织水平因素的分摊影响（规模和教学状况）和患者水平因素（人口统计学，长期条件和残疾的存在）。我们选择被尊重和尊严的治疗和疼痛控制作为主要的结果参数。其他选择域的问题分数进行了分析，作为次要parameters.Results的整体方差的比例在组织层面上是小的，0.5%（NS）的尊重和尊严，0.4%（NS）的疼痛控制。长期的条件和随之而来的残疾与低分数有关。其他项目的分数也表明，最大的影响是从患者层面factors.Conclusions当一个单一的微系统，急性医疗入院过程中，是孤立的，方差的经验分数主要是由有限的组织层面的影响，患者层面的因素解释。这对使用通用患者经验调查进行信任之间的比较有影响，并应促使进一步的研究，以探索是否可以开发更多的判别式调查。
Objectives Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital.Setting Acute medical admission units in all NHS Acute Trusts in England.Participants We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1-2 nights, so as to isolate the experience delivered during the acute admission process.Primary and secondary outcome measures We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected being treated with respect and dignity' and pain control' as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters.Results The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors.Conclusions When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between Trusts and should prompt further research to explore if more discriminant surveys can be developed.