Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals.
Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals.
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不同医院的患者体验比较公平吗？
DOI：
10.1097/mlr.0000000000000144
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发表时间：
2014
期刊：
影响因子：
3
通讯作者：
Zaslavsky,AlanM
中科院分区：
文献类型：
--
作者：
Cleary,PaulD;Meterko,Mark;Wright,StevenM;Zaslavsky,AlanM
背景：调查越来越多地用于评估患者的医疗保健体验。基于患者经验调查的医院评分比较应根据可能影响调查结果的患者特征进行调整。这些特征通常来自于收集很少（如果有的话）临床信息的患者调查。因此，一些医院，特别是那些治疗特别复杂的患者的医院，一直担心标准调整方法不能充分反映治疗患者的挑战。目的：在仅使用调查报告的患者特征和使用更完整的临床和医院信息进行调整后，比较不同类型医院的评分。研究设计：我们使用的临床和调查数据来自全国样本的1858名退伍军人住院的初始急性心肌梗死（AMI）在退伍军人事务部（VA）2003年和2004年财政年度的医疗中心。我们使用VA管理数据来描述医院。该调查询问了患者对医院护理的体验。临床数据包括从医疗记录中提取的14项指标，这些指标可预测AMI后的生存率。结果：仅根据患者报告的健康状况和社会人口学特征调整的医院间评分的比较与根据患者临床特征调整的评分相似;在住院经历的9个维度上，2组调整后评分之间的斯皮尔曼等级顺序相关性> 0.97。这项研究并不支持患者护理经验的测量是不公平的，因为常用的模型不能充分调整潜在的混淆患者的临床特征。
Background:Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients.Objectives:To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information.Research Design:We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI.Results:Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were> 0.97 across 9 dimensions of inpatient experience.Conclusions:This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics.