Patient Characteristics Associated with and Changes Over Time in Trust in Inpatient Physicians.
Patient Characteristics Associated with and Changes Over Time in Trust in Inpatient Physicians.
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与住院医生信任度相关的患者特征及其随时间的变化。
DOI：
10.1007/s11606-021-06649-0
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发表时间：
2022
影响因子：
5.7
通讯作者：
Arora,VineetM
中科院分区：
文献类型：
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作者：
Prochaska,MicahT;Zhang,Hui;Meltzer,DavidO;Arora,VineetM
方法从 2006 年至 2018 年，招募成年普通内科住院患者参与一项正在进行的医院护理研究。出院30天后，我们通过电话联系同意的患者并询问：“在您住院期间，您对治疗您的医生有信心和信任吗？”回答包括 (1) 是的，总是；(2) 是的，有时； (3) 否。使用多变量逻辑回归（结合回答“是，总是”和“是，有时”）模型来测试患者的年龄、性别、种族、保险状况、住院时间 (LOS)、查尔森合并症评分 (CCS) 和入院年份 (2006-2018) 是否与患者对住院医生的信任相关。模型中纳入了性别与种族、性别与年龄之间的交互变量，以测试性别、种族和年龄之间的差异及其与患者信任的关系。 结果从 2006 年到 2018 年，76,265 名患者符合研究参与资格，54,430 名患者（71%）同意参加，37,116 名患者（68%）完成了随访调查。患者平均年龄为 58 岁，其中 21,779 名 (59%) 为女性，26,777 名 (72%) 为非裔美国人（表 1）。总体而言，35,267 名患者 (95%) 表示信任他们的住院医生，只有 1849 名患者 (5%) 表示不信任。在回归模型中（表 2），对医生的信任与年龄较大（年龄：44-59 OR= 1.2，p < 0.01，60-74 OR= 1.6，p=< 0.01，≥ 75 OR= 1.6，p=< 0.01）和拥有私人保险（OR= 1.2，p < 0.01）相关。女性（OR 0.63，p < 0.01）不太可能信任她们的医生。性别和种族之间存在显着的相互作用，女性被认定为非裔美国人（OR 1.5，p < 0.01）、其他种族（OR 1.6，p < 0.01）或未知/拒绝（OR 1.8，p < 0.01）种族，报告比白人女性更信任她们的医生。患者对医生的信任与 LOS 或 CCS 之间没有关联。除了 2013 年（OR = 1.3，p = 0.03）和 2018 年（OR = 1.4，p < 0.01）（图 1）之外，患者对医生的信任度与入院年份之间没有关联，在这两个年份观察到信任度略有增加。控制住院服务与非住院服务并没有改变结果。
METHODSFrom 2006 to 2018, adult general medicine inpatients were recruited into an ongoing study of hospital care. Consented patients were contacted by phone 30 days after discharge and asked:“During your hospitalization did you have confidence and trust in the doctors treating you?” Responses included (1) Yes, always;(2) Yes, Sometimes; and (3) No. A multivariable logistic regression (combining responses “Yes, always” and “Yes, sometimes”) model was used to test whether patients’ age, gender, race, insurance status, length of stay (LOS), Charlson Comorbidity Score (CCS), and year of admission (2006–2018) were associated with patient trust in their inpatient physician. Interaction variables between gender and race and gender and age were included in the model to test for differences across gender, race, and age, and their association with patient trust.RESULTSFrom 2006 to 2018, 76,265 patients were eligible for study participation, 54,430 (71%) consented to participate, and 37,116 (68%) completed the follow-up survey. The mean patient age was 58, 21,779 (59%) were female, and 26,777 (72%) were African American (Table 1). Overall, 35,267 (95%) expressed trust in their inpatient physician, and only 1849 (5%) patients expressed no trust. In the regression model (Table 2), trust in their physician was associated with older age (age: 44–59 OR= 1.2, p< 0.01, 60–74 OR= 1.6, p=< 0.01,≥ 75 OR= 1.6, p=< 0.01), and having private insurance (OR= 1.2, p< 0.01). Females (OR 0.63, p< 0.01) were less likely to trust their physician. There was a significant interaction between gender and race, with females identifying as African American (OR 1.5, p< 0.01), other (OR 1.6, p< 0.01), or unknown/refused (OR 1.8, p< 0.01) race, reporting greater trust in their physician than white females. There was no association between patient trust in their physician and LOS or CCS. There was no association between patient trust in their physician and the year of admission besides 2013 (OR= 1.3, p= 0.03) and 2018 (OR= 1.4, p< 0.01)(Fig. 1), where small increases in trust were observed. Controlling for hospitalist service vs non-hospitalist did not change the results.