The relationship between measured performance and satisfaction with care among clinically complex patients.
The relationship between measured performance and satisfaction with care among clinically complex patients.
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临床复杂患者的测量表现与护理满意度之间的关系。
DOI：
10.1007/s11606-008-0734-6
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发表时间：
2008
影响因子：
5.7
通讯作者：
Chang,VirginiaW
中科院分区：
文献类型：
--
作者：
Werner,RachelM;Chang,VirginiaW
背景最近的工作表明，临床复杂的患者更有可能接受推荐的护理，但尚不清楚个人绩效目标的更高实现是否会改善复杂患者的护理，还是会损害其他重要但不可衡量的护理方面，目的探讨临床复杂性高血压患者的护理表现与护理满意度之间的关系，患者设计和实验室观察分析了2003和2004财政年度纳入外部同行评议计划的35，927名退伍军人的全国样本。测量首先，遵守个人绩效测量（乳腺癌筛查，乳房X线摄影，结肠直肠癌筛查，流感疫苗接种，肺炎球菌疫苗接种，血脂监测，心力衰竭时使用ACE抑制剂，和糖尿病眼检查）以及推荐护理的总体接受情况作为每个患者的临床复杂性的函数进行估计。第二，全球满意度估计作为临床复杂性和遵守性能measurements.Main ResultsHigher临床复杂性预测略高的整体性能（OR 1.13，95%CI 1.09至1.18）和更高的性能，对大多数个人的性能指标，效果是介导的访问频率增加。在临床复杂性高的患者中，高测量性能与较高的护理满意度相关。事实上，随着复杂性的增加，实现高性能的效果的几率满意的护理也increasedConclusionsNot只有测量性能更高的临床复杂的患者，但满意度与护理也更高的临床复杂的患者高测量性能，这表明遵守性能措施在临床复杂的患者并不排挤未测量的护理。
BackgroundRecent work has shown that clinically complex patients are more likely to receive recommended care, but it is unknown whether higher achievement on individual performance goals results in improved care for complex patients or detracts from other important but unmeasured aspects of care, resulting in unmet needs and lower satisfaction with care.ObjectiveTo examine the relationship between measured performance and satisfaction with care among clinically complex patientsDesign and ParticipantsAn observational analysis of a national sample of 35,927 veterans included in the External Peer Review Program in fiscal years 2003 and 2004.MeasurementsFirst, compliance with individual performance measures (breast cancer screening with mammography, colorectal cancer screening, influenza vaccination, pneumococcal vaccination, lipid monitoring, use of ACE inhibitor in heart failure, and diabetic eye examination), as well as overall receipt of recommended care, was estimated as a function of each patient’s clinical complexity. Second, global satisfaction with care was estimated as a function of clinical complexity and compliance with performance measures.Main ResultsHigher clinical complexity was predictive of slightly higher overall performance (OR 1.13, 95% CI 1.09 to 1.18) and higher performance on most individual performance measures, an effect that was mediated by increased visit frequency. High measured performance was associated with higher satisfaction with care among patients with high clinical complexity. In fact, as complexity increased, the effect of achieving high performance on the odds of being satisfied with care also increasedConclusionsNot only was measured performance higher in clinically complex patients, but satisfaction with care was also higher among clinically complex patients with high measured performance, suggesting that compliance with performance measures in clinically complex patients does not crowd out unmeasured care.