Patient-reported use of health service resources compared with information from health providers
Patient-reported use of health service resources compared with information from health providers
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DOI：
10.1046/j.1365-2524.2003.00457.x
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发表时间：
2003-11-01
影响因子：
2.4
通讯作者：
Peters, TJ
中科院分区：
文献类型：
--
作者：
Richards, SH;Coast, J;Peters, TJ
本研究的目的是检查老年人的报告的准确性，从急性护理出院后的卫生服务资源的使用与医疗保健提供者的信息相比。配对数据来自医疗服务提供者和连续样本的住院患者（年龄60岁或以上），这些患者参加了一项随机对照试验，比较了在家住院与常规急性护理。在基线和4周和12周随访期间获得了使用（是/否）和患者住院人数以及社区护理、物理治疗、健康访视和全科医生（GP）服务的回顾性报告，尽管不同资源的回忆期不同。配对报告的可比性进行了检查，通过使用粗和机会校正的协议，并通过测试的系统性差异的配对响应的分布。在入组试验的219例患者中，分别有190例和185例患者在第4周（87%）和第12周（84%）提供了数据。粗一致性超过72%（范围= 42-93%），12次比较中有11次的机会校正一致性为中等或良好（kappa系数为0.23至0.71）。在7个比较中观察到配对反应模式的系统性差异。患者更经常报告接受常规家庭医生家访（12周），而医疗服务提供者报告统计学显著（P < 0.05）更多患者入院（12周）和每人更多入院，要求家庭医生家访（12周）或手术咨询，并接受地区护理（4周和12周）和物理治疗（仅4周）。数据表明，与保健提供者相比，在相对较短的时间内，患者往往低估了所使用的资源。
The objectives of the present study were to examine the accuracy of older people's reports of health services resource use after discharge from acute care compared with information from healthcare providers. Paired data were obtained from health providers and a consecutive sample of hospitalised patients (aged 60 years or over) enrolled in a randomised controlled trial of hospital-at-home versus usual acute care. Retrospective reports of the use (yes/no) and number of patient hospital admissions, and community nursing, physiotherapy, health visiting and general practitioner (GP) services were obtained between baseline, and 4- and 12-week follow-ups, although the recall period varied for different resources. The comparability of paired reports was examined by using crude and chance-corrected agreement, and by testing for systematic differences in the distribution of paired responses. Out of 219 patients enrolled in the trial, 190 and 185 patients provided data at 4 (87%) and 12 weeks (84%), respectively. Crude agreement was over 72% (range = 42-93%), and chance-corrected agreement was moderate or good (kappa coefficients from 0.23 to 0.71) for 11 out of 12 comparisons. Systematic differences in the pattern of paired responses were observed for seven comparisons. Patients more often reported receiving a routine GP home visit (by 12 weeks), whilst health providers reported statistically significantly (P < 0.05) more patients admitted to hospital (12 weeks) and more admissions per person, requesting a GP home visit (12 weeks) or surgery consultation, and having district nursing (4 and 12 weeks) and physiotherapy (4 weeks only). The data indicate that patients tend to underestimate resources used compared with health providers over relatively short time frames.