Patients' global ratings of their health care are not associated with the technical quality of their care
Patients' global ratings of their health care are not associated with the technical quality of their care
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DOI：
10.7326/0003-4819-144-9-200605020-00010
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发表时间：
2006-05-02
影响因子：
39.2
通讯作者：
Wenger, NS
中科院分区：
文献类型：
--
作者：
Chang, JT;Hays, RD;Wenger, NS
背景：患者的全球护理评级通常用于评估卫生保健。然而，这些护理评估在多大程度上与所接受的护理的技术质量有关还不是很清楚。设计：观察性队列研究。设置：2个管理型医疗机构，患者：通过对在13个月期间在2个管理型医疗机构接受护理的65岁或65岁以上的社区成年人的简短访谈确定的脆弱老年患者。测量：使用消费者评估医疗服务提供者和系统计划第二阶段的调查问题来确定患者对医疗保健和提供者沟通的全球评级。由评估易受伤害老年人护理项目定义的236个质量指标用于测量22种临床条件下的技术护理质量；207个质量指标通过使用图表摘要或患者访谈的数据进行评估。结果：获得236个易受伤害老年患者的全球评分项目、沟通量表和技术护理质量评分的数据。在包括患者和临床因素的多变量Logistic回归模型中，更好的沟通与更高的全球卫生保健评级相关。技术护理质量与全球护理评级没有显著相关性。限制：研究结果仅限于登记在管理护理组织中的弱势老年人，可能不能推广到其他年龄段或其他类型的保险覆盖范围。结论：脆弱老年人的全球护理评级不应作为技术护理质量的标志。护理质量评估应包括患者评估和技术质量的独立评估。
Background: Patient global ratings of care are commonly used to assess health care. However, the extent to which these assessments of care are related to the technical quality of care received is not well understood. objective: To investigate the relationship between patient-reported global ratings of health care and the quality of providers' communication and technical quality of care.Design: Observational cohort study.Setting: 2 managed care organizations,Patients: Vulnerable older patients identified by brief interviews of a random sample of community-dwelling adults 65 years of age or older who received care in 2 managed care organizations during a 13-month period.Measurements: Survey questions from the second stage of the Consumer Assessment of Healthcare Providers and Systems program were used to determine patients' global rating of health care and provider communication. A set of 236 quality indicators, defined by the Assessing Care of Vulnerable Elders project, were used to measure technical quality of care given for 22 clinical conditions; 207 quality indicators were evaluated by using data from chart abstraction or patient interview.Results: Data on the global rating item, communication scale, and technical quality of care score were available for 236 vulnerable older patients. In a multivariate logistic regression model that included patient and clinical factors, better communication was associated with higher global ratings of health care. Technical quality of care was not significantly associated with the global rating of care.Limitations: Findings were limited to vulnerable elders who were enrolled in managed care organizations and may not be generalizable to other age groups or types of insurance coverage.Conclusions: Vulnerable elders' global ratings of care should not be used as a marker of technical quality of care. Assessments of quality of care should include both patient evaluations and independent assessments of technical quality.