Quality dimensions that most concern people with physical and sensory disabilities
Quality dimensions that most concern people with physical and sensory disabilities
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DOI：
10.1001/archinte.163.17.2085
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发表时间：
2003-09-22
影响因子：
--
通讯作者：
O'Day, B
中科院分区：
文献类型：
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作者：
Iezzoni, LI;Davis, RB;O'Day, B
背景：身体和感官残疾人在获得高质量的医疗保健方面面临着重大挑战。我们研究了是否人谁是盲人或视力低下，谁是聋人或听力障碍，或谁有行动不便或手动灵活性的问题是满意的技术和人际关系方面的care.Methods：通过使用1996年的全国代表性调查16403社区居住的老年人和残疾人医疗保险受益人，我们确定了残疾人的条件。调整后的优势比（AORs）和95%置信区间（CIS）控制人口统计学特征和管理式护理成员资格，预测对12个护理维度的不满。在估计的3358万非机构医疗保险受益人中，64.1%（估计2151万）报告至少有I种潜在残疾，29.5%（估计989万）报告超过I种潜在残疾。大约98%的残疾人和非残疾人认为他们的医生有能力并且训练有素。但在统计学上，更多的残疾人对12个质量维度中的10个不满意。报告任何重大残疾的人更有可能对医生完全了解他们的病情感到不满（AOR，2.4; 95% CI，1.9-3.1），医生完全讨论患者，健康问题（AOR，2.4; 95% CI，1.9-2.9），医生回答所有患者的问题（AOR，2.3; 95% CI，1.7-3.1），医生往往显得匆忙（AOR，1.6; 95% CI，1.4-1.9）。残疾人普遍对他们的护理持积极看法，尽管他们更有可能报告沟通不畅和缺乏彻底的护理。这些发现与致残条件无关。需要有系统的方法来改善沟通，减少可能影响残疾人医疗保健体验的时间压力。
Background: People with physical and sensory disabilities face important challenges in obtaining high-quality health care. We examined whether persons who are blind or have low vision, who are deaf or hard of hearing, or who have mobility impairments or manual dexterity problems are satisfied with the technical and interpersonal aspects of their care.Methods: By using a 1996 nationally representative survey of 16403 community-dwelling elderly and disabled Medicare beneficiaries, we identified persons with disabling conditions. Adjusted odds ratios (AORs) and 95% confidence intervals (CIS) controlled for demographic characteristics and managed care membership in predicting dissatisfaction with 12 dimensions of care.Results: Of an estimated 33.58 million noninstitutionalized Medicare beneficiaries, 64.1% (an estimated 21.51 million) reported at least I potential disability and 29.5% (an estimated 9.89 million) reported more than I potential disability. Roughly 98% of people with and without disabilities believed their physicians were competent and well trained. But statistically significantly more people with disabilities reported dissatisfaction with care for 10 of the 12 quality dimensions. Persons reporting any major disability were more likely to be dissatisfied with physicians completely understanding their conditions (AOR, 2.4; 95% CI, 1.9-3.1), physicians completely discussing patients, health problems (AOR, 2.4; 95% CI, 1.9-2.9), physicians answering all patients' questions (AOR, 2.3; 95% CI, 1.7-3.1), and physicians often seeming hurried (AOR, 1.6; 95% CI, 1.4-1.9).Conclusions: Persons with disabilities generally reported positive views of their care, although they were significantly more likely to report poor communication and lack of thorough care. These findings held regardless of the disabling condition. Thoughtful systematic approaches are required to improve communication and to reduce time pressures that might compromise the health care experiences of people with disabilities.