Does doctor-patient communication affect patient satisfaction with hospital care? Results of an analysis with a novel instrumental variable
Does doctor-patient communication affect patient satisfaction with hospital care? Results of an analysis with a novel instrumental variable
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DOI：
10.1111/j.1475-6773.2008.00849.x
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发表时间：
2008-10-01
影响因子：
3.4
通讯作者：
Meltzer, David O.
中科院分区：
文献类型：
--
作者：
Clever, Sarah L.;Jin, Lei;Meltzer, David O.
Objective.确定医生的沟通行为和患者对医院护理的总体满意度之间的关系，使用一种新的工具变量来解决患者属性对这种关联的可能混淆。行政记录和出院后的调查数据，从1997年7月1日至2000年6月30日之间在城市三级护理学术医院的普通医学服务出院的患者。管理数据包括合并症、人口统计学数据和付款人状态。在出院调查中，患者对他们的主治医生的四个沟通行为，他们住院的其他方面，以及他们的整体医院护理进行评价。主要结果是患者对医院护理的总体满意度评分，主要自变量是患者对医生沟通行为的评分。为了消除患者对医生沟通的评价与其他患者特定属性的总体满意度之间的关联可能的混淆，我们在两阶段线性回归中创建了一个工具变量（IV）。IV是由该医生照顾的其他患者给予每位医生的沟通评级的平均值。3123例患者纳入分析。在普通最小二乘回归中，总体满意度与主治医师沟通行为的总体评分之间存在显著的正相关关系，总体沟通行为每增加1分，总体满意度在5分制量表上增加0.58分，p
Objective. To determine the relationship between physicians' communication behaviors and patients' overall satisfaction with hospital care using a novel instrumental variable to address possible confounding of this association by patient attributes.Data Sources/Study Setting. Administrative records and postdischarge survey data were obtained from patients discharged from the General Medicine service at an urban tertiary-care academic hospital between July 1, 1997 and June 30, 2000. Administrative data included comorbidities, demographic data, and payer status. In the discharge survey, patients rated their attending physician on four communication behaviors, other aspects of their hospital stay, and their overall hospital care.Study Design. The primary outcome was patients' ratings of their overall satisfaction with hospital care, and the primary independent variable was patients' ratings of their physicians' communication behaviors. To remove possible confounding of the association between patient ratings of physician communication and overall satisfaction by other patient-specific attributes, we created an instrumental variable (IV) in a two-stage linear regression. The IV was the mean of the communication ratings given to each physician by the other patients cared for by that physician.Principle Findings/Conclusions. Three thousand one hundred and twenty-three patients were included in the analysis. In the ordinary least squares regression, there was a significant positive relationship between overall satisfaction and overall ratings of attendings' communication behaviors, with an increase in overall satisfaction of 0.58 points on a 5-point scale for each 1-point increase in overall attendings' communication behaviors, p