Determinants of patient satisfaction and willingness to return with emergency care
Determinants of patient satisfaction and willingness to return with emergency care
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DOI：
10.1016/s0196-0644(00)70003-5
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发表时间：
2000-05-01
影响因子：
6.2
通讯作者：
Burstin, HR
中科院分区：
文献类型：
--
作者：
Sun, BC;Adams, J;Burstin, HR
研究目的：确定急诊科流程护理措施与满意度和返回意愿显著相关。方法：对5所城市教学医院急诊科急诊室的患者满意度和返回意愿进行评估。进行了基线问卷调查、图表回顾和10天的电话随访，收集了每个受访者的38项护理过程措施和30名患者特征。总体满意度用有序Logistic回归进行建模。结果：在1个月的研究期间，共完成现场问卷2899份(占合格问卷的84%)。2333名患者完成了电话采访(80%的患者完成了问卷调查)。患者报告的与满意度高度相关的问题包括在需要时没有得到帮助(优势比[OR]0.345；95%可信区间[CI]0.261至0.456)，对问题原因的解释不佳(OR 0.434；95%CI 0.345至0.546)，未被告知潜在的等待时间(OR 0.479；95%CI 0.399至0.577)，未被告知何时恢复正常活动(OR 0.691，95%CI 0.531至0.901)，对测试结果的不良解释(OR 0.647；95%可信区间0.495~0.845)，未告知何时返回急诊室(OR 0.656；95%可信区间0.494~0.871)。其他与满意度相关的护理过程测量包括非急性分流状态(OR 0.701，95%CI 0.578至0.851)和急诊室治疗次数(每次治疗OR 1.164；95%CI 1.073至1.263)。显著预测满意度较低的患者特征包括较年轻的年龄和黑人种族。返回意愿的决定因素包括对问题原因的解释不佳(OR 0.328；95%CI 0.217至0.495)、无法给家人留言(OR 0.391；95%CI 0.226至0.677)、未被告知潜在的等待时间(OR 0.561；95%CI 0.381至0.825)、对测试结果解释不当(OR 0.541；95%CI 0.347至0.846)、需要帮助时得不到帮助(OR 0.537；95%CI 0.340至0.846)。与腹痛患者的参考人群相比，以手部撕裂为主诉的患者不太愿意再来。回归意愿受总体满意度的强烈预测(OR 2.601；95%CI 2.292至2.951)。结论：这些数据确定了具体的护理过程措施，这些措施是患者满意度和回归意愿的决定因素。提高患者满意度和恢复意愿的努力应侧重于改善急诊科在这些已确定的过程措施上的表现。
Study objective: To identify emergency department process of care measures that are significantly associated with satisfaction and willingness to return.Methods: Patient satisfaction and willingness to return at 5 urban, teaching hospital EDs were assessed. Baseline questionnaire, chart review, and 10-day follow-up telephone inter views were performed, and 38 process of care measures and 30 patient characteristic were collected for each respondent. Overall satisfaction was modeled with ordinal logistic regression. Willingness to return was modeled with logistic regression.Results: During a 1-month study period, 2,899 (84% of eligible) on-site questionnaires were completed. Telephone interviews were completed by 2,333 patients (80% of patients who completed a questionnaire). Patient-reported problems that were highly correlated with satisfaction included help not received when needed (odds ratio [OR] 0.345; 95% confidence interval [CI] 0.261 to 0.456), poor explanation of causes of problem (OR 0.434; 95% CI 0.345 to 0.546), not told about potential wait time (OR 0.479; 95% CI 0.399 to 0.577), not told when to resume normal activities (OR 0.691, 95% CI 0.531 to 0.901), poor explanation of test results (OR 0.647; 95% CI 0.495 to 0.845), and not told when to return to the ED (OR 0.656; 95% CI 0.494 to 0.871). Other process of care measures correlated with satisfaction include nonacute triage status (OR 0.701, 95% CI 0.578 to 0.851) and number of treatments in the ED (OR 1.164 per treatment; 95% CI 1.073 to 1.263). Patient characteristics that significantly predicted less satisfaction included younger age and black race. Determinants of willingness to return include poor explanation of causes of problem (OR 0.328; 95% CI 0.217 to 0.495), unable to leave a message for family (OR 0.391; 95% CI 0.226 to 0.677), not told about potential wait time (OR 0.561; 95% CI 0.381 to 0.825), poor explanation of test results (OR 0.541; 95% CI 0.347 to 0.846), and help not received when needed (OR 0.537; 95% CI 0.340 to 0.846). Patients with a chief complaint of hand laceration were less willing to return compared with a reference population of patients with abdominal pain. Willingness to return is strongly predicted by overall satisfaction (OR 2.601; 95% CI 2.292 to 2.951).Conclusion: These data identify specific process of care measures that are determinants of patient satisfaction and willingness to return. Efforts to increase patient satisfaction and willingness to return should focus on improving ED performance on these identified process measures.