Evolving Concepts of Patient-Centered Care and the Assessment of Patient Care Experiences: Optimism and Opposition
Evolving Concepts of Patient-Centered Care and the Assessment of Patient Care Experiences: Optimism and Opposition
复制标题
DOI：
10.1215/03616878-3620881
复制
发表时间：
2016-08-01
影响因子：
4.2
通讯作者：
Cleary, Paul D.
中科院分区：
文献类型：
--
作者：
Cleary, Paul D.
Avedis Donabedian在他关于医疗质量的开创性工作中指出，患者满意度是医疗质量的关键指标，在20世纪70年代和80年代，大量研究探讨了患者满意度的决定因素。随后，注意力转向评估护理经验，现在有大量的证据与基于调查的护理评估的可靠性和有效性有关。随着这类调查的使用增加，对这类调查的有效性和使用的关切也增加了。然而，现有的研究表明，这种调查是可靠的，有效的，与其他质量指标在个人和环境之间相互关联，并预测更好的结果。病人的经验，现在定期测量，并投入大量的努力，提供高质量的以病人为中心的护理。提供以病人为中心的护理不需要从其他质量改进工作中转移资源。改善基础设施，支持某些方面的护理可能会产生广泛的影响，因为系统的变化可以影响多个结果。因此，而不是从一般的质量改进工作减损，作出改变，促进以病人为中心的护理可能会导致更广泛的改善。我们有充分的理由乐观地认为，我们的医疗保健系统将越来越“以病人为中心”。"
In his seminal work on health care quality, Avedis Donabedian noted that patient satisfaction was a key indicator of health care quality, and in the 1970s and 1980s a great deal of research explored the determinants of patient satisfaction. Subsequently, attention shifted toward assessing care experiences, and there is now a large body of evidence related to the reliability and validity of survey-based assessments of care. As the use of such surveys has increased, so too have concerns about the validity and uses of such surveys. The available research, however, indicates that such surveys are reliable, valid, correlated across individuals and settings with other quality indicators, and predictive of better outcomes. Patient experiences are now routinely measured, and substantial effort is being devoted to providing high-quality patient-centered care. Providing patient-centered care need not divert resources away from other quality improvement efforts. Improving the infrastructure supporting certain aspects of care may have broad effects because systemchanges can influence multiple outcomes. Thus, rather than detract from general quality improvement efforts, making changes that facilitate patient-centered care maylead to broader improvements. There is good reason to be optimistic that our health care system will increasingly be "patient centered."