Associations of CAHPS Composites With Global Ratings of the Doctor Vary by Medicare Beneficiaries' Health Status.
Associations of CAHPS Composites With Global Ratings of the Doctor Vary by Medicare Beneficiaries' Health Status.
复制标题
DOI：
10.1097/mlr.0000000000000942
复制
发表时间：
2018-08
期刊：
影响因子：
3
通讯作者：
Elliott MN
中科院分区：
文献类型：
--
作者：
Hays RD;Mallett JS;Haas A;Kahn KL;Martino SC;Gaillot S;Elliott MN
卫生保健提供者之间的护理协调对于高质量的护理至关重要，并且与医生的整体评级密切相关。护理协调对于病情较重和慢性病患者尤其重要，因为他们的护理涉及多个提供者。本研究探讨了护理协调与个人医生全球评级之间的关联是否因慢性病和自测健康状况的数量而异。我们使用具有全国代表性的医疗保险消费者对医疗保健提供者和系统的评估（CAHPS®）调查数据来评估护理协调、医生沟通、获得所需护理、快速获得护理、六种慢性病的计数（心绞痛、癌症、慢性阻塞性肺病、糖尿病、心脏病发作、中风），自评一般健康状况（5分制，从差到优，线性评分），以及它们之间的相互作用作为CAHPS全球私人医生评级的预测因素（评分为0-100，100为最佳私人医生）。分析样本包括2013年的242，871名医疗保险收费服务和管理式医疗受益人：56%女性; 14% 18-64，47% 65-74，27% 75-84，11% 85岁及以上;和48%的高中或以下教育。CAHPS复合材料（护理协调、医生沟通、获得所需护理和快速获得护理）和慢性病数量与私人医生评分显著正相关（p <0. 05）。在自评健康状况较差的患者中，护理协调和医生沟通与个人医生的积极评价有更强的相关性（p < 0.001）。结果与假设一致，即健康状况较差的患者在全球医生评估中比健康状况较好的患者更重视护理协调。强调改善护理协调，特别是对健康状况较差的患者，可能会改善患者对其提供者的总体评估。这项研究为以病人为中心的护理时代的护理协调经验的重要性提供了进一步的证据。
Care coordination among health care providers is essential for high-quality care and it is strongly associated with overall ratings of doctors. Care coordination may be especially important for sicker and chronically ill patients because of the multiple providers involved in their care. This study examines whether the association of care coordination with global ratings of one’s personal doctor varies by number of chronic conditions and self-rated health. We used nationally representative Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey data to evaluate care coordination, doctor communication, getting needed care, getting care quickly, count of six chronic conditions (angina, cancer, COPD, diabetes, heart attack, stroke), self-rated general health (5-point scale, poor to excellent, scored linearly), and interactions among them as predictors of the CAHPS global rating of personal doctor (scored 0-100 with 100 being best possible personal doctor) using linear regression models. The analytic sample included 242,871 Medicare Fee-for-Service and managed care beneficiaries in 2013: 56% female; 14% 18-64, 47% 65-74, 27% 75-84, and 11% 85 and older; and 48% high school education or less. The CAHPS composites (of care coordination, doctor communication, getting needed care, and getting care quickly) and number of chronic conditions were significantly positively associated with ratings of personal doctor (p < 0.05). Care coordination and doctor communication had a stronger association with positive ratings of the personal doctor among those with worse self-rated health (p < 0.001). Results were consistent with the hypothesis that patients in worse health weigh care coordination more heavily in global physician assessments than patients in better health. Emphasis on improving care coordination, especially for patients in poorer health, may improve patients’ overall assessments of their providers. The study provides further evidence for the importance of care coordination experiences in the era of patient-centered care.