Managed Care and Physician Satisfaction

说明： 背景：两个研究主题将通过分析 二次数据来自我们之前的医生推荐研究(AHRQ HS06833)。在……里面 市场竞争和管理式医疗的时代，越来越多的 医生们对自己的工作不满意。我们对此知之甚少 主治医生的不满是否正在伤害患者-医生 关系和健康结果。其次，更有管理的计划中的患者是 对他们的主治医生不太满意，但对他们的了解要少得多 管理式护理和患者对专家和健康结果的满意度。 目标：目标是：1)确定管理型医疗保健、 主治医生满意度、患者与主治医生关系、 和健康结果；以及2)确定管理型医疗保健、 患者对专家的满意度，以及健康结果。 设计：#年261名基层医生办公室的前瞻性队列研究 西雅图的私人诊所。患者(n=17,187)在等待中进行筛查 房间，将2850名患者分成三组：(1)疼痛患者 单纯L(n=5.14，53%)：(2)单纯抑郁症状患者(n=575； 20%)；(3)有疼痛和抑郁症状的患者(761例；27%)。 患者(n=2004)在1个月、3个月和6个月时完成随访调查。 约95%的参与医生和96%的办公室经理完成了 自填式问卷。 医生满意度：医生工作满意度指数、医生推荐 满意度指数。 医患关系：患者对主治医生的评分、患者-主治医师 医生关系指数、主治医生连续性、患者 专家评级。 管理医疗的措施：对于每个患者，患者的可管理性？S 健康计划、计划福利指数、是否有心理健康 开拓，病人管理式护理的强度？S初级保健办公室， 医生的经济激励，以及医生是否阅读或使用AHCPR 背部疼痛和抑郁的临床指南。 结果测量：对于疼痛患者，疼痛困扰，疼痛 干预、限制活动天数和患者对初级治疗的满意度 医生。对于有抑郁症状的患者，结果就是症状。 抑郁症、限制活动天数和患者满意度的检查表 和主治医生一起。 数据分析：多元回归分析以确定AIMS中的关联 1和2。

DESCRIPTION: Background: Two research topics will be addressed through analysis of secondary data from our previous Physician Referral Study (AHRQ HS06833). In the era of market competition and managed care, more and more primary physicians are dissatisfied with their jobs. We know very little about whether primary physician dissatisfaction is harming patient-physician relationships and health outcomes. Second, patients in more managed plans are less satisfied with their primary physicians, but far less is known about managed care and patient satisfaction with specialists and health outcomes. Aims: Aims are: 1) to determine the associations between managed care, primary physician satisfaction, the patient-primary physician relationship, and health outcomes; and 2) to determine the association between managed care, patient satisfaction with specialists, and health outcomes. Design: Prospective cohort study in offices of 261 primary physicians in private practice in Seattle. Patients (n=l7,187) were screened in waiting rooms, enrolling 2,850 patients in three groups: (1) patients with pain only (n=l, 5 14; 53%); (2) patients with depressive symptoms only (n=575; 20%); and (3) patients with pain and depressive symptoms (n=761; 27%). Patients (n=2004)completed follow-up surveys at one, three, and six months. About 95% of participating physicians and 96% of office managers completed self-administered questionnaires. Physician Satisfaction: Physician job satisfaction index, physician referral satisfaction index. Patient-Physician Relationship: Patient rating of primary physician, patient-primary physician relationship index, primary physician continuity, patient rating of specialists. Measures of Managed Care: For each patient, the managed-ness of the patient?s health plan, plan benefit indexes, presence or absence of a mental health carve-out, intensity of managed care in the patient?s primary care office, physician financial incentives, and whether the physician read or used AHCPR clinical guidelines for back pain and depression. Outcome Measurements: For pain patients, pain bothersomeness, pain interference, restricted activity days, and patient satisfaction with primary physician. For patients with depressive symptoms, outcomes were the Symptom Checklist for Depression, restricted activity days, and patient satisfaction with primary physician. Data Analysis: Multiple regression analysis to determine associations in Aims 1 and 2.