Patient-physician connectedness and quality of primary care.
Patient-physician connectedness and quality of primary care.
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DOI：
10.7326/0003-4819-150-5-200903030-00008
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发表时间：
2009-03-03
影响因子：
39.2
通讯作者：
Barry MJ
中科院分区：
文献类型：
--
作者：
Atlas SJ;Grant RW;Ferris TG;Chang Y;Barry MJ
有效地衡量医生的表现需要准确地识别医生所负责的病人。在所有看医生的病人中，有些人会比其他人与他们的医生联系更紧密，但联系对医生表现的影响尚不清楚。确定医患关系是否会影响临床表现。基于人群的队列研究。4个社区卫生中心和9个医院附属初级保健实践的学术网络。从2003年到2005年，155590名成年人有1次或更多的访问研究实践。一种经过验证的算法用于将患者与181名医生中的1名或他们接受最多护理的13家诊所中的1家联系起来。绩效评估包括对符合条件的患者进行乳腺癌、宫颈癌和结直肠癌筛查；糖尿病患者血红蛋白A1c的检测与控制；糖尿病和冠心病患者低密度脂蛋白胆固醇的测定与控制。总体而言，92 315名患者（59.3%）与特定医生联系，53 669名患者（34.5%）仅与特定诊所联系，9606名患者（6.2%）无法与医生或诊所联系。一个诊所中可以联系到医生的患者比例差异显著（45.6%至71.2%的患者每个诊所；P < 0.001）。与医生有联系的患者相比，与诊所有联系的患者更有可能接受与指南一致的护理（例如，调整后的乳房x光检查率为78.1%对65.9% [P < 0.001]，调整后的血红蛋白A1c率为90.3%对74.9% [P < 0.001]）。预防性护理的接受程度因患者与医生的联系程度而异，而非因种族或民族而异。在1个初级保健网络中评估了患者与医生的连通性。在初级保健实践中看到的患者似乎与特定的医生有不同的联系，而联系较少的患者不太可能接受与指南一致的护理。
Valid measurement of physician performance requires accurate identification of patients for whom a physician is responsible. Among all patients seen by a physician, some will be more strongly connected to their physician than others, but the effect of connectedness on measures of physician performance is not known. To determine whether patient–physician connectedness affects measures of clinical performance. Population-based cohort study. Academic network of 4 community health centers and 9 hospital-affiliated primary care practices. 155 590 adults with 1 or more visits to a study practice from 2003 to 2005. A validated algorithm was used to connect patients to either 1 of 181 physicians or 1 of 13 practices in which they received most of their care. Performance measures included breast, cervical, and colorectal cancer screening in eligible patients; hemoglobin A1c measurement and control in patients with diabetes; and low-density lipoprotein cholesterol measurement and control in patients with diabetes and coronary artery disease. Overall, 92 315 patients (59.3%) were connected to a specific physician, whereas 53 669 patients (34.5%) were connected only to a specific practice and 9606 patients (6.2%) could not be connected to a physician or practice. The proportion of patients in a practice who could be connected to a physician varied markedly (45.6% to 71.2% of patients per practice; P < 0.001). Physician-connected patients were significantly more likely than practice-connected patients to receive guideline-consistent care (for example, adjusted mammography rates were 78.1% vs. 65.9% [P < 0.001] and adjusted hemoglobin A1c rates were 90.3% vs. 74.9% [P < 0.001]). Receipt of preventive care varied more by whether patients were more or less connected to a physician than by race or ethnicity. Patient–physician connectedness was assessed in 1 primary care network. Patients seen in primary care practices seem to be variably connected with a specific physician, and less connected patients are less likely to receive guideline-consistent care.
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通讯作者：
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