A TAXONOMY OF PATIENT REQUESTS & PHYSICIAN RESPONSES

在今天的管理式护理环境中， 患者影响其护理的主要手段是 提出请求 请求是明确的口头或书面请求， 询问医生信息或行动的通信。 为 临床谈判的蓬特，要求占据中心位置 在遭遇战中。在初步工作中，调查人员 患者请求分类法（TORP）。 拖普 目前包括11类信息请求，8 行动请求类别和8类医生 应答 此应用程序的目标是完善此新系统， 编码患者的请求，以估计不同的患病率 请求类型和响应，并阐明前因和 有问题的请求的后果。 调查人员将完成 1）增加新的代码，以提高TORP的相关性， 2）为TORP的可靠性提供额外的证据; 和3）进行一系列分析，旨在评估 增强的分类法的并发、构造和预测有效性。 到项目结束时，一个有效和可靠的分类法将可用于 研究受管理的患者请求和医生响应 医疗保健设置。 相对于所需资源而言，这一项目的要求很高，因为 拟议分析所需的大部分数据已经 收集。 300个流动遭遇的录音带是 从1994年的一项研究中获得，该研究对访问一小群 萨克拉门托内科医生;另外60次与心脏病专家的会面 将重新记录。 计划中的研究将在三年内进行 阶段 首先，使用卡片分类技术， 要求和医生的反应将被开发，以增加TORP的 对管理式医疗中存在问题的敏感性。 第二，附加 编码的评分者间和评分者内可靠性研究 计划将执行。 第三， 发育数据集（n=142次内科就诊）将 在来自剩余158个内部数据集的验证数据集中进行评估 医学会议加上60个新记录的心脏病学会议。 将通过五项评估关系的研究进行验证 直接观察到的患者请求和1）医生报告的 请求; 2）有争议的医患协商; 3）患者 人口统计学和健康特征; 4）访视满意度;以及5） 医生专业，一旦验证，TORP承诺是一个强大的， 用于分析医生的关键方面的综合系统- 患者互动。

During a typical outpatient visit in today's managed care environment, the principal means by which patients can influence their care is by making requests. A request is an explicit verbal or written communication asking the physician for information or action. As the focal pont for the clinical negotiation, requests occupy a central place in the encounter. In preliminary work, the investigators have constructed a detailed Taxonomy of Requests by Patients (TORP). TORP currently consists of 11 categories of requests for information, 8 categories of requests for action, and 8 categories of physicians responses. The objectives of this application are to refine this new system for coding patients requests, to estimate the prevalence of different request types and responses, and to elucidate the antecedents and consequences of problematic requests. The investigators will accomplish these objectives by: 1) adding new codes to enhance TORP's relevance to managed care; 2) producing additional evidence for TORP's reliability; and 3) performing a series of analyses designed to assess the concurrent, construct, and predictive validity of the enhanced taxonomy. By project's end, a valid and reliable taxonomy will be available to study patients requests and physicians responses across managed healthcare settings. This project is ambitious relative to the resources requested because much of the data required for the proposed analyses has already been collected. Three-hundred tape recordings of ambulatory encounters are available from a 1994 study of patients visiting a small group of Sacramento internists; an additional 60 encounters with cardiologists will be recorded de novo. The planned research will proceed in three stages. First, using card-sorting techniques, new categories of patient requests and physician responses will be developed to increase TORP's sensitivity to problematic issues in managed care. Second, additional studies concerning the inter- and intra-rater reliability of the coding scheme will be performed. Third, the coding scheme generated in the developmental dataset (n=142 internal medicine encounters) will be assessed in a validation dataset derived from the remaining 158 internal medicine encounters plus the 60 newly recorded cardiology encounters. Validation will occur by way of five studies assessing relationships between directly-observed patient requests and 1) physician-reported requests; 2) contentious physician-patient negotiation; 3) patients demographic and health characteristics; 4) visit satisfaction; and 5) physicians speciality, once validated, TORP promises to be a robust, comprehensive system for analyzing a critical aspect of the physician- patient interaction.