Patients' Perception of Hospital Care in the United States

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2021医学考研复试:护理[SC长难句翻译文]

2021医学考研复试:护理[SC长难句翻译文]

SCI长难句护理第一章-髋关节护理Patient Reported Outcome Measures(PROMs)are being used to measure the quality of services from the patients’perspective within the National Health Service(NHS).The Department of Health encouraged the use of PROMs initially in four clinical procedures,hip and knee replacements, hernia and varicose vein surgery.It was mandated that all providers of NHS funding care should collect PROMs in these areas from the first of April2009.The health status information collected from patients by way of PROMs questionnaires before and after an intervention was expected to provide an indication of the outcomes or quality of care delivered to NHS patients.病人报告结果测量(PROMs)被用来从病人的角度来衡量英国国家医疗服务体系(NHS)的服务质量。

卫生部最初鼓励在四项临床手术中使用PROMs,包括髋关节和膝关节置换、疝气和静脉曲张手术。

从2009年4月1日开始,所有NHS 资金资助的医疗机构都必须在这些地区收集PROMs。

通过PROMs问卷收集的患者在干预前后的健康状况信息,有望提示向NHS患者提供的护理结果或质量。

住院患者对责任护士人文关怀行为感知及满意度调查分析

住院患者对责任护士人文关怀行为感知及满意度调查分析

World Latest Medicine Information (Electronic Version) 2019 V o1.19 No.30投稿邮箱:sjzxyx88@298·调研分析·住院患者对责任护士人文关怀行为感知及满意度调查分析陈敏,聂臣聪(自贡市第四人民医院,四川 自贡)摘要:目的 了解责任护士工作中的人文关怀现状,分析患者关怀感知中对责任护士满意度的影响因素,为护理管理者在制定护士人文关怀培养方案及临床关怀行为提供参考。

方法 采用自制问卷对784名在院患者进行问卷调查,对结果进行卡方检验及Logistic 回归分析。

结果 护士微笑服务、告知患者操作的目的及注意事项、告知患者所用药物的目的及注意事项是患者对责任护士满意度的影响因素,差异均有统计学意义(P<0.05)。

结论 微笑服务是护士工作中的人文关怀重要措施,也是影响患者对责任护士满意度的主要因素,另外,护士工作中主动告知患者操作、用药目的及注意事项会提高患者对责任护士的满意度。

关键词:责任护士;人文关怀;关怀行为; 满意度;影响因素分析中图分类号:R471 文献标识码:B DOI: 10.19613/ki.1671-3141.2019.30.167本文引用格式:陈敏,聂臣聪. 住院患者对责任护士人文关怀行为感知及满意度调查分析[J].世界最新医学信息文摘,2019,19(30):298-299.Investigation and Analysis of Hospitalized Patients' Perception and Satisfaction of Humanistic Care Behavior ofResponsible NursesCHEN Min, NIE Chen-cong(Zigong Fourth People’s Hospital, Zigong Sichuan)ABSTRACT: Objective To understand the current situation of humanistic care in the work of responsible nurses, and analyze theinfluencing factors of patient care perception on the satisfaction of responsible nurses, so as to provide reference for nursing managers in formulating humanistic care training program and clinical caring behavior. Methods 784 patients in hospital were investigated by self-made questionnaire, and the results were analyzed by chi-square test and Logistic regression. Results Nurses’ smile service, the purpose and matters needing attention of informing patients of the operation, and the purpose and matters needing attention of informing patients of the drugs used were the influencing factors of patients’ satisfaction with the responsible nurses, with statistically significant differences (P<0.05). Conclusion Smile service is an important measure of humanistic care in nurses’ work, and also a major factor affecting patients’ satisfaction with the responsible nurses. In addition, nurses’ active notification of patients’ operation, medication purpose and matters needing attention will improve patients’ satisfaction with the responsible nurses.KEY WORDS: Responsible nurses; Humanistic care; Caring behavior; Satisfaction; Influencing factor analysis0 引言人文关怀护理,作为时代发展和社会进步的必然产物,是实施优质服务的重要体现。

手术患者压力性损伤风险评估的研究进展

手术患者压力性损伤风险评估的研究进展

手术患者压力性损伤风险评估的研究进展崔纪林摘要综述了手术惠者术中压力性损伤的危险因素,对近几年国内外研制出的针对手术惠者的压力性损伤风险评估量表进行分析,寻求较为适用于手术患者的压力性损伤风险评估量表。

认为手术患者压力性损伤的预防应从外界因素、患者自身因素、手术相关因素等围绕压力性损伤发生的高危因素进行。

一个适用于手术患者的压力性损伤风险评估量表,不仅能对压力性损伤的发生起到前馈控制的作用,也能准确筛查出易发压力性损伤的高危人群,减轻护士的工作量。

关键词:手术患者;压力性损伤;风险评估手术患者因术中麻醉作用、手术体位、手术时间等因素成为住院患者压疮的高危人群。

有研究表明其压疮发生率可高达&1%~54.8%。

压疮的定义也在不断的更新,而在2016年D01:10.19792/ki.1006-6411.2021.05.002工作单位:237005六安安徽省六安市人民医院手术室崔纪林:男,本科,护师收稿日期:2019-12-30压疮的定义由美国压疮顾问小组改为压力性损伤,压力性损伤是皮肤和(或)皮下软组织的局部损伤,通常发生在骨突部位或相关的医疗设备器械压迫部位。

针对我国住院患者压疮发生率,有研究显示与手术相关的压疮占院内压疮的23%⑷。

随着对压力性损伤的不断认识,压力性损伤在美国已被认为是一种采取有效措施即可被避免的并发症,而且其医疗保险也不再将院内发生压力性损伤作为赔付项目。

因此,应重点关注压力性损伤发生的高风险因素,针对危险因素采用适用于手术患者[7]Jada A,Mackel C E,Hwang S W,et al.Evaluation and man­agement of adolescent idiopathic scoliosis:a review[J].Neu-rosurg Focus,2017,43(04):2.[8]黄忍,王星,李志军,等.青少年特发性脊柱侧弯的诊治进展[J].中国临床解剖学杂志,2016,04:472-475.[9]Lonstein J E.Scoliosis:surgical versus nonsurgical treatment[J].Clin Orthop Relat Res,2006,443:248-259.[10]Yamada K,Yamamoto H,Nakagawa Y,et al.Etiology Of Idi­opathic scoliosis[J].Clin Orthop,1998,184(35*7):50-57.[11]Weiss H R,Weiss G,Pelermann F.Incidence of curvature pro­gression in idiopathic scoliosis patients treated with scoliosis in-patient rehabilitation(SIR):an age-and sex-matchedcontrolled study[J].Pediatr Rehabil,2003,6(01):23-30. [12]Sanchez-Raya J,Bago J,Pellise F,et al.Does the lower in­strumented vertebra have an effect on lumbar mobility,sub­jective perception of trunk flexibility,and quality of life in pa­tients with idiopathic scoliosis treated by spinal fusion[J].JSpinal Disord Tech,2012,25(08):437-442.[13]Stone B,Beekman C,Hall V,et al.The effect of an exerciseprogram on change in curve in adolescents with minimal idio­pathic scoliosis.A preliminary study[J].Phys Ther,1979,59(06):759-763.[14]田飞,丁桃,闫博,等•运动疗法治疗青少年特发性脊柱侧弯研究进展[J].中国康复,2017,05:425-427.[15]Zaina F,Donzelli S,Negrini A,et al.SpineCor,exercise andSPoRT rigid brace:what is the best for Adolescent IdiopathicScoliosis?Short term results from2retrospective studies[J].Stud Health Technol Inform,2012,176:361-364.[16]Pugacheva N.Corrective exercises in multimodality therapy ofidiopathic scoliosis in children-analysis of six weeks effi­ciency-pilot study[J].Stud Health Technol Inform,2012,176:365-371.[17]Alves D A M,Bezerra D S E,Bragade M D,et al.The effec­tiveness of the Pilates method:reducing the degree of non-structural scoliosis,and improving flexibility and pain in fe­male college students[J].J Bodyw Mov Ther,2012,16(02):191-19&[18]Diab A A.The role of forward head correction in managementof adolescent idiopathic scoliotic patients:a randomized con-troUed trial[J].Clin Rehabil,2012,26(12):1123-1132.[19]陈青云,潘琼华,何燕玲,等.运动处方对糖尿病患者治疗后血压疗效的前瞻性研究[J].中华高血压杂志,2012,11:1076-1079.[20]傅涛,厉彦虎.功能性康复训练改善青少年特发性脊柱侧弯的研究[J].中国组织工程研究,2017,28:4462-446& [21]杨宁,徐盼.运动干预青少年脊柱侧弯Cobb角的变化[J].中国组织工程研究,2013,22:4161-4168.[22]Swain D P,Leutholtz B C.Heart rate reserve is equivalent to%VQ reserve,not to%V02max[J].Med Sci Sports Exerc,1997,29(03):410-414.[23]姚天富,厉彦虎.90s脊柱牵拉操干预青少年特发性脊柱侧弯的效果研究[J].当代体育科技,2015,35:13-15. [24]林伟锋,赵家友,李黎,等.手法结合运动干预治疗青少年特发性脊柱侧弯21例临床观察[J].新中医,2016,02:117-120.(本文编辑:王萍谭哲煜)的压力性损伤风险评估量表,来对手术患者发生压力性损伤的高危人群采取防护措施。

Patient care standards以患者为中心的标准

Patient care standards以患者为中心的标准
Process for complaints, investigation and resolution
PFR4 患者权利告示张贴,告知患者
Patient rights posted, patient informed
12
一般同意和知情同意
GENERAL CONSENT AND INFORMED CONSENT PFR5 PFR5.1 PFR5.2 PFR5.3 PFR5.4
PFR1 领导和员工保护患者和家属权利
Leadership and all staff protects patient and family rights PFR1.1 辨别和克服患者和家属权利的障碍及其影响 Identify, overcome and reduce impact of barrier to rights PFR1.2 确定,尊重和回应患者宗教信仰 Identify, respect and respond to patient’s religious belief PFR1.3 确定并尊重患者的隐私和保密权 Identify & respect patient’s privacy & confidentiality PFR1.4 个人物品:信息和安全保障 Personal belongings: information and safeguard PFR1.5 防止弱势群体被攻击 Protect vulnerable population from assault
参与,信息和疼痛控制权
投诉和权利通知权
Right to complaints and to be informed of rights
ቤተ መጻሕፍቲ ባይዱ
一般同意和知情同意

教学查房与体格检查规范

教学查房与体格检查规范
bedside teaching rounds as patients may perceive a medical team that engages in being more compassionate providers, supporting a patient-centered argument that teaching rounds should return to the bedside.
住院医师规范化培训
教学查房与体格检查 规范
Teaching rounds 教学查房
• 教学查房是临床教学 的重要环节,是根据 教学需要,选择典型 或疑难、罕见的教学 病例,针对学员所进 行的结合理论与病人 具体实际情况,深入 介绍,讲解、分析的 教学活动 。
Dr. Bates – The book is not enough…
perceived barrier to the use of bedside teaching rounds is a fear of it causing patient discomfort or dissatisfaction. The objective of this study was to compare patient perception of bedside versus nonbedside teaching rounds. METHODS: Study participants were adults admitted to a family medicine inpatient team at a large university teaching hospital. Upon admission, participants were randomized to receive bedside or nonbedside teaching rounds conducted by a team consisting of medical students, family medicine residents, and one attending physician. Each participant completed a questionnaire administered on the day of discharge assessing patients' perception of their involvement in medical decision making, trust in the medical team, satisfaction with care, and provider compassion. Statistical analysis was performed to examine any differences between the two groups. RESULTS: The vast majority of the sample indicated that they knew what they were being treated for in the hospital (n = 105, 98%), reported the medical team spent an adequate amount of time with them (n = 100, 94%), and reported the medical team explained the diagnosis and care in easy-tounderstand terms (n = 101, 94%). On 1- to 5-point scales, participants reported that the medical team involved them in making decisions (4.62, standard deviation [SD] 0.72), they trusted the medical team (4.91, SD 0.32), they were satisfied with their care (4.85, SD 0.38), and their medical team was compassionate toward them (4.84, SD 0.44). Overall levels of satisfaction were positive on all of the measures, with no statistical significance between the two groups regarding measures of involvement in medical decision making, trust in the medical team, and satisfaction with care. Interestingly, subjects perceived level of compassion of their medical team to be significantly higher with a bedside teaching approach compared with a nonbedside approach. CONCLUSIONS: Despite concerns that bedside teaching rounds may lead to patient discomfort, this study found no evidence supporting this perception. In fact,

如何处理好医生与病人之间的关系英语作文

如何处理好医生与病人之间的关系英语作文

如何处理好医生与病人之间的关系英语作文全文共3篇示例,供读者参考篇1How to Handle the Doctor-Patient RelationshipThe relationship between a doctor and their patient is a sacred one, built on trust, compassion, and mutual respect. As a medical student, I have come to understand the profound significance of this bond and the delicate balance that must be struck to maintain its integrity. In this essay, I will delve into the nuances of navigating this intricate connection, offering insights drawn from personal experiences and academic studies.Firstly, it is imperative to acknowledge the inherent power dynamic that exists within the doctor-patient relationship. Doctors, by virtue of their extensive training and expertise, hold a position of authority and influence over their patients. This imbalance can create a sense of vulnerability for the patient, who entrusts the doctor with their well-being and places their life in their hands. Consequently, it is the doctor's ethical responsibility to wield this power judiciously, fostering an environment of trust and making the patient feel heard, understood, and respected.Effective communication is the cornerstone of any successful doctor-patient relationship. Doctors must cultivate active listening skills, allowing patients to express their concerns, symptoms, and fears without interruption. By demonstrating empathy and validating the patient's emotions, doctors can establish a rapport that transcends the clinical setting. Clear and comprehensible explanations of medical jargon, treatment plans, and potential risks are essential, empowering patients to make informed decisions about their healthcare.Privacy and confidentiality are paramount in maintaining the sanctity of the doctor-patient relationship. Patients must feel secure in the knowledge that their personal information, medical history, and intimate details will be treated with the utmost discretion. Breaching this trust can have severe consequences, eroding the foundation of the relationship and undermining the patient's willingness to divulge sensitive information crucial for accurate diagnosis and effective treatment.Cultural competence and sensitivity are indispensable qualities for doctors navigating the diverse tapestry of patients they encounter. Respecting cultural beliefs, traditions, and preferences can foster a deeper connection and enhance the patient's comfort level. By acknowledging and accommodatingcultural nuances, doctors can tailor their approach, ensuring that their care is inclusive and resonates with the patient's values and lived experiences.Professionalism and ethical conduct are non-negotiable in the medical field. Doctors must maintain objectivity, avoiding personal biases or judgments that could compromise their ability to provide impartial care. Adhering to strict ethical guidelines, such as respecting patient autonomy and maintaining appropriate boundaries, is essential for preserving the integrity of the doctor-patient relationship.Furthermore, continuity of care plays a vital role in strengthening this bond. When patients have the opportunity to establish long-term relationships with their doctors, a deeper level of understanding and trust can develop. Consistent care enables doctors to monitor the patient's progress, adjust treatment plans as needed, and foster a sense of familiarity and comfort for the patient.While the doctor-patient relationship is primarily focused on the well-being of the patient, it is crucial to acknowledge the emotional toll that medical professionals often face. Dealing篇2The doctor-patient relationship is a delicate and complex dynamic that requires careful navigation from both parties. As a medical student, I have come to understand the importance of cultivating a strong rapport with patients, built on trust, empathy, and effective communication. This essay will explore various strategies for fostering positive doctor-patient relationships, drawing from personal experiences and insights gained during my clinical rotations.Firstly, it is crucial to approach each patient interaction with an open mind and a willingness to listen. Patients often come to their appointments with a myriad of concerns, fears, and preconceptions about their health condition. As a doctor, it is our responsibility to create a safe and non-judgmental environment where patients feel comfortable expressing themselves freely. Active listening is key – paying close attention to not only the patient's words but also their body language, tone, and underlying emotions. This helps us better understand their unique perspective and tailor our approach accordingly.Empathy is another cornerstone of a successfuldoctor-patient relationship. We must strive to view the situation through the patient's eyes, acknowledging their struggles, validating their feelings, and showing genuine compassion.Simple gestures, such as maintaining eye contact, offering a comforting touch (with consent), and using reassuring language, can go a long way in making patients feel heard and supported. It is important to remember that patients are not just a collection of symptoms but whole individuals with complex lives and experiences.Clear and effective communication is also essential in building trust and fostering a collaborative partnership with patients. As medical professionals, we must be mindful of using plain language that is easily understandable, avoiding jargon or overly technical terms whenever possible. Encouraging patients to ask questions and providing thorough explanations about their condition, treatment options, and potential risks or side effects can help alleviate anxiety and empower them to make informed decisions about their care.Furthermore, it is crucial to respect patient autonomy and involve them in the decision-making process. While we possess the medical expertise, patients have the right to make choices about their own bodies and have their personal values and preferences taken into account. Presenting all viable options objectively, without coercion or bias, and engaging in shareddecision-making can strengthen the doctor-patient bond and improve treatment adherence.Cultural competence and sensitivity are also important considerations in building successful doctor-patient relationships. We must be aware of and respect different cultural beliefs, practices, and communication styles that may influence a patient's perception of health and illness. Taking the time to understand a patient's cultural background and adapting our approach accordingly can help bridge potential gaps and foster better understanding and trust.Maintaining professionalism and setting appropriate boundaries is another key aspect of managing thedoctor-patient relationship. While empathy and rapport are essential, it is important to maintain a certain level of detachment and objectivity to ensure that our clinical judgment is not compromised. Setting clear boundaries and expectations from the outset, such as addressing privacy concerns, respecting personal space, and avoiding inappropriate personal disclosures, can help maintain a healthy and ethical dynamic.Lastly, continuity of care and follow-up are crucial for building long-term, meaningful relationships with patients. Consistently seeing the same provider or team of providers canfoster a sense of familiarity and trust, allowing for more efficient communication and a deeper understanding of the patient's unique needs. Regular follow-up appointments and check-ins, whether in-person or through telemedicine, can reinforce the doctor-patient bond and ensure that patients feel supported throughout their healthcare journey.In conclusion, cultivating positive doctor-patient relationships is a multifaceted endeavor that requires a combination of active listening, empathy, clear communication, respect for patient autonomy, cultural sensitivity, professionalism, and continuity of care. By consistently applying these principles, we can create an environment of trust, understanding, and collaboration, ultimately leading to better health outcomes and a more fulfilling experience for both patients and healthcare providers. As future physicians, it is our responsibility to continuously strive for excellence in this realm, recognizing the profound impact that strong doctor-patient relationships can have on the healing process and overall quality of care.篇3How to Handle the Doctor-Patient RelationshipThe relationship between a doctor and their patient is a delicate and complex dynamic that requires care, empathy, and professionalism from both parties. As future medical professionals, it is crucial for us to understand the nuances of this relationship and develop strategies to navigate it effectively. In this essay, I will explore the key elements of a healthydoctor-patient relationship and provide insights on how we, as students, can cultivate and maintain positive interactions with our future patients.The first and foremost aspect of a successful doctor-patient relationship is trust. Patients entrust their well-being, and sometimes their lives, to the expertise and care of their doctors. It is our responsibility to foster an environment of trust by demonstrating competence, integrity, and respect. We must actively listen to our patients, acknowledge their concerns, and provide clear, honest communication throughout the treatment process. By establishing trust, patients are more likely to feel comfortable sharing sensitive information, adhering to treatment plans, and engaging in open dialogue about their health.Effective communication is the cornerstone of a strong doctor-patient relationship. As medical students, we mustdevelop exceptional communication skills to ensure that our patients fully understand their conditions, treatment options, and the potential risks and benefits associated with each choice. Clear and comprehensible language, free from excessive medical jargon, is essential to facilitate understanding and foster a collaborative decision-making process. Additionally, we should encourage our patients to ask questions, voice their concerns, and actively participate in their own care.Empathy is another crucial element in building a positive doctor-patient relationship. We must strive to understand our patients' perspectives, emotions, and life circumstances, as these factors can significantly impact their health and well-being. By demonstrating empathy, we can establish a deeper connection with our patients, which can lead to improved treatment adherence, better health outcomes, and a more satisfying overall experience for both parties.Cultural competence is also an essential aspect of a successful doctor-patient relationship. We must be aware of and sensitive to the diverse cultural backgrounds, beliefs, and values of our patients. By respecting and accommodating cultural differences, we can build trust, enhance communication, and provide more culturally appropriate care. This approach not onlyimproves the quality of care but also promotes inclusivity and fosters a more equitable healthcare system.Maintaining professional boundaries is crucial in the doctor-patient relationship. While empathy and rapport are essential, it is important to maintain a professional distance to ensure objectivity and avoid potential conflicts of interest. We must be mindful of the power dynamics inherent in thedoctor-patient relationship and refrain from engaging in inappropriate or unethical behaviors that could compromise our professional integrity or the well-being of our patients.Confidentiality is another key aspect of the doctor-patient relationship. Patients must feel confident that their personal health information will be treated with the utmost privacy and discretion. As future medical professionals, we must uphold strict confidentiality standards and ensure that patient data is securely maintained and shared only with authorized individuals involved in their care.Finally, it is important to recognize the emotional toll that caring for patients can have on healthcare professionals. We must prioritize our own mental and physical well-being to avoid burnout and maintain the ability to provide compassionate and competent care. Seeking support from colleagues, mentors, orprofessional counseling services when needed can help us navigate the emotional challenges of our profession and maintain a healthy work-life balance.In conclusion, the doctor-patient relationship is a multifaceted dynamic that requires careful cultivation and maintenance. By fostering trust, effective communication, empathy, cultural competence, professional boundaries, confidentiality, and self-care, we can create an environment that promotes better health outcomes, patient satisfaction, and a more fulfilling professional experience for ourselves as future medical practitioners. It is our responsibility to uphold these principles and continuously strive to improve the quality of our interactions with patients, ensuring that we provide the highest standard of care while maintaining the utmost respect and compassion for those we serve.。

有耐心的对待病人英语作文

有耐心的对待病人英语作文

有耐心的对待病人英语作文Title: The Art of Patience in Patient Care。

In the realm of healthcare, the virtue of patience stands as a cornerstone in the provision of quality patient care. Patience is not merely the ability to wait, but it encompasses an attitude of understanding, empathy, and perseverance in the face of challenges. In this essay, we delve into the significance of patience in healthcare settings and explore how healthcare professionals can embody this virtue to enhance patient outcomes.Firstly, patience plays a pivotal role in building rapport and trust between healthcare providers and patients. When patients are unwell, they may feel vulnerable, anxious, or even distressed. In such moments, a patient's perception of time may be skewed, and they might require more time to comprehend information or express their concerns. Apatient-centric approach demands that healthcare professionals exercise patience, actively listen topatients, and address their needs with empathy. By demonstrating patience, healthcare providers create a conducive environment where patients feel valued, understood, and respected, thereby fostering a therapeutic alliance that is fundamental to effective healthcare delivery.Moreover, patience is essential in navigating the complexities of diagnosis and treatment. Healthcare professionals encounter diverse patient populations with unique medical histories, cultural backgrounds, and personal beliefs. Consequently, arriving at an accurate diagnosis and formulating an effective treatment plan often requires careful consideration, collaboration, and sometimes trial and error. Patience empowers healthcare providers to approach each case with diligence, thoroughness, and an open mind. It enables them to persevere through diagnostic uncertainties, setbacks, and treatment challenges, while maintaining a steadfast commitment to delivering optimal care to every patient.Furthermore, patience is instrumental in supportingpatients through their recovery journey. Recovery is seldom a linear process, and setbacks or slow progressions maytest both patients and healthcare providers alike. Patience enables healthcare professionals to provide ongoing encouragement, education, and support to patients, empowering them to navigate obstacles and achieve their health goals. Whether it involves teaching a patient self-care techniques, monitoring progress over time, or adjusting treatment plans as needed, patience allows healthcare providers to remain steadfast advocates fortheir patients' well-being.In addition, patience is integral to promotingeffective communication and resolving conflicts in healthcare settings. Misunderstandings, disagreements, or miscommunications may arise between healthcare providers, patients, and their families, particularly in moments of stress or uncertainty. Patience encourages healthcare professionals to approach such situations with composure, active listening, and a willingness to understand differing perspectives. It fosters constructive dialogue, mutual respect, and collaborative problem-solving, ultimatelyleading to improved patient satisfaction and outcomes.Moreover, patience extends beyond individual interactions to encompass broader systemic challengeswithin the healthcare landscape. Addressing issues such as long wait times, bureaucratic hurdles, or resource constraints requires a collective commitment to patience, perseverance, and advocacy for positive change. By advocating for systemic improvements and championingpatient-centered policies, healthcare professionals can contribute to creating a more equitable, accessible, and efficient healthcare system that better serves the needs of all patients.In conclusion, patience is not merely a virtue but a foundational principle in the provision of quality patient care. By embodying patience, healthcare professionals can build trust, navigate complexities, support recovery,foster communication, and drive systemic improvementswithin the healthcare ecosystem. In a world where time is often perceived as a scarce commodity, patience reminds us of the profound impact that empathy, understanding, andperseverance can have on the lives of those we serve. As healthcare providers, let us embrace patience as a guiding beacon in our commitment to healing, compassion, and excellence in patient care.。

介绍医生成为被病人抱怨的原因英语作文

介绍医生成为被病人抱怨的原因英语作文

Doctor-Patient Misunderstandings: Reasons Why Doctors Become the Target of PatientComplaintsIn the realm of healthcare, doctors often occupy a position of authority and trust. However, despite their best efforts and dedication, doctors sometimes become the unwitting recipients of patient complaints. This phenomenon is not unique to any particular region or healthcare system but is a global issue that deserves attention. This article aims to explore the reasons why doctors may become the target of patient complaints and suggest ways to address these issues.Firstly, communication gaps between doctors andpatients can lead to misunderstandings and dissatisfaction. Medical terminology can be complex and intimidating fornon-experts, and doctors may sometimes assume that patients understand the information they are providing. Failure to communicate effectively can result in patients feeling ignored or misunderstood, leading to feelings of dissatisfaction and even resentment.Secondly, the emotional toll of dealing with illness can cloud patients' perspectives. When facing a health crisis, patients and their families may be under immense stress and anxiety. This emotional state can lead to patients being more reactive or emotional during interactions with doctors, which can in turn affect the doctor's ability to provide objective and compassionate care.Thirdly, the demands of modern healthcare systems can put doctors under pressure, affecting their performance. With increasing patient loads and tighter time constraints, doctors may feel pressured to rush through consultations or make quick decisions. This can lead to a perceived lack of attention or care on the part of the doctor, sparking complaints from patients.Moreover, the perception of a lack of empathy or compassion from doctors can also be a major factor. Patients often expect doctors to display empathy and understanding during their vulnerable state. If doctorsfail to demonstrate these qualities, patients may feel thatthey are not being treated as individuals and may voicetheir dissatisfaction through complaints.Lastly, issues related to medical errors or negligence can also lead to patient complaints. While doctors striveto provide the best care possible, mistakes can occur dueto human error or system failures. When these mistakesresult in adverse outcomes for patients, they may feel justified in voicing their complaints.In addressing these issues, doctors can take several steps to improve patient satisfaction and reduce complaints. Firstly, effective communication skills are crucial.Doctors should strive to use clear and understandable language when explaining medical conditions and treatment options. They should also actively listen to patients' concerns and address them promptly.Secondly, doctors should prioritize emotional supportfor their patients. By acknowledging patients' emotional needs and providing compassionate care, doctors can help ease their anxiety and improve their overall experience.Additionally, doctors should seek to manage their workload and avoid burnout. By taking steps to reducestress and improve work-life balance, doctors can ensure that they are able to provide high-quality care to their patients.Finally, doctors should strive to continuously improve their skills and knowledge. By participating in regular training and education programs, doctors can reduce therisk of medical errors and ensure that they are providing the best possible care to their patients.In conclusion, while doctors may become the target of patient complaints for various reasons, it is important to recognize that these complaints are often the result of misunderstandings or systemic issues rather than individual failures. By addressing these issues and prioritizing communication, empathy, and continuous improvement, doctors can reduce the likelihood of complaints and improve the overall quality of healthcare delivery.**医生与病人之间的误解:医生成为病人抱怨对象的原因** 在医疗领域,医生常常占据权威和信任的地位。

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T h e ne w engl a nd jour na l o f medicinen engl j med 359;18 october 30, 20081921Patients’ Perception of Hospital Carein the United StatesAshish K. Jha, M.D., M.P.H., E. John Orav, Ph.D., Jie Zheng, Ph.D.,and Arnold M. Epstein, M.D., M.A.From the Department of Health Policy and Management, Harvard School of Public Health (A.K.J., J.Z., A.M.E.); the Division of General Medicine, Brigham and Wom-en’s Hospital (A.K.J., E.J.O., A.M.E.); and the Boston Veterans Affairs Healthcare System (A.K.J.) — all in Boston. Address reprint requests to Dr. Jha at the Depart-ment of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115, or at ajha@.N Engl J Med 2008;359:1921-31.Copyright © 2008 Massachusetts Medical Society.Abstr actBackgroundPatients’ perceptions of their care, especially in the hospital setting, are not well known. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey provide a portrait of patients’ experiences in U.S. hospitals.MethodsWe assessed the performance of hospitals across multiple domains of patients’ experiences. We examined whether key characteristics of hospitals that are thought to enhance patients’ experiences (i.e., a high ratio of nurses to patient-days, for-profit status, and nonacademic status) were associated with a better experience for patients. We also examined whether a hospital’s performance on the HCAHPS sur-vey was related to its performance on indicators of the quality of clinical care.ResultsWe found moderately high levels of satisfaction with care (e.g., on average, 67.4% of a hospital’s patients said that they would definitely recommend the hospital), with a high degree of correlation among the measures of patients’ experiences (Cronbach’s alpha, 0.94). As compared with hospitals in the bottom quartile of the ratio of nurses to patient-days, those in the top quartile had a somewhat better performance on the HCAHPS survey (e.g., 63.5% vs. 70.2% of patients responded that they “would definitely recommend” the hospital; P<0.001). Hospitals with a high level of patient satisfaction provided clinical care that was somewhat higher in quality for all conditions examined. For example, those in the top quartile of HCAHPS ratings performed better than those in the bottom quartile with respect to the care that patients received for acute myocardial infarction (actions taken to provide appropriate care as a proportion of all opportunities for providing such ac-tions, 95.8% vs. 93.1% in unadjusted analyses; P<0.001) and for pneumonia (90.5% vs. 88.6% in unadjusted analyses, P<0.001).ConclusionsThis portrait of patients’ experiences in U.S. hospitals offers insights into areas that need improvement, suggests that the same characteristics of hospitals that lead to high nurse-staffing levels may be associated with better experiences for patients, and offers evidence that hospitals can provide both a high quality of clinical care and a good experience for the patient.T h e ne w engl a nd jour na l o f medicinen engl j med 359;18 october 30, 20081922The quality of health care in t he United States varies according to region and setting and is too often inadequate.1-3 In response to uneven care among hospitals, fed-eral policy makers and private organizations have launched an important program to collect and publicly report data on the quality of the health care Americans receive. The Hospital Quality Al-liance (HQA) program,2 overseen by private and public entities, including the Centers for Medicare and Medicaid Services (CMS) and the Joint Com-mission, is leading this effort in the hospital sec-tor, producing quarterly reports on the provision of effective services for common conditions. Al-though the HQA has made these data increas-ingly available to the public, there has been little information on the quality of hospital care from the patients’ perspective. As the Institute of Med-icine points out, the provision of patient-centered care is a key element of a high-quality health care system.1To address this information gap, the HQA pro-gram incorporated the Hospital Consumer As-sessment of Healthcare Providers and Systems (HCAHPS) survey into its battery of measure-ments.4,5 Many of the nation’s hospitals have made a commitment to providing responses to the survey from patients discharged from their facilities. The first set of national HCAHPS data became publicly available on March 28, 2008.The new HCAHPS data allow us to gain key insights into the experiences of patients in the hospital and the ways in which these experi-ences relate to other aspects of care. We ad-dressed four questions: How do U.S. hospitals perform on measurements of patients’ experi-ences, and is performance with respect to one element of a patient’s experience (e.g., commu-nication with physicians) related to performance with respect to another element (e.g., communi-cation with nurses)? Do patients who receive care in hospitals with three key characteristics (being a for-profit hospital, having a higher ratio of nurses to patient-days, and being a nonteaching hospital) report better experiences than patients in hospitals without these characteristics? Is a hospital’s ability to provide patient-centered care related to its performance on measures of clini-cal quality? Finally, how variable is the perfor-mance of hospitals across regions?MethodsHCAHPS and the Domains of Patients’ ExperiencesThe HCAHPS survey, developed by the Agency for Healthcare Research and Quality, asks patients 27 questions about their experiences in the hospital and about their demographic characteristics. Re-sponses to 14 of the questions (possible responses: always, usually, sometimes, and never) are sum-marized by CMS and reported in 6 domains as composites: communication with physicians, com-munication with nurses, communication about medications, quality of nursing services, adequacy of planning for discharge, and pain management (for specific questions, see Appendix 1 in the Supplementary Appendix, available with the full text of this article at ). The CMS calculated composite ratings for the domains by averaging the responses to each individual item within that domain, as described in the technical appendix in the Supplementary Appendix. Other domains reflect individual questions about wheth-er the rooms were clean and whether they were quiet (possible responses: always, usually, some-times, and never) and two overall ratings: a global rating of the hospital on a scale of 0 to 10, with 0 being the worst and 10 being the best a hospital can be, and a question about whether the patient would recommend the hospital to family and friends (possible responses: definitely yes, prob-ably yes, probably no, and definitely no). The global ratings were grouped by the CMS into one of three categories, 0 to 6, 7 or 8, or 9 or 10, rather than made available individually. The de-tails of the development of the survey, psycho-metric testing, and factor analyses used to create summary ratings within domains have been de-scribed previously.5-10 Data are adjusted for the method of administration of the survey, as well as for eight factors related to the patient (e.g., age, educational level, and health status) in order to substantially reduce nonresponse bias, as de-scribed in the technical appendix in the Supple-mentary Appendix and at .Under the CMS’s authority to monitor provid-ers of care and to oversee care for Medicare pa-tients, the CMS and its Quality Improvement Organizations can require that the HCAHPS sur-vey be administered to patients who are beingPatients’ Perception of Hospital Caren engl j med 359;18 october 30, 20081923discharged from hospitals that receive Medicare payment. It seems likely that nearly all hospitals in the nation will participate in the program in the future, although some hospitals chose to withhold data from public reporting in the first year. The HCAHPS data in this study reflect the experiences of patients with respect to care de-livered during the period from July 2006 through June 2007.HQA Data on Provision of High-Quality Clinical CareThe HQA also provides data on the compliance of hospitals with 24 measures of evidence-based processes with respect to care for three condi-tions — acute myocardial infarction, congestive heart failure, and pneumonia — and with respect to the prevention of complications from surgery (see Appendix 2 in the Supplementary Appendix). To create condition-specific summary scores, we used a common method,11 in which the summary score is a percentage derived from the sum of the number of times a hospital performed the appro-priate action across all measures for that condi-tion (numerator) divided by the number of op-portunities the hospital had to provide appropriate care (denominator). Composite scores for a con-dition were calculated only if a hospital had at least 30 patients for at least one measure.Structural Characteristics of HospitalsWe linked the HCAHPS data to the annual survey of the American Hospital Association, which col-lects the following information from hospitals: nurse-staffing levels, profit status, status of mem-bership in the Council of Teaching Hospitals and Health Systems, number of beds, census region, location (region and urban vs. rural), percentage of patients receiving Medicaid, and presence or absence of a medical intensive care unit (ICU). We calculated the ratio of nurses to patient-days by dividing the number of full-time-equivalent nurses on staff by 1000 patient-days.Statistical AnalysisWe used chi-square tests and t-tests to compare hospital characteristics between hospitals that reported HCAHPS data and those that chose not to do so. We calculated the average proportion of respondents who rated hospitals in the highestcategories in the two overall ratings and in indi-vidual domains. We next calculated the correla-tions between the two overall ratings of hospitals’ performance and among the individual domains.The two highest ratings of overall measures of patients’ experiences (global rating of 9 or 10 for a hospital and response of “would definitely recommend the hospital”) were, not surprisingly, highly correlated with each other (r = 0.87). There-fore, we focused primarily on the fraction of pa-tients who rated the hospital in the highest cate-gory (9 or 10 on a scale of 0 to 10) as the primary indicator of patient satisfaction. We chose, a pri-ori, to examine three key characteristics that we postulated might be related to a patient’s experi-ence in the hospital: the ratio of nurses to patient-days, profit status (for-profit vs. not-for-profit), and academic status (teaching vs. nonteaching, as defined by membership or nonmembership in the Council of Teaching Hospitals and Health Systems). We posited that hospitals with more nurses might provide more patient-centered care because there would be more staff available to tend to patients’ needs. We also hypothesized that for-profit hospitals would be highly attuned to patients’ experiences and that teaching hospi-tals might focus more on technical aspects of quality than on optimizing patients’ experiences. We examined bivariate relationships between each of these characteristics and HCAHPS ratings and subsequently constructed multivariable linear re-gression models that adjusted for the other two characteristics as well as other characteristics that might be potential confounders: number of beds in the hospital, census region, location (ur-ban vs. rural), presence or absence of a medical ICU (as a marker of technological capability), and percentage of patients receiving Medicaid (as a measure of the extent to which the hospital pro-vides care for a low-income population). The de-pendent variable was the proportion of patients who rated their care as 9 or 10.We examined the relationship between a hos-pital’s performance with respect to the overall experience of the patients and measures of clini-cal process using the HQA summary scores de-scribed above. We categorized all hospitals into quartiles of HCAHPS ratings and examined the mean score for clinical quality within each quar-tile, using a test for trend to determine whetherT h e ne w engl a nd jour na l o f medicinen engl j med 359;18 october 30, 20081924a higher rating on the HCAHPS survey was as-sociated with better clinical HQA scores. We subsequently constructed multivariable models to adjust for other hospital characteristics in or-der to assess the independent relationship be-tween performance on the HCAHPS survey and HQA scores.Finally, we examined performance on the HCAHPS survey according to hospital-referral regions, which are based on access to tertiary care.12 We aggregated the total number of pa-tients with each of the four clinical conditions for which we had HQA clinical data and chose the 40 hospital-referral regions with the largest number of patients. We then calculated the per-formance on each of the HCAHPS measures for each hospital-referral region by averaging the ratings for all hospitals in that hospital-referral region, weighted by hospital size. We subsequent-ly ranked all hospital-referral regions according to the overall proportion of patients who gave their care a high global rating (a score of 9 or 10). We present data on both overall measures (a high global rating and a positive response to the question of whether the patient would recom-mend the hospital) for the top-ranked and bot-tom-ranked hospital-referral regions.R esultsCharacteristics of Hospitals that Reported HCAHPS DataOf the 4032 hospitals that report any quality data to the HQA program, 2429 (60.2%) reported data on patients’ experiences to the CMS. More than 75% of the hospitals had 300 or more patients who responded to the survey, whereas only 3% had fewer than 100 respondents. Only data on categorical responses were made available. On average, 36% of the patients who were invited to participate chose to do so. All reported data were adjusted for the method of administration of the survey, the case mix, and nonresponse bias (see the technical appendix in the Supplementary Ap-pendix). Hospitals that were large and private not-for-profit, hospitals with ICUs, teaching hos-pitals, and hospitals located in urban areas and in the Northeast were more likely to report HCAHPS data than not to report the data (Table 1). Reporting hospitals also had a better performance on HQA measures. Reporting and nonreporting hospitals had similar percentages of Medicaid patients and ratios of nurses to patient-days.Patients’ Satisfaction with Hospital CareOn average, 63% of patients gave their care a high global rating (9 or 10), and an additional 26% rated their care as 7 or 8, whereas only 11% gave a rating of 6 or less. Sixty-seven percent of the patients said that they would definitely recom-mend the hospital in which they had received care, and another 27% of patients said they would probably recommend the hospital. The distribu-tion of performance on these two measures is shown in Appendixes 3a through 3d in the Sup-plementary Appendix. The proportion of patients who reported satisfaction with their care in spe-cific domains varied substantially: on average, 79% of patients reported that doctors always com-municated well, whereas only 54% of patients re-ported that their room was always quiet (Fig. 1).The domains of patients’ experiences were highly correlated overall (Cronbach’s alpha, 0.94), with individual correlation coefficients ranging from 0.32 (for the correlation between adequate discharge instructions and adequate nursing ser-vice) to 0.84 (for the correlation between com-munication with nurses and adequate pain con-trol). Fifteen of the 28 correlation coefficients were greater than 0.6, whereas only 2 coefficients were 0.4 or less (Appendix 4 in the Supplemen-tary Appendix).Hospital Characteristics and Patients’ ExperiencesWe found that two of the three characteristics of a hospital that we had hypothesized to be associ-ated with HCAHPS performance actually were, but the association of one of the two was in the opposite direction of our hypothesis (Table 2). The ratio of nurses to patient-days was a predictor of performance on the HCAHPS survey: a larger percentage of patients in hospitals in the top quartile of the ratio of nurses to patient-days, as compared with the bottom quartile, gave the hospital a global rating of 9 or 10 (65.9% vs. 60.5%, P<0.001 for trend). Fewer patients in for-profit hospitals gave a global rating of 9 or 10 than patients in either private or public not-for-profit hospitals (59.1% vs. 64.8% and 65.4%, re-spectively; P<0.001 for both comparisons). There was no significant difference between teaching and nonteaching hospitals in the percentage of patients who gave the highest global rating (63.3% and 62.8%, respectively; P = 0.51).We then examined each of these three char-acteristics and the ratings on individual HCAHPSPatients’ Perception of Hospital Caren engl j med 359;18 october 30, 20081925components in detail (Table 3). Although the performance of hospitals in the highest quartile of the ratio of nurses to patient-days was better than that of hospitals in the lowest quartile for each component, the biggest differences were in the areas of nursing services (4.2 percentage points), discharge instructions (3.2 percentage points), communication with nurses (3.0 percent-age points), and communication about medica-tions (3.0 percentage points), whereas the differ-ences were smaller with respect to whether the room was quiet (2.2 percentage points) and clean (2.0 percentage points) and with respect to com-munication with physicians (0.9 percentage point). The performance of for-profit hospitals was worse than that of private and public not-for-profit hospitals in all areas. Differences between teaching and nonteaching hospitals were small and inconsistently significant.Patients’ Satisfaction with Care and Quality of CareWe found that patients’ satisfaction with care was associated with the quality of clinical care in the hospitals for all four conditions measured. In un-adjusted analyses, the HQA scores for hospitals* Plus–minus values are means ±SD. AMI denotes acute myocardial infarction, CHF congestive heart failure, HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems, HQA Hospital Quality Alliance, and ICU inten-sive care unit.† The HQA score is a percentage derived from the sum of the number of times a hospital performed the appropriate ac-tion across all measures for that condition (numerator) divided by the number of opportunities the hospital had to pro-vide appropriate care (denominator).T h e ne w engl a nd jour na l o f medicinen engl j med 359;18 october 30, 20081926in the highest quartile of HCAHPS ratings were, on average, about 2 to 4 percentage points higher than the HQA scores for hospitals in the lowest quartile of HCAHPS ratings. The results were sim-ilar when we adjusted the analysis for key hospital characteristics (Table 4). For example, the average adjusted HQA score for the quality of surgical care was 85.7% for hospitals in the top quartile of HCAHPS ratings, as compared with 82.8% for hospitals in the bottom quartile (P<0.001).Patients’ Satisfaction in the 40 Largest Hospital-Referral RegionsWe found a substantial range of performance across the 40 largest regions: in Birmingham, Alabama, on average, 71.9% of the patients gave their care a high global rating (9 or 10), whereas in East Long Island, New York, only 49.9% of patients did so (Table 5). There was a similar range in the percentage of patients who would definitely recommend the hospital (Table 5). There were also differences of 15 to 25 percentage points between the best and worst regions in perfor-mance on individual HCAHPS components (data not shown).DiscussionThe HCAHPS data provide a national portrait of patients’ experiences in U.S. hospitals; they arelikely to provide a baseline for the measures that will be used to monitor patient-reported quality performance in the future. We found that although most patients were generally satisfied with their care, there was room for improvement. Patients who received care in hospitals with a high ratio of nurses to patient-days reported somewhat bet-ter experiences than those who received care in hospitals with a lower ratio, and hospitals that performed well on the HCAHPS survey generally provided a higher quality of care across all mea-sures of clinical quality than did those that did not perform well on the survey, although the strength of this relationship was modest. There were large regional variations in patients’ experi-ences with their care, with Birmingham, Alabama, performing better than other regions and the New York City area lagging behind.Patients’ ratings of hospital care are of inter-est because they are, in many ways, “the bottom line.” The ratings we found leave room for im-provement. On average, hospitals received a rating of 9 or 10 from 63% of their patients and a rat-ing or 7 or better from 89%; although these ratings suggest that only a small percentage of patients were seriously dissatisfied, very few hos-pitals received the highest ratings from 90% or more of their patients (see Appendixes 3a and 3c in the Supplementary Appendix). More important, HCAHPS highlights specific areas for improve-Patients’ Perception of Hospital Caren engl j med 359;18 october 30, 20081927* A high global rating was defined as a rating of 9 or 10 (on a scale of 0 to 10, with higher scores reflecting better perfor-mance) on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In the adjust-ed analysis, performance on the HCAHPS survey was adjusted for all the other characteristics shown. † P values are for the results of adjusted analyses.‡ Academic status was defined according to whether the hospital was a member of the Council of Teaching Hospitals and Health Systems.T h e ne w engl a nd jour na l o f medicinen engl j med 359;18 october 30, 20081928* T h e d a t a s h o w n a r e t h e p e r c e n t a g e s o f p a t i e n t s w h o r e s p o n d e d t h a t t h e y “a l w a y s ” h a d a p o s i t i v e e x p e r i e n c e w i t h r e s p e c t t o t h e i n d i v i d u a l c o m p o n e n t s o f t h e H o s p i t a l C o n s u m e rA s s e s s m e n t o f H e a l t h c a r e P r o v i d e r s a n d S y s t e m s (H C A H P S ) s u r v e y . F o r t h e q u e s t i o n o f w h e t h e r t h e p a t i e n t w o u l d r e c o m m e n d t h e h o s p i t a l , t h e d a t a a r e t h e p e r c e n t a g e s o f p a t i e n t s w h o r e s p o n d e d “d e f i n i t e l y y e s .” T h e d a t a w e r e a d j u s t e d f o r n u m b e r o f b e d s , r e g i o n , p r o f i t s t a t u s , a c a d e m i c s t a t u s , l o c a t i o n , p r e s e n c e o r a b s e n c e o f a n i n t e n s i v e c a r e u n i t , p e r c e n t a g e o f M e d i c a i d p a t i e n t s , a n d r a t i o o f n u r s e s t o p a t i e n t -d a y s e x c e p t f o r t h e v a r i a b l e o f i n t e r e s t . † T h e P v a l u e i s f o r t h e c o m p a r i s o n a m o n g t h e t h r e e c a t e g o r i e s .‡ A c a d e m i c s t a t u s w a s d e f i n e d a c c o r d i n g t o w h e t h e r t h e h o s p i t a l w a s a m e m b e r o f t h e C o u n c i l o f T e a c h i n g H o s p i t a l s a n d H e a l t h S y s t e m s .Patients’ Perception of Hospital Caren engl j med 359;18 october 30, 20081929ment, such as nursing care, communication about medications, pain control, and provision of clear discharge instructions.We found a moderate relationship between the ratio of nurses to patient-days and patients’ experiences in the hospital. Although ensuring adequate staffing of nurses has been of consid-erable interest to clinical managers and policy-makers, data on the relationship between high nurse-staffing levels and high-quality care have been mixed. Several studies have shown that units with higher nurse-staffing levels have lower com-plication and mortality rates,13-15 but others have not shown this relationship.16,17 Clark et al. found that hospitals in states with nursing short-ages had lower levels of patient satisfaction 18 than hospitals in states with no nursing short-ages, and others have also found a relationship between the nurse-staffing levels and patient sat-isfaction, although the data are usually derived from a small number of providers 19 or from hospitals outside the United States.20-22 Our study of U.S. hospitals offers preliminary evi-dence that a higher ratio of nurses to patient-days may be associated with somewhat better performance with respect to certain interperson-al aspects of patient care. Whether this relation-ship is causal or a marker of the hospitals’ com-mitment to better service is not clear.It is perhaps surprising to note that there was suboptimal performance in areas that have been the target of quality-improvement initiatives for some time. Nearly a third of the patients did not give high ratings in the domain of pain control, despite the focus on this area by the Joint Com-mission.23 In addition, despite long-standing in-terest by the CMS and others in reducing the rate of readmission, many patients did not rate their discharge instructions highly. It is less surprising to see that communication about medications was often not rated highly, given reports of dif-ficulties with adverse events related to medica-tions.24,25 Poor communication at discharge is likely to exacerbate these problems.Previous studies on the relationship between patients’ experiences and the quality of clinical care have had mixed results. Schneider et al. found that although enrollees in Medicare man-aged-care plans that had better performance on the measures in the Healthcare Effectiveness Data and Information Set reported better experiences in obtaining information on health plans and in dealing with customer service,26 they did not give higher global ratings of the plan. Chang et al. found no relationship between patients’ experi-ences and the quality of clinical care among elderly patients in two managed-care organiza-tions.27 Others have also failed to find a rela-tionship between patients’ experiences and the quality of clinical care.28,29 We found a positive relationship between patients’ experiences and the quality of clinical care in U.S. hospitals. Al-though the differences in quality between hospi-tals that received high ratings on the HCAHPS* The Hospital Quality Alliance (HQA) score is the percentage derived from the sum of the number of times a hospital performed the appropriate action across all measures for that condition (numerator) divided by the number of oppor-tunities the hospital had to provide appropriate care (denominator). See Appendix 2 in the Supplementary Appendix for component measures of each condition. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) rating is based on the percentage of patients who rated their hospital experience as 9 or 10 on a 10-point scale, with higher scores reflecting better performance.† The score was adjusted for number of beds, academic status, region, location, profit status, ratio of nurses to patient-days, and percentage of patients receiving Medicaid.T h e ne w engl a nd jour na l o f medicinen engl j med 359;18 october 30, 20081930survey and hospitals that received low ratings were not large, care was consistently better in the hospitals that received high ratings across all conditions independently of other covariates measured. Our findings suggest that there is no need for tradeoffs between these two areas of performance.Finally, we found substantial differences in patients’ experiences across hospital-referral re-gions. These probably reflect regional differences in the interpersonal quality of care related to the style of caregiving and in organizational leader-ship and quality management that are focused on optimizing patients’ experience. However, un-measured confounders, such as cultural differ-ences in patients’ perceptions and expectations of care, may also contribute substantially to these patterns. Some portion of the differences ob-served between for-profit hospitals and not-for-profit hospitals may also reflect confounding; the patient population seen at for-profit hospitals might differ in important ways, including expec-tations, from the population seen at not-for-profit hospitals.Our study has several limitations. Although we examined patients’ experiences at more than 2400 hospitals, nearly 40% of U.S. hospitals failed to provide HCAHPS data. The quality of clinical care at nonresponding hospitals was slightly lower than that at responding hospitals, and their performance on the HCAHPS survey may differ as well. Although the number of non-responding hospitals should diminish quickly over time, perhaps lowering overall performance, the relationships we found between patient- reported quality and nurse staffing or clinical-quality measures are unlikely to change. High ratios of nurses to patient-days may identify hos-pitals that are more broadly focused on optimiz-ing a patient’s experience. Further investigation of the causality and strength of the relationship between nurse-staffing levels and patients’ expe-riences would be helpful. Our data represent a snapshot of patients’ experiences, and it will be critical to understand the ways in which these scores change over time and the factors that underlie their improvement. The CMS does not make data available according to the specific item in the composite domains or according to a spe-cific rating. Thus, we were limited to the catego-ries we report. Although efforts to account for nonresponse bias seem to have been effective in pilot testing 6,8 and with current data,30 we can-not be sure that the responses are fully reflective of patients’ experiences in all hospitals.In summary, the data presented here provide a comprehensive portrait of patients’ experiences in U.S. hospitals. It is clear that the performance of hospitals is variable and that there are plenti-ful opportunities for improvement. Public release of data on clinical performance has previously prompted improvements in the quality of clini-cal care in hospitals.31 We are hopeful that regu-lar reporting of performance on patient-reported measures of quality will catalyze similar improve-ments in patient-centered care.Supported by a grant from the Commonwealth Fund, New York, and in part by the Robert Wood Johnson Foundation Faculty Scholar Program (to Dr. Jha).No potential conflict of interest relevant to this article wasreported.* Plus–minus values are means ±SD. HCAHPS denotes Hospital Consumer Assessment of Healthcare Providers and Systems.ReferencesCorrigan JM, Donaldson MS, Kohn LT, 1. eds. Crossing the quality chasm: a new health system for the 21st century. Wash-ington, DC: National Academy Press, 2001.Jha AK, Li Z, Orav EJ, Epstein AM. 2. Care in U.S. hospitals — the Hospital Quality Alliance program. N Engl J Med 2005;353:265-74.McGlynn EA, Asch SM, Adams J, et al. 3. The quality of health care delivered toadults in the United States. N Engl J Med 2003;348:2635-45.Darby C, Hays RD, Kletke P. Develop-4. ment and evaluation of the CAHPS hos-。

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