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首页> 外文期刊>The Journal of Graduate Medical Education >Determinants of Patient Satisfaction in Internal Medicine Resident Continuity Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative
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Determinants of Patient Satisfaction in Internal Medicine Resident Continuity Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

机译：内科医师住院医师连续性诊所患者满意度的决定因素：教育创新项目动态协作的发现

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What was known Internal medicine programs reorganized their resident continuity clinics to improve residents' and patients' experience.;What is new Patient satisfaction was significantly higher in traditional and block continuity models than a combination model with some weekly experiences and some ambulatory block rotations.;Limitations Lack of randomization of clinics to the models; inability to control for some patient- and resident-related factors.;Bottom line Two internal medicine resident continuity clinic models resulted in higher patient satisfaction, which also was associated with improved outcomes of care.;Introduction Patients' satisfaction with their health care has been associated with increased adherence to medical regimens1,2 and improved clinical outcomes,3 and the Medicare program plans to link a portion of its value-based purchasing bonuses to patients' perceptions of quality of care.4 Factors that have been shown to affect patient satisfaction include patient age, functional status, and socioeconomic status.5 Other factors associated with higher patient satisfaction in ambulatory settings include improved provider-specific continuity,6,7 increased patient-perceived encounter time,8 use of health information technology,9 better patient-physician communication,5,10 and overall fulfillment of expectations.5,11,12 Single-site studies have found that a heavy inpatient workload is associated with decreased patient satisfaction in resident continuity clinics13 and that changes in residency practice continuity are associated with improved satisfaction and clinical outcomes.14,15 The continuity clinic experience differs significantly across internal medicine (IM) programs, and there have been multiple calls for reorganization of ambulatory training practices.16–18 A number of programs have developed block models seeking to separate inpatient from outpatient care during residency training.14,19,20 We compare patient satisfaction results of the traditional ambulatory model with 2 new clinic models within multiple residencies participating in the Accreditation Council for Graduate Medical Education's Educational Innovations Project (EIP)21 and discuss elements associated with higher patient satisfaction. We also examined the relationship between patient satisfaction and other practice variables, such as continuity, ambulatory workload, utilization, resident satisfaction, and quality of care across participating programs.;Methods Study Population and Setting Twelve programs participated in the EIP Ambulatory Collaborative (EPAC; table?1)22; patient satisfaction data were available from 11 (the 12th program used a different survey for institution historical comparison). For the 11 programs, consent to participate was obtained from 97% (569 of 586) of residents. Texas Tech University Health Sciences Center El Paso provided oversight of the project. View larger version (37K) TABLE 1Educational Innovations Project Ambulatory Collaborative Participating Programs;Results Patient satisfaction data were available for 523 of 569 eligible residents (92%) with a median of 17 surveys completed per resident. Our primary analysis examined the relationship between clinic model and patient satisfaction. Data were available for 128 residents in group 1 (traditional model), 218 residents in group 2 (combination model), and 177 residents in group 3 (block model). Results comparing the models, along with overall mean values, are displayed in table?2. The percentage of patients seeing their usual physician and the number of visits reported in the last 12?months did not differ across groups. The responses related to how well the physician provided explanations, listened carefully, gave easy-to-understand instructions, seemed to know important medical information, showed respect, and spent enough time were significantly better in the traditional and block model programs than the combination model programs. However, there were no significant di
机译：所谓的内科医学计划重组了他们的居民连续性诊所，以改善居民和患者的经验。新内容与具有每周经验和一些非卧床轮换的组合模型相比，传统和区块连续性模型的患者满意度明显更高。局限性缺乏对模型的诊所随机化;无法控制某些与患者和住院患者相关的因素。底线两种内科住院医师连续性诊所模式导致患者满意度更高，这也与改善的护理效果相关。简介患者对医疗保健的满意度一直很高与增加对医疗方案的依从性1,2和改善的临床结局3有关，医疗保险计划计划将其基于价值的购买奖金的一部分与患者对护理质量的看法联系起来。4已显示影响患者满意度的因素包括患者年龄，功能状态和社会经济状况。5与门诊环境中患者满意度较高相关的其他因素包括特定于服务提供者的连续性，6,7增加患者感知的接触时间，8使用健康信息技术，9更好的患者-医师沟通[5,10]和总体期望的实现[5,11,12]。单点研究发现住院工作量大与住院医师连续性诊所的患者满意度下降13相关，住院医师实践连续性的变化与满意度和临床结果的改善相关。14,15连续性诊所的经验在内部医学（IM）计划之间存在显着差异，并且多次呼吁重新组织门诊培训实践。16-18许多计划开发了模块模型，以寻求在住院医师培训期间将住院患者与门诊患者分开。14,19,20我们将传统门诊模型的患者满意度结果与两家新诊所进行了比较参加研究生医学教育认证委员会教育创新项目（EIP）21的多个居民中的模型，并讨论与提高患者满意度相关的要素。我们还研究了患者满意度与其他实践变量之间的关系，例如连续性，门诊工作量，利用率，住院患者满意度以及参与计划中的护理质量。方法研究人群和设置12个项目参加了EIP门诊合作（EPAC）;表？1）22;患者满意度数据可从11个获得（第12个程序使用不同的调查进行机构历史比较）。在这11个计划中，有97％（586人中的569个）居民获得了参与的同意。德州理工大学健康科学中心El Paso对项目进行了监督。查看大图（37K）表1：教育创新项目动态协作参与计划;结果569位合格居民中的523位患者（92％）可获得患者满意度数据，平均每位居民完成17个调查。我们的主要分析检查了临床模型与患者满意度之间的关系。可获得第1组的128位居民（传统模型），第2组的218位居民（组合模型）和第3组的177位居民（块模型）的数据。表2中显示了比较模型的结果以及总体平均值。两组之间就诊的患者百分比和最近12个月内报告的就诊次数没有差异。与医师提供解释，认真聆听，给出易于理解的说明，似乎了解重要的医学信息，表现出敬意并花费足够的时间有关的回答在传统模型和模块模型程序中明显优于组合模型程式。但是，没有明显的差异

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