People with limiting long-term conditions report poorer experiences and more problems with hospital care

BMC Health Services Research

Angela Coulter¹  Crispin Jenkinson¹  Chris Graham²  Alex Skew²  Paul Hewitson¹ 

[1] Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, Headington, England;Picker Institute Europe, Buxton Way, 3 West Way, Oxford OX2 0JB, England

关键词: Patient satisfaction;    Questionnaire survey;    Long term conditions;    Questionnaire development;    Patient reported experience;   

Others  :  1134266
DOI  :  10.1186/1472-6963-14-33

 received in 2013-05-17, accepted in 2014-01-09,  发布年份 2014

【 摘 要 】

Background

Long-term conditions have a significant impact on individuals, their families, and the health service. As people with these conditions represent a high proportion of hospital admissions, investigating their experiences of inpatient care has become an important area of investigation. We conducted a secondary analysis of the NHS adult inpatient survey for England to compare the hospital experiences of three groups of patients: those without long-term conditions, those with a single long-term condition, and those with multiple long-term conditions. We were particularly interested in the extent to which these patients received self-management support from hospital staff, so we developed a brief summary tool drawn from salient questions in the survey to aid the comparison.

Methods

Analysis of data from the 2011 national adult inpatient survey (n = 65,134) to compare the experiences of three groups of patients: those with no limiting long-term conditions (No-LLTC), those with one limiting long-term condition (S-LLTC), and those with two or more limiting long-term conditions (M-LLTC). The main outcome measure was patients’ self-reports of their experience of inpatient care, including staff-patient interactions, information provision, involvement in decisions and support for self-care and overall ratings of care. A short form scale, the Oxford Patient Involvement and Experience scale (OxPIE) was developed from the adult inpatient survey and used to compare the groups using logistic regression.

Results

There were significant differences between the No-LLTC group in comparison to both the S-LLTC and M-LLTC groups. Patients with limiting long-term conditions reported significantly worse hospital experiences than those without, as measured by OxPIE: S-LLTC odds ratio = 1.23, 95% CI 1.03-1.48; M-LLTC odds ratio = 1.64, 95% CI 1.19 – 2.26. Responses to a single global rating question were more positive but not strongly correlated with OxPIE.

Conclusions

Patients with LLTCs were more critical of their inpatient care than those with no LLTCs. Those with more than one long-term condition reported worse experiences than those with a single limiting condition. Simple rating questions may not be sufficiently sensitive to reflect important aspects of patients’ experience.

【 授权许可】

   
2014 Hewitson et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012, 380:37-43.
• [2]Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, Blumenthal D: Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med 2007, 22(Suppl 3):391-395.
• [3]Agborsangaya CB, Lau D, Lahtinen M, Cooke T, Johnson JA: Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health 2012, 12:201. BioMed Central Full Text
• [4]Department of Health: Long term conditions compendium of information 2012 (third edition). http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_134486.pdf webcite
• [5]Wagner EH: Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1998, 1:2-4.
• [6]Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH: Improving the quality of health care for chronic conditions. Qual Saf Health Care 2004, 13:299-305.
• [7]Bayliss EA, Edwards AE, Steiner JF, Main DS: Processes of care desired by elderly patients with multimorbidities. Fam Pract 2008, 25:287-293.
• [8]Burt J, Roland M, Paddison C, Reeves D, Campbell J, Abel G, Bower P: Prevalence and benefits of care plans and care planning for people with long-term conditions in England. J Health Serv Res Policy 2012, 17(Suppl 1):64-71.
• [9]Newbould J, Burt J, Bower P, Blakeman T, Kennedy A, Rogers A, Roland M: Experiences of care planning in England: interviews with patients with long term conditions. BMC Fam Pract 2012, 13:71. BioMed Central Full Text
• [10]Heyworth ITM, Hazell ML, Linehan MF, Frank TL: How do common chronic conditions affect health-related quality of life? Br J Gen Pract 2009, 59:e353-e358.
• [11]Tooth L, Hockey R, Byles J, Dobson A: Weighted multimorbidity indexes predict mortality, health service use, and health-related quality of life in older women. J Clin Epi 2008, 61:151-159.
• [12]Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Meinow B, Fratiglioni L: Aging with multimorbidity: a systematic review of the literature. Aging Res Reviews 2011, 10:430-439.
• [13]de Groot V, Beckerman H, Lankhorst GJ, Bouter LM: How to measure comorbidity: a critical review of available methods. J Clin Epi 2003, 56:221-229.
• [14]Bayliss EA, Ellis JL, Steiner JF: Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument. Health Qual Life Outcomes 205(3):51.
• [15]Bayliss EA, Ellis JL, Steiner JF: Seniors’ self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures. J Clin Epi 2009, 62:550-557.
• [16]Richards N, Coulter A: Is the NHS becoming more patient-centred? Trends from the national surveys of NHS patients in England 2002–07. Oxford: Picker Institute Europe; 2007.
• [17]Jenkinson C, Coulter A, Bruster S: The picker patient experience questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care 2002, 14:353-358.
• [18]Jenkinson C, Coulter A, Reeves R, Bruster S, Richards N: Properties of the picker patient experience questionnaire in a randomized controlled trial of long versus short form survey instruments. J Public Health Med 2003, 25:197-201.
• [19]Ware JE: User manual for the SF12. 2nd edition. Boston: The Health Institute; 1994.
• [20]Nunnally J, Bernstein H: Psychometric Theory (3rd ed). New York: McGraw Hill; 1994.
• [21]Kline P: A Psychometrics Primer. London: Free Association Books; 2000.
• [22]Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, Bouter LM, de Vet HCW: The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 2010, 10:22. BioMed Central Full Text
• [23]DeCoster J, Iselin AM, Gallucci M: A conceptual and empirical examination of justifications for dichotomization. Psychol Methods 2009, 14:349-366.
• [24]MacCallum RC, Zhang S, Preacher KJ, Rucker DD: On the practice of dichotomization of quantitative variables. Psychol Methods 2002, 7:19-40.
• [25]Zaslavsky AM, Zaborski LB, Cleary PD: Factors affecting response rates to the consumer assessment of health plans study survey. Med Care 2002, 40:485-499.
• [26]Boyd G, Hodgkiss F: Variations in the experiences of inpatients in Scotland: analysis of the 2010 Scottish inpatient survey. http://www.scotland.gov.uk/Resource/Doc/356540/0120509.pdf webcite
• [27]Office of the Chief Analyst: Statistical bulletin: overall patient experience scores. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/185937/Statistical_Commentary.pdf webcite
• [28]Bowling A, Rowe G, McKee M: Patients’ experiences of their healthcare in relation to their expectations and satisfaction: a population survey. J R Soc Med 2013, 106:143-149.
• [29]Ekdahl AW, Hellstrom I, Andersson L, Friedrichsen M: Too complex and time-consuming to fit in! Physicians’ experiences of elderly patients and their participation in medical decision making: a grounded theory study. BMJ Open 2012, 2:3.
• [30]Fung CH, Setodji CM, Kung FY, Keesey J, Asch SM, Adams J, McGlynn EA: The relationship between multimorbidity and patients’ ratings of communication. J Gen Intern Med 2008, 23:788-793.
• [31]Cornwell J, Levenson R, Sonola L, Poteliakhoff E: Continuity of care for older hospital patients. http://www.kingsfund.org.uk/publications/continuity-care-older-hospital-patients webcite
• [32]NHS England: Urgent and emergency care review - evidence base engagement. http://www.england.nhs.uk/wp-content/uploads/2013/06/urg-emerg-care-ev-bse.pdf webcite
• [33]NHS England: Emerging principles from the urgent and emergency care review. http://www.england.nhs.uk/wp-content/uploads/2013/06/uec-emerg-princ.pdf webcite