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In the queue for coronary artery bypass grafting: patients' perceptions of risk and 'maximal acceptable waiting time'. 总被引:2,自引:0,他引:2
H Llewellyn-Thomas E Thiel M Paterson D Naylor 《Journal of health services research & policy》1999,4(2):65-72
OBJECTIVES: To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting. METHODS: Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement. RESULTS: Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, > or = 1.45%) or 6 (upper quartile, > or = 10%) months. However, MAWT scores were related only to expected waiting time (r = 0.47; P < 0.0001). CONCLUSIONS: Most patients reject waiting 6 months for elective CABG, even if offered along with a halving in surgical mortality (from 2% to 1%). Intolerance for further delay seems to be determined primarily by patients' attachment to their scheduled surgical dates. Many also have severely inflated perceptions of their risk of myocardial infarction in the queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred. 相似文献
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Keeman JN 《Nederlands tijdschrift voor geneeskunde》1999,143(45):2225-2229
Imaging techniques may lead to better insight in the diagnosis of the acute abdomen, and in specific cases to a more rapid diagnosis, especially in the upper abdomen. However, frequently the only result of the accessory diagnostic methods is delay of the necessary treatment. The yield of CT scanning in acute abdomen is too small to justify routine use. Ultrasonography is useful in selected cases, but not for routine application. Laparoscopic examination in acute abdomen in certain conditions facilitates making the correct diagnosis, but it constitutes an aggressive method for patients found free of abnormalities. Skillful history-taking and adequate performance of physical examination still constitute the basis of correct diagnosing. Technical aids may be of value. Good systematical studies of the clinical results and the cost effectiveness of physical examination and of the technological aids are still largely lacking. 相似文献
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《Healthcare benchmarks》2000,7(11):124-5, 121
Perhaps you think that patient satisfaction data are the lightweights among all your beanchmarking data. Not so, according to a Chicago-area behavioral health hospital. The information you can glean from patient perceptions is so important at Alexian Brothers Behaviors Health Hospital taht last year it opted to change its surveys. 相似文献
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Paterson R 《Health affairs (Project Hope)》2002,21(3):70-79
Since 1996 New Zealand has had a Code of Patients' Rights enforceable by complaints to an independent ombudsman. Patients are entitled to receive health care of an appropriate standard, to give informed consent, and to complain to a health commissioner about perceived malpractice. The commissioner investigates and reports on complaints, recommends practice changes by providers, is a gatekeeper to discipline by professional boards, and acts as a public advocate for patient safety. In this paper the current commissioner describes New Zealand's experience with the patients' complaints system and discusses the implications for the quality of health care. 相似文献
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Edward T Davis Elizabeth A Lingard Emil H Schemitsch James P Waddell 《International journal for quality in health care》2008,20(1):40-46
OBJECTIVE: To identify whether patients in lower socioeconomic groups had worse pain and functional levels prior to total knee arthroplasty and then establish whether these patients had poorer post-operative outcomes following total knee arthroplasty. METHOD: Data was obtained from a prospective observational study of 974 patients undergoing primary total knee arthroplasty for osteoarthritis. The study was undertaken in 13 centers in 4 countries. Pre-operative data was collected and patients were followed for 2 years post-operatively. Pre-operative details of the patients' demographics; socioeconomic status (SES) (education and income); height; weight and co-morbid conditions were obtained. The WOMAC scores were obtained preoperatively and during follow-up. RESULTS: Using multivariate linear regression analysis, patients with a lower income had a significantly worse pre-operative WOMAC Pain (P = 0.021) and function score (P = 0.039) than those with higher incomes. However, income did not have a significant impact on outcome at final follow-up after adjusting for other significant covariates. Level of education did not correlate with pre-operative scores or with outcome at any time during follow-up. CONCLUSION: Across all four countries, patients with lower incomes appeared to have a greater need for total knee arthroplasty. However, level of income and educational status did not appear to affect the final outcome following total knee arthroplasty. Patients with lower incomes appeared able to compensate for their worse pre-operative score and obtain similar outcomes post-operatively. These findings are in contrast to studies on other medical conditions and surgical interventions, in which a lower SES has been found to have a negative impact on patient outcomes. 相似文献
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