Instruments to measure patient experience of health care quality in hospitals: a systematic review protocol

Barriers and Enablers of Second-Order Problem-Solving Behavior: How Nurses Can Break Away From the Workaround Culture

BACKGROUND AND OBJECTIVES

Nurses are challenged by numerous day-to-day unexpected problems due to poorly performing work systems that hinder patient care. These operational failures persist in hospitals, partly because nurses tend to prefer quick fixes or workarounds over real improvements that prevent recurrence. The aim of this review is to shed light on the barriers to and enablers of nurses' second-order problem-solving behavior and their consequences, so that hospitals can learn from failure and improve organizational outcomes.

METHODS

We conducted a systematic review, with quantitative, qualitative, and mixed-method articles, searching 6 databases (PubMed, Embase, Web of Science, CINAHL, and Google Scholar) following the Preferred Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality assessment for inclusion was performed by 2 independent authors using the Mixed Methods Appraisal Tool (MMAT). A descriptive synthesis was used for analysis.

RESULTS

This study reveals the barriers and enablers for second-order problem-solving behavior, and synthesizes improvement proposals within 3 perspectives, namely the "empowerment" perspective, the "process improvement" perspective, and the "time" perspective. Furthermore, we found that limited attention is given to the patient's perspective, and the existence of a no-action behavior.

CONCLUSION

Although operational failures have several important consequences for hospital staff and organizations, there has been hardly any research into the barriers and enablers that initiate second-order problem-solving behavior; stemming this nursing behavior has thus rarely appeared as a suggestion for improvement.

Measuring cannabis-related knowledge, attitudes, perceptions, motivations, and influences among women of reproductive age: a scoping review

Background

Cannabis use among women of reproductive age has increased substantially in recent decades. Understanding reasons for cannabis use in this population is critical for cannabis use prevention efforts. Thus, this scoping review aimed to identify and synthesize current measures on reasons for cannabis use in women of reproductive age.

Methods

We searched PubMed, PyschINFO, CINAHL, and Google Scholar for relevant studies published in English between January 2010 and April 2021. Peer-reviewed, quantitative studies reporting on measures of cannabis-related knowledge, attitudes, perceptions, motivations, and influences among women of reproductive age were eligible for inclusion. We excluded studies not focused on women of reproductive age and studies reporting cannabis use prevalence data only.

Results

We included 11 studies (10 primary studies and 1 review) with varying subpopulation samples of women, including non-pregnant women (n = 2), women experiencing infertility (n = 1), pregnant women (n = 4), postpartum women (n = 3), and women in the perinatal period (n = 1). Measurement topic areas included information received from health care professionals, attitudes, perceptions and experiences about cannabis use, knowledge of potential harms, and motivations for cannabis use. Most studies including measures of risk perceptions were conducted among pregnant or postpartum women (n = 4). A single study measured influences of cannabis use; no studies measured social or peer influences of use. Most studies (n = 7) created their own measures, with 2 studies using secondary data via measures from population-based surveillance systems in the United States, and one using a previously validated instrument. Recommendations for future research were centered around addressing knowledge gaps of health effects of cannabis use across different time periods, and etiology of cannabis use.

Conclusions

We found vast measurement gaps in current measures of antecedents of cannabis use among women of reproductive age, providing clear direction for future research in this area. Findings necessitate psychometric evaluation of existing measures to ascertain validity and reliability, as well as development of additional measures of women’s cannabis-related attitudes, perceptions, motivations, and influences. This work is critical to guide not only epidemiologic studies, but cannabis-related prevention work as well.

Supplementary information

The online version contains supplementary material available at 10.1186/s12905-022-01673-6.

Construction of a Scale Assessing Patients' Perceptions Regarding Sanitation and Hygiene in a Clinical Setting

OBJECTIVE

This study attempted to develop a scale, hereby called HYGIENICCARE, that assesses patients' perceptions regarding sanitation and hygiene in a healthcare environment. It also evaluated the relationship between the new measure and a previously validated scale measuring healthcare quality.

METHODS

This study was a psychometric test in which we constructed a new survey and administered the survey to patients in wards and the outpatient departments of 5 hospitals in Accra North. A robust procedure, including a review of selected questions by an expert panel, was followed to determine the original bank of items of the instrument. Principal component analysis with varimax rotation was used to select items for the scale, whereas confirmatory factor analysis was used to assess construct validity. Multiple linear regression was used to examine the association between the new scale and an existing measure of healthcare quality.

RESULTS

A bank of 10 items was determined through a systematic review of the literature and the engagement of 7 expert reviewers. Through principal component analysis, the items were reduced to 9. Principal component analysis yielded 2 factors: "environment and equipment" and "personnel and process," which both explained 82% of the total variance and produced Cronbach α coefficients of 0.912 and 0.86, respectively. Confirmatory factor analysis confirmed the 2-factor solution and produced satisfactory discriminant validity and convergent validity indicators. The 2 domains of the new scale were highly correlated with all dimensions of a scale measuring healthcare quality called HEALTHQUAL (r ≥ 0.76, P < 0.001). In multiple linear regression, each of the 2 domains of HYGIENICCARE explained a total variance of 41% or greater in all domains of HEALTHQUAL (P < 0.001).

CONCLUSIONS

We developed a brief scale measuring hospital hygiene and sanitation that correlated well with an existing measure of healthcare quality. This effort shows that the new tool is a valid measure of patient-perceived hospital hygiene and sanitation.

Patient Satisfaction of Telemedicine Remote Patient Monitoring: A Systematic Review

Introduction: To examine the variety of patient satisfaction instruments (i.e., measures, methods, and scales) used within telemedicine remote patient monitoring (RPM) services; and to assess the quality of RPM patient satisfaction instruments. Methods: Three databases were searched for articles that used survey instrumentation to assess patient satisfaction of RPM services: (1) Healthcare Administration Database (PROQUEST), (2) Cumulative Index to Nursing and Allied Health Literature (CINAHL), and (3) PubMed (MEDLINE). The quality of survey instrumentation methods was assessed based on validity and reliability using the Terwee et al. framework. Results: Nine studies were included in the final review. For internal consistency, seven out of nine studies received an "indeterminant" quality rating; six out of nine of the studies received a "positive" quality rating for measurement error. For content validity, seven out of nine studies received a "positive" quality rating. Discussion: There are several RPM surveys that are used to assess patient satisfaction. This review suggests wide variation among the quality, reliability, and validity of the surveys currently used in practice. Assessing patient satisfaction of RPM services by organizations, researchers, and practitioners should be done through use of reliable instrumentation.

Factors associated with the experience of patients presenting in pain to the emergency department

AIMS AND OBJECTIVES

This study aims to examine the association between person, environment, health and illness factors, pain care and the patient experience in the emergency department, guided by symptom management theory.

BACKGROUND

Current outcome measures of pain care in the emergency department focus on process measures such as the time taken to deliver analgesic medication. Patient-reported outcomes of pain care are rare in emergency department literature and predominantly focus on patient satisfaction. Measuring overall patient experience is common, with extensive surveys undertaken in the United Kingdom, United States of America and Australia; however, these are not used as an outcome of pain care.

DESIGN

Prospective cohort study.

METHODS

One hundred and ninety patients arriving at a large, inner-city adults-only emergency department in moderate to severe pain were recruited to answer a modified version of the emergency department patient experience of care survey.

RESULTS

Fifteen factors were identified as influencing the patient experience of care when presenting in pain. These influences of patient experience included the emergency department environment, time to first analgesic medication and the provision of analgesic medication.

CONCLUSIONS

In addition to pain care factors, there is a significant association between the emergency department environment-especially workload, throughput and patient placement-and the experience of patients who present in pain to the emergency department.

RELEVANCE TO CLINICAL PRACTICE

This study demonstrated an association between time to first analgesic medication and the patient experience of care. Providing timely care, including pain care, in emergency departments is difficult, but necessary to improve the patient experience of care.

Main factors affecting perceived quality in healthcare: a patient perspective approach

Purpose

Delivering patient-centered healthcare is now seen as one of the basic requirements of good quality care. In this research, the impact of the perceived quality of three experiential dimensions (Physical Environment, Empowerment and Dignity and Patient–Doctor Relationship) on patient's Experiential Satisfaction is assessed.

Design/methodology/approach

259 structured interviews were performed with patients in private and public hospitals across Italy. The research methodology is based in testing mediation and moderation effects of the selected variables.

Findings

The study shows that: perceived quality of Physical Environment has a positive impact on patient's Experiential Satisfaction; perceived quality of Empowerment and Dignity and perceived quality of Patient–Doctor Relationship mediate this relationship reinforcing the role of Physical Environment on Experiential Satisfaction; educational level is a moderator in the relationship between perceived quality of Patient–Doctor Relationship and overall Satisfaction: more educated patients pay more attention to relational items. Subjective Health Frailty is a moderator in all the tested relationships with Experiential Satisfaction: patients who perceive their health as frail are more reactive to the quality of the above-mentioned variables.

Originality/value

Physical Environment items are enablers of both Empowerment and Dignity and Patient–Doctor Relationship and these variables must be addressed all together in order to improve the value proposition provided to patients. Designing a hospital, beyond technical requirements that modern medicine demands and functional relationships between different medical departments, means dealing with issues like the anxiety of the patient, the stressful working environment for the hospital staff and the need to build a sustainable and healing building.

Relationship between patient safety culture and patient experience in hospital settings: a scoping review protocol

INTRODUCTION

Hospitals commonly examine patient safety culture and other quality indicators to evaluate and improve performance in relation to quality and safety. A growing body of research has separately examined relationships between patient safety culture and patient experience on clinical outcomes and other quality indicators. However, there is a knowledge gap regarding the relationship between these two important domains. This article describes the protocol for a scoping review of published literature examining the relationship between patient safety culture and patient experience in hospital settings. The scoping review will provide an overview of research into the relationship between patient safety culture and patient experience in hospital contexts, map key concepts underpinning these domains and identify research gaps for further study.

METHODS AND ANALYSIS

The scoping review will be conducted using the five stages of Arksey and O'Malley's framework: identify the research question; identify relevant studies; study selection; chart data; and collate, summarise and report the results. The inclusion criteria will be applied using the Population, Concept and Context Framework. Searches will be conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, Scopus and SciELO databases, without applying date range limits. Hand-searching of grey literature will also be performed to find relevant, non-indexed literature. Data will be extracted using a standardised data extraction form developed by the Joanna Briggs Institute. Both descriptive and thematic analyses will be undertaken to scope key concepts within the body of reviewed literature.

ETHICS AND DISSEMINATION

This type of study does not require an ethics review. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.

Patient-Reported Experience Measures in Stroke Care: A Systematic Review

BACKGROUND AND PURPOSE

Patient-reported experience measures (PREMs) assess patients' perception of health care. We aimed to identify all reported PREMs for stroke care and critically appraise psychometric properties of PREMs validated for patients with stroke.

METHODS

Studies on the development, validation, or utilization of PREMs for adult patients with stroke were systematically identified. The Consensus-Based Standards for the Selection of Health Measurement Instruments criteria were used to appraise psychometric performance.

RESULTS

We included 18 studies, examining 13 PREMs. Two PREMs had been developed for stroke care: Consumer Quality Index: Cerebrovascular Accident and Riksstroke. Consumer Quality Index: Cerebrovascular Accident was given a positive psychometric assessment, but its length and limited language applicability impede clinical implementation. Riksstroke was appraised as doubtful. Eleven PREMs were generic. The psychometric performance of 5 generic PREMS, validated for patients with stroke, received conflicting assessments. Six generic PREMs had not been validated in patients with stroke and were therefore not assessed for instrument performance.

CONCLUSIONS

Thirteen PREMs have been published for use in stroke care. The stroke-specific Consumer Quality Index: Cerebrovascular Accident has favorable psychometric performance but lacks practical feasibility. Other PREMs have inadequate or unknown psychometric properties. This indicates the need for developing stroke-specific PREMs to support quality improvement and enhance patient-centered care.

Which instruments are used to measure shared, supported and assisted healthcare decision-making between patients who have limited, impaired or fluctuating capacity, their family carers and healthcare professionals? A systematic review protocol

Background: Shared decision-making (SDM) is a dialogical relationship where the physician and the patient define the problem, discuss the available options according to the patient’s values and preferences, and co-construct the treatment plan. Undertaking SDM in a clinical setting with patients who have limited, impaired or fluctuating cognitive capacity may prove challenging. Supported (defined “Assisted” in the Irish context) decision-making describes how people with impaired or fluctuating capacity remain in control of their healthcare-related choices through mechanisms which build and maximise capacity.

Supported and assisted decision-making (ADM) within healthcare settings is theoretically and practically novel. Therefore, there is a knowledge gap about the validity of psychometric instruments used to assess ADM and its components within clinical settings. This systematic review aims to identify and characterise instruments currently used to assess shared, supported and assisted healthcare decision-making between patients with limited, impaired or fluctuating capacity, their family carers and healthcare professionals.

Methods: A systematic review and narrative synthesis will be performed using a search strategy involving the following databases (PubMed, Cinahl, Embase, Web of Science, Scopus and PsycINFO). Quantitative studies published in the last decade and describing psychometric instruments measuring SDM, supported decision-making and ADM with people having limited or fluctuating capacity will be considered eligible for inclusion. Title and abstract screening will be followed by full-text eligibility screening, data extraction, synthesis and analysis. This review will be structured and reported according to the PRISMA checklist. The COSMIN Risk of bias checklist will be used to assess the quality of the instruments.

Discussion: The results will inform and be useful to HCPs and policymakers interested in having updated knowledge of the available instruments to assess SDM, supported and assisted healthcare decision-making between patients who have impaired or fluctuating capacity, their family carers and healthcare professionals.

Registration: PROSPERO CRD42018105360; registered on 10/08/2018.

Tools to assess the measurement properties of quality of life instruments: a meta-review

OBJECTIVE

This meta-review aims to discuss the methodological, research and practical applications of tools that assess the measurement properties of instruments evaluating health-related quality of life (HRQoL) that have been reported in systematic reviews.

DESIGN

Meta-review.

METHODS

Electronic search from January 2008 to May 2020 was carried out on PubMed, CINAHL, PsycINFO, SCOPUS, WoS, Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) database, Google Scholar and ProQuest Dissertations and Theses.

RESULTS

A total of 246 systematic reviews were assessed. Concerning the quality of the review process, some methodological shortcomings were found, such as poor compliance with reporting or methodological guidelines. Regarding the procedures to assess the quality of measurement properties, 164 (66.6%) of reviewers applied one tool at least. Tool format and structure differed across standards or scientific traditions (ie, psychology, medicine and economics), but most assess both measurement properties and the usability of instruments. As far as the results and conclusions of systematic reviews are concerned, only 68 (27.5%) linked the intended use of the instrument to specific measurement properties (eg, evaluative use to responsiveness).

CONCLUSIONS

The reporting and methodological quality of reviews have increased over time, but there is still room for improvement regarding adherence to guidelines. The COSMIN would be the most widespread and comprehensive tool to assess both the risk of bias of primary studies, and the measurement properties of HRQoL instruments for evaluative purposes. Our analysis of other assessment tools and measurement standards can serve as a starting point for future lines of work on the COSMIN tool, such as considering a more comprehensive evaluation of feasibility, including burden and fairness; expanding its scope for measurement instruments with a different use than evaluative; and improving its assessment of the risk of bias of primary studies.

PROSPERO REGISTRATION NUMBER

CRD42017065232.

Which instruments are used to measure shared, supported and assisted healthcare decision-making between patients who have limited, impaired or fluctuating capacity, their family carers and healthcare professionals? A systematic review protocol

Background: Shared decision-making (SDM) is a dialogical relationship where the physician and the patient define the problem, discuss the available options according to the patient’s values and preferences, and co-construct the treatment plan. Undertaking SDM in a clinical setting with patients who have limited, impaired or fluctuating cognitive capacity may prove challenging. Supported (defined “Assisted” in the Irish context) decision-making describes how people with impaired or fluctuating capacity remain in control of their healthcare-related choices through mechanisms which build and maximise capacity. Supported and assisted decision-making (ADM) within healthcare settings is theoretically and practically novel. Therefore, there is a knowledge gap about the validity of psychometric instruments used to assess ADM and its components within clinical settings. This systematic review aims to identify and characterise instruments currently used to assess shared, supported and assisted healthcare decision-making between patients with limited, impaired or fluctuating capacity, their family carers and healthcare professionals. Methods: A systematic review and narrative synthesis will be performed using a search strategy involving the following databases (PubMed, Cinahl, Embase, Web of Science, Scopus and PsycINFO). Quantitative studies published in the last decade and describing psychometric instruments measuring SDM, supported decision-making and ADM with people having limited or fluctuating capacity will be considered eligible for inclusion. Title and abstract screening will be followed by full-text eligibility screening, data extraction, synthesis and analysis. This review will be structured and reported according to the PRISMA checklist. The COSMIN Risk of bias checklist will be used to assess the quality of the instruments. Discussion: The results will inform and be useful to HCPs and policymakers interested in having updated knowledge of the available instruments to assess SDM, supported and assisted healthcare decision-making between patients who have impaired or fluctuating capacity, their family carers and healthcare professionals. Registration: PROSPERO CRD42018105360; registered on 10/08/2018.

What is Important to Older People with Multimorbidity and Their Caregivers? Identifying Attributes of Person Centered Care from the User Perspective

Introduction:

Health systems are striving to design and deliver care that is ‘person centred’—aligned with the needs and preferences of those receiving it; however, it is unclear what older people and their caregivers value in their care. This paper captures attributes of care that are important to older people and their caregivers.

Methods:

This qualitative descriptive study entailed 1–1 interviews with older adults with multimorbidity receiving community based primary health care in Canada and New Zealand and caregivers. Data were analyzed to identify core attributes of care, important to participants.

Findings:

Feeling heard, appreciated and comfortable; having someone to count on; easily accessing health and social care; knowing how to manage health and what to expect; feeling safe; and being independent were valued. Each attribute had several characteristics including: being treated like a friend; having contact information of a responsive provider; being accompanied to medical and social activities; being given clear treatment options including what to expect; having homes adapted to support limitations and having the opportunity to participate in meaningful hobbies.

Conclusions:

Attributes of good care extend beyond disease management. While our findings include activities that characterize these attributes, further research on implementation barriers and facilitators is required.

Patient experiences: a systematic review of quality improvement interventions in a hospital setting

Purpose: In the era of value-based healthcare, one strives for the most optimal outcomes and experiences from the perspective of the patient. So, patient experiences have become a key quality indicator for healthcare. While these are supposed to drive quality improvement (QI), their use and effectiveness for this purpose has been questioned. The aim of this systematic review was to provide insight into QI interventions used in a hospital setting and their effects on improving patient experiences, and possible barriers and promoters for QI work. Methods: Prisma guidelines were used to design this review. International academic literature was searched in Embase, Medline OvidSP, Web of Science, Cochrane Central, PubMed Publisher, Scopus, PsycInfo, and Google Scholar. In total, 3,289 studies were retrieved and independently screened by the first two authors for eligibility and methodological quality. Data was extracted on the study purpose, setting, design, targeted patient experience domains, QI strategies, results of QI, barriers, and promotors for QI. Results: Twenty-one pre-post intervention studies were included for review. The methodological quality of the included studies was assessed using a Critical Appraisal Skills Program (CASP) Tool. QI strategies used were staff education, patient education, audit and feedback, clinician reminders, organizational change, and policy change. Twenty studies reported improvement in patient experience, 14 studies of the 21 included studies reported statistical significance. Most studies (n=17) reported data-related barriers (eg, questionnaire quality), professional, and/or organizational barriers (eg, skepticism among staff), and 14 studies mentioned specific promoters (eg, engaging staff and patients) for QI. Conclusions: Several patient experience domains are targeted for QI using diverse strategies and methodological approaches. Most studies reported at least one improvement and also barriers and promoters that may influence QI work. Future research should address these barriers and promoters in order to enhance methodological quality and improve patient experiences.

Does evidence-based medicine training improve doctors' knowledge, practice and patient outcomes? A systematic review of the evidence

Courses in Evidence-Based Medicine (EBM) for doctors have consistently demonstrated short-term improvements in knowledge. However, there is no strong evidence linking EBM training to changes in clinical practice or patient outcomes. This systematic review investigates whether EBM training leads to sustained improvements in doctors' knowledge and practice behaviors that may also facilitate changes in patient outcomes and experiences. A literature search was undertaken in Ovid Medline, Ovid Embase, The Cochrane Library, ERIC and Scopus. Studies published from 1997 to 2016 that assessed outcomes of EBM educational interventions amongst doctors and used measures of knowledge, skills, attitudes, practice or patient outcomes were included. Fifteen studies were included in the analysis: four randomized controlled trials (RCTs), three non-RCTs, and eight before-after (longitudinal cohort) studies. Heterogeneity among studies prevented meaningful comparisons. Varying degrees of bias due to the use of subjective measures were identified, limiting study validity. Results showed that EBM interventions can improve short-term knowledge and skills, but there is little reliable evidence of changes in long-term knowledge, attitudes, and clinical practice. No study measured improvement in patient outcomes or experiences. EBM training for medical practitioners needs to incorporate measures of behavioral changes while incorporating patient outcomes and experience measures.

Patient Satisfaction with Psychiatric Outpatient Care at University of Gondar Specialized Hospital: A Cross-Sectional Survey

Background

Patient satisfaction is an imperative and commonly used indicator for measuring the quality of healthcare. Patient satisfaction with psychiatry services is an important construct, which influences multiple areas including treatment adherence and outcome. The aim of the present study was to assess the level of patient satisfaction and determine associated factors with psychiatric outpatient care.

Method

An institution-based cross-sectional study was conducted from April 15 to May 15, 2017. A total of 250 psychiatric patients visiting psychiatric outpatient care in University of Gondar Specialized Hospital during the study period were included in the study. Data were collected using structured questionnaires and entered to and analyzed using Statistical Packages for Social Sciences (SPSS) version 20. Descriptive statistics and one-way ANOVA with post hoc test were used to determine the characteristics of the participants and examine the difference among different variables. P value<0.05 and confidence interval (CI) of 95% were used as cut-off points for determining statistical significance.

Results

During the one-month data collection period, 250 participants (92.593% response rate) were included in the analysis. Majority (133 (53.2%)) of them were males and cannot read and write (107 (42.8%)). Majority (194 (77.6%)) of study participants were satisfied with the outpatient care. The overall level of satisfaction among participants was good with a mean satisfaction score of 3.87. Majority (173 (69.2%)) of the participants claimed that health professionals working in outpatient care did not provide adequate information about payment for services. Statistically significant satisfaction difference with respect to the psychiatric outpatient care was found in the type of mental illness (t=2.224, P=0.043) and the participants' employment status (t=2.981, P=0.003).

Conclusion

In general, the overall participants' satisfaction towards outpatient care was high. Statistically significant satisfaction difference with respect to the psychiatric outpatient care was found in the type of mental illness and the participants' employment status. Regular service evaluation is important to improve patient satisfaction and further research is needed to investigate why satisfaction difference exists among different types of mental illnesses.

Informing quality in emergency care: understanding patient experiences

PURPOSE

Assessing performance and quality in healthcare organisations is moving from focussing solely on clinical care measurement to considering the patient experience as critical. Much patient experience research is quantitative and survey based. The purpose of this paper is to report a qualitative study gathering in-depth data in an emergency department (ED).

DESIGN/METHODOLOGY/APPROACH

The authors used empirical data from seven focus groups to understand patient experience as participants progressed through a major teaching hospital in an Ireland ED. A convenience sampling technique was used, and 42 participants were invited to share their perceptions and outline key factors affecting their journey. A role-playing exercise was used to develop improvement themes. Data were analysed using thematic analysis and data analysis software (NVivo 10).

FINDINGS

Capturing ED patient experience increases our understanding and process impact on the patient journey. Factors identified include information, access, assurance, responsiveness and empathy, reliability and tangibles such as surroundings, food and seating.

RESEARCH LIMITATIONS/IMPLICATIONS

Owing to the ED patient's emergency nature, participants were recruited if triaged at levels 3-5 (Manchester Triage System). The study explored patients' immediate rather than post hoc experiences where recollections may change over time.

ORIGINALITY/VALUE

To the authors' knowledge, no study has examined in-depth, ED patient experience in Ireland using qualitative interviewing, obtaining critical process insights as it occurs. The potential to inform patient process improvements in Irish EDs is significant.

Evidence-Based Design Has a Sustainable Positive Effect on Patients' Perceptions of Quality of Care in Forensic Psychiatry: A 3-Year Follow-Up Study

This prospective longitudinal study aimed to assess the sustainable effect on patients' assessment of ward atmosphere and quality of care at three forensic psychiatric clinics relocated to new facilities built with the latest evidence-based healthcare environment design to support recovery. Baseline data were collected in the old facilities and during three follow-ups after relocation, between 2010 and 2016. Of 74 patients who gave informed consent to participate, 58 patients (100%) answered the questionnaires at baseline, with 25 patients (43%) completing them at Follow-up 1, 11 patients (19%) at Follow-up 2, and seven patients (12%) at Follow-up 3. This study provides evidence that the mean values of patients' perceptions of care quality in these forensic psychiatric facilities increased when moving to new buildings and were stable up to 3 years after relocation, which was statistically significant in the domain of secluded environment (p < 0.05). The sample size at Follow-up 3 was small, and thus the results are limited, which indicates that further research is needed to confirm the findings.

Development and Validation of a Questionnaire to Measure Patient's Experiences of Health Care in Pulmonary Arterial Hypertension Outpatient Clinics

BACKGROUND

Measuring the patients' experience of care at an outpatient clinic can provide feedback about the quality of health care and if needed, can be support for quality improvements. To date, there is no patient reported experience measurement (PREM) developed targeting patients at the pulmonary arterial hypertension (PAH) outpatient clinics. Therefore, the aim was to develop and evaluate the psychometric properties of a PREM scale to be used for patients at PAH-outpatient clinics.

METHODS

The development and psychometric evaluation of the PREM for patients at PAH outpatient clinics followed two stages: (I) development of the PAH Clinic PREM (PAHC-PREM) scale based on interviews with patients; and (II) psychometric evaluation of the PAHC-PREM scale including data quality, factor structure (construct validity), criterion validity and internal consistency.

RESULTS

A sample of 156 patients at PAH outpatient clinics completed the PAHC-PREM scale (median age 69 years, 57% women). Unidimensionality of the PAHC-PREM scale was supported by parallel analysis. A single factor explained 67% of the variance. Inter-item and item-total correlations were satisfactory (0.46-0.88 and 0.64-0.91, respectively). Internal consistency reliability with ordinal coefficient alpha was good (0.93).

CONCLUSIONS

The PAHC-PREM scale was demonstrated to have good psychometric properties and is now ready to be used to measure quality of health care experience from patients at PAH-outpatient clinics.

Psychometric properties of instruments measuring quality and satisfaction in mental health: A systematic review

AIM

To identify the methodological quality of each study and analyse the psychometric properties of instruments measuring quality and satisfaction with care from the perspective of mental health patients and professionals.

BACKGROUND

In recent years, interest in rigorously assessing quality of care in mental health and nursing has increased. Health professionals and researchers should select the most adequate instrument based on knowledge of its measurement properties.

REVIEW DESIGN

A psychometric review was conducted of the instruments from the perspectives of both patients and professionals according to the COnsensus-based Standards for the selection of health Measurement INstruments panel (COSMIN).

DATA SOURCES

Articles published from January 2005 - September 2016 were identified in a search of MEDLINE, CINAHL, and SCOPUS. We included studies in English, Spanish, and Portuguese.

REVIEW METHODS

Inclusion criteria were applied to all articles validated and reviewed by a second independent reviewer. The analysis included the use of the COSMIN checklist and the Terwee quality criteria.

RESULTS

In the 34 studies selected, a total of 22 instruments which measure quality and satisfaction with care provided, according to patients and/or professionals, were identified. Most are instruments with sound, contemporary theoretical foundations. They vary to the extent to which they have been used in empirical studies and with respect to evaluation of their validity and reliability, although five instruments stand out as yielding good-excellent values in quality criteria.

CONCLUSION

The present psychometric review found that five of the instruments met valid psychometric criteria. In light of the current economic situation, future reviews should include analysis of the usefulness of instruments based on cost-effectiveness, acceptability, and educational impact.

'I thought they were going to handle me like a queen but they didn't': A qualitative study exploring the quality of care provided to women at the time of birth

OBJECTIVE

To explore experiences of care during labour and birth from the perspectives of both the healthcare provider and women receiving care, to inform recommendations for how the quality of care can be improved and monitored, and, to identify the main aspects of care that are important to women.

DESIGN

A descriptive phenomenological approach. 53 interviews and 10KII as per table 1 took place including in-depth interviews (IDI), focus group discussions (FGD) and key informant interviews (KII) conducted with women, healthcare providers, managers and policy makers. Following verbatim transcription thematic framework analysis was used to describe the lived experience of those interviewed.

SETTING

11 public healthcare facilities providing maternity care in urban Tshwane District, Gauteng Province (n = 4) and rural Waterberg District, Limpopo Province (n = 7), South Africa.

PARTICIPANTS

Women who had given birth in the preceding 12 weeks (49 women, 7 FGD and 23 IDI); healthcare providers working in the labour wards (33 healthcare providers; nurses, midwives, medical staff, 5 FGD, 18 IDI; managers and policy makers (10 KII).

FINDINGS

Both women and healthcare providers largely feel alone and unsupported. There is mutual distrust between women and healthcare providers exacerbated by word of mouth and the media. A lack of belief in women's ability to make appropriate choices negates principles of choice and consent. Procedure- rather than patient-centred care is prioritised by healthcare providers. Although healthcare providers know the principles of good quality care, this was not reflected in the care women described as having received. Beliefs and attitudes as well as structural and organisational problems make it difficult to provide good quality care. Caring behaviour and environment as well as companionship are the most important needs highlighted by women. Professional hierarchy is rarely seen as supportive by healthcare providers but when present, good leadership changes the culture and experience of women and care providers. The use of mobile phones to provide feedback regarding care was positively viewed by women.

CONCLUSION

Clarity regarding what a healthcare facility can (or cannot provide) is important in order to separate practice issues from structural and organisational constraints. Improvements in quality that focus on caring as well as competence should be prioritised. Increased dialogue between healthcare providers and users should be encouraged and prioritised.

IMPLICATIONS FOR PRACTICE

A renewed focus is needed to ensure companionship during labour and birth is facilitated. Training in respectful maternity care needs to prioritise caring behaviour and supportive leadership.

Translation, adaptation and psychometric validation of the Good Perioperative Nursing Care Scale (GPNCS) with surgical patients in perioperative care

AIM

To test the psychometric validity of the Good Perioperative Nursing Care Scale (GPNCS), a self-administered questionnaire, following translation and adaptation.

INTRODUCTION

Patients' satisfaction with and experience of nursing care in orthopaedic or perioperative settings are currently not routinely measured and few standardized patient-reported experience measurement tools exist for these settings.

MATERIALS AND METHODS

Cross-sectional survey. The 34-question, seven-factor questionnaire was translated, adapted, and face-validated; the translated version was then validated with a group of surgical patients in perioperative settings. The internal consistency of the translated version was validated and tested using confirmatory factor analysis combined with Cronbach's alpha.

RESULTS

In the orthopaedic department of a regional public hospital, 361 acute, traumatic and elective surgical patients were screened for eligibility; 215 were included. The full-scale model fit estimates were moderate. Factor loadings typically ranged from 0.65 to 0.97, except for the questions concerning Technical Skills (0.38-0.63) and Nursing Process (0.28). The Cronbach's alpha value for the total scale score was 0.92, with subfactors ranging from 0.72 to 0.87.

CONCLUSION

Providing evidence for quality, or lack thereof, the Danish version of the GPNCS is a valid tool for measuring surgical patients' experiences with perioperative nursing care. The electronic version proved practical.

RELEVANCE TO CLINICAL PRACTICE

The validated Danish version of the tool will help healthcare professionals to identify areas of nursing care that need improvement, facilitate international benchmarking of units and enable comparison of care quality, nationally and internationally.

Continuity of care is an important and distinct aspect of childbirth experience: findings of a survey evaluating experienced continuity of care, experienced quality of care and women's perception of labor

Background

To compare experienced continuity of care among women who received midwife-led versus obstetrician-led care. Secondly, to compare experienced continuity of care with a. experienced quality of care during labor and b. perception of labor.

Methods

We conducted a questionnaire survey in a region in the Netherlands in 2014 among 790 women after they gave birth. To measure experienced continuity of care, the Nijmegen Continuity Questionnaire was used. Quality of care during labor was measured with the Pregnancy and Childbirth Questionnaire, and to measure perception of labor we used the Childbirth Perception Scale.

Results

Three hundred twenty five women consented to participate (41%). Of these, 187 women completed the relevant questions in the online questionnaire. 136 (73%) women were in midwife-led care at the onset of labor, 15 (8%) were in obstetrician-led care throughout pregnancy and 36 (19%) were referred to obstetrician-led care during pregnancy. Experienced personal and team continuity of care during pregnancy were higher for women in midwife-led care compared to those in obstetrician-led care at the onset of labor. Experienced continuity of care was moderately correlated with experienced quality of care although not significantly so in all subgroups. A weak negative correlation was found between experienced personal continuity of care by the midwife and perception of labor.

Conclusion

This study suggests that experienced continuity of care depends on the care context and is significantly higher for women who are in midwife-led compared to obstetrician-led care during labor. It will be a challenge to maintain the high level of experienced continuity of care in an integrated maternity care system.

Experienced continuity of care seems to be a distinctive concept that should not be confused with experienced quality of care or perception of labor and should be considered as a complementary aspect of quality of care.

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1615-y) contains supplementary material, which is available to authorized users.

Key strategies to improve systems for managing patient complaints within health facilities - what can we learn from the existing literature?

BACKGROUND

Information from patient complaints - a widely accepted measure of patient satisfaction with services - can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems.

OBJECTIVES

The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research.

METHODS

We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands.

RESULTS

Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients' awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context.

CONCLUSIONS

Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.

Instruments to assess patient comfort during hospitalization: A psychometric review

AIM

To analyse the psychometric properties and the utility of instruments used to measure patient comfort, physical, social, psychospiritual and/or environmental, during hospitalization.

BACKGROUND

There are no systematic reviews nor psychometric reviews of instruments used to measure comfort, which is considered an indicator of quality in health care associated with quicker discharges, increased patient satisfaction and better cost-benefit ratios for the institution.

DESIGN

Psychometric review.

DATA SOURCES

MEDLINE, CINAHL, PsycINFO, Web of Knowledge, ProQuest Thesis&Dissertations, Google.

REVIEW METHODS

We limited our search to studies published between 1990-2015. The psychometric analysis was performed using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN), along with the Quality Criteria for Measurement Properties. The utility of the instruments was assessed according to their cost-efficiency, acceptability and educational impact. Protocol registration in PROSPERO, CRD42016036290.

RESULTS

Instruments reviewed showed moderate methodological quality and their utility was poorly reported. Thus, we cannot recommend any questionnaire without reservations, but the Comfort Scale, the General Comfort Questionnaire and their adaptations in adults and older patients, the Psychosocial Comfort Scale and the Incomfort des Patients de Reanimation are the most recommendable instruments to measure comfort.

CONCLUSIONS

The methodology of the studies should be more rigorous and authors should adequately report the utility of instruments. This review provides a strategy to select the most suitable instrument to assess patient comfort according to their psychometric properties and utility, which is crucial for nurses, clinicians, researchers and institutions.

The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study

BACKGROUND

Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence.

METHODS

Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level.

RESULTS

A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (β=7.2; P=0.029) and with the doctor consultation (β=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction.

CONCLUSION

The factors that affect patients' ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes.

Factors that shape the patient's hospital experience and satisfaction with lower limb arthroplasty: an exploratory thematic analysis

OBJECTIVE

It is generally accepted that the patients' hospital experience can influence their overall satisfaction with the outcome of lower limb arthroplasty; however, little is known about the factors that shape the hospital experience. The aim of this study was to develop an understanding of what patients like and do not like about their hospital experience with a view to providing insight into where service improvements could have the potential to improve the patient experience and their satisfaction, and whether they would recommend the procedure.

DESIGN

A mixed methods (quan-QUAL) approach.

SETTING

Large regional teaching hospital.

PARTICIPANTS

216 patients who had completed a postoperative postal questionnaire at 12 months following total knee or total hip arthroplasty.

OUTCOME MEASURES

Overall satisfaction with the outcome of surgery, whether to recommend the procedure to another and the rating of patient hospital experience. Free text comments on the best and worst aspects of their hospital stay were evaluated using qualitative thematic analysis.

RESULTS

Overall, 77% of patients were satisfied with their surgery, 79% reported a good-excellent hospital experience and 85% would recommend the surgery to another. Qualitative analysis revealed clear themes relating to communication, pain relief and the process experience. Comments on positive aspects of the hospital experience were related to feeling well informed and consulted about their care. Comments on the worst aspects of care were related to being made to wait without explanation, moved to different wards and when they felt invisible to the healthcare staff caring for them.

CONCLUSIONS

Positive patient experiences were closely linked to effective patient-health professional interactions and logistics of the hospital processes. Within arthroplasty services, the patient experience of healthcare could be enhanced by further attention to concepts of patient-centred care. Practical examples of this include more focus on developing staff-patient communication and the avoidance of 'boarding' procedures.

Quality tools and resources to support organisational improvement integral to high-quality primary care: a systematic review of published and grey literature

OBJECTIVE

To conduct a systematic review of the literature to identify existing online primary care quality improvement tools and resources to support organisational improvement related to the seven elements in the Primary Care Practice Improvement Tool (PC-PIT), with the identified tools and resources to progress to a Delphi study for further assessment of relevance and utility.

STUDY DESIGN

Systematic review of the international published and grey literature.

DATA SOURCES

CINAHL, Embase and PubMed databases were searched in March 2014 for articles published between January 2004 and December 2013. GreyNet International and other relevant websites and repositories were also searched in March-April 2014 for documents dated between 1992 and 2012.

STUDY SELECTION

All citations were imported into a bibliographic database. Published and unpublished tools and resources were included in the review if they were in English, related to primary care quality improvement and addressed any of the seven PC-PIT elements of a high-performing practice. Tools and resources that met the eligibility criteria were then evaluated for their accessibility, relevance, utility and comprehensiveness using a four-criteria appraisal framework.

DATA EXTRACTION AND SYNTHESIS

We used a data extraction template to systematically extract information from eligible tools and resources. A content analysis approach was used to explore the tools and resources and collate relevant information: name of the tool or resource, year and country of development, author, name of the organisation that provided access and its URL, accessibility information or problems, overview of each tool or resource and the quality improvement element(s) it addresses. If available, a copy of the tool or resource was downloaded into the bibliographic database, along with supporting evidence (published or unpublished) on its use in primary care.

CONCLUSIONS

This systematic review identified 53 tools and resources that can potentially be provided as part of a suite of tools and resources to support primary care practices in improving the quality of their practice, to achieve improved health outcomes.

Cancer patient experience measures: An evidence review

OBJECTIVES

This research investigates the instruments currently available to measure the cancer patient experience of health care. An investigation of the number of instruments, the domains covered by the instruments, and the structure and psychometric performance of instruments is undertaken.

METHODS

A narrative synthesis approach is used to gather evidence from multiple studies and explain the findings. Purposely broad search terms and strategies are used to capture studies with cancer patients at all stages of disease and across a range of cancer types and health care settings.

RESULTS

The majority of identified instruments were originally designed for the oncology field. Twelve of the studies developed new cancer patient measures; eight studies adapted existing or utilized items from existing instruments, and seven studies assessed the psychometric properties of existing instruments or assessed validated tools under different conditions (e.g., cross-cultural adaptation). The number of instruments assessing cancer patient experience that have sound psychometric properties across items was found to be low. The properties least tested are test-retest reliability, construct, convergent and discriminant validity, scale variability (floor/ceiling effects), and interpretability.

CONCLUSION

This review examined 10 years of research on the development of instruments to measure the cancer patient experience of health care. It found that research in this area is still in early stages of development. Further inquiry based on development and validation of cancer patient experience measures is required to support improvements in cancer care based on the perspective of cancer patients.

Effect of Coexisting Pelvic Floor Disorders on Fecal Incontinence Quality of Life Scores: A Prospective, Survey-Based Study

BACKGROUND

The association between an objective measure of fecal incontinence severity and patient-reported quality of life is poorly understood.

OBJECTIVE

The purpose of this study was to evaluate patients with various degrees of fecal incontinence to determine whether their quality of life as measured by the Fecal Incontinence Quality of Life Scale is affected by coexisting pelvic floor disorders.

DESIGN

This was a prospective, survey-based study.

SETTINGS

The study was conducted at a tertiary pelvic floor disorders center.

PATIENTS

Included patients were all of those presenting between January 2007 and March 2014.

MAIN OUTCOME MEASURES

Survey data were analyzed to determine the association between Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life Scale, as well as scores from the Constipation Severity Instrument, Pelvic Floor Impact Questionnaire, Pelvic Organ Distress Inventory, and Urinary Distress Inventory.

RESULTS

A total of 585 patients reported fecal incontinence ranging from none (n = 191) to mild/moderate (n = 159) to severe (n = 235). As expected, patients with severe fecal incontinence have worse scores on all fecal incontinence quality-of-life subscales (lifestyle, coping/behavior, depression/self-perception, and embarrassment) and worse colorectal/anal symptoms than those with mild/moderate or no fecal incontinence (p < 0.0001). Patients with severe fecal incontinence also have worse bladder/urinary symptoms (p ≤ 0.0001). Pelvic organ prolapse and constipation symptoms were similar between groups (p ≥ 0.61). After correcting for baseline differences in patient comorbidities and bladder/urinary symptoms, a significant association persisted between Fecal Incontinence Severity Index and all of the subscales of the fecal incontinence quality-of-life instrument (p < 0.0001). However, urinary distress scores also remained significantly associated with all of the fecal incontinence quality-of-life subscales except for embarrassment after risk adjustment (p < 0.01).

LIMITATIONS

Nongeneral population and a lack of patient data on previous medical management of fecal incontinence were limitations of this study.

CONCLUSIONS

The Fecal Incontinence Quality of Life Scale correlates strongly with instruments measuring both fecal and urinary incontinence. This underscores the importance of quantifying the presence or absence of coexistent urinary leakage in studies where a drop in fecal incontinence quality of life is considered a primary end point.

Systematic Review of the Clinical Disease Severity Indices for Inflammatory Bowel Disease

BACKGROUND

Clinical disease severity indices are increasingly being used in choosing treatment and monitoring the response of patients with inflammatory bowel disease (IBD). The aim of this study was to systematically review the clinical disease severity indices in IBD and to appraise their measurement properties and methodological quality.

METHODS

We searched the MEDLINE, Embase, and PsycINFO databases for original articles describing the development and/or evaluation of one or more of the measurement properties of clinical disease severity indices used in IBD. We assessed these properties (e.g., internal consistency, reliability, validity, responsiveness) using a standardized checklist.

RESULTS

We examined the full text of 142 articles that we deemed potentially eligible and identified 22 clinical disease severity indices in IBD. No clinical disease index has met all the required measurement properties. All of the validation studies were not descriptive enough to allow assessment of their methodology.

CONCLUSIONS

Although commonly used in multiple clinical trials, none of the clinical disease severity indices in IBD had all the required measurement properties. Further validation studies are required.

A cross-sectional study assessing the association between online ratings and structural and quality of care measures: results from two German physician rating websites

Background

Even though physician rating websites (PRWs) have been gaining in importance in both practice and research, little evidence is available on the association of patients’ online ratings with the quality of care of physicians. It thus remains unclear whether patients should rely on these ratings when selecting a physician. The objective of this study was to measure the association between online ratings and structural and quality of care measures for 65 physician practices from the German Integrated Health Care Network “Quality and Efficiency” (QuE).

Methods

Online reviews from two German PRWs were included which covered a three-year period (2011 to 2013) and included 1179 and 991 ratings, respectively. Information for 65 QuE practices was obtained for the year 2012 and included 21 measures related to structural information (N = 6), process quality (N = 10), intermediate outcomes (N = 2), patient satisfaction (N = 1), and costs (N = 2). The Spearman rank coefficient of correlation was applied to measure the association between ratings and practice-related information.

Results

Patient satisfaction results from offline surveys and the patients per doctor ratio in a practice were shown to be significantly associated with online ratings on both PRWs. For one PRW, additional significant associations could be shown between online ratings and cost-related measures for medication, preventative examinations, and one diabetes type 2-related intermediate outcome measure. There again, results from the second PRW showed significant associations with the age of the physicians and the number of patients per practice, four process-related quality measures for diabetes type 2 and asthma, and one cost-related measure for medication.

Conclusions

Several significant associations were found which varied between the PRWs. Patients interested in the satisfaction of other patients with a physician might select a physician on the basis of online ratings. Even though our results indicate associations with some diabetes and asthma measures, but not with coronary heart disease measures, there is still insufficient evidence to draw strong conclusions. The limited number of practices in our study may have weakened our findings.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-015-1051-5) contains supplementary material, which is available to authorized users.

Instruments to measure patient experience of healthcare quality in hospitals: a systematic review

BACKGROUND

Improving and sustaining the quality of hospital care is an international challenge. Patient experience data can be used to target improvement and research. However, the use of patient experience data has been hindered by confusion over multiple instruments (questionnaires) with unknown psychometric testing and utility.

METHODS

We conducted a systematic review and utility critique of questionnaires to measure patient experience of healthcare quality in hospitals. Databases (Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO) and Web of Knowledge until end of November 2013) and grey literature were scrutinised. Inclusion criteria were applied to all records with a 10 % sample independently checked. Critique included (1) application of COSMIN checklists to assess the quality of each psychometric study, (2) critique of psychometric results of each study using Terwee et al. criteria and (3) development and critique of additional aspects of utility for each instrument. Two independent reviewers completed each critique. Synthesis included combining findings in a utility matrix.

RESULTS

We obtained 1157 records. Of these, 26 papers measuring patient experience of hospital quality of care were identified examining 11 international instruments. We found evidence of extensive theoretical/development work. The quality of methods and results was variable but mostly of a high standard. Additional aspects of utility found that (1) cost efficiency was mostly poor, due to the resource necessary to obtain reliable samples; (2) acceptability of most instruments was good and (3) educational impact was variable, with evidence on the ease of use, for approximately half of the questionnaires.

CONCLUSIONS

Selecting the right patient experience instrument depends on a balanced consideration of aspects of utility, aided by the matrix. Data required for high stakes purposes requires a high degree of reliability and validity, while those used for quality improvement may tolerate lower levels of reliability in favour of other aspects of utility (educational impact, cost and acceptability).

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42013006754.

Aplicabilidade dos resultados da pesquisa de satisfação dos usuários pela Enfermagem

Objetivo Analisar a utilização de resultados da pesquisa de satisfação dos usuários pelas chefias de Enfermagem das unidades de internação. Métodos Pesquisa exploratória, descritiva, realizada em hospital universitário. O instrumento de pesquisa foi um formulário aplicado por entrevista com 14 enfermeiras. Os depoimentos transcritos foram submetidos à análise de conteúdo. Resultados Emergiram quatro categorias: a comunicação como forma de transmissão das informações para a equipe de Enfermagem; a contribuição da pesquisa de satisfação do usuário para o atendimento em saúde; mudanças implementadas nas unidades a partir dos resultados da pesquisa; e a influência da pesquisa de satisfação na avaliação de desempenho da equipe de Enfermagem. Conclusão As informações obtidas pela pesquisa de satisfação fornecem um panorama da performance do serviço e podem auxiliar gestores na tomada de decisões. Servem ainda como fonte de informação para a avaliação do desempenho individual dos funcionários e indicadores de qualidade da assistência.

Systematic review of health-related quality of life measures for inflammatory bowel disease

BACKGROUND AND AIM

Several measures have been developed to assess the health-related quality of life [HRQoL] of patients with inflammatory bowel disease [IBD]. Our aim is to systematically review the HRQoL measures specific for patients with IBD and to appraise their measurement properties and methodological quality.

METHODS

We searched the PubMed, Embase, and PsycINFO databases for original articles describing the development and/or evaluation of one or more of the measurement properties [e.g. internal consistency, reliability, validity, responsiveness] of HRQoL measures specific for IBD. We assessed the measurement properties and examined the methodological quality of the measurement properties of each instrument using a standardized checklist.

RESULTS

We examined the full text of 75 articles that we deemed potentially eligible and identified 10 disease-specific HRQoL measures in IBD that covered different aspects of patients' lives. Internal consistency, construct validity, and content validity were the commonly evaluated measurement properties. Seven HRQoL measures scored positive for at least four of eight measurement properties. The majority of studies were rated as 'fair' to 'poor' when assessing their methodology quality. The most established HRQoL measure in the literature was the Inflammatory Bowel Disease Questionnaire [IBDQ].

CONCLUSIONS

Most of the included HRQoL measures did not include all the required measurement properties or had a problem with their methodological quality. The most widely used and validated measure was the IBDQ. Further validation studies are required to support the use of other HRQoL measures.

Psychometric Testing of a Comprehensive Patient Satisfaction Survey in Arabic

Background and Purpose: Although patient satisfaction is an important indicator of the quality of care received in hospitals, no reliable and valid Arabic comprehensive inpatient satisfaction survey has been published. The purpose of this study was to evaluate the psychometric properties of an Arabic patient satisfaction survey. Methods: A cross-sectional design was used where 1,339 randomly selected patients were interviewed by phone. The questionnaire was adopted and from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, refined and tested over a 4-year period. Results: Item–item correlations for the 22 items on the survey ranged from .52 to .92, and the Cronbach’s alpha coefficient was .87. Construct and predictive validity were also adequate. Conclusion: The survey is recommended for use in hospitals in Lebanon and other Middle Eastern countries to facilitate benchmarking and quality improvement.

A satisfaction survey of opioid-dependent patients with methadone maintenance treatment

The aim of this study was to examine opioid-dependent patients' satisfaction with the methadone maintenance treatment (MMT) program in Malaysia and identify predictors of satisfaction. We used an interviewer-administered questionnaire developed and validated by Rankin Court, New South Wales, Australia. Of 502 patients approached in 11 MMT centers in Malaysia, 425 agreed to participate giving a response rate of 85%. In terms of overall satisfaction, a high percentage of respondents (85%) were satisfied with the MMT services. A logistic regression analysis showed that only "centres" and marital status were associated with overall satisfaction and that being single (OR 3.31; 95% CI 1.52 to 7.20) or married (OR 4.06; 95% CI 1.76 to 9.38) was associated with higher odds of overall satisfaction compared to being divorced or separated. An analysis of the responses pertaining to the most desired changes required at the center found dosing hours, waiting area and staff shortages to be common. The findings acquired from this survey will be useful to attain a clearer perspective on what aspects of the MMT service need to be reviewed for the improvement of service delivery.