What is important in evaluating health care quality? An international comparison of user views

BACKGROUND: Quality of care from the perspective of users is increasingly used in evaluating health care performance. Going beyond satisfaction studies, quality of care from the users' perspective is conceptualised in two dimensions: the importance users attach to aspects of care and their actual experience with these aspects. It is well established that health care systems differ in performance. The question in this article is whether there are also differences in what people in different health care systems view as important aspects of health care quality. The aim is to describe and explain international differences in the importance that health care users attach to different aspects of health care. METHODS: Data were used from different studies that all used a version of the QUOTE-questionnaire that measures user views of health care quality in two dimensions: the importance that users attach to aspects of care and their actual experience. Data from 12 European countries and 5133 individuals were used. They were analysed using multi-level analysis. RESULTS: Although most of the variations in importance people attach to aspects of health care is located at the individual level, there are also differences between countries. The ranking of aspects shows similarities. 'My GP should always take me seriously' was in nearly all countries ranked first, while an item about waiting time in the GP's office was always ranked lowest. CONCLUSION: Differences between countries in how health care users value different aspects of care are difficult to explain. Further theorising should take into account that importance and performance ratings are positively related, that people compare their experiences with those of others, and that general and instrumental values might be related through the institutions of the health care system

Measuring patients' experiences with palliative care : the Consumer Quality Index Palliative Care

Background: The Consumer Quality Index Palliative Care (CQ-index PC) is a structured questionnaire for measuring the quality of palliative care from the perspective of care users. CQ-indices assess which care aspects need quality improvement by relating answers about actual care experiences to answers about the importance of certain aspects of care. Methods: To improve the chance that the new instrument has good content validity, a literature study and individual and group discussions were performed, and a steering committee was consulted to establish the instrument’s face and content validity. The questionnaire was administered to patients with a life expectancy of 6 months or less and/or who were receiving palliative treatment. Descriptive analyses were carried out on the items about actual care experiences and the importance of care aspects, and on ‘need for improvement’ scores. Results: 15 care organisations participated. 133 patients met the inclusion criteria (net response n=85). Patients considered the following aspects the most important: ‘offering help in good time in acute situations’, ‘caregivers having the necessary expertise’ and ‘caregivers taking the patient seriously’. The three care aspects with the highest ‘need for improvement’ scores were: ‘support when the patient feels depressed’, ‘support when the patient is anxious’ and ‘support when the patient has shortness of breath’. Conclusions: The CQ-index PC provides opportunities for care organisations to assess which care aspects have the highest priority for quality improvement within their organisation. Further research is needed to assess whether the instrument has enough discriminative power to assess differences between organisations.(aut. ref.

Comparison of patient evaluations of health care quality in relation to WHO measures of achievement in 12 European countries

OBJECTIVES: To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. METHODS: Patient evaluations were derived from a series of Quote (QUality of care Through patients' Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intraclass correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 - Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. FINDINGS: Intra-class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients' problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider's understanding of patients' problems and responsiveness according to WHO. CONCLUSIONS: Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO's performance measures of health care systems

Measuring relatives' perspectives on the quality of palliative care: the Consumer Quality Index Palliative Care

Context: A Consumer Quality Index (CQ-index) is a questionnaire assessing the actual care experiences and how important the recipient finds certain care aspects, as well as the priorities for improving quality. A CQ-index Palliative Care (CQ-index PC) for bereaved relatives was developed to measure the quality of palliative care. Objectives: This article provides insight into the development and psychometric characteristics of this questionnaire, as well as quality improvement priorities. Methods: The content of the CQ-index PC was based on existing questionnaires, literature, and interviews and focus group discussions with relatives, patients, and caregivers. The questionnaire was tested in 31 care facilities providing palliative care. Close relatives/contact persons of patients who died non-suddenly six weeks to six months earlier were eligible for inclusion. Psychometric analyses were performed to shorten the questionnaire and to assess its reliability. “Need for improvement scores” also were computed to identify care aspects with the highest priority for quality improvement. Results: Three hundred ninety-two bereaved relatives were eligible for inclusion. The net response was 52% (n=204). Psychometric analyses resulted in six scales (Cronbach's alphas ranging from 0.71 to 0.90). The quality aspects relatives considered most important were dying peacefully, getting help in good time in acute situations, and personal attention. Aftercare was the aspect with the highest priority for quality improvement. Conclusion: The CQ-index PC for relatives can be used to assess the quality of palliative care from the perspective of bereaved relatives. This instrument gives health care professionals insight into care aspects with the highest priority for quality improvement. (aut. ref.

Comparison of patient evaluations of health care quality in relation to WHO measures of achievement in 12 European countries.

OBJECTIVES: To gain insight into similarities and differences in patient evaluations of quality of primary care across 12 European countries and to correlate patient evaluations with WHO health system performance measures (for example, responsiveness) of these countries. METHODS: Patient evaluations were derived from a series of Quote (QUality of care Through patients' Eyes) instruments designed to measure the quality of primary care. Various research groups provided a total sample of 5133 patients from 12 countries: Belarus, Denmark, Finland, Greece, Ireland, Israel, Italy, the Netherlands, Norway, Portugal, United Kingdom, and Ukraine. Intraclass correlations of 10 Quote items were calculated to measure differences between countries. The world health report 2000 - Health systems: improving performance performance measures in the same countries were correlated with mean Quote scores. FINDINGS: Intra-class correlation coefficients ranged from low to very high, which indicated little variation between countries in some respects (for example, primary care providers have a good understanding of patients' problems in all countries) and large variation in other respects (for example, with respect to prescription of medication and communication between primary care providers). Most correlations between mean Quote scores per country and WHO performance measures were positive. The highest correlation (0.86) was between the primary care provider's understanding of patients' problems and responsiveness according to WHO. CONCLUSIONS: Patient evaluations of the quality of primary care showed large differences across countries and related positively to WHO's performance measures of health care systems

Patient experiences of inpatient hospital care: A department matter and a hospital matter

Objective To examine the added value of measuring and possibly presenting patient experiences at the department level, in addition to the hospital level, and to explore the possibility that patient experiences differ according to the ‘type’ of hospital department. Design Secondary analysis of data from a widely used survey on patient experiences of Dutch inpatient hospital care [Consumer Quality Index (CQI) Inpatient Hospital Care]. Setting Inpatient hospital care experience survey of patients of 78 Dutch hospitals. Participants A total of 15 171 randomly selected inpatients from 78 Dutch hospitals, who had at least one night of hospitalization between October 2006 and October 2007. Main outcome measures Explained variance in patient experiences at the department level, compared with the explained variance at the hospital level. Significant differences in patient experiences between types of departments, expressed in regression coefficients. Patient experiences were measured using validated quality indicators, calculated from specific survey items. Results Adding the department level to the analyses of patient experiences is statistically worthwhile for a number of quality indicators of the CQI Inpatient Hospital Care, and will enable the presentation of more detailed results within hospitals. Furthermore, the results indicated that there are some systematic differences in patient experiences between specific types of hospital departments across hospitals. However, the proportion of variance in experiences explained by both department and hospital is limited (max. 14%). Conclusions Analyses of quality information on patient experiences of inpatient hospital care should not only take the hospital level, but also at the more specific department level into account. Keywords: quality of health care, patient satisfaction, survey methodology, hospitals, statistics Topic: hospital departments, inpatient, quality indicators, continuous quality improvement, measures of outcome, hospital car