The impact of accessibility and service quality on the frequency of patient visits to the primary diabetes care provider : results from a cross-sectional survey performed in six European countries

BackgroundVisits to the primary diabetes care provider play a central role in diabetes care. Therefore, patients should attend their primary diabetes care providers whenever a visit is necessary. Parameters that might affect whether this condition is fulfilled include accessibility (in terms of travel distance and travel time to the practice), as well as aspects of service quality (for example in-practice waiting time and quality of the provider's communication with the patient). The relationships of these variables with the frequency of visits to the primary diabetes care provider are investigated.MethodsThe investigation is performed with questionnaire data of 1086 type 2 diabetes patients from study regions in England (213), Finland (135), Germany (218), Greece (153), the Netherlands (296) and Spain (71). Data were collected between October 2011 and March 2012. Data were analysed using log-linear Poisson regression models with self-reported numbers of visits in a year to the primary diabetes care provider as the criterion variable. Predictor variables of the core model were: country; gender; age; education; stage of diabetes; heart problems; previous stroke; problems with lower extremities; problems with sight; kidney problems; travel distance and travel time; in-practice waiting time; and quality of communication. To test region-specific characteristics, the interaction between the latter four predictor variables and study region was also investigated.ResultsWhen study regions are merged, travel distance and in-practice waiting time have a negative effect, travel time no effect and quality of communication a positive effect on visit frequency (with the latter effect being by far largest). When region specific effects are considered, there are strong interaction effects shown for travel distance, in-practice waiting time and quality of communication. For travel distance, as well as for in-practice waiting time, there are region-specific effects in opposite directions. For quality of communication, there are only differences in the strength with which visit frequency increases with this variable.ConclusionsThe impact of quality of communication on visit frequency is the largest and is stable across all study regions. Hence, increasing quality of communication seems to be the best approach for increasing visit frequency.Peer reviewe

Development of a universal short patient satisfaction questionnaire on the basis of SERVQUAL : Psychometric analyses with data of diabetes and stroke patients from six different European countries

Objective A short questionnaire which can be applied for assessing patient satisfaction in different contexts and different countries is to be developed. Methods Six items addressing tangibles, reliability, responsiveness, assurance, empathy, and communication were analysed. The first five items stem from SERVQUAL (SERVice QUALity), the last stems from the discussion about SERVQUAL. The analyses were performed with data from 12 surveys conducted in six different countries (England, Finland, Germany, Greece, the Netherlands, Spain) covering two different conditions (type 2 diabetes, stroke). Sample sizes for included participants are 247 in England, 160 in Finland, 231 in Germany, 152 in Greece, 316 in the Netherlands and 96 in Spain for the diabetes surveys; and 101 in England, 139 in Finland, 107 in Germany, 58 in Greece, 185 in the Netherlands, and 92 in Spain for the stroke surveys. The items were tested by (1) bivariate correlations between the items and an item addressing 'general satisfaction', (2) multivariate regression analyses with 'general satisfaction' as criterion and the items as predictors, and (3) bivariate correlations between sum scores and 'general satisfaction'. Results The correlations with 'general satisfaction' are 0.48 for tangibles, 0.56 for reliability, 0.58 for responsiveness, 0.47 for assurance, 0.53 for empathy, and 0.56 for communication. In the multivariate regression analysis, the regression coefficient for assurance is significantly negative while all other regression coefficients are significantly positive. In a multivariate regression analysis without the item 'assurance' all regression coefficients are positive. The correlation between the sum score and 'general satisfaction' is 0.608 for all six items and 0.618 for the finally remaining five items. The country specific results are similar. Conclusions The five items which remain after removing 'assurance', i.e. the SERVQUAL-MOD-5, constitute a short patient satisfaction index which can usefully be applied for different medical conditions and in different countries.Peer reviewe

Capacity management of nursing staff as a vehicle for organizational improvement

<p>Abstract</p> <p>Background</p> <p>Capacity management systems create insight into required resources like staff and equipment. For inpatient hospital care, capacity management requires information on beds and nursing staff capacity, on a daily as well as annual basis. This paper presents a comprehensive capacity model that gives insight into required nursing staff capacity and opportunities to improve capacity utilization on a ward level.</p> <p>Methods</p> <p>A capacity model was developed to calculate required nursing staff capacity. The model used historical bed utilization, nurse-patient ratios, and parameters concerning contract hours to calculate beds and nursing staff needed per shift and the number of nurses needed on an annual basis in a ward. The model was applied to three different capacity management problems on three separate groups of hospital wards. The problems entailed operational, tactical, and strategic management issues: optimizing working processes on pediatric wards, predicting the consequences of reducing length of stay on nursing staff required on a cardiology ward, and calculating the nursing staff consequences of merging two internal medicine wards.</p> <p>Results</p> <p>It was possible to build a model based on easily available data that calculate the nursing staff capacity needed daily and annually and that accommodate organizational improvements. Organizational improvement processes were initiated in three different groups of wards. For two pediatric wards, the most important improvements were found to be improving working processes so that the agreed nurse-patient ratios could be attained. In the second case, for a cardiology ward, what-if analyses with the model showed that workload could be substantially lowered by reducing length of stay. The third case demonstrated the possible savings in capacity that could be achieved by merging two small internal medicine wards.</p> <p>Conclusion</p> <p>A comprehensive capacity model was developed and successfully applied to support capacity decisions on operational, tactical, and strategic levels. It appeared to be a useful tool for supporting discussions between wards and hospital management by giving objective and quantitative insight into staff and bed requirements. Moreover, the model was applied to initiate organizational improvements, which resulted in more efficient capacity utilization.</p

The validity of the EQ-5D-3L items: An investigation with type 2 diabetes patients from six European countries

Background: Most previous studies concerning the validity of the EQ-5D-3L items refer to applications of only a single language version of the EQ-5D-3L in only one country. Therefore, there is little information concerning the extent to which the results can be generalised across different language versions and

Creating Coherence-Based Nurse Planning in the Perinatology Care System

The combination of increasing demand and a shortage of nurses puts pressure on hospital care systems to use their current volume of resources more efficiently and effectively. This study focused on gaining insight into how nurses can be assigned to units in a perinatology care system to balance patient demand with the available nurses. Discrete event simulation was used to evaluate the what-if analysis of nurse flexibility strategies and care system configurations from a case study of the Perinatology Care System at Radboud University Medical Center in Nijmegen, the Netherlands. Decisions to exercise nurse flexibility strategies to solve supply-demand mismatches were made by considering the entire patient care trajectory perspective, as they necessitate a coherence perspective (i.e., taking the interdependency between departments into account). The study results showed that in the current care system configuration, where care is delivered in six independent units, implementing a nurse flexibility strategy based on skill requirements was the best solution, averaging two fewer under-/overstaffed nurses per shift in the care system. However, exercising flexibility below or above a certain limit did not substantially improve the performance of the system. To meet the actual demand in the studied setting (70 beds), the ideal range of flexibility was between 7% and 20% of scheduled nurses per shift. When the care system was configured differently (i.e., into two large departments or pooling units into one large department), supply-demand mismatches were also minimized without having to implement any of the three nurse flexibility strategies mentioned in this study. These results provide insights into the possible solutions that can be implemented to deal with nurse shortages, given that these shortages could potentially worsen in the coming years