Jany Rademakers

Structure, process or outcome: which contributes most to patients' overall assessment of healthcare quality?

Research questions The paper explores which type of quality aspects (structure, process, outcome) most strongly determines patients overall assessment of healthcare, and whether there is a variation between different types of patient groups in this respect. Methods Secondary analyses were undertaken on survey data from patients who underwent hip or knee surgery, cataract surgery, patients suffering from varicose veins, spinal disc herniation or rheumatoid arthritis. In these analyses, the patient-given global rating served as the dependent variable, and experiences regarding structure (waiting times, continuity of care), process (doctor–patient communication and information) and outcome aspects (improvement or worsening of symptoms) served as independent variables. Results Experiences regarding process aspects explained most of the variance in the global rating (16.4–23.3%), followed by structure aspects (8.1–21.0%). Experiences regarding outcome did not explain much variance in the global rating in any of the patient groups (5.3–13.5%). The patient groups did not differ with respect to the type of quality aspects that most predicted the overall assessment. Discussion Improving process and structure aspects of healthcare is most likely to increase patients overall evaluation of the quality of care as expressed in a global rating. A more sophisticated method of patient reported outcome measurement, with pre- and post-treatment questionnaires and the inclusion of quality-of-life criteria, might lead to higher associations between outcome and the overall evaluation of the received care.

The Dutch consumer quality index: an example of stakeholder involvement in indicator development.

BackgroundLike in several other Western countries, in the Dutch health care system regulated competition has been introduced. In order to make this work, comparable information is required about the performance of health care providers in terms of effectiveness, safety and patient experiences. Without further coordination, external actors will all try to force health care providers to be transparent. For health care providers this might result in a situation in which they have to deliver data for several sets of indicators, defined by different actors. Therefore, in the Netherlands an effort is made to define national sets of performance indicators and related measuring instruments. In this article, the following questions are addressed, using patient experiences as an example:- When and how are stakeholders involved in the development of indicators and instruments that measure the patients experiences with health care providers?- Does this involvement lead to indicators and instruments that match stakeholders information needs?DiscussionThe Dutch experiences show that it is possible to implement national indicator sets and to reach consensus about what needs to be measured. Preliminary evaluations show that for health care providers and health insurers the benefits of standardization outweigh the possible loss of tailor-made information. However, it has also become clear that particular attention should be given to the participation of patient/consumer organisations.SummaryStakeholder involvement is complex and time-consuming. However, it is the only way to balance the information needs of all the parties that ask for and benefit from transparency, without frustrating the health care system.

The importance of patient-centered care for various patient groups.

OBJECTIVESnTo assess differences in the importance ascribed to patient-centered care between various patient groups and demographic groups.nnnMETHODSnSurvey data collected using questionnaires were analyzed for patients that underwent hip or knee surgery (n=214), patients suffering from rheumatoid arthritis (n=343), spinal disk herniation (n=145), breast abnormalities (n=596) or congestive heart failure (n=118). A composite for patient-centered care priorities was constructed (α=0.82) and compared to the average importance over all healthcare aspects in the surveys.nnnRESULTSnAll patient groups considered patient-centered care to be of above-average importance (ps<0.001). Small but significant differences were observed: patient-centered care was more important for patients suffering from congestive heart failure (p<0.001) and patients who were younger, female, well-educated and healthier (ps<0.05). Patients who had undergone hip or knee surgery considered patient-centered care more important than patients with spinal disk herniation did (p<0.05).nnnCONCLUSIONnPatient-centered care is important to all patient groups. Differential policies regarding patient-centered care for patient subgroups do not seem required.nnnPRACTICAL IMPLICATIONSnGiven the importance attributed to patient-centered care, it is essential that elements of patient-centered care are included in surveys, indicators of quality of care, and the training of doctors and nurses.

Consumers' interpretation and use of comparative information on the quality of health care: the effect of presentation approaches.

Backgroundu2002 Public reports about health‐care quality have not been effectively used by consumers thus far. A possible explanation is inadequate presentation of the information.

Measuring patients’ experiences with rheumatic care: the consumer quality index rheumatoid arthritis

Rheumatologists and other caregivers can learn from patients’ experiences with the quality of care that can be measured with the CQ-index Rheumatoid Arthritis (CQ-index RA) survey. Patients with RA (nxa0=xa0590) received this survey were they rated their actual experiences and what they find important in rheumatic healthcare. Descriptive analyses and psychometric methods were used to test the reliability. The response rate was 69%. The items in the pilot instrument could be grouped into 10 scales (α ranged from 0.77 to 0.94). The most important quality aspects according to patients concerned the alertness when prescribing medication. Providing patients with information on a special website of the hospital about RA was the highest quality improvement aspect. The results of this study show that the CQ-index RA is a reliable instrument for quality assessment from the patients’ perspective. The instrument provides rheumatologists and other caregivers with feedback for service improvement initiatives.

Verschillende dataverzamelingsmethoden in CQI onderzoek: een overzicht van de respons en representativiteit van respondenten

SamenvattingInleiding: In dit artikel wordt uiteengezet welke dataverzamelingsmethoden er tot nu toe gebruikt zijn bij CQ-index (CQI) onderzoek en wat de respons en representativiteit van respondenten waren. Methode: Uit verschenen CQI publicaties werd de volgende informatie gehaald: gebruikte dataverzamelingsmethode(n), aantal verstuurde herinneringen, het aantal vragen van de gebruikte CQ-index, respons, representativiteit van respondenten voor leeftijd en geslacht. Met correlaties is bekeken waar de respons mee samenhing. Resultaten: Bijna driekwart (22) van de CQI metingen vond schriftelijk plaats. Bij uitzondering werd mondeling (2), via internet (1) of via een combinatie van internet en schriftelijke vragenlijsten (3) gegevens verzameld. De respons was het hoogst bij een mondelinge dataverzameling en het laagst bij dataverzameling via internet. De respons was niet gerelateerd aan de leeftijd van respondenten of het aantal vragen in de vragenlijst. Mannen vulden over het algemeen eerder een internetvragenlijst in dan vrouwen en mannen waren doorgaans ondervertegenwoordigd bij schriftelijke dataverzamelingen. Conclusie: Tot nu toe worden bij CQI onderzoek de gegevens voornamelijk schriftelijk verzameld. De respons varieert zowel binnen als tussen dataverzamelingsmethoden en een combinatie van methoden kan de respons verhogen. De keuze van een dataverzamelingsmethode heeft invloed op de demografische samenstelling van de groep respondenten.AbstractDifferent methods of data collection in CQI research: an overview of the response and representativeness of respondentsIntroductionThis article describes different methods of data collection using consumer quality index (CQI) surveys.The response and representativeness of respondents are also examined. Method: From publications of CQI measurements, the following aspects were reported: data collection method(s), number of reminders, number of questions in the survey, response, comparison of respondents and the sample for age and gender. Using correlational analyses we also studied how the response was related to various other features of CQI measurements. Results: For the majority of CQI surveys, questionnaires were distributed by mail (22). Occasionally, data were collected by interviews (2), the Internet (1) or a combination of internet and mail data collection (3). The response was the highest with interviews and the lowest for the Internet. The response did not correlate with the number of questions in the questionnaire. Men were more likely to respond to an Internet questionnaire compared to women and men were generally underrepresented in data collections through mail. Conclusion: CQI questionnaires were mainly distributed by mail. The response varied within and between methods of data collection. A combination of methods may improve the response. The methods of data collection affects the demographic composition of the group respondents.Keywords: customer experiences, CQ-index, data collection,health care

The effect of the proximity of patients’ nearest alternative hospital on their intention to search for information on hospital quality

Objective In several countries, patients are encouraged to choose health care providers. Simultaneously, there is a tendency towards the concentration of health care, which might lessen the choice. Our aim was to assess the impact of patients’ distances from their providers on their information-seeking, which is one element of choice. Methods Two thousand members of the Dutch Health Care Consumer Panel were sent a questionnaire that included a question on whether they would search for information about hospitals to inform their choice. Distances from providers were obtained from a database that includes the distances between all postcodes in the Netherlands. To assess the influence of distance on information-seeking, logistic regression analyses were conducted. Results There was a good response (75%). Older, less educated respondents were less inclined to seek information when their nearest alternative was located further away (OR 0.85; 95% CI: 0.79–0.92), and younger, more educated respondents were more inclined to search in this situation (OR 1.11; 95% CI: 1.01–1.22). Conclusions As fewer older, less educated patients would search for information to guide their choice, they might not opt for the best hospital. Additionally, the need for providers to compete for the patronage of these patients might be lessened.

What role does health literacy play in patients' involvement in medical decision-making?

Patients vary in their preferences towards involvement in medical decision-making. Previous research, however, gives no clear explanation for this observed variation in their involvement. One possible explanation might be health literacy. Health literacy refers to personal characteristics and social resources needed for people to access, understand and use information to make decisions about their health. This study aimed to examine the relationship between health literacy and self-reported patient involvement. With respect to health literacy, we focused on those competences relevant for medical decision-making. We hypothesized that people with higher health literacy report that they are more involved in medical decision-making. A structured questionnaire was sent to members of the Dutch Health Care Consumer Panel in May 2015 (response 46%, N = 974). Health literacy was measured using five scales of the Health Literacy Questionnaire. A regression model was used to estimate the relationship between health literacy and self-reported involvement. In general, our results did not show a relationship between health literacy and self-reported involvement. We did find a positive significant association between the health literacy scale appraisal of health information and self-reported involvement. Our hypothesis was partly confirmed. The results from this study suggest that higher order competences, that is to say critical health literacy, in particular, are important in reporting involvement in medical decision-making. Future research is recommended to unravel further the relationship between health literacy and patient involvement in order to gain insight into whether health literacy might be an asset to enhance patient participation in medical decision-making.

Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients

Various north‐western European health‐care systems encourage patients to make an active choice of health‐care provider. This study explores, qualitatively, patients hospital selection processes and provides insight into the reasons why patients do or do not make active choices.

De constructie van een CQI meetinstrument: ervaringen uit de praktijk

SamenvattingDe ontwikkeling van een CQI meetinstrument bestaat uit verschillende fasen. In dit artikel wordt ingegaan op de constructie van de vragenlijst en op de statistische analyses ten aanzien van de psychometrische aspecten en het discriminerend vermogen. De beschrijving van deze fasen zal geïllustreerd worden aan de hand van voorbeelden uit de CQI Huisartsenzorg Overdag, de CQI Heup/knie-operatie, de CQI Mammacare en de CQI Reumatoïde Artritis. Verder zullen de ervaringen met verschillende onderdelen van het constructieproces en de CQI meetsystematiek als geheel worden bediscussieerd.AbstractThe construction of a CQ-index questionnaire: practise experiencesThe development of a CQ-index questionnaire consists of several phases. In this article the construction of a questionnaire and the statistical analyses with regard to the psychometrical properties and discriminative capacity of the instrument are discussed. The description will be illustrated with examples from four CQI’s: the CQI General Practice, the CQI Hip/knee-surgery, the CQI Mammacare and the CQI Reumatoid Artritis. The experiences with different phases of the construction process as well as with the CQI systematics in general will be discussed.