Thomas R. Zastowny

Patient satisfaction and experience with health services and quality of care.

This article discusses the use of patient satisfaction and personal health care experiences as a measure of health care quality. It also presents a field-proven patient experience and satisfaction assessment methodology known as the Patient Experience Survey (PES) that has been employed throughout the country for the last decade. Finally, it offers recommendations and comments on the use of patient satisfaction data in quality assessment and improvement.

Patient satisfaction with mental health services: a meta-analysis to establish norms.

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.

Sociodemographic and Attitudinal Correlates of Alcohol and Other Drug Use Among Children and Adolescents: Analysis of a Large-Scale Attitude Tracking Study

Data from the Partnership Attitude Tracking Study are analyzed to provide a greater understanding of the contributing factors to alcohol and other drug use among children and adolescents. The data were collected from children (ages 9 to 12) and teenagers (ages 13 to 17) in central locations (usually shopping malls) located in 100 primary sampling units across the United States. The analysis, which primarily employed stepwise multiple regression for model estimation, reinforced the importance of friends use, perceived risk, and tobacco and alcohol use in predicting marijuana use. An exposure model, which included antidrug advertisements, was a particularly powerful model. Implications of the findings are discussed.

Patient satisfaction surveys and multicollinearity.

The measurement of patient satisfaction is now an integral part of hospital market research. Just as consumer satisfaction is a function of the extent to which providers do things right, the value of consumer-oriented market research is directly related to whether the research itself is done right. The use of poorly designed consumer research instruments, no matter how well executed, can cause multicollinearity among the independent variables, which, in turn, can result in misleading conclusions.

Behavioral treatment of adult obesity: Attentional controls and a 2-year follow-up

Abstract This research included controls for both amount of extra-therapy attention focused on target behaviors and for quality and duration of attention provided during therapy. Two pairs of therapists each conducted one group for each of four experimental conditions: nonspecific therapy, nonspecific therapy + attention prompting, behavior therapy, behavior therapy + positive induction (procedures designed to maximize favorableness of expectancies). Sixty-five obese adults ( X overweight = 52%) attended 12 weekly group sessions and 3-month and 2-yr follow-ups. Ratings of expectancies, credibility and therapist characteristics were equivalent in all experimental conditions. Attrition was low (9.7%) and S s averaged 1–2 lb weight losses per week during treatment, while improving concurrently in eating habits, cardiovascular fitness and adjustment. However, only participants who were in groups conducted by the therapist pair which was rated especially ‘democratic’ maintained average weight losses at the 2-yr follow-up. These results demonstrate the potentially vital role of several ‘nonspecific’ factors in long-term outcomes associated with behavioral treatments for adult obesity.

The consistency of estimates obtained through central-location sampling: analysis of the Partnership for a Drug-Free America Attitude Tracking Study.

To evaluate the reliability and validity of estimates of drug use obtained through multiple-site central-location sampling, data from the Partnership Attitude Tracking Study (PATS), collected annually beginning in 1987, are tracked longitudinally and compared with data collected through traditional household interviews. Comparisons with demographic estimates from Current Population Surveys indicate that central-location sampling can provide a broadly representative sample of the adult population. However, there is some coverage bias in central-location sampling, most notably in the underrepresentation of adults who do not have high school diplomas. Sample estimates obtained from central-location sampling are consistent over time. Basic demographic characteristics of the samples--education, income, marital status, and area of residence--vary by less than 5% across the four waves of the tracking study. Prevalence estimates of self-reported drug use demonstrate an even higher degree of consistency over time. Comparisons of PATS and National Household Survey of Drug Abuse data and the Monitoring the Future data indicate a higher level of drug use and a lower level of perceived risk of occasional use among PATS respondents. While the trends in use and perceived risk reported in all studies are similar, we suggest that perceived threats to confidentiality and anonymity often result in significant underreporting of drug use, particularly in household surveys. Sample estimate differences are attributed to sampling and measurement error. Some discrepancy in prevalence estimates is associated with the fact that the PATS sample is not a true probability sample; as a result, the sampling error of the overall study cannot be estimated precisely. It is also likely that the difference in estimates between the studies is a product of the decreased measurement error of PATS methodology. In central-location sampling, respondents are completely anonymous and may feel more comfortable in providing honest answers about illicit activities such as drug use. The potential applications of this methodology are discussed.

Intensive inpatient treatment of young adult chronic patients.

Young adults with chronic mental disorders have become a major concern among mental health professionals during the past decade. Many of these patients require frequent hospitalizations, are noncompliant with treatment, experience behavioral crises that threaten themselves or others, abuse drugs and alcohol, and alienate their families and support systems. The authors describe an intensive inpatient program for young adult chronic patients who have repeatedly failed to respond to community-based and standard state hospital care and appear to need extended institutional care. The program, which integrates psychiatric and rehabilitation strategies, has succeeded in increasing the amount of time these patients remain in the community. Although the goal for such patients remains a community-based treatment program, the value of an extended period of active inpatient treatment for some patients may be overlooked in current planning for them.

The development of an instrument for measuring leadership behaviors in therapy groups

Research on leadership behavior in therapy groups emphasizes the need for precise theories and clinically meaningful instruments to study leadership variables. This paper reviews the development of the Group Leader Behavior Instrument (GLBI) and investigates its relationship to an earlier measure, the Group Leadership Questionnaire (GTQ-C). Both instruments were completed by 40 practicing group therapists. Analyses confirm a moderate degree of similarity between the leadership profiles obtained from the GLBI and GTQ-C. Differences due to the construction of the two scales are also examined. The authors conclude with a discussion of the potential uses of the GLBI to assess leadership behaviors in ongoing groups, to train group therapists, and to further progress in process and outcome research on group leadership.