Obstetric risks and outcomes: birth centre compared with conventional labour ward.

Birth centres in Australia provide an option for women and their professional advisors when choosing the setting for childbirth. It is important that empirical information about the risks is available to enable informed decisions to be made. The purpose of this study was to compare the obstetric outcomes for women admitted to the Birth Centre at Royal Hospital for Women in Sydney with outcomes for women admitted to the conventional labour ward, controlling for prenatal and intrapartum risk. The findings indicate that, with the existing back-up provided by the conventional service, the outcomes for women admitted to the Birth Centre were at least as good as those of the other women. The study also shows that there are differences between the two settings in the management of the intrapartum period. The rate of intervention is substantially higher for women admitted to the Labour Ward, after risk is taken into consideration. The evaluation indicates that the Birth Centre offers a viable choice for women with relatively low obstetric risk.

Obstetric high risk screening and prediction of neonatal morbidity.

A retrospective study using an obstetric risk score protocol was applied to a stratified sequential sample of 843 singleton livebirths, occurring in the Royal Hospital for Women, Sydney, over a 12-month period (March, 1985-February, 1986). Data collection included 53 prenatal factors, 41 intrapartum factors and 37 neonatal factors. The study was comprised of 346 women admitted to the hospital birth centre and 497 women admitted to labour ward. In labour ward admitted women there was a significant association between high prenatal scores, high intrapartum scores and high neonatal morbidity scores. Women admitted to the birth centre were subjected to a screening procedure which resulted in low prenatal and relatively low intrapartum risk scores. However, neonatal morbidity scores were similar for both groups. The risk scoring protocol used in this study requires further revision to allow the adequate selection of low risk women delivering infants with a low risk of neonatal morbidity in a low risk obstetric setting.

Planning birth centres.

This paper draws attention to the different definitions of 'birth centre', and the lack of consensus regarding the physical and organisational characteristics that distinguish a birth centre from conventional labour suites. Two case studies of decision-making about the location of a new birth centre are presented; they illustrate the need to take account of the views of each client and professional group concerned. The need for integrating organisational development with physical planning procedures is emphasised.

Patient satisfaction with outpatient primary health care in a metropolitan medical center.

This paper presents rates and correlates of patient satisfaction with primary care in a New York medical center. Over an eight-week period, we studied only first-time, "workup" encounters. Patient satisfaction was measured with three scales and one single-item measure. The highest rates of satisfaction were registered in relation to (1) the encounter in general, followed by (2) doctor conduct and (3) convenience. Four sets of independent variables were studied: sociodemographic variables, social psychological antecedent variables, other patient characteristics, and physician characteristics. Age was found to be the most important sociodemographic characteristic of patients affecting their satisfaction with the encounter; having positive expectations of the encounter had more effect on subsequent satisfaction ratings than other social psychological variables studied here. When each of the satisfaction measures was regressed on the sets of independent variables, the proportion of variance explained changed, as did the relative contribution of the different independent variables. We discuss the importance of studying patient satisfaction with specific medical encounters, along with the findings of our study.

The multidimensionality of patient satisfaction with a clinic visit.

Three hypotheses regarding the factor structure of patient satisfaction with an ambulatory health care encounter were tested in a New York medical center outpatient sample. All three hypotheses were generally supported. It was found that patients evaluated four distinct aspects of the clinic visit: doctor conduct, convenience, appointment getting, and the visit in general. A significant proportion of the variance in general satisfaction was explained by satisfaction with doctor conduct and satisfaction with convenience. Three factor scales of patient satisfaction were developed with demonstrable internal consistency reliability. Some possible effects of response method on satisfaction ratings were studied; these method effects were not substantial, and it is suggested that this type of psychometric procedure be used in further studies of patient satisfaction.

The meaning of patient satisfaction with prepaid primary health care in Israel.

This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.

Toward a theory of patient satisfaction.

Despite the widespread concern in health care literature with patients'--or clients'--satisfaction, there has been no explicit definition of that concept nor systematic consideration of its determinants and consequences. The definition of satisfaction proposed here is derived from Fishbein and Ajzen's attitude theory and from job satisfaction research. Among the various probable determinants of a patient's satisfaction with health care are his/her attitudes and perceptions prior to experiencing that care; after reviewing relevant social science theories, we hypothesize five such social psychological variables which affect satisfaction ratings. The present attempt to define the concept patient satisfaction and to hypothesize some of its determinants can be regarded as first steps in building a theory of patient satisfaction.

Social psychological determinants of patient satisfaction: a test of five hypothesis.

Five hypothesis regarding the social psychological determinants of patient satisfaction were tested among patients attending the primary care clinics of a university medical center in Manhatten. The social psychological variables operationalized here were expectations, values, entitlement and perceived occurrences; the three dimensions of satisfaction studied were doctor conduct, convenience and general satisfaction. The social psychological variables together were found to explain only a small proportion of the variance in satisfaction, although their contribution varied with the dimension of satisfaction. Expectations consistantly explained most of the variance in satisfaction ratings; particularly noteworthy was the direct effect of prior expectations of the doctor's conduct on subsequent satisfaction with that dimension of the care received. Values had little independent effect on satisfaction, and the combination of values and expectations (their interaction) was unrelated to satisfaction. Feelings of entitlement were also unrelated to satisfaction ratings. There was some support for the discrepancy model, which holds that the greater the discrepancy between perceived occurrences and prior expectations the less the satisfaction. The importance of carrying out further methodological studies aimed at developing reliable measures of these constructs is stressed.