Patient satisfaction with clinical trial participation.

OBJECTIVE: To assess satisfaction of patients who participate in clinical trials requiring informed consent and to analyse factors determining patient satisfaction. SETTING: The survey took place in 26 clinical trials at the University Hospital Maastricht (azM), The Netherlands. DESIGN AND STUDY PARTICIPANTS: A personal interview and telephone questionnaire were used consecutively (n= 135; 135 out of 172=78.5% response rate) to measure patient's expectancies before starting the trial during the informed consent procedure and to evaluate aspects of trial participation. An additional control group of 34 patients was interviewed only by telephone (100% response). MEASURES: Satisfaction was assessed in two distinct ways: first, by measuring the patient's subjective evaluation of several aspects of trial participation; secondly, by comparing prior expectations and subsequent evaluations. Patient satisfaction was subdivided with respect to medical-technical, interpersonal and organizational aspects of trial participation. Changes in patient's health and illness perceptions were regarded as confounding factors in the relationship between satisfaction and its possible causes. RESULTS: Although patient satisfaction was quite high, dissatisfaction with aspects of trial participation became apparent when both prior expectations and subsequent evaluations were compared with each other. CONCLUSION: Prior expectations and general attitudes towards medical care and research before entering the trial have an impact on satisfaction with aspects of trial participation (10-20% explained variance). No linear relationship was found between perceived improvements in health and illness conditions and patient satisfaction with trial participation.

Registration of adverse patient occurrences in a university hospital: relations between adverse patient occurrences and characteristics of hospitalized patients.

This paper reports the results of a survey on adverse patient occurrences (APOs) in patient care in a university hospital in The Netherlands. Screening for APOs is important as an instrument of quality assurance. Results from 1 year of screening have been related to specific patient characteristics. Age, length of stay and diagnosis group are strongly related to the identified APOs. The chances of APOs are very high if the patient belongs to certain diagnosis groups (operation procedure salivary gland, malignant disorder ear, nose, throat) and at the same time has a long length of stay in the hospital. The chances of being afflicted with more than one APO are strongly related to age and length of stay. With regard to the types of APO, this study shows a relation between patient characteristics and some APOs, but the statistical significance or the nature of these relations varies with type.

Health science information management. An approach to improving QA and clinical practice.

To help quality assurance (QA) professionals and clinical practitioners keep up with advances in health care knowledge and technology, we describe a prototype Health Science Information Management (HSIM) publication. We conceptualize HSIM to include: (a) identification of unique science information needs; (b) rapid retrieval of valid needed information; and (c) use the information to improve health care benefits. To more adequately accomplish these functions, we suggest that five specific categories of information will be essential: (1) reports of recent advances in Science Information Management methods; (2) original reports of Science Information Syntheses (SISs) providing information immediately applicable for QA; (3) previously published reports of "classic" SISs relevant to QA; (4) reviews of new technologies and products immediately applicable to quality management; (5) cumulative indexing of the above methods and products. Making the above information available to QA professionals might substantially improve the impact of quality management.

Teaching quality assurance in Malaysia: a report on six workshops on quality assurance in patient care services for health care providers in government service.

In the government hospitals of Malaysia quality assurance activities have been introduced since 1985. Local clinicians and other health care workers had been stimulated by the Ministry of Health to pursue these activities, but they found themselves untrained and ill-prepared for the job. With the help of the World Health Organization a programme of training courses has been set up and conducted, most recently, in February 1989. A model for teaching quality assurance was developed, geared towards the needs of the Malaysian clinicians and taking into account the recent progress made in the development of quality assurance approaches worldwide. Moreover, quality assurance results from one Malaysian hospital were used, thus increasing the relevance of the teaching. Results show that Malaysian clinicians have appreciated the training and have relaxed in their attitude towards quality assurance and the government's involvement in it. During the various courses pitfalls have been identified in the teaching of modern quality assurance in health care for audiences from developing and newly industrialized countries.

[Health care quality assurance in the Netherlands]. / Garantía de la calidad de la atención a la salud en los Países Bajos.

In this paper the main structural features of the dutch health system are described, together with a historical survey of its development in recent years. The basic elements of quality assurance in the country are also discussed.

Improving the quality of hospital services in The Netherlands. The role of CBO--The National Organization for Quality Assurance in The Netherlands.

In The Netherlands, quality assurance activities in hospitals began in 1976 with a formal declaration of the National Specialists Organization that quality assurance is a task of the medical profession. It was also recognized that physicians in hospitals were as yet unable to execute the various tasks that come with formal quality assurance. Hence the creation of a support organization that would assist clinicians in taking up and fulfilling their commitment to quality assurance. The creation of CBO took place in 1979; its role has been expanded to encompass such functions as technical assistance, education and training, research and development, acting as a clearing-house, and providing a forum. CBO has recently obtained an additional function; acting as a role model for similar structures in other countries in Europe and on other continents. A network of support organizations has been formed through which the development of quality assurance in health care is furthered.

Defining quality of care: mission impossible?

Finding the definition of quality has haunted mankind since the beginning of time. As far back as ancient Egypt and classical Greece, descriptions of quality show man's struggle with a concept that has not yet ended. Since the beginning of this century, descriptions of quality of health care have begun to take form in long lists of categories that make up the elements of quality. This catalog approach to defining quality has been replaced by the evaluative approach since Donabedian's conceptual studies in the 1960s. It has become commonplace now to define quality in evaluative terms: by comparing actual care with preset criteria, a judgement, and consequently a description or definition, can be obtained on real quality of care. In criteria and their derivatives one can document his intentions as to good quality; only after measurement and judgement can one be certain that quality has been described. A frequent source of concern is the erroneous belief that scientific research is synonymous with quality assessment. Research results form the basis of criteria for good care, and as such contribute to quality, but having obtained good research results does not imply that health care is properly and appropriately provided.

Quality assurance in the health care system in The Netherlands.

Thirteen years of activities in the field of quality assurance in the health care field in The Netherlands bring to life the many ups and some downs in this intriguing endeavour. Back in 1974, quality assurance was in the minds of few individuals and in the hands of nobody. This has changed dramatically: not only are there now functioning programmes carried out by knowledgeable and dedicated health care providers, there is legislation that suits the convenience of quality assurance, and a firm delineation of responsibilities. At the same time there is flexibility which enables the various actors to interpret their roles according to their capabilities and tastes. The various contributions in this issue are part of this national development.

Patient information and patient preparation in orthognathic surgery: a medical audit study.

In 110 patients who had undergone various kinds of orthognathic surgery, patient satisfaction was measured by means of a written questionnaire. Ninety-four percent expressed satisfaction, both with regard to total preparation and the final outcome of the surgical procedure itself. Twenty to forty percent of the patients, however, were not properly informed about postoperative complications. On the basis of the deficiencies, indicated in the questionnaire, appropriate written information was developed. In the near future the effect of the recently added information will be investigated.