Defining and measuring patient satisfaction with medical care.

This paper describes the development of Form II of the Patient Satisfaction Questionnaire (PSQ), a self-administered survey instrument designed for use in general population studies. The PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests. Internal-consistency and test-retest estimates indicate satisfactory reliability for studies involving group comparisons. The PSQ well represents the content of characteristics of providers and services described most often in the literature and in response to open-ended questions. Empirical tests of validity have also produced generally favorable results.

Consumer perceptions of health care services: implications for academic medicine.

The factor analytic development of various measures of consumer perceptions regarding characteristics of doctors and health care services is described. Index scores meeting factor analytic and reliability criteria were used to study the importance of consumer perceptions in relation to behavioral outcomes. Numerous dimensions of consumer perceptions were identified and described, including beliefs about doctor conduct in terms of quality of care and humaneness of health care delivery as well as satisfaction with such enabling components as the continuity of care, availability and convenience of services, and various access mechanisms (cost, payment mechanisms, and ease of emergency care facilities). Measures of these perceptions were shown to be related to differences in several estimates of health services utilization. The use of the index scores which have met empirical criteria is in contrast to the common practice of using individual questionnaire items as the unit of analysis in health care research. Findings are discussed in relation to program planning and evaluation in medical education, and suggestions for future research are noted.

Dimensions of patient attitudes regarding doctors and medical care services.

The factor analytic development and validation of numerous index scores to measure patient attitudes regarding characteristics of doctors and medical care services is described. Index scores meeting factor analytic criteria and found to be reliable were used to study the nature and number of attitudinal dimensions underlying patient satisfaction. The use of index scores which have met logical and empirical criteria is in contrast to the common practice of using individual questionnaire items as the unit of analysis. Four major dimensions of patient attitudes were identified and described, including attitudes toward doctor conduct (humanness and quality) and such enabling components as availability of services, continuity/convenience of care and access mechanisms (cost, payment mechanisms, and ease of emergency care). Measures of attitudes toward caring (humanness) and curing (quality/competence) aspects of doctor conduct appear to reflect the same underlying attitudinal dimension. Findings are discussed in relation to concepts and measures mentioned in the published literature and suggestions are offered for future research.