Improving quality in healthcare: What makes a satisfied patient?

OBJECTIVE: To update the metric properties of a perceived quality questionnaire for patients admitted to hospital medical departments, to determine the level of patient satisfaction achieved, and to identify the variables which predict satisfaction. METHODS: Self-administered questionnaire completed at home following patient discharge, using a questionnaire prepared by the authors on a sample of 7207 users of medical departments in 9 public hospitals during the years 2006-2009. A principal component analysis with varimax rotation was performed. Reliability was assessed using internal consistency coefficient. An analysis was made of the compliance with each indicator reported by respondents. A logistic regression analysis was performed to determine the perceived quality dimensions which predicted overall patient satisfaction. RESULTS: The results of the reliability analysis indicated good coefficients for interpersonal manner (0.94) and professional competence (0.85) dimensions, and moderate values for the other dimensions (comfort 0.55, information 0.38, and organisation 0.37). Factor analyses showed single factors in each of the perceived quality dimensions, with a percentage of explained variance greater than 35% for information, interpersonal manner, professional competence, and comfort, and less than 30% for organisation. The dimensions which predicted satisfaction were interpersonal manner of healthcare staff, professional competence, and information. CONCLUSIONS: The metric properties of the questionnaire used have been updated, yielding a valid and reliable questionnaire for assessing patient satisfaction in quality management programmes, both for internal purposes and for conducting external comparisons. A positive relationship was obtained between the level of patient satisfaction and level of professional competence, interpersonal manner of healthcare staff, and information received.

Normas técnicas y control metabólico del paciente diabético enatención primaria de la Región de Murcia / Technical guidelines and metabolic control diabetic patients in primary health care in the region of Murcia (Spain)

Objetivo: Evaluar los grados de cumplimiento de las normas técnicas y su relación con el grado de control metabólico en pacientes diabéticos de atención primaria. Material y métodos: Diseño: Estudio observacional, transversal y retrospectivo. Evaluación mediante auditoría externa de historias clínicas por investigadores entrenados al efecto. Ámbito: atención primaria de la Región de Murcia. Población de estudio: pacientes incluidos en el Servicio de Atención a Pacientes con Diabetes (hasta el 30 de septiembre de 1998). Variables de registro: hemoglobina glucosilada (HbA1c) y cumplimentación de las 10 normas técnicas y 32 subnormas del servicio. Criterios: buen control metabólico, HbA1c < 7,5 por ciento, y malo, HbA1c 7,5 por ciento. Resultados: Resultados sobre 901 historias clínicas. El porcentaje de cumplimiento de las normas técnicas fue aceptable para todas excepto en los criterios de repercusión visceral (38 ñ 3,2 por ciento) y fondo de ojo (39 ñ 3,1 por ciento). El 57 por ciento de los sujetos cumplía con los criterios de buen control. No hubo diferencias en el porcentaje de cumplimientos de normas técnicas entre buen y mal control metabólico. No se encontró relación entre el cumplimiento de las normas técnicas y los valores de HbA1c; la r2 corregida fue de 7,6 por ciento. Conclusiones: Los pacientes diabéticos evaluados reciben una calidad asistencial aceptable en términos de indicadores de proceso que, por desgracia, no repercute en la medida deseada en la mejora de su grado de control metabólico. Es conveniente desarrollar intervenciones de calidad destinadas a mejorar, sobre todo, los registros de indicadores de resultados (HbA1c) y los criterios referentes a la valoración clínica (AU)

Quality of the information contained in the minimum basic data set: results from an evaluation in eight hospitals.

To assess the quality of the information included in the minimum basic data set (MBDS) of the eight public hospitals of the Murcia region in order to ascertain what should be improved to be valid and reliable. An external encoder performed a recoding of a random sample of hospital discharges, using the patients hospital records and comparing afterwards the information obtained with the one reflected in the MBDS databases. Quality was assessed using 12 criteria. The reviewed discharges sample consisted at least of 96 cases per hospital (Type I error = 0.05, Type II = 0.10, for the most unfavorable case). A total of 796 cases were reviewed. The MBDS disagreement percentages with the patient record data were higher for the clinical data, with 41.6% for the main diagnosis and 33.5% for the main surgical procedure, being in both cases higher in those hospitals that had used to codify just the discharge record with regard to those that did so with the complete patient record. The variation rate in the diagnosis-related group (DRG) assignment was of 29.6%, and there was a decrease in the case-mix index of 1.07397 when reviewing with the patient record to 1.05555 in the MBDS. Within the administrative data, the highest disagreement rate was for the physician that signs the discharge (60.5%) and the patient's address (31.6%). In many of these assessed aspects there are significant differences between hospitals. A reliability problem was identified in the collected data, which mainly affects the clinical variables. It is therefore advisable to carefully assess the use of this information (both the MBDS directly as well as its grouping through the use of patient classification systems), and the indicators derived from it as its quality is not guaranteed. Systematic assessment and quality control of the MBDS production is advised.