Abstract
BackgroundImproving and sustaining the quality of hospital care is an international challenge. Patient experience data can be used to target improvement and research. However, the use of patient experience data has been hindered by confusion over multiple instruments (questionnaires) with unknown psychometric testing and utility.MethodsWe conducted a systematic review and utility critique of questionnaires to measure patient experience of healthcare quality in hospitals. Databases (Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO) and Web of Knowledge until end of November 2013) and grey literature were scrutinised. Inclusion criteria were applied to all records with a 10 % sample independently checked. Critique included (1) application of COSMIN checklists to assess the quality of each psychometric study, (2) critique of psychometric results of each study using Terwee et al. criteria and (3) development and critique of additional aspects of utility for each instrument. Two independent reviewers completed each critique. Synthesis included combining findings in a utility matrix.ResultsWe obtained 1157 records. Of these, 26 papers measuring patient experience of hospital quality of care were identified examining 11 international instruments. We found evidence of extensive theoretical/development work. The quality of methods and results was variable but mostly of a high standard. Additional aspects of utility found that (1) cost efficiency was mostly poor, due to the resource necessary to obtain reliable samples; (2) acceptability of most instruments was good and (3) educational impact was variable, with evidence on the ease of use, for approximately half of the questionnaires.ConclusionsSelecting the right patient experience instrument depends on a balanced consideration of aspects of utility, aided by the matrix. Data required for high stakes purposes requires a high degree of reliability and validity, while those used for quality improvement may tolerate lower levels of reliability in favour of other aspects of utility (educational impact, cost and acceptability).Systematic review registrationPROSPERO CRD42013006754Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0089-0) contains supplementary material, which is available to authorized users.
Highlights
Improving and sustaining the quality of hospital care is an international challenge
Educational impact was good for five of the instruments (HCAHPS [26, 29, 48], Scottish Inpatient Patient Experience Survey (SIPES) [45, 46], Norwegian Patient Experience Questionnaire (NORPEQ) [37], Patient Experiences with Inpatient Care (I-PAHC) [37], Perceptions of Quality (PPQ) [53]) as there was evidence of the instruments being used for their intended purpose, i.e. hospital ranking or quality improvement
Five instruments (QPP [55], Quality from the Patients’ Perspective Shortened (QPPS) [27], PPE-15 [25], National Health Service Inpatient (NHSIP) [13, 40], Hong Kong Inpatient Experience Questionnaire (HKIEQ) [22]) were rated as fair as there was some evidence of educational impact, and Patient Experience Questionnaire (PEQ) was rated as poor as there was no enough information to determine educational impact
Summary
Improving and sustaining the quality of hospital care is an international challenge. Patient experience data can be used to target improvement and research. Patients who have experienced hospitalisation can offer unique insights into quality of care, which can be used for improvement. If patient experience data is to be used to improve quality of care in hospitals, it needs to be reliable and valid yet usable in practice [11, 54]. Measurement is fundamental to improving the quality of hospital care [43]. Measuring the patient experience in a robust way enables facts to be established from the complex phenomena of quality of care [32]. Measuring the patient experience can highlight potential solutions, opportunities to improve hospital care
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