Perceived Quality Of Health Care Research Articles

Vulnerable Patients’ Perceptions of Health Care Quality and Quality Data

Little is known about how patients served by safety-net hospitals utilize and respond to hospital quality data. To understand how vulnerable, lower income patients make health care decisions and define quality of care and whether hospital quality data factor into such decisions and definitions. Mixed quantitative and qualitative methods were used to gather primary data from patients at an urban, tertiary-care safety-net hospital. The study hospital is a member of the first public hospital system to voluntarily post hospital quality data online for public access. Patients were recruited from outpatient and inpatient clinics. Surveys were used to collect data on participants' sociodemographic characteristics, health literacy, health care experiences, and satisfaction variables. Focus groups were used to explore a representative sample of 24 patients' health care decision making and views of quality. Data from focus group transcripts were iteratively coded and analyzed by the authors. Focus group participants were similar to the broader diverse, low-income clinic. Participants reported exercising choice in making decisions about where to seek health care. Multiple sources influenced decision-making processes including participants' own beliefs and values, social influences, and prior experiences. Hospital quality data were notably absent as a source of influence in health care decision making for this population largely because participants were unaware of its existence. Participants' views of hospital quality were influenced by the quality and efficiency of services provided (with an emphasis on the doctor-patient relationship) and patient centeredness. When presented with it, patients appreciated the hospital quality data and, with guidance, were interested in incorporating it into health care decision making. Results suggest directions for optimizing the presentation, content, and availability of hospital quality data. Future research will explore how similar populations form and make choices based on presentation of hospital quality data.

Where Would You Rather Live If You Were Insured? Assessing Community Uninsurance Spillover Effects on the Insured

This study sought to understand the cost, quality of, and access to health care for the insured population in the context of spillover effects resulting from community-level uninsurance. We examined the health care access, quality, and cost experienced by insured Latina mothers in two communities, Minneapolis, Minnesota and McAllen, Texas. These communities differ substantially by the size of the local population without health insurance coverage. Four focus groups were conducted with insured Latina mothers who were caring for at least one child in their household. Eleven and thirteen mothers participated in each community, respectively. The experiences of the insured population in McAllen were substantially different from the experiences of the insured population in Minneapolis. The perceptions of health care quality and access by insured Latina mothers were substantially lower in McAllen while out-of-pocket costs were perceived to be higher in Minneapolis. Our study provides key insights about the US health care system and the role that the relative size of the local uninsured population may have in impacting the health care experiences of the insured. Health insurance coverage rates are expected to increase substantially across US communities within the next few years but local health care system challenges related to cost, quality, and access will remain for both the insured and the uninsured.

Patient–physician social concordance, medical visit communication and patients’ perceptions of health care quality

Social characteristics (e.g. race, gender, age, education) are associated with health care disparities. We introduce social concordance, a composite measure of shared social characteristics between patients and physicians. ObjectiveTo determine whether social concordance predicts differences in medical visit communication and patients’ perceptions of care. MethodsRegression analyses were used to determine the association of patient–provider social concordance with medical visit communication and patients’ perceptions of care using data from two observational studies involving 64 primary care physicians and 489 of their patients from the Baltimore, MD/Washington, DC/Northern Virginia area. ResultsLower patient–physician social concordance was associated with less positive patient perceptions of care and lower positive patient affect. Patient–physician dyads with low vs. high social concordance reported lower ratings of global satisfaction with office visits (OR=0.64 vs. OR=1.37, p=0.036) and were less likely to recommend their physician to a friend (OR=0.61 vs. OR=1.37, p=0.035). A graded-response was observed for social concordance with patient positive affect and patient perceptions of care. ConclusionPatient–physician concordance across multiple social characteristics may have cumulative effects on patient–physician communication and perceptions of care. Practice implicationsResearch should move beyond one-dimensional measures of patient–physician concordance to understand how multiple social characteristics influence health care quality.

Military Sexual Trauma and Patient Perceptions of Veteran Health Administration Health Care Quality

Background Although sexual trauma is associated with poorer patient perceptions of health care quality, few studies have investigated this relationship in settings with comprehensive policies surrounding detection and treatment of sexual trauma, such as the Veterans Health Administration (VHA). We examined the association of military sexual trauma (MST) with patient satisfaction with VHA outpatient care among men and women. Methods This is a cross-sectional study of a national representative sample of 164,632 VHA outpatients (5,758 women and 158,884 men) from fiscal year 2007. Measures included MST status, patients’ ratings of overall satisfaction with VHA care in the last 2 months, and nine other dimensions of patient satisfaction. We assessed bivariate and multivariate associations between MST and overall satisfaction and each dimension of patient satisfaction. Multivariate models were adjusted for demographic characteristics, health status, and medical utilization. All analyses were stratified by gender. Findings The proportion of patients reporting very good or excellent overall satisfaction was 78.5% for men and 72.3% for women. Findings showed that, once confounding was controlled, men and women veterans’ MST status was not associated with satisfaction ratings of VHA health care overall. However, women veterans with a history of MST rated the dimensions of overall coordination and education and information less favorably than women veterans without an MST history. Post hoc analysis of individual items in these domains suggested that areas of improvement might include greater attention to provider–patient communication, including communication across multiple providers. There was no association between men’s MST status and subdomains of health care satisfaction. Conclusion Patient ratings of overall satisfaction of VHA care are high. Opportunities exist, however, to educate providers on the special coordination needs of female veterans with histories of MST. These female veterans might benefit from care coordination. When investigating satisfaction in patients with histories of sexual trauma, our findings suggest the importance of adjusting analyses for important patient characteristics.

Bypassing health providers: The quest for better price and quality of health care in Chad

This paper investigates individuals’ bypassing behavior in the health sector in Chad and the determinants of individuals’ facility choice. We introduce a new way for measuring bypassing which uses the patients’ own knowledge of alternative health providers available to them, instead of assuming perfect information as previously done. We analyze how objective and perceived health care quality and prices impact patients’ bypassing decisions. The analysis uses data from a health sector survey carried out in 2004 covering 281 primary health care centers and 1801 patients. We observe that income inequalities translate into health service inequalities. We find evidence of two distinct types of bypassing activities in Chad: (1) patients from low-income households bypass high quality facilities they cannot afford and go to low-quality facilities, and (2) rich individuals bypass low-quality facilities and aim for more expensive facilities which also offer a higher quality of care. These significant differences in patients’ facility choices are observed across income groups as well as between rural and urban areas.

Psychosocial stress at work and perceived quality of care among clinicians in surgery

BackgroundLittle is known about the association between job stress and job performance among surgeons, although physicians' well-being could be regarded as an important quality indicator. This paper examines associations between psychosocial job stress and perceived health care quality among German clinicians in surgery.MethodsSurvey data of 1,311 surgeons from 489 hospitals were analysed. Psychosocial stress at work was measured by the effort-reward imbalance model (ERI) and the demand-control model (job strain). The quality of health care was evaluated by physicians' self-assessed performance, service quality and error frequency. Data were collected in a nationwide standardised mail survey. 53% of the contacted hospitals sent back the questionnaire; the response rate of the clinicians in the participating hospitals was about 65%. To estimate the association between job stress and quality of care multiple logistic regression analyses were conducted.ResultsClinicians exposed to job stress have an increased risk of reporting suboptimal quality of care. Magnitude of the association varies depending on the respective job stress model and the indicator of health care quality used. Odds ratios, adjusted for gender, occupational position and job experience vary between 1.04 (CI 0.70-1.57) and 3.21 (CI 2.23-4.61).ConclusionFindings indicate that theoretical models of psychosocial stress at work can enrich the analysis of effects of working conditions on health care quality. Moreover, results suggest interventions for job related health promotion measures to improve the clinicians' working conditions, their quality of care and their patients' health.

Predictors of perceived health care quality for registered nurses during and after health care reform

Limited research has focused on the predictive nature of organizational culture and trust on registered nurses' perceived health care quality in reformed health care systems. The purpose of this article was to investigate nurses' perceptions of organizational culture factors, trust in employer, and perceived health care quality during and 5 years after major organizational reform in the acute care setting and to test a model linking culture to perceived health care quality. Survey data collected from two samples of nurses (N = 222,343) during and 5 years after major organizational reform in the acute care setting of one Canadian province were analyzed, and an exploratory model linking aspects of culture, trust, and quality was tested. For both periods, most variable scores were in the low range and depicted moderately positive intercorrelations with each other. Support for the proposed model was mixed. Select culture variables predicted health care quality at both periods, but trust emerged as a significant predictor in 2000 only. The findings support the negative impact of system transformation on nurses and the link between culture and health care quality. The study findings suggest that managers and policy makers must develop and implement supportive and nurturing strategies that will enhance the organizational culture (emotional climate, collaborative relations), which should result in more positive perceptions of health care quality. However, further research is required to gain a better understanding of the relationships among trust, organizational culture, and perceptions of health care quality and what implications this may or may not have for nursing practice.

Associations Between Self-reported Quality of Care and County Characteristics Are Largely Similar in Rural and Urban Settings

The content and spectrum of rural health care services are different from those in urban areas. The extent to which health care consumers' perceptions of the quality of these services vary across settings and the association of these perceptions with features of rural and urban settings are unclear. To determine whether perceptual differences of quality exist and contrast rural/urban associations between contextual characteristics and perceived quality of health care. Multilevel, cross-sectional analysis of a state-representative sample of 33 786 adults, stratified by rural/urban status linked with county-level data describing contextual features (eg, health care, economics, and social capital). The dependent variable was respondents' perceived quality of health care received in the past year. Weighted multilevel random intercept models examined the independent association of contextual characteristics with perceived quality. Overall perceived quality did not differ between rural and urban settings. Similarly, the pattern of associations between perceived quality and contextual characteristics was generally comparable between settings. A notable difference was an association between higher quality with an increasing proportion of hospitals offering more than 25 services in urban areas (beta = .763; P < .05). Despite rural/urban differences in contextual characteristics with potential influence on health care delivery, overall consumer perception of health care quality was similar in both settings. This suggests that health care managers may be adopting setting-specific strategies to enhance consumer satisfaction despite contextual differences.

Healthcare Intensity Is Associated With Lower Ratings of Healthcare Quality by Younger Adults

Previous studies suggest a negative relationship between regional intensity of healthcare services and Medicare patients' perceptions of healthcare quality. However, no studies to date have examined the relationship across a broad age range of the population. We describe the responses of 64 088 respondents aged 19 to 69 years to an online interactive patient assessment and feedback system. We learn that in higher-intensive regions, specialty use is higher regardless of patient illness burden and that overall quality of care was lower in higher-intensity regions. The findings that "more is not better" previously associated with Medicare patients seems to apply across a much broader age segment of the population.

Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso

This study aims to identify the reasons why enrolled people decide not to renew their membership in following years. Household survey is used to collect information on the factors influencing dropping out from community-based health insurance (CBI). Information from CBI agency databank is used to describe the general situation of enrolment and drop-out. Since the launch of CBI the enrolment rate has been low ranging from 5.2% to 6.3%. The drop-out rate, however, has been high ranging from 30.9% to 45.7%. It is found, by the multivariate analysis, that female household head, higher age or lower education of a household head, lower number of illness episodes in the past three months, fewer children or elderly in a household, poor perceived health care quality, less seeking care in the past month positively effected on drop-out, increasing the rate. However, the household six-month expenditure and the distance to the contracted health facility did not have the hypothesised sign. In contrast, a higher household expenditure and a shorter distance to the contracted health facility increased the drop-out. High drop-out rates endanger the sustainability of CBI not only because they reduce the size of the insurance pool, but also because they bear a negative impact on further enrolment and drop-out. The drop-out rate in the scheme of the Nouna Health District, Burkina Faso, is very high. The reasons for drop-out may be related to affordability, health-needs and health demand, quality of care, household head and household characteristics. This study represents a valuable attempt towards further increasing the sustainability of CBI schemes, by understanding not what motivates people to first enrol in CBI, but what motivates them to renew membership year after year.

Ambulatory Facility Design and Patients' Perceptions of Healthcare Quality

This research examines whether the physical attractiveness of an outpatient practice influences patients' perceptions of healthcare quality, including patient and staff perceptions of the quality of staff-patient interaction. Despite the high and increasing percentage of healthcare dollars for care delivered on an outpatient basis, relatively little research has examined the relationship between the design of ambulatory facilities and patient outcomes. Few studies have examined how patients' perceptions of healthcare quality differ in the same outpatient practice before and after a move to a new facility designed to be patient-centered. This study is the second phase of a study comparing patients' perceived quality of care in ambulatory facilities that differ markedly in physical attractiveness. Using both a patient and staff survey, and structured interviews, this study compared staff and patient perceptions of healthcare quality (including staff-patient interactions) before and after a move to a new facility designed to be patient-centered. Patients' perceived quality of care, and their perceptions of the quality of interaction with staff, was significantly better in the patient-centered facility. Few differences were found in actual patient-staff interaction behaviors. This study is consistent with other studies that examined the relationship among the physical attractiveness of healthcare settings, patient satisfaction, and perceived quality of care. For this reason, the results are more credible than they would be were they inconsistent with other research or were this the only study examining these issues. These results support the value of investing in the physical attractiveness of patient areas in the ambulatory care setting. Further research is needed to identify specific physical elements that contribute to positive attributions related to quality of care, as well as where the "tipping point" is in investments to improve physical attractiveness.

Impact of pharmacy care services on patients’ perceptions of health care quality for diabetes

ObjectivesTo (1) construct and evaluate a measure of patients’ perceptions of the quality of diabetes care and (2) determine the impact of pharmacy care services (PCSs) on patients’ perceptions of the quality of their diabetes care while controlling for patient-related factors. DesignTwo-phased study using a single-group, pretest–posttest design. SettingCommunity pharmacies that provided PCSs to diabetic patients as part of the Patient Self-Management Program for Diabetes in North Carolina, Georgia, Ohio, and Wisconsin. Participants218 patients with diabetes covered by self-insured employers’ health plans. InterventionsPharmacist-provided care services using scheduled consultations, clinical goal setting, monitoring, and collaborative drug therapy management with physicians and referrals to diabetes educators. Main outcomes measuresChanges in patients’ perceptions of quality measured by a self-administered questionnaire that included a six-item scale of information quality, a five-item scale of provider quality, and a one-item overall rating of care. ResultsThe assessment of the baseline data (Phase I) demonstrated that the measures of perceived quality possessed acceptable psychometric properties. After PCSs were implemented (Phase II), the scores for the information scale improved significantly (paired t = 7.64, P < 0.01), as did the scores for the provider scale (paired t = 6.30, P < 0.01) and the overall rating (paired t = 5.54, P 7lt;0.01). In multivariate analyses, the improvement in perceived quality was not explained by the change in glycosylated hemoglobin when controlling for age, gender, race/ethnicity, and baseline quality perceptions. ConclusionPCSs enhanced patients’ perceived quality of their diabetes care. The improvement in perceived quality was not explained by the change in glycemic control, which suggests that nonclinical factors in care are important to patients’ evaluations of quality.

Exploring Quality Perceptions of Health Care Operations

Patient care has become increasingly important in the health care environment of Mauritius. Patients' satisfaction and their expectations of health care are valid indicators of quality health care. The present paper reports the results of a survey of patient satisfaction with heath care, administered by face-to-face interview to 300 in-patient adults discharged from five main regional hospitals based in Mauritius. It examines the predictors and level of patients' satisfaction across the five regional hospitals of Mauritius. In this study, a modified version of HEALTHQUAL scale was used for determining patient satisfaction with health care in the regional public hospitals. Multiple regression analysis was conducted to understand the relationships among patients' perceptions of in-patient services and their overall perceptions of health care quality, and also satisfaction with their care and willingness to return or recommend the same hospital's services to others. The dimensions labelled as "Patients' perceptions of ward/hospital environment" and "Patients' perceptions of medical and nursing staff" served a significant impact on nearly all measures of patient satisfaction in the regional public hospitals of Mauritius.

Caregiving at the End of Life: Perceptions of Health Care Quality and Quality of Life Among Patients and Caregivers

This study explored the association between perceptions of health care quality and quality of life in patients with advanced metastatic cancer and their informal caregivers ( n = 39). Patients' and caregivers' perceptions of health care quality, mental health, health-related quality of life, symptoms, and burden were measured. The key findings included the following: 1) patients' mental health and depression scores correlated with those of caregivers, suggesting that the mental health of patients and their caregivers are associated; 2) patients and caregivers shared similar perceptions regarding health care quality; 3) the presence of depression in caregivers correlated with caregivers being less satisfied with the health care being given to their patients (this correlation did not exist for patients, a finding that may be due in part to the protective buffering effect that caregivers provide their patients as illness progresses); and 4) a modified Primary Care Assessment Survey, originally designed for primary care patients, was a useful measure of health care assessment for both patients and caregivers. These data suggest that patients with advanced disease and their caregivers share similar perceptions and evolve as a “unit of care,” and caregivers, as unique and important members of the patient's health care team, are also in need of care. When depressed, caregivers may unilaterally lose trust by becoming less satisfied with the quality of health care being provided to their patients.

Health care quality from the perspective of health care providers and patients during and shortly after acute care restructuring in Newfoundland and Labrador

To monitor changes in providers' perceptions of health care quality and the importance of health reform, and in patients' satisfaction with services during and two years after restructuring, comparing the region of the province that was restructured (St John's) with those regions in which hospitals were not aggregated. The Employee Attitude Survey questionnaire was sent to acute care providers (n = 5353) to assess personal characteristics and perceptions of the impact of reform on workplace conditions, work-related attitudes and turnover intentions. The response rate for 2000 and 2002 was 42% (n = 1222 and 1034, respectively). Only respondents in both surveys (n = 589) were used in the analysis because study results were the same for both the repeat sample and total samples. A Patient Satisfaction Survey questionnaire was administered to patients discharged from acute care facilities in 2000 (n = 1741) and 2002 (n = 704). Response rates were 82.5% and 90.2%, respectively. Most providers felt, at both time periods, that restructuring of the health care system was a positive step, but felt that health care quality was low. In the St John's region, perceptions of quality and standards of care improved over time. Patients were extremely satisfied with the admission process and hospital stay at both time periods in St John's. However, satisfaction declined in 2002 in regions outside St John's. Aggregation of acute care hospitals is possible without adverse effects on providers' perceptions of health care quality or on patient satisfaction.

PATIENT PERCEPTIONS OF THE QUALITY OF HEALTH SERVICES

As calls are made for a more patient-centered health care system, it becomes critical to define and measure patient perceptions of health care quality and to understand more fully what drives those perceptions. This chapter identifies conceptual and methodological issues that make this task difficult, including the confusion between patient perceptions and patient satisfaction and the difficulty of determining whether systematic variations in patient perceptions should be attributed to differences in expectations or actual experiences. We propose a conceptual model to help unravel these knotty issues; review qualitative studies that report directly from patients on how they define quality; provide an overview of how health plans, hospitals, physicians, and health care in general are currently viewed by patients; assess whether and how patient health status and demographic characteristics relate to perceptions of health care quality; and identify where further, or more appropriately designed, research is needed. Our aim is to find out what patients want, need and experience in health care, not what professionals (however well-motivated) believe they need or get.

Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health care quality in 7 rural, underserved communities where telemedicine was implemented. This study also assesses factors associated with travel outside of local communities for health care services. Community-based pretelemedicine and posttelemedicine random telephone surveys were conducted in 7 northern California rural communities assessing local residents' perceptions of health care quality and the frequency of travel outside their community for health care services. Five-hundred rural residents were interviewed in each of the pretelemedicine and posttelemedicine surveys. Between surveys, telemedicine services were made available in each of the communities. Residents aware of telemedicine services in their community had a significantly higher opinion of local health care quality (P =.002). Satisfaction with telemedicine was rated high by both rural providers and patients. Residents with lower opinions of local health care quality were more likely to have traveled out of their community for medical care services (P =.014). The introduction of telemedicine into rural communities is associated with increases in the local communities' perception of local health care quality. Therefore, is it possible that telemedicine may result in a decrease in the desire and need for local patients to travel outside of their community for health care services.

Exploring Physicians' Perceptions of the Quality of Medical Care Under the Case Payment System

Objectives. The aims of this study were to understand physicians' perceptions of the overall quality of care after implementation of the case payment system in Taiwan, to identify quality indicators for quality assurance under the case payment system, and to explore how the quality of medical care has been influenced by implementation of the case payment system. Methods In total, 336 questionnaires were delivered to physicians at 11 teaching hospitals in metropolitan Taipei. The relationships between physicians' perceptions of the quality of medial care under the case payment and physicians' gender, age, professional experience, and specialties were analyzed by t test and one-way ANOVA. Results. A total of 202 questionnaires were returned (60.8%). More than 63% of respondents felt that health care quality in Taiwan had worsened since the implementation of case payment. The Kruskal-Wallis test revealed that perception of healthcare quality under case payment was associated with age and professional experience of physicians. About 55% of respondents felt that the quality monitoring system implemented by the Bureau of the National Health Insurance (BNHI) was poor. The indicators which respondents felt most needed to be monitored under the case payment system were the occurrence of complications and comorbidities. Conclusions The majority of respondents considered the monitoring system under the case payment system to be inadequate. We recommend that the BNHI take physician inputs into consideration before revising the quality monitoring system to improve the quality of medical care for all case payment items.

Perceptions of health care quality in Central America.

To examine user perceptions of health care delivery in selected rural and urban areas of three Central American countries. Three focus group studies were conducted in 1997-98 in Honduras, Costa Rica, and Panama. In each selected region, 10 to 15 groups met to discuss health services available, access to and use of the services, satisfaction with different aspects of care and suggestions for improvement. Regions chosen represented the poorest areas in each country and the dominant health care systems in Central America: the Ministry of Health system and the Social Security system based on mandatory contributions. 351 residents from rural and urban communities represented different genders, ages, occupations, health, and socio-economic status. Participants considered private care to be the best, but too costly. Their main preoccupations focused on prompt access to trusted physicians, effective and inexpensive medication, and quality attention in public hospitals. Hondurans favor the personal care offered in public clinics and rural hospitals, and hope for improved medical services. In Costa Rica and Panama, users prefer Social Security clinics for the medical specialties and perceived sophisticated technology, despite delays and poor attention. The rural poor, especially indigenous people, voice basic needs with little regard for quality. Health care quality is extremely variable in the three regions, requiring increased community participation to improve. Focus groups offered important, confidential and cost-effective information on quality and breadth of health care delivery and should be part of quality monitoring initiatives.

Are rural residents and Hispanics less satisfied with medical care? Evidence from the Permian Basin.

Few population-based studies of consumers' perceptions of health care quality have included both rural residents and Hispanics. Using data collected through a random-digit telephone survey of households in the Permian Basin region of west Texas, an area with a relatively high percentage of Mexican Americans, we tested for rural/urban and ethnic differences in satisfaction with medical care. The study had several limitations, but the findings suggest that rural residents of this region rate the quality of their medical care overall more negatively than do their urban counterparts. No ethnic differences were found when controlling for demographic, social, economic, and health-status characteristics. Other factors, including part-time employment, a lack of continuous health insurance coverage, and poor health status appear to have a stronger, negative relationship with satisfaction. The collection and reporting of more specific measures of interpersonal and technical quality would further enable policy-makers, managers, and clinicians to better serve their patient populations.