Adaptation and validation of two surveys on quality of medical care in a local setting
DOI:
https://doi.org/10.62059/htenz027Keywords:
Quality of healt care, hospitalization, SurveysAbstract
Abstract Introduction: Quality of hospital care is a key component in health system evaluation, associated with patient safety and satisfaction of both users and professionals. Although internationally validated tools exist, their combined application in local settings remains limited. Objectives: To validate the local adaptation of the CAHPS® hospital survey. To assess the validity and reliability of a professional commitment questionnaire in medical residents. To determine the feasibility of implementing both instruments jointly. Material and Methods: Observational, cross-sectional, quantitative study. Adult inpatients at discharge and medical residents from different specialties were included. Locally adapted surveys were administered. Validity was assessed using exploratory and confirmatory factor analysis, and reliability with Cronbach’s alpha. Feasibility was evaluated through response rate and administration time. Results: A total of 140 patients and 24 residents were included. Among patients, highest scores were for physician care (4.6±0.5) and nursing care (4.5±0,6), while lowest were for nighttime noise (3.1±1.1) and medication information (3.3±1.0). Overall hospital rating was 4.0±0.7, with 78% recommendation. Reliability: α=0.89. Among residents, professional commitment averaged 4.4±0.4; α=0.87. Conclusions: Both instruments showed adequate validity and reliability, supporting their joint feasibility for assessing quality of care from both patient and professional perspectives.References
1. Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260(12):1743-8.
2. World Health Organization. Quality of care: a process for making strategic choices in health systems. Geneva: WHO; 2006
3. World Health Organization. Delivering quality health services: a global imperative. Geneva: WHO; 2018.
4. Blendon RJ, Benson JM, Hero JO. Public trust in physicians—U.S. medicine in international perspective. N Engl J Med. 2014;371(17):1570-2.
5. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570.
6. Manary MP, Boulding W, Staelin R, Glickman SW. The patient experience and health outcomes. N Engl J Med. 2013;368(3):201-3.
7. Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev. 2014;71(5):522-54.
8. Black N. Patient reported outcome measures could help transform healthcare. BMJ. 2013;346:f167.
9. Meterko M, Wright S, Lin H, Lowy E, Cleary PD. Mortality among patients with acute myocardial infarction: the influences of patient-centered care and evidence-based medicine. Health Serv Res. 2010;45(5 Pt 1):1188-204.
10. Centers for Medicare & Medicaid Services. Hospital Value-Based Purchasing Program. Baltimore: CMS; 2020
11. Arrieta A, García-Prado A. Quality of health care in Latin America. Health Policy Plan. 2016;31(9):1181-3.
12. Nigenda G, Machado MH, Ruiz F, et al. Health workforce and universal health coverage in Latin America. Hum Resour Health. 2019;17(1):1-8.
13. Agency for Healthcare Research and Quality. CAHPS® program overview. Rockville: AHRQ; 2018.
14. Darby C, Crofton C, Clancy CM. Consumer assessment of health providers and systems (CAHPS): evolving to meet stakeholder needs. Am J Med Qual. 2006;21(2):144-7.
15. Hays RD, Shaul JA, Williams VS, Lubalin JS, Harris-Kojetin LD, Sweeny SF, et al. Psychometric properties of the CAHPS Hospital Survey. Health Serv Res. 2005;40(6 Pt 2):1925-44.
16. Centers for Medicare & Medicaid Services. HCAHPS: patients’ perspectives of care survey. Baltimore: CMS; 2019.
17. Giordano LA, Elliott MN, Goldstein E, Lehrman WG, Spencer PA. Development, implementation, and public reporting of the HCAHPS survey. Med Care Res Rev. 2010;67(1):27-37.
18. Ryan AM, Krinsky S, Maurer KA, Dimick JB. Changes in hospital quality associated with hospital value-based purchasing. N Engl J Med. 2017;376(24):2358-66.
19. Hurtado MP, Swift EK, Corrigan JM, editors. Envisioning the National Health Care Quality Report. Washington: National Academies Press; 2001
20. Aoki T, Yamamoto Y, Ikenoue T, et al. Development and validation of a Japanese version of the HCAHPS. Int J Qual Health Care. 2016;28(6):789-94.
21. Dackiewicz N, Vázquez Peña F, et al. Adaptación y validación del HCAHPS pediátrico en Argentina. Arch Argent Pediatr. 2019;117(2):e123-9.
22. Reis CT, Laguardia J, Vasconcelos AGG, Martins M. Reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture. BMC Health Serv Res. 2016;16:1-10.
23. Jenkinson C, Coulter A, Reeves R, Bruster S, Richards N. Properties of the Picker Patient Experience Questionnaire. BMJ. 2002;325(7365):480-3
24. Bjertnaes OA, Iversen HH, Skrivarhaug T. The Patient Experience Questionnaire (PEQ): reliability and validity. Int J Qual Health Care. 2012;24(3):259-65.
25. Greaves F, Ramirez-Cano D, Millett C, Darzi A, Donaldson L. Use of mobile devices to collect patient experience data. BMJ Qual Saf. 2013;22(3):251-5.
26. Stern DT. Measuring medical professionalism. New York: Oxford University Press; 2006.
27. ABIM Foundation. American Board of Internal Medicine professionalism project. Philadelphia: ABIM; 2002.
28. Al-Eraky MM, Donkers J, Wajid G, van Merriënboer JJG. Faculty development for professionalism. Med Teach. 2015;37 Suppl 1:S40-6.
29. Cruess RL, Cruess SR, Steinert Y. Teaching medical professionalism. Cambridge: Cambridge University Press; 2009.
30. Hodges BD, Ginsburg S, Cruess R, et al. Assessment of professionalism: recommendations. Med Teach. 2011;33(5):354-63.
31. Cruess SR, Cruess RL. Professionalism and medicine’s social contract. J Bone Joint Surg Am. 2008;90(3):668-74.
32. van Mook WNKA, et al. Evaluation of professionalism. Med Teach. 2009;31(10):e517-26.
33. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226-35.
34. Aoki T, Yamamoto Y, et al. Validation of HCAHPS in Japan. Int J Qual Health Care. 2016;28(6):789-94.
35. Wong EL, Coulter A, Hewitson P, et al. Patient experience surveys in primary care. BMJ Qual Saf. 2013;22(7):563-72.
36. Care Quality Commission. National patient survey programme. London: CQC; 2018.
37. Dackiewicz N, et al. Validación HCAHPS pediátrico. Arch Argent Pediatr. 2019;117(2):e123-9.
38. Reis CT, et al. Patient safety culture in Brazil. BMC Health Serv Res. 2016;16:1-10.
39. Busch IM, Moretti F, Mazzi M, et al. Validation of professionalism tools in Latin America. BMC Med Educ. 2019;19:1-9.
40. Schaufeli WB, Bakker AB. Utrecht Work Engagement Scale. Utrecht: Utrecht University; 2003.
41. Sofaer S, Firminger K. Patient perceptions of the quality of health services. Annu Rev Public Health. 2005;26:513-59.
42. Elliott MN, Lehrman WG, Goldstein EH, et al. Hospital survey and quality improvement. Med Care. 2010;48(2):140-7.
43. Raleigh VS, Foot C. Getting the measure of quality. London: King’s Fund; 2010.
44. West CP, Dyrbye LN, Shanafelt TD. Physician burnout. JAMA. 2018;320(11):1131-50.
45. Panagioti M, Geraghty K, Johnson J, et al. Association between burnout and patient safety. JAMA Intern Med. 2018;178(10):1317-30.
46. Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff wellbeing and patient safety. PLoS One. 2016;11(7):e0159015.
47. Rao KD, Peters DH, Bandeen-Roche K. Towards patient-centered health services in LMICs. Soc Sci Med. 2006;62(3):605-15.
48. Busch IM, et al. O-RON validation in Argentina. BMC Med Educ. 2019;19:1-9.
49. Wong EL, Coulter A, et al. Short-form patient experience questionnaire. BMJ Qual Saf. 2013;22(7):563-72.
50. Doyle C, Lennox L, Bell D. Patient experience and outcomes. BMJ Open. 2013;3:e001570.
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