急诊病人满意度量表的设计与评价

目的 探讨急诊病人满意度量表研制的方法与内容。方法 急诊病人满意度的调查内容、量表设计、调查方式、满意度影响因素等所涉及的方法学问题。结果 急诊病人满意度调查内容为救护车服务、医生服务、辅助科室服务、护理服务、治疗结果与花费、知情权、就医环境、等待时间；量表条目的考核采用应答率法、CR值法、相关系数法和变异系数法；对量表信度的分析，采用Cronbach’s α系数评价量表和因素的内部一致性；对量表效度的分析，用探索性因子分析和验证性因子分析。结论 可信和有效的急诊病人满意度量表是评价急诊医疗服务的重要手段和可行方法。     

Real-time patient satisfaction survey and improvement process

The purpose of this article is to describe how one multidisciplinary hospital responded to patient-satisfaction issues and improved communication throughout its organization by implementing a real-time assessment of patient and staff satisfaction for a faster and better-focused improvement process. The survey process is based on eliciting information from several different sources in a manner that allows corrective action plans to be made and implemented within 4 to 8 weeks of patient encounters. Organized groups can then review feedback from the implemented action plans within 9 to 16 weeks of patient encounters. This 4-month process is repeated on a quarterly basis, as lessons learned from the previous cycle are fed into the upcoming survey process for continuous patient-satisfaction improvement. Employees, faculty, and administrators have accepted the Real-Time Patient Satisfaction Survey and Improvement Process as a routine activity within the normal operating structure at the Moffitt Cancer Center. This activity of problem identification-action-feedback has been well integrated in the system and will continue to rotate throughout all patient care clinical services at the Moffitt Cancer Center. The program has become a method for goal-setting and establishing management accountability. As an adaptation of continuous quality improvement, The Real-Time Patient Satisfaction Survey and Improvement Process at the Moffitt Cancer Center is applicable for use in other hospitals and cancer centers in the United States. The general design, materials, and analysis plan can be directed toward the needs of the specific institution (and are available for distribution by contacting the authors).     

患者满意度调查中不确定性问题理论探讨

分析了在患者满意度调查中,患者满意评价的自我确定程度低,是导致满意度分值无法准确反映患者对医疗服务实际满意水平的重要原因;提出了可以通过合理选择调查场景、明确告知调查目的、尽量让患者独立完成问卷等方法,减少患者满意度调查中的心理学偏倚;阐述了研究患者满意不确定性问题的理论依据和研究线索,构建了患者满意不确定性研究的数学模型,以更好地推进患者满意的理论研究和实践应用.     

Directing student response to early patient contact by questionnaire

CONTEXT: First year medical students experienced early patient contact by observing outpatient consultations. OBJECTIVES: To evaluate a questionnaire designed to examine emerging attitudes during the development of a doctor-patient relationship. METHODS: First year medical students participated in medical outpatient consultations as observers. These consultations represented a total of 295 registered clinical appointments. After each observation, the students completed a questionnaire surveying themes related to the doctor-patient encounter. An instructor met the students at the end of the appointments to discuss the questions raised. The Dundee Ready Education Environment Measure was used to assess the course environment. RESULTS: Students found the activity useful and enjoyable. They reported increased self-esteem and enhanced enthusiasm for the study of medicine. They completed write-ups describing and evaluating the questionnaire data. The questionnaire notes showed homogeneity among the students. The Dundee Measure indicated the students regarded the learning environment positively (62.2%); social and ambient conditions were rated highly (64.6% and 64.7%, respectively). CONCLUSION: The teaching of humanitarian attitudes by observation of the doctor-patient relationship in practice was welcomed by students. The environment in which this educational programme was carried out was considered adequate. The outpatient service schedule and the limited time available for student instruction on the part of staff doctors made this activity productive. The programme motivated students towards higher achievement and the pursuit of medical responsibility as well as more developed humanitarian behaviour patterns.     

Validation of a questionnaire measuring patient satisfaction with general practitioner services

BACKGROUND: In order that patient satisfaction may be assessed in a meaningful way, measures that are valid and reliable are required. This study was undertaken to assess the construct validity and internal reliability of the previously developed Patient Satisfaction Questionnaire (PSQ). METHOD: A total of 1390 patients from five practices in the North of England, the Midlands, and Scotland completed the questionnaire. Responses were checked for construct validity (including confirmatory factor analysis to check the factor structure of the scale) and internal reliability. RESULTS: Confirmatory factor analysis showed that items loaded on the appropriate factors in a five factor model (doctors, nurses, access, appointments, and facilities). Scores on the specific subscales showed highly significant positive correlations with general satisfaction subscale scores suggesting construct validity. Also, the prediction (derived from past research) that older people would be more satisfied with the service was borne out by the results (F (4, 1312) = 57.10; p < 0.0001), providing further construct validation. The five specific subscales (doctors, nurses, access, appointments, and facilities), the general satisfaction subscale, and the questionnaire as a whole were found to have high internal reliability (Cronbach's alpha = 0.74-0.95). CONCLUSION: The results suggest that the PSQ is a valid and internally reliable tool for assessing patient satisfaction with general practitioner services.     

Getting satisfaction. The CMS survey publicly revealing patient satisfaction with hospitals is one step closer to becoming a reality

Now that the 30-day comment period has ended for the CMS' H-CAHPS patient-satisfaction survey, it can start being used next year. Dan Varga, left, chief medical officer for Norton Healthcare in Louisville, Ky., is pleased to see the government catching up to efforts that Norton has used for years.     

Development and validation of an in-patient satisfaction questionnaire.

OBJECTIVE: To develop a psychometrically sound, hospital patient satisfaction questionnaire to be administered to patients discharged from medical and surgical services. DESIGN: Cross-sectional survey in Spanish. SETTING: Four acute care general hospitals of the Basque Health Service. STUDY PARTICIPANTS: Random samples of 650 discharged patients from each hospital during February and March 2002. A total of 1910 patients responded to the questionnaire (73.5%). MAIN OUTCOME MEASURES: Overall perceived quality of health care and perceived health improvement. RESULTS: No sociodemographic differences were found between respondents and non-respondents. Six dimensions were identified from the factor analysis, explaining 50% of the variance. All items, except two, revealed loadings above 0.4. Cronbach's alpha exceeded 0.7 for all dimensions, except privacy. Comfort was the dimension with the lowest level of patient satisfaction, whereas privacy was the most satisfactory. The interscale correlations never exceeded the internal consistency of each scale. The analysis of the dimensions with two items of global assessment showed a positive correlation. CONCLUSIONS: The results obtained from the development and validation of the questionnaire provide evidence of its psychometric properties, although it would be useful to carry out further analyses to assess time-based properties of reliability. We found a positive relation between the degree of patient satisfaction and overall evaluation of the quality of health care, providing evidence of the ability of the questionnaire to correlate with other concepts. The in-patient satisfaction questionnaire could become a useful instrument in quality-of-care assessment.     

Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services

Despite an emerging consensus on appropriate preventive services, a minority of patients receive them. A study was undertaken to assess the impact of computer-generated reminders to adult patients, their physicians, or both patients and physicians on adherence to five recommended preventive services: cholesterol measurements, fecal occult blood testing, mammography, Papanicolaou smears, and tetanus immunization. During the academic year 1988-1989, all 7397 adult patients and their 49 physicians in a university family medicine clinical practice were randomized by practice group into one of four study groups: control, physician reminders, patient reminders, and both physician and patient reminders. Adherence was defined in community-oriented terms: the percentage of patients within each group who had received the preventive service in the recommended interval. During the study period, adherence to four of the five preventive services increased significantly, with the largest increases in the physician and patient reminder group: cholesterol measurements increased from 19.5% to 38.1%, fecal occult blood testing 9.3% to 27.0%, mammography 11.4% to 27.1%, and tetanus immunization 23.4% to 35.4% (for each increase, P less than .0001, McNemar's chi-square test). In general, increases were greater in blacks and in patients with any form of insurance coverage. Computer-based physician and patient reminder systems have great promise of improving adherence to preventive services in primary care settings.     

Development of a French inpatient satisfaction questionnaire.

OBJECTIVE: To develop a brief French-language, generic, self-administered questionnaire to measure inpatient satisfaction. DESIGN: Issues relevant to patients were identified using three open-ended questions designed in accordance with the disconfirmation paradigm. The content of patients' responses was analysed and then supplemented by items taken from published instruments in order to generate a pool of 93 items. Twenty-nine items were selected following a strict procedure. Content validity was judged by comparing the questionnaire to existing instruments. Construct validity was supported by testing specific hypotheses derived from the literature and by performing principal component analysis. Reliability was estimated by calculating Cronbach's alpha. SETTING: A 2200-bed French teaching hospital. SUBJECTS: A mail survey was carried out on a random sample of 1000 inpatients within 2-4 weeks of discharge. Eligible subjects were medical, surgical and obstetrics inpatients who had stayed in the hospital for more than 24 hours. RESULTS: The participation rate (71%) and the completion rate (95%) were indicators of acceptability. There were modest differences between the questionnaire and published instruments (financial aspects, amenities). Construct representation by principal component analysis consisted of six scales which accounted for 58% of the variance in total satisfaction scores. The reliability estimates of internal consistency ranged from 0.67 to 0.86. CONCLUSION: We propose that the self-administered multidimensional inpatient satisfaction questionnaire provided encouraging preliminary psychometric information. This instrument is intended to involve patient feedback in a continuous quality health care improvement strategy.