The consumer quality index (CQ-index) in an accident and emergency department: development and first evaluation

ABSTRACT: BACKGROUND: Assessment of patients' views are essential to provide a patient-centred health service and to evaluating quality of care. As no standardized and validated system for measuring patients' experiences in accident and emergency departments existed, we have developed the Consumer Quality index for the accident and emergency department (CQI A&E). METHODS: Qualitative research has been undertaken to determine the content validity of the CQI A&E. In order to assess psychometric characteristics an 84-item questionnaire was sent to 653 patients who had attended a large A&E in the Netherlands. Also, fifty importance questions were added to determine relevance of the questions and for future calculations of improvement scores. Exploratory factor analysis was applied to detect the domains of the questionnaire. RESULTS: Survey data of 304 (47%) patients were used for the analysis. The first exploratory factor analysis resulted in three domains based on 13 items: 'Attitude of the healthcare professionals', 'Environment and impression of the A&E' and 'Respect for and explanation to the patient'. The first two had an acceptable internal consistency. The second analysis, included 24 items grouped into 5 domains: 'Attitude of the healthcare professionals', 'Information and explanation', 'Environment of the A&E','Leaving the A&E' and 'General information and rapidity of care'. All factors were internal consistent. According to the patients, the three most important aspects in healthcare performance in the A&E were: trust in the competence of the healthcare professionals, hygiene in the A&E and patients' health care expectations. In general, the highest improvement scores concerned patient information. CONCLUSIONS: The Consumer Quality index for the accident and emergency department measures patients' experiences of A&E healthcare performance. Preliminary psychometric characteristics are sufficient to justify further research into reliability and validity.     

High risk for sleep apnea in the Berlin questionnaire and coronary artery disease

Introduction  

Obstructive sleep apnea (OSA) affects up to 30% of the adult population and is a risk factor for coronary artery disease (CAD). The diagnostic process, involving polysomnography, may be complex. Berlin questionnaire (BQ) is a validated and economical screening tool.     

25 years of aortic valve replacement using mechanical valves: Risk factors for early and late mortality

This study describes the changes that have taken place in patientcharacteristics in 25 years of aortic valve replacement usingmechanical valves, and looks for risk factors for early andlate mortality. During this period, 1449 mechanical valves wereimplanted. Overall early mortality (<30 days) was 5·3%and for aortic valve replacement without concomitant procedures3·9%. Overall survival rates at 5, 10 and 15 years were80%, 63% and 49%, respectively. Despite an increased proportionof higher risk patients (older age, more reoperations, moreconcomitant coronary bypass surgery) survival rates improvedthroughout the study period. Early mortality was related toan early year of operation, urgency, reoperation and concomitantsurgery to the tricuspid valve or ascending aorta. Late mortalitywas higher for patients of older age, with an early year ofoperation, male gender, concomitant coronary bypass surgery,mitral valve surgery or replacement of the ascending aorta.Aortic regurgitation did not have a major influence on earlynor late mortality. The improvement in early and late mortalityin more recent years was largely the result of the introductionof cardioplegia. A changing, non-proportional effect was observedfor several risk factors during the follow-up period. This studyillustrates the changes and improvements in medical care thathave taken place in patients requiring aortic valve replacement.