Evaluating Differential Item Functioning in the English General Practice Patient Survey

Setodji, Claude Messan; Elliott, Marc N.; Abel, Gary; Burt, Jenni; Roland, Martín; Campbell, John

doi:10.1097/mlr.0000000000000397

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…Previous research have suggested that Asians' low extreme response tendency may explain ethnic differences seen in patient experiences [3]. Other have demonstrated no differential item functioning and measurement equivalence between Whites and Asians in responses to experience scales [20,21], suggesting that lower scores among Asians reflect differences in care [22]. No special measures were taken to include immigrants in the survey, as this was not one of its original aims.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Kjøllesdal¹,

Indseth²,

Iversen³

et al. 2020

BMC Health Serv Res

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Background Patient experience is an important indicator of quality of health care. In Norway, little is known about the quality of health care for immigrants. The aim of this study was to compare patient-reported experiences with general practice between the Norwegian-born population and immigrant groups. Methods We performed secondary analyses of data from a national survey on patient experiences with general practice, including assessments of general practitioners (GPs) and their GP offices. The survey was carried out in Norway in 2018–19. The total number of respondents was 2029, with a response rate of 42.6%. Region of birth was available for 1981 participants, and these were included in the analyses (“Norway” (N = 1756), “Asia, Africa or South America” (N = 95), “Eastern Europe” (N = 70) and “Western Europe, North America or Oceania” (N = 60)). Five indicators of patient experiences were used as dependent variables in bivariate and multivariate analyses, with region of birth as the main exposure variable and other background variables about the patient as adjustment variables: “the GP” (measures related to communication and competency), “auxiliary staff” (politeness, competency, organization), “accessibility” (waiting times), “coordination” (with other services) and `enablement` (GP facilitates coping with/understanding illness). Results Immigrants as a whole reported poorer experiences with general practice than the majority population, with significantly poorer scores on four of five patient experience indicators. Patients from Asia/Africa/South America reported poorer experiences than those from Norway on the indicators “GP”, “auxiliary staff”, “accessibility” and “coordination”: on a scale from 0 to 100 where 100 is the best, the difference ranged from 7.8 (GP) to 20.3 (accessibility). Patients from Eastern Europe reported lower scores on “GP” and patients from Western Europe/North America/Oceania reported lower scores on “auxiliary staff”. These associations were still significant after adjustment for sex, age, self-rated physical and mental health, number of contacts with the GP and education. Conclusions For countries with a substantial proportion of foreign-born patients in the health system, immigrant background is an important parameter in quality improvement work. Immigrant background is also an important parameter in health service research.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Kjøllesdal¹,

Indseth²,

Iversen³

et al. 2020

BMC Health Serv Res

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“…Our analysis of GP Patient Survey data, drawing on item response theory to explore whether or not items receive systematically different responses from South Asian and white British groups, suggested that this was unlikely to be the case. 159 Yet there are also other, alternative drivers of poorer ratings of similar care, most notably that the evaluation of consultations by South Asian respondents is influenced by systematic variations in their expectations of, or preferences for, care.…”

Section: Introduction and Rationale For The Studymentioning

confidence: 99%

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Burt

Campbell

Abel

et al. 2017

Programme Grants Appl Res

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BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…A number of studies have been conducted to explore patient experiences in immigrant groups or by ethnicity/race, in a range of settings [12][13][14][15][16][17][18][19][20][21][22], and most have found poorer experiences in minority groups than in the Hilde Hestad Iversen and Kjersti Eeg Skudal have contributed equally to this work. majority population.…”

Section: Introductionmentioning

confidence: 99%

“…The main objective of the current study was to assess the association between parents' geographical origin and their experiences with the outpatient clinics, adjusting for other predictors at the individual level, and using multilevel analysis to adjust for the health care level. The knowledge base from this setting is scarce, but based on the general literature [12][13][14][15][16][17][18][19][20][21][22], we expected minority parents to report poorer experiences than parents born in Norway. Based on recent Norwegian findings on patient experiences with general practitioners [23], we expected poorer experiences for parents born in Asia, Africa, South America, and Eastern Europe.…”

Section: Introductionmentioning

confidence: 99%

Are parents’ geographical origin associated with their evaluation of child and adolescent mental health services? Results from a national survey in Norway

Bjertnæs

Iversen

Skudal

et al. 2020

Eur Child Adolesc Psychiatry

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The objective was to assess the association between parents' geographical origin and their evaluation of outpatient child and adolescent mental health services (CAMHS). Data were collected in a national parent's experience survey of all outpatient CAMHS in Norway in 2017. Following exclusions, 16,143 parents were part of the study, of which 5932 responded (36.1%). Diagnosis and global psychosocial functional level were collected from the National Patient Register. Multilevel regression was used to assess the association between parents' geographical origin and parent evaluation of the outpatient CAMHS on ten indicators. Sentiment and content analysis was conducted on open-ended comments from parents. The estimated regression coefficients showed that parents born in Eastern Europe scored the services significantly poorer than parents born in Norway on outcome of treatment (− 7.73, p < 0.01), general satisfaction (− 5.53, p < 0.05), ease of getting in contact with health personnel outside of scheduled appointments (− 17.04, p < 0.001), and knowledge of the services that the child has received at the service (− 10.63, p < 0.001). Parents born in Asia/Africa/South America scored the services similar as Norwegian parents on eight of ten indicators, better on one (waiting time) and poorer on one (ease of getting in contact). Sentiment analysis showed that 54% of the comments from parents born in Eastern Europe were negative, compared to 42% for the Norwegian group and 36% for Asia/Africa/South America. The parents' evaluation of the outpatient CAMHS were partly associated with their geographical origin, with parents born in Eastern Europe reporting poorer experiences than parents born in Norway.

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Evaluating Differential Item Functioning in the English General Practice Patient Survey

Cited by 7 publications

References 33 publications

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience

Are parents’ geographical origin associated with their evaluation of child and adolescent mental health services? Results from a national survey in Norway

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