Instruments to measure patient experience of healthcare quality in hospitals: a systematic review

Abstract

BackgroundImproving and sustaining the quality of hospital care is an international challenge. Patient experience data can be used to target improvement and research. However, the use of patient experience data has been hindered by confusion over multiple instruments (questionnaires) with unknown psychometric testing and utility.MethodsWe conducted a systematic review and utility critique of questionnaires to measure patient experience of healthcare quality in hospitals. Databases (Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO) and Web of Knowledge until end of November 2013) and grey literature were scrutinised. Inclusion criteria were applied to all records with a 10 % sample independently checked. Critique included (1) application of COSMIN checklists to assess the quality of each psychometric study, (2) critique of psychometric results of each study using Terwee et al. criteria and (3) development and critique of additional aspects of utility for each instrument. Two independent reviewers completed each critique. Synthesis included combining findings in a utility matrix.ResultsWe obtained 1157 records. Of these, 26 papers measuring patient experience of hospital quality of care were identified examining 11 international instruments. We found evidence of extensive theoretical/development work. The quality of methods and results was variable but mostly of a high standard. Additional aspects of utility found that (1) cost efficiency was mostly poor, due to the resource necessary to obtain reliable samples; (2) acceptability of most instruments was good and (3) educational impact was variable, with evidence on the ease of use, for approximately half of the questionnaires.ConclusionsSelecting the right patient experience instrument depends on a balanced consideration of aspects of utility, aided by the matrix. Data required for high stakes purposes requires a high degree of reliability and validity, while those used for quality improvement may tolerate lower levels of reliability in favour of other aspects of utility (educational impact, cost and acceptability).Systematic review registrationPROSPERO CRD42013006754Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0089-0) contains supplementary material, which is available to authorized users.

Patient and Family Experience in the Healthcare Value Equation

“…Hospitals that are rated more highly in PFE also show higher adherence to clinical guidelines, lower risk-adjusted mortality rates, and lower readmission rates [5,12,13]. Patients who have positive health care experiences have improved outcomes and more efficient utilization of the healthcare system [6,14]. As an example, one meta-analysis of surgical outcomes revealed that hospitals with higher scores in patient experience had more efficient care, shorter lengths of stay, lower readmission rates, and lower mortality rates.…”

“…our healthcare systems [6], PFE is the overarching connection between quality and cost and patient experience should be viewed as a vital component of hospital quality and outcomes [10]. Quality in healthcare is best defined as the amalgam of Experience + Outcomes + Safety, where outcomes and safety are strongly influenced by PFE.…”

“…Numerous modalities have been used in the past to gauge patient and family attitudes and perceptions about healthcare delivery systems with varying levels of success [6,7] (Table 1). We now recognize that any tool assessing PFE must deliver valid, reliable, and reproducible results if we are to accurately report metrics.…”

“…Focusing on PFE is a fundamentally essential goal [5], because as the recipients of care, patients provide unique insights into hospital quality as a whole. Patient's impressions and feelings educate us on how the care we think we provide compares to the patient perspective of that care and therefore, provides a true gauge of the value our healthcare systems deliver [6].…”

High satisfaction ratings in an orthogeriatric ward: A cross-sectional survey

“…[1] Patients' unique experiences enable them to offer key insights into the quality of care and treatment, specifically concerning the way treatment, processes or interactions are perceived. [2] Research shows that patient satisfaction present a highly optimistic picture, whereas detailed questions about specific aspects of patient experiences are likely to be more useful for monitoring quality in care. [3] Questions assessing patient experience are directed more towards a particular service, hospital episode or clinician and respondents are asked to report whether or not certain processes or events occurred.…”