Evaluating patient-reported outcome measures in Peru: a cross-sectional study of satisfaction and net promoter score using the 2016 EnSuSalud survey

Abstract

BackgroundPatient-reported measures attempt to quantify the value health services provide to users. Satisfaction is a common summative measure, but often has limited utility in identifying poor quality care. We compared satisfaction and the net promoter score (NPS), which was developed to help businesses quantify consumer sentiment, in a nationally representative survey in Peru. We aimed to compare NPS and satisfaction as individual ratings of care, assess the relationship of patient-reported experience ratings to these outcome measures and consider the utility of these measures as indicators of facility performance based on reliability within facilities and capacity to discriminate between facilities.MethodsWe analysed the 2016 National Survey on User Satisfaction of Health Services, a cross-sectional outpatient exit survey. We assessed ratings by patient characteristics and compared the distributions of satisfaction and NPS categories. We tested the association of patient-reported experience measures with each outcome using multilevel ordinal logistic regression. We used intraclass correlation (ICC) from these models to predict minimum sample for reliable assessment and compared patient-reported experience measures in facilities with average satisfaction but below or above average NPS.Results13 434 individuals rated services at 184 facilities. Satisfaction (74% satisfied) and NPS (17% reported at least 9 out of 10) were largely concordant within individuals but weakly correlated (0.37). Ratings varied by individual factors such as age and visit purpose. Most domains of patient-reported experience were associated with both outcomes. Adjusted ICC was higher for NPS (0.26 vs 0.11), requiring a minimum of 7 (vs 20) respondents for adequate reliability. Within the 70% of facilities classified as average based on satisfaction, NPS-based classification revealed systematic differences in patient-reported experience measures.ConclusionWhile satisfaction and NPS were broadly similar at an individual level, this evidence suggests NPS may be useful for benchmarking facility performance as part of national efforts in Peru and throughout Latin America to identify deficits in health service quality.

User-reported quality of care: findings from the first round of the People's Voice Survey in 14 countries

“…In addition to its relationship to visit quality, facility recommendation score might be less cognitively demanding for respondents and produces a continuous response that requires fewer assumptions in analysis than other measures, such as Likert scale responses. 10 Facility recommendation score is an important complement to patient satisfaction indicators currently in use.…”

“…To measure facility recommendation, we asked participants the following survey question: “Using a scale from zero to 10, where zero means you definitely would not recommend and 10 means you definitely would recommend, how likely is it that you would recommend this healthcare provider or facility to a friend or family member?” This item, a measure of potential future recommendation, has been used extensively in customer satisfaction surveys and has been proposed as a more intuitive indicator for evaluating health services. 10 The resulting recommendation score is the number between zero and ten selected by the respondent. Full survey questions and response options are available in appendix 2 (pp 1–2) .…”

What are the determinants of variation in caretaker satisfaction with sick child consultations? A cross-sectional analysis in five low-income and middle-income countries

“…This finding is consistent with two previous studies. In Peru, Leslie et al 20 found that user experience accounted for a larger proportion of variance in all user satisfaction measures, including three and five categories of net promoter score and satisfaction level, than the proportion explained by individual, facility and contextual factors combined. Similarly, Bleich et al ’s study 4 based on 21 European Union countries reported that all variables considered in the analyses (eg, user experience, user expectations) accounted for 17.5% of the observed variation in user satisfaction, of which 10% was explained by user experience.…”

Measuring people’s views on health system performance: Design and development of the People’s Voice Survey

“…We include both objective and subjective rankings to gauge what is acceptable to users in PLOS MEDICINE different contexts. We ask whether respondents would recommend the recently used facility to a friend or family member to calculate a net promoter score, an approach to assessing whether users are "promoters" or "detractors" of health care facilities [14].…”