Involving patients in detecting quality gaps in a fragmented healthcare system: development of a questionnaire for Patients' Experiences Across Health Care Sectors (PEACS)

Abstract

ObjectiveThe purpose of this study was to develop and validate a generic questionnaire to evaluate experiences and reported outcomes in patients who receive treatment across a range of healthcare sectors.DesignMixed-methods design including focus groups, pretests and field test.SettingThe patient questionnaire was developed in the context of a nationwide program in Germany aimed at quality improvements across the healthcare sectors.ParticipantsFor the field test, 589 questionnaires were distributed to patients via 47 general practices.Main MeasurementsDescriptive item analyzes non-responder analysis and factor analysis (PCA). Retest coefficients (r) calculated by correlation of sum scores of PCA factors. Quality gaps were assessed by the proportion of responders choosing a response category defined as indicating shortcomings in quality of care.ResultsThe conceptual phase showed good content validity. Four hundred and seventy-four patients who received a range of treatment across a range of sectors were included (response rate: 80.5%). Data analysis confirmed the construct, oriented to the patient care journey with a focus on transitions between healthcare sectors. Quality gaps were assessed for the topics ‘Indication’, including shared-decision-making (6 items, 24.5–62.9%) and ‘Discharge and Transition’ (10 items; 20.7–48.2%). Retest coefficients ranged from r = 0.671 until r = 0.855 and indicated good reliability. Low ratios of item-non-response (0.8–9.3%) confirmed a high acceptance by patients.ConclusionsThe number of patients with complex healthcare needs is increasing. Initiatives to expand quality assurance across organizational borders and healthcare sectors are therefore urgently needed. A validated questionnaire (called PEACS 1.0) is available to measure patients' experiences across healthcare sectors with a focus on quality improvement.

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“…Patient satisfaction is reflected a key performance sign in assessing quality of patient care and is highly obligated by accreditation agencies in the monitoring of quality of hospital care in order to identify needed care areas to improvement [5]. Patient satisfaction has become an increasingly important aspect in quality of patient care.…”

“…Patient satisfaction is a factor that not only can guide care received, but it also impacts the financial support of the institution as well. Measurement and reporting of patients' experiences has become an important element of health-service evaluation worldwide [5].…”

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“…Moreover, there is strong evidence showing that collecting, reporting and comparing patient experience data is associated with improving patient experience (Murante et al 2014b;Fowler and Patterson 2013), and that cross-sectoral measurements impact improvement in quality of care (Szecsenyi et al 2012). While it is clear that the fragmentation of care is a challenge both for patients and for healthcare services providers (Coleman and Berenson 2004), some initial evidence is available on the contribution of cross-sectoral patient data on the identification and evaluation of quality gaps in the continuum of healthcare service delivery (Noest et al 2014;Nuti et al 2010Nuti et al , 2017a. In particular, pathway-related data can help to overcome a silo-vision of healthcare and to promote a personalized medicine approach, also improving the overall quality of care pathway for each patient in terms of outcomes (Nuti et al 2016a).…”

“…• to identify strengths and weaknesses in the continuum of care, as experienced by patients, and encouraging partnerships between providers (Noest et al 2014;Nuti et al 2010Nuti et al , 2016a); • to promote and improve professionals' awareness of the weaknesses and strengths of the whole healthcare pathway in which they are involved (Murante et al 2014a); • to support healthcare organizations in activating and implementing quality improvement plans based on the analysis of the patient survey results and in general of the PMS indicators.…”

Routinedaten der gesetzlichen Krankenversicherung und Versichertenbefragungen in der Qualitätsberichterstattung – Potenzial, Probleme und Perspektiven

“…Zum einen bilden sie das tatsächliche Bindeglied verschiedener Versorgungssektoren und können daher über die praktische Realisierungsstufe der für eine effektive, insbesondere chronischer Erkrankungen erforderlichen Kooperation bzw. Integration besser urteilen als andere Involvierte[20,21]. Da Pa tienten in den Institutionen der gesundheitlichen Versorgung den gesamten Behandlungsprozess und dessen Ergebnis überbli cken, kann die spezifische Kompetenz des Patienten genutzt wer Werden, wie in dem zitierten Beispiel, GKVRoutinedaten zur Identifikation oder Selektion von Zielgruppen verwendet, sind in der Regel nur retrospektive Befragungen möglich, da die Kran kenkassen erst mit der Abrechnung, nach Erbringung der gesundheitlichen Leistung, von einer entsprechenden Leis tungsinanspruchnahme erfahren.…”