Perception of quality of care of patients with potentially severe diseases evaluated at a distinct quick diagnostic delivery model: a cross-sectional study

Abstract

BackgroundAlthough hospital-based outpatient quick diagnosis units (QDU) are an increasingly recognized cost-effective alternative to hospitalization for the diagnosis of potentially serious diseases, patient perception of their quality of care has not been evaluated well enough. This cross-sectional study analyzed the perceived quality of care of a QDU of a public third-level university hospital in Barcelona.MethodsOne hundred sixty-two consecutive patients aged ≥ 18 years attending the QDU over a 9-month period were invited to participate. A validated questionnaire distributed by the QDU attending physician and completed at the end of the first and last QDU visit evaluated perceived quality of care using six subscales.ResultsResponse rate was 98 %. Perceived care in all subscales was high. Waiting times were rated as ‘short’/’very short’ or ‘better’/’much better’ than expected by 69–89 % of respondents and physical environment as ‘better’/’much better’ than expected by 94–96 %. As to accessibility, only 3 % reported not finding the Unit easily and 7 % said that frequent travels to hospital for visits and investigations were uncomfortable. Perception of patient–physician encounter was high, with 90–94 % choosing the positive extreme ends of the clinical information and personal interaction subscales items. Mean score of willingness to recommend the Unit using an analogue scale where 0 was ‘never’ and 10 ‘without a doubt’ was 9.5 (0.70). On multivariate linear regression, age >65 years was an independent predictor of clinical information, personal interaction, and recommendation, while age 18–44 years was associated with lower scores in these subscales. No schooling predicted higher clinical information and recommendation scores, while university education had remarkable negative influence on them. Having ≥4 QDU visits was associated with lower time to diagnosis and recommendation scores and malignancy was a negative predictor of time to diagnosis, clinical information, and recommendation.DiscussionIt is worthy of note that the questionnaire evaluated patient perception and opinions of healthcare quality including recommendation rather than simply satisfaction. It has been argued that perception of quality of care is a more valuable approach than satisfaction. In addition to embracing an affective dimension, satisfaction appears more dependent on patient expectations than is perception of quality.ConclusionsWhile appreciating that completing the questionnaire immediately after the visit and its distribution by the QDU physician may have affected the results, scores of perceived quality of care including recommendation were high. There were, however, significant differences in several subscales associated with age, education, number of QDU visits, and diagnosis of malignant vs. benign condition.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1070-2) contains supplementary material, which is available to authorized users.

Patients' Perceptions of Perioperative Quality of Care in Relation to Self-rated Health

“…The results showed that the factor associated with patients' satisfaction within the dimension of identity-oriented approach of the caregivers, including the quality of information, encouragement and participation, was self-estimated physical health. This contrasts with previous research [8][9][10] showing that the most important predictor of satisfaction across settings is age. Within the dimension of identity-oriented approach of the caregivers, which was the largest dimension, participants who estimated their physical health as being good were more satisfied than those who reported their physical health as being less than good.…”

“…Within the dimension of identity-oriented approach of the caregivers, which was the largest dimension, participants who estimated their physical health as being good were more satisfied than those who reported their physical health as being less than good. Such results are consistent with the findings of previous studies 6,7,9 conducted in other care settings, which were that good health correlates with perceptions of good care.…”

“…Across different settings, the evidence [7][8][9][10] shows that the most important sociodemographic predictor of satisfaction is age, with older patients being more satisfied with healthcare services. In addition, healthier patients have shown 6,7,9 to be generally more satisfied with their care than those with less than good health. In their literature review Heidegger et al 11 noted that few validated studies have examined quality of care from the patients' perspective in perioperative care environments.…”

What is the relevance of an ambulatory quick diagnosis unit or inpatient admission for the diagnosis of pancreatic cancer? A retrospective study of 1004 patients

“…In addition to a time to diagnosis similar to the length-of-stay for similar conditions, QDUs are useful to decrease referrals from PC to emergency departments (EDs), are cost-saving, and are associated with higher patients’ satisfaction scores than hospitalization. [ 12 – 15 ]…”

Time to diagnosis and associated costs of an outpatient vs inpatient setting in the diagnosis of lymphoma: a retrospective study of a large cohort of major lymphoma subtypes in Spain

“…Although reported data on these units are limited, several advantages over hospitalization have been established: in addition to ensuring a time to diagnosis similar to the length of stay for the same evaluable conditions, they are known to decrease emergency department (ED) referrals from PC easing ED overcrowding, are associated with higher patient satisfaction scores, and are considerably cost-saving [ 11 – 13 , 15 , 16 , 25 – 29 ]. Yet to be evaluated, patients’ physical performance should allow them to travel from home to hospital and back for visits and investigations.…”