Kiwa Prismant, P,O, Box 85200, 3508 AE Utrecht, the Netherlands.
BMC Med Res Methodol. 2010 Aug 19;10:75. doi: 10.1186/1471-2288-10-75.
The CQ Index for the elderly, a quality-of-care questionnaire administered by conducting interviews, is used to assess clients' experiences in Dutch nursing homes and homes for the elderly. This article describes whether inter-interviewer differences influence the perceived quality of healthcare services reported by residents, the size of this interviewer effect and the influence of the interviewer characteristics on CQ Index dimensions for public reporting.
Data from 4345 questionnaires was used. Correlations were calculated, reliability analyses were performed, and a multilevel analysis was used to calculate the degree of correlation between two interviewers within one health care institution. Five models were constructed and the Intra Class Correlation (ICC) was calculated. Healthcare institutions were given 1-5 stars on every quality dimensions (1 = worst and 5 = best), adjusted for resident and interviewer characteristics. The effect of these characteristics on the assignment of the stars was investigated.
In a multilevel approach, the ICC showed a significant amount of variance on five quality dimensions. Of the interviewer characteristics, only previous interviewing experience, the reason of interviewing and general knowledge of health care had a significant effect on the quality dimensions. Adjusting for interviewer characteristics did not affect the overall star assignment to the institutions regarding 7 of 12 quality dimensions. For the other five dimensions (Shared decision-making, Meals, Professional competency, Autonomy, and Availability of personnel) a minor effect was found.
We have shown that training, the use of experienced interviewers, written instructions, supervision and educational meetings do not automatically prevent interviewer effects. While the results of this study can be used to improve the quality of services provided by these institutions, several CQ index dimensions should be interpreted with caution for external purposes (accountability and transparency).
CQ 指数是一种通过访谈进行评估的老年人护理质量问卷，用于评估荷兰养老院和老年人护理院居民的体验。本文描述了访谈者之间的差异是否会影响居民所报告的医疗服务质量感知，这种访谈者效应的大小，以及访谈者特征对公共报告的 CQ 指数维度的影响。
使用了 4345 份问卷的数据。计算了相关性，进行了可靠性分析，并使用多水平分析计算了一个医疗机构内两名访谈者之间的相关性程度。构建了五个模型并计算了组内相关系数（ICC）。对每个质量维度（1=最差，5=最佳），根据居民和访谈者的特征，对医疗机构进行了星级评定。研究了这些特征对星级评定的影响。
在多水平方法中，五个质量维度的 ICC 显示出显著的方差。在访谈者特征中，只有之前的访谈经验、访谈原因和对医疗保健的一般了解对质量维度有显著影响。调整访谈者特征不会影响机构在 12 个质量维度中的 7 个维度的整体星级评定。对于其他五个维度（共同决策、膳食、专业能力、自主权和人员可用性），则发现了较小的影响。
我们已经表明，培训、使用经验丰富的访谈者、书面说明、监督和教育会议并不能自动防止访谈者效应。虽然本研究的结果可用于提高这些机构提供的服务质量，但在外部目的（问责制和透明度）方面，应谨慎解释几个 CQ 指数维度。
