Faculty of Health Sciences, University of Southampton, Southampton, UK.
Health Technol Assess. 2012 Jul;16(30):i-xii, 1-509. doi: 10.3310/hta16300.
There is recognition of the importance of measuring patients' experiences, expectations and satisfaction.
To assess the literature on the concept and measurement of patients' expectations for health care, and to develop and test a measure of patients' expectations, using adult patients in community, general practice and hospital outpatient departments in Greater London, Norwich and Essex, UK.
Major electronic databases including the British Nursing Index, EMBASE, MEDLINE, PsycINFO and the Applied Social Sciences Index and Abstracts were searched between 2000 and 2009.
Narrative review, semi-structured exploratory study and surveys of GP patients and hospital outpatients immediately before and after their surgery/clinic visit to measure their pre-visit expectations for their health care and their post-visit experiences (expectations met and satisfaction with visit) (site specific).
A total of 20,439 titles and 266 abstracts were identified, of which 211 were included in the review. Most research designs were weak, with small or selected samples, and a theoretical frame of reference was rarely stated. The origin of questions about expectations was often absent, questions were frequently untested and those with reported reliability or validity data had generally mixed results. In the survey data the expectations measures met acceptability criteria for reliability; all exceeded the threshold of α = 0.70, in each mode of administration and sample type. Items and subscales also correlated at least moderately with those variables that they were expected to be associated with, supporting their validity. The item means within subscales were generally similar between samples and all-item-total correlations exceeded the acceptability threshold. Descriptive findings revealed that most patients ideally expected cleanliness, information about where to go, convenient and punctual appointments and helpful reception staff, the doctor to be knowledgeable, clear and easy to understand, to be involved in treatment decisions and to experience a reduction in symptoms/problems. Expectations least likely to be met included being seen on time and choice of hospital/doctor (items requested by the ethics committee). Other items that had low met expectations included helpfulness of reception staff, doctor being respectful and treating with dignity (hospital sample), doctor knowledgeable (hospital), being given reassurance, receiving advice about health/condition, information about cause and management of condition and information about benefits/side effects of treatment, being given an opportunity to discuss problems, and the three items on outcome expectancies. Previous consultations/experiences of health services and health-care staff/professionals most commonly influenced expectations. Overall, pre-visit realistic expectations were lower than patients' ideals or hopes. Most post-visit experiences indicated some unmet expectations (e.g. cause and management of health/condition, benefits/side effects of treatments) and some expectations that were exceeded. Generally, GP patients reported higher pre-visit expectations and post-visit met expectations. Correlations between subscale domains were strongest between the structure and process of health care, doctor-patient communication style and doctor's approach to giving information, all common indicators of the quality of health care, supporting the validity of the measures. The post-visit experiences subscale significantly predicted single-item summary ratings of overall met expectations and satisfaction. GP rather than hospital patients were also independently predictive of expectations met. Other predictors were having no/little anxiety/depression, older age (satisfaction) and fewer effects of health on quality of life (met expectations).
The surveys in clinics were based on convenience, not random sampling methods.
These findings have implications for establishing the quality of health services and informing their improvement. Awareness of the patient's met and unmet expectations should enable staff to understand the patient's perspective and improve communication. This study examined the perspective of the patient only; it is not possible to examine the extent to which any expectations might have been unrealistically too high or too low. This is a challenge for future research.
The National Institute for Health Research Health Technology Assessment programme and the National Co-ordinating Centre for Research Methodology (NCCRM).
人们已经认识到衡量患者体验、期望和满意度的重要性。
评估有关医疗保健患者期望的概念和测量的文献，并开发和测试一种患者期望的测量方法，该方法将在英国大伦敦、诺维奇和埃塞克斯的社区、全科医生诊所和医院门诊患者中使用。
包括英国护理索引、EMBASE、MEDLINE、PsycINFO 和应用社会科学索引和摘要在内的主要电子数据库在 2000 年至 2009 年期间进行了检索。
叙述性综述、半结构式探索性研究和对全科医生患者和医院门诊患者在手术/就诊前和就诊后立即进行的调查，以衡量他们对医疗保健的就诊前期望和就诊后体验（期望满足和就诊满意度）（特定地点）。
共确定了 20,439 个标题和 266 个摘要，其中 211 个被纳入综述。大多数研究设计都很薄弱，样本量小或选择，很少有理论框架。期望问题的来源通常不清楚，问题经常未经测试，那些报告可靠性或有效性数据的问题通常结果混杂。在调查数据中，期望测量方法具有可接受的可靠性标准；在每种管理模式和样本类型中，所有方法的可靠性均超过了α=0.70 的阈值。在项目和子量表之间，也至少与它们预期相关的那些变量中度相关，支持其有效性。在子量表内的项目平均值在样本之间通常相似，所有项目与总分的相关性都超过了可接受的阈值。描述性发现表明，大多数患者理想地期望清洁、有关去向的信息、方便和准时的预约以及有帮助的接待人员，医生知识渊博、清晰易懂、参与治疗决策并体验到症状/问题的减轻。最不可能满足的期望包括准时就诊和选择医院/医生（伦理委员会要求的项目）。其他期望较低的项目包括接待人员的帮助程度、医生的尊重和尊严（医院样本）、医生的知识（医院）、得到保证、获得有关健康/状况的建议、了解病情的原因和管理以及治疗的好处/副作用、有机会讨论问题，以及三个关于预期结果的项目。以前的医疗服务和医疗保健人员/专业人员的咨询/经验最常影响期望。总体而言，就诊前的现实期望低于患者的理想或希望。大多数就诊后体验表明存在一些未满足的期望（例如，健康/状况的原因和管理、治疗的好处/副作用）和一些超出期望的期望。一般来说，全科医生患者就诊前的期望更高，就诊后的期望满足程度更高。子量表域之间的相关性最强的是医疗保健的结构和过程、医患沟通风格和医生提供信息的方式，这些都是医疗保健质量的常见指标，支持了这些测量方法的有效性。就诊后体验子量表显著预测了总体期望满足和满意度的单项总结评价。而不是医院患者的全科医生患者也是期望满足的独立预测因素。其他预测因素包括没有/很少有焦虑/抑郁、年龄较大（满意度）和健康对生活质量的影响较小（期望满足）。
诊所的调查是基于便利，而不是随机抽样方法。
这些发现对确定医疗服务质量并为其改进提供了依据。了解患者的满足和未满足的期望应该使员工能够理解患者的观点并改善沟通。本研究仅从患者的角度进行了检查；不可能检查任何期望是否可能不切实际地过高或过低。这是未来研究的一个挑战。
英国国家卫生研究院卫生技术评估计划和国家协调研究方法学中心（NCCRM）。
