Wisniewski Janna M, Diana Mark L, Yeager Valerie A, Hotchkiss David R
Department of Global Health Management and Policy, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Department of Health Management and Policy, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
Int J Qual Health Care. 2018 Jul 1;30(6):472-479. doi: 10.1093/intqhc/mzy052.
Examine the relationship between patients' perceptions of quality and the objective level of quality at government health facilities, and determine whether the pre-existing attitudes and beliefs of patients regarding health services interfere with their ability to accurately assess quality of care.
Cross-sectional, visit-level analysis.
Three regions (Nord-Ubangi, Kasai/Kasai-Central and Maniema/Tshopo) of the Democratic Republic of Congo.
Data related to the inpatient and outpatient visits to government health facilities made by all household members who were included in the survey was used for the analysis. Data were collected from patients and the facilities they visited.
Patients' perceptions of the level of quality related to availability of drugs and equipment; patient-centeredness and safety serve compared with objective measures of quality.
Objective measures and patient perceptions of the drug supply were positively associated (β = 0.16, 95% CI = 0.03, 0.28) and of safety were negatively associated (β = -0.12, 95% CI = -0.23, -0.01). Several environmental factors including facility type, region and rural/peri-urban setting were found to be significantly associated with respondents' perceptions of quality across multiple outcomes.
Overall, patients are not particularly accurate in their assessments of quality because their perceptions are impacted by their expectations and prior experience. Future research should examine whether improving patients' knowledge of what they should expect from health services, and the transparency of the facility's quality data can be a strategy for improving the accuracy of patients' assessments of the quality of the health services, particularly in low-resourced settings.
研究患者对政府医疗机构服务质量的认知与客观服务质量水平之间的关系，并确定患者对医疗服务预先存在的态度和信念是否会干扰他们准确评估医疗服务质量的能力。
横断面、就诊层面分析。
刚果民主共和国的三个地区（北乌班吉、开赛/开赛中部和马尼埃马/乔波）。
调查中纳入的所有家庭成员在政府医疗机构的住院和门诊就诊相关数据用于分析。数据收集自患者及其就诊的医疗机构。
患者对与药品和设备可及性相关的质量水平的认知；以患者为中心和安全性与客观质量指标的比较。
药品供应的客观指标与患者认知呈正相关（β = 0.16，95%可信区间 = 0.03，0.28），安全性指标与患者认知呈负相关（β = -0.12，95%可信区间 = -0.23，-0.01）。发现包括医疗机构类型、地区和农村/城郊环境在内的几个环境因素与受访者对多个结果的质量认知显著相关。
总体而言，患者对服务质量的评估不太准确，因为他们的认知受到期望和既往经历的影响。未来的研究应探讨提高患者对医疗服务期望的认知，以及医疗机构质量数据的透明度是否可以作为提高患者对医疗服务质量评估准确性的策略，尤其是在资源匮乏的环境中。
