Bahrampour Mina, Bahrampour Abbas, Amiresmaili Mohammadreza, Barouni Mohsen
Institute of Futures Study, Kerman, Iran.
Kerman University of Medical Sciences , Kerman, Iran.
Int J Health Care Qual Assur. 2018 Aug 13;31(7):676-683. doi: 10.1108/IJHCQA-01-2017-0006.
High quality healthcare is important to all patients. If healthcare is felt to be high quality, then patients will be satisfied, and the relationship between patients and healthcare providers will improve. Patient satisfaction is among the most commonly used service quality indicators; however, it is not fully known which factors influence satisfaction. Therefore, it is necessary to pay attention to the elements that affect both healthcare quality and patient satisfaction. Nowadays, several methods are used in health economics to assess patient preferences, prioritize them and help health policy makers improve services. Discrete choice experiment (DCE) is one method that is useful to elicit patient preferences regarding healthcare services. The purpose of this paper is to apply DCE and elicit patient preferences in medical centers to rank certain healthcare quality factors.
DESIGN/METHODOLOGY/APPROACH: The descriptive, analytical study used a cross-sectional questionnaire that the authors developed. In total, 12 scenarios were chosen after applying fractional factorials. The questionnaire was completed by patients who were admitted to Kerman General Teaching Hospitals, South-East Iran in 2015. Patient preferences were identified by calculating the characteristics' marginal effects and prioritizing them. The generalized estimation equation (GEE) model was used to determine attribute effects on patient preferences.
In total, 167 patients completed the questionnaire. Prioritizing the attributes showed that "physical examination" was the most important attribute. Other key features included "cleanliness," "training after discharging," "medical staff attention," "waiting for admission" and "staff attitude." All attributes were statistically significant ( p<0.05) except staff behavior. No demographic characteristic was significant.
To increase hospital patient satisfaction, health policy makers should develop programs to enhance healthcare quality and hospital safety by increasing physical examination quality and other services.
ORIGINALITY/VALUE: To estimate DCE independent variables, logistic regression models are usually used. The authors used the GEE model to estimate discrete choice experiment owing the explanatory variables' dependency.
高质量的医疗保健对所有患者都很重要。如果患者认为医疗保健质量高，那么他们就会感到满意，患者与医疗服务提供者之间的关系也会得到改善。患者满意度是最常用的服务质量指标之一；然而，尚不完全清楚哪些因素会影响满意度。因此，有必要关注影响医疗质量和患者满意度的因素。如今，卫生经济学中使用了几种方法来评估患者偏好、对其进行排序，并帮助卫生政策制定者改善服务。离散选择实验（DCE）是一种有助于引出患者对医疗服务偏好的方法。本文的目的是应用DCE并在医疗中心引出患者偏好，以对某些医疗质量因素进行排序。
设计/方法/途径：这项描述性分析研究使用了作者编制的横断面问卷。在应用分数因子设计后，总共选择了12种情景。问卷由2015年入住伊朗东南部克尔曼综合教学医院的患者填写。通过计算特征的边际效应并对其进行排序来确定患者偏好。使用广义估计方程（GEE）模型来确定属性对患者偏好的影响。
共有167名患者完成了问卷。对属性进行排序显示，“体格检查”是最重要的属性。其他关键特征包括“清洁度”、“出院后培训”、“医务人员关注度”、“等待入院时间”和“工作人员态度”。除工作人员行为外，所有属性均具有统计学意义（p<0.05）。没有人口统计学特征具有显著性。
为了提高医院患者满意度，卫生政策制定者应制定计划，通过提高体格检查质量和其他服务来提升医疗质量和医院安全性。
原创性/价值：为了估计DCE自变量，通常使用逻辑回归模型。由于解释变量的相关性，作者使用GEE模型来估计离散选择实验。
