Department of Community Health, Tufts University, 574 Boston Ave, Suite 208, MedfordMA02155, United States of America (USA).
Department of Global Health and Population, Harvard University, Boston, USA.
Bull World Health Organ. 2024 Jul 1;102(7):509-520. doi: 10.2471/BLT.24.290519. Epub 2024 Jun 4.
To examine how a general inpatient satisfaction survey functions as a hospital performance measure.
We conducted a mixed-methods pilot study of the Hospital Consumer Assessment of Health Providers and Systems survey in Odisha, India. We divided the study into three steps: cognitive testing of the survey, item testing with exploratory factor analysis and content validity indexing. Cognitive testing involved 50 participants discussing their interpretation of survey items. The survey was then administered to 507 inpatients across five public hospitals in Odisha, followed by exploratory factor analysis. Finally, we interviewed 15 individuals to evaluate the content validity of the survey items.
Cognitive testing revealed that six out of 18 survey questions were not consistently understood within the Odisha inpatient setting, highlighting issues around responsibilities for care. Exploratory factor analysis identified a six-factor structure explaining 66.7% of the variance. Regression models showed that interpersonal care from doctors and nurses had the strongest association with overall satisfaction. An assessment of differential item functioning revealed that patients with a socially marginalized caste reported higher disrespectful care, though this did not translate into differences in reported satisfaction. Content validity indexing suggested that discordance between experiences of disrespectful care and satisfaction ratings might be due to low patient expectations.
Using satisfaction ratings without nuanced approaches in value-based purchasing programmes may mask poor-quality interpersonal services, particularly for historically marginalized patients. Surveys should be designed to accurately capture true levels of dissatisfaction, ensuring that patient concerns are not hidden.
探讨一般住院患者满意度调查如何作为医院绩效衡量指标。
我们在印度奥里萨邦进行了一项医院消费者评估健康提供者和系统调查的混合方法试点研究。我们将研究分为三个步骤：调查的认知测试、探索性因子分析和内容效度指数的项目测试。认知测试涉及 50 名参与者讨论他们对调查项目的解释。然后在奥里萨邦的五家公立医院对 507 名住院患者进行了调查，随后进行了探索性因子分析。最后，我们采访了 15 个人，以评估调查项目的内容效度。
认知测试显示，18 个调查问题中有 6 个在奥里萨邦住院患者环境中理解不一致，突出了对护理责任的问题。探索性因子分析确定了一个由 6 个因素组成的结构，解释了 66.7%的方差。回归模型显示，医生和护士的人际护理与整体满意度的关联最强。差异项目功能评估显示，社会边缘化种姓的患者报告了更高的不尊重护理，但这并没有转化为报告满意度的差异。内容效度指数表明，不尊重护理和满意度评分之间的不和谐可能是由于患者的期望较低。
在基于价值的购买计划中使用满意度评分而不采用细致的方法可能会掩盖低质量的人际服务，特别是对历史上处于边缘地位的患者。调查应该设计为准确捕捉真实的不满水平，确保患者的担忧不会被隐藏。
