Satisfaction/ behavioral indices

1. Satisfaction/behavioral indices Wei-Chu Chie outcome research

2. Background • Over the past decade/market-oriented care • an indicator of quality of care • multi-level performance assessment • development of patient care models • quality assurance, cost improvement, total quality management, cost-effectiveness outcome research

3. Health care policy/management • Structure • Process • Outcome • Donnabedian, 1966 outcome research

4. Anderson’s health behavior model • Predisposing • enabling • need • utilization • satisfaction outcome research

5. Rationales & arguments • Patient can play an important role in defining how health are is delivered. • Patients can play an important role in defining quality of care by determining what values should be associated with different outcomes. • The quality of physicians’ interpersonal skills influences patient outcomes. outcome research

6. Rationales & arguments • Satisfaction can affect outcomes through a placebo effect, which in some instances, has shown to contribute to up to one-third of the actual healing process. • As medical care increasingly becomes a consumer good, patient (consumer) satisfaction becomes more salient. outcome research

7. Definition of patient satisfaction • A health care recipient’s reaction to salient aspects of his or her service experience • Pascoe, 1983 outcome research

8. Definition of patient satisfaction • A patient’s (affective or emotional) response to his or her (cognitive or knowledge-based) evaluation of the health care provider’s performance (perceived quality) during a health care consumption experience • Ross et al., 1987 outcome research

9. Basic components • Emotional or cognitive evaluation of a health care provider’s performance • based on relevant aspects of the experience outcome research

10. Fields involved • Marketing research • clinical practice • information asymmetry • subjective in nature outcome research

11. Aspects • Interpersonal • accessibility, availability & convenience • continuity • physical setting • technical quality • efficacy • financial consideration outcome research

12. Marketing models • Multi-dimensional, dynamic construct • vary across time • emotional + cognitive • comparison with expectations • physician may influence expectations outcome research

13. Clinical models • A distinct outcome of care closely related to health status outcomes • overall (gestalt) + particular • subjective, influenced by experiences • based on investigator’s conception outcome research

14. Measurement • Problems of amorphous (abstract) concept measurement • different dimensions can show different results • overall • specific: multi-dimensional • Likert’s scale vs. visual analog scale outcome research

15. Existing tools • GHAA survey • Picker/commonwealth • patient satisfaction scale (PSS) • CAHPS • Oberst visual analog scale • SAT32 (EORTC) outcome research

16. GHAA survey • Group Health Association of America • 60 questions: multi- + single-item scales • provider • care (general) • health plan/health insurance • use of care • personal characteristics outcome research

17. Picker/commonwealth • Hospital satisfaction survey • 52 questions • communication • financial information • patient’s needs and preferences • emotional support • physical support outcome research

18. Picker/commonwealth • Pain management • education • family participation • discharge preparation/continuity of care outcome research

19. Patient satisfaction scale (PSS) • 27 questions • 4 subscales/25 questions • communication abilities • affective behavior • technical competence • general satisfaction • 2 questions: job and family outcome research

20. CAHPS • Consumer assessment of health plans study • a future project • access, communication, interaction • continuity & coordination • preventive care • administrative burden • health plan’s customer service outcome research

21. CAHPS • Enrollment • personal contribution toward the premium • health status • respondent characteristics outcome research

22. Oberst VAS • Visual analog between 1 and 0: • far expected my expectations/the best... and • did not meet my expectations at all/the worst .. • six questions • the care: nursing/medical • information: self-care/illness • recommendation or not (Likert’s scale) outcome research

23. EORTC-SAT32 • Supplementary for EORTC QLQ-C30 • Likert’s scale • 32 questions/three parts • physician • nursing • knowledge, skill, manner, attention, ... • Organization • accessibility, convenience, building, ... outcome research

24. Health education and health care intervention • Health behaviors* • Self-efficacy* • Health status • Health care utilization • Chronic diseases self-management program • Lorig et al., 1996 outcome research

25. Health behaviors • Primary prevention: • Exercise, diet, smoking, alcohol, … • Stress coping, injury prevention, ... • Immunization and chemoprophylaxis • Secondary prevention: screening • cancer • cardiovascular, … • Tertiary prevention • compliance, disease management and self-care outcome research

26. Health behaviors: nature • Usually short-term • directly associated with education • less predictable to further outcomes • sometimes abstract: • knowledge/cognition/perception • attitude/beliefs • practices outcome research

27. Health behaviors: measurement • Observation • Questionnaire • frequency • intensity outcome research

28. Self-efficacy • Confidence to perform certain behaviors • health behaviors • disease management • compliance and self-care • community participation • usually/special conditions outcome research

29. Efficacy assessment • Comparison of different groups • Direct comparison of outcome status/values • compare and reassure the comparability of baseline • adjust the baseline • Change of status/values: • change from baseline • Choice of methods of comparison • based on goals & hypothesis outcome research

30. Efficacy assessment: examples • Status • disease/well alive/death • change of status: event • from well to disease • from alive to death • values • BP vs. BP change from baseline • Qol vs. QoL change from baseline outcome research