Health Services & inPatient Experience (HS&PE): Development of a patient-centered outcome measure for inpatient settings in Italy

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Anna Coluccia
Fabio Ferretti
Andrea Pozza
Francesca Lorini


Background. The evolution of health systems toward more patient-oriented services has led to emphasize the importance of evaluating aspects such as the humanization of the service and health communication, variables related to  patient health outcome. There is therefore a need for tools able to identify gaps in the behaviour of health professionals, which could improve patients’ health outcomes.Objective. The present study aims to present the psychometric properties of the questionnaire Health Services and Patient Experience (HS&PE). The tool was developed as an outcome measure of patient-centered care in inpatient settings.Methods. The questionnaire was administered to 724 inpatients overall at Santa Maria alle Scotte University Hospital of Siena in Italy. Analyses of the tool’s psychometric properties were performed using Exploratory and Confirmatory Factor Analyses along with the examination of the indices of internal consistency. A multiple linear regression with the stepwise method was conducted to evaluate the HS&PE three factors as predictors of overall satisfaction for the entire healthcare pathway.Results. The results suggested a structure based on three factors with a satisfactory fit to the model. The factors were identified as Humanization, Communication and the information received at hospital discharge (Enablement). The strongest determinant of satisfaction was the quality of communication.Conclusions. The HS&PE may be a useful tool to orient management policies toward training interventions with the aim of improving treatment efficacy from a Patient-centered perspective. Future research should investigate the relationship between the HS&PE three dimensions and health-related outcomes, like quality of life and treatment compliance.

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Mead, N., & Bower, P. (2000). Patient-centeredness: A conceptual framework and review of the empirical literature. Social Science and Medicine 51, 1087-1110.

Mead, N., & Bower, P. (2002). Patient-centered consultations and outcomes in primary care: a review of the literature. Patient Education Counseling 48, 51-61.

Mead, N., Bower, P., & Hann, M. (2000). The impact of general practicioners’ patient-centredness on patients’ post-consultation satisfaction and enablement. Social Science Medicine 55, 283-299.

Epstein, R.M., Franks, P., Fiscella, K., Cleveland, G., Shields, S.C., Meldrum, S.C., Kravitz, R.L., & Duberstein, P.R. (2005). Measuring patient-centred communication in Patient–Physician consultations: Theoretical and practical issues. Social Science and Medicine 61, 1516-1528.

Bertakis, K.D., & Azari, R. (2011). Determinants and outcomes of patient-centered care. Patient Education and Counseling 85, 46-52.

Zolnierek, K.B., & DiMatteo, M.R. (2009). Physician Communication and Patient Adherence to Treatment: A Meta-analysis. Medical Care 47, 826-834.

Groene, O., Lombarts, M.J.M.H., Klazinga, N., Alonso, J., Thompson, A., Sunol, R. (2009). Is patient-centredness in European hospitals related to existing quality improvement strategies? Analysis of a cross-sectional survey (MARQulS study). Quality and Safety in Health Care 18, 44-50.

Kaplan, S., Greenfield, S., & Ware, J. (1989). Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical Care 27, 110-127.

Kinmonth, A.L., Woodcock, A., Griffin, S., Spiegal, N., & Campbell, M.J. (1998). Randomised controlled trial of patient-centred care of diabetes in general practice: impact on current well-being and future disease risk. British Medical Journal 317, 1202-1208.

Strasser, S., Aharony, P., & Greenberger, D. (1993). The patient satisfaction process: Moving toward a comprehensive model. Medical Care Review 50, 219-248.

Wagner, E.H., Bennett, S.M., Austin, B.T., Greene, S.M., Schaefer, J.K., & Vonkorf, M. (2005). Finding common ground: Patient-centredness and evidence-based chronic illness care. Journal of Alternative and Complementary Medicine 11, 7-15.

Gowen, C.R., McFaddenb, K.L., Hooblerc, J.M., & Tallond, W.J. Exploring the efficacy of healthcare quality practices, employee, commitment and employee control. Journal of Operations Management 24, 765-778.

Williams, S., Weinmann, J., & Dale, J. (1998). Doctor-Patient communication and Patient satisfaction: A review. Family Practice 15, 480-492.

Gorkin L, Goldstein LG, & Follick MJ. Strategies for enhancing adherence in clinical trials. In Shumaker S.A., Shron E., Ockene J.K. (Eds.). The Handbook of Health Behaviour Change. New York: Springer; 1990.

Clever, S.L., Ford, D.E., Rubenstein, L.V., Rost, K.M., Meredith, L.S., Sherbourne, C.D., Wang, N., Arbelaez, J.J., & Cooper, L.A. (2006). Primary Care Patients' Involvement in Decision-Making Is Associated With Improvement in Depression. Medical Care 44, 398-405.

Coulter, A., Entwistle, V., & Gilbert, D. (1999). Sharing decisions with patients: Is the information good enough?. British Medical Journal 318, 318-322.

Griffin, S.J., Kinmonth, A., Veltman, M.W.M., Gillard, S., Grant, J., & Stewart, M.A. (2004). Effect on Health-Related Outcomes of Interventions to Alter the Interaction Between Patients and Practitioners: A Systematic Review of Trials. Annals Family Medicine 2, 595-608.

Stewart, M.A. (1995). Effective physician-patient communication and health outcomes: A review. Canadian Medical Association Journal 152, 1423-1433.

Epstein, R.M., Franks, P., Shields, C.G., Meldrum, S.C., Miller, K.N., Campbell, T.L., & Fiscella, K. (2005). Patient-centred communication and diagnosis testing. Annals of Family Medicine 3, 415–21.

Jenkinson, C., Coulter, A., Bruster, S., Richards, N., & Chandola, T. (2002). Patients’ experience and satisfaction with healthcare: results of a questionnaire study of specific aspects of care. Quality and Safety in Health Care 11, 335-339.

Van Campen, C., Sixma, H., Friele, R.D., Kerssens, J.J., & Peters, L. (1995). Quality of care and patient satisfaction: A review of measuring instruments. Medical Care and Research Review 52, 109-133.

Lewis, J.R. (1994). Patients views on quality care in general practice: Literature review. Social Science and Medicine 39, 655-670.

Wensing, M., Jung, H.P., Mainz, J., Olesen, F., & Grol, R. (1998). A systematic review of the literature on patient priorities for general practice care. Social Science and Medicine 47, 1573-1588.

Calnan, M. (1983). Managing minor disorders. Journal of Sociology and Health and Illness 5, 149-167.

Stewart, M., Brown, J.B., Donner, A., McWhinney, I.R., Oates, J., Weston, W.W., & Jordan, J. (2000). The impact of patient-centered care on outcomes. Journal of Family Practice 49, 796-804.

Lamiani, G., Meyer, E.C., Rider, E.A., Browning, D.A., Vegni, E., Mauri, E., Moja, E.A., & Truog, R.D. (2008). Assumptions and blind spots in patient-centredness: action research between American and Italian health care professionals. BMC Medical Education 42, 712-720.

Cortina, J.M. (1993). What is coefficient alpha: an examination of theory and applications. Journal of Applied Psychology 78, 98-104.

Kaiser, H.F. (1974). An index of factorial simplicity. Psychometrika 39, 31-36.

Tabachnick, B.G., & Fidell, L.S. (1996). Using multivariate statistics. New York: Harper Collins.

Bartlett, M.S. (1954). A note on the multiplying factors for various χ² approximation. Journal of Royal Statistics Society Series B 16, 296-298.

Costello, A.B., & Osborne, J.W. (2005). Best Practices in Exploratory Factor Analysis: Four Recommendations for Getting the Most From Your Analysis. Practical Assessment Research and Evaluation 7, 1-9.

Bollen, K.A. (1989). Structural Equations with Latent Variables. New York: John Wiley & Sons.

Jöreskog, K., Sörbom, D., du Toit, S., & du Toit, M. (2000). LISREL 8: New Statistical Features. Lincolnwood: Scientific Software International.

Joosten, E.A.G., DeFuentes-Merillas, L., de Weert, G.H., Sensky, T., van der Staak, C.P.F., & de Jong, C.A.J. (2008). Systematic Review of the Effects of Shared Decision-Making on Patient Satisfaction, Treatment Adherence and Health Status. Psychotherapy and Psychosomatics 77, 219-226.

Kinnersley, P., Stott, N., Peters, T.J., & Harvey, I. (1999). The patient-centredness of consultations and outcome in primary care. British Journal of General Practice 49, 711-716.

Street, R.L. (1991). Physicians' Communication and Parents' Evaluations of Paediatric Consultations. Medical Care 29, 1146-1152.

Ong, L.M.L., Visser, M.R.M., Lammes, F.B., & De Haes, J.C.J.M.. (2000). Doctor–Patient communication and cancer patients’ quality of life and satisfaction. Patient Education and Counseling 41, 145-156.

Castle, N.G., Brown, J., Hepner, K.A., & Hays, R.D. (2005). Review of the literature on survey instruments used to collect data on hospital patients' perceptions of care. Health Services Research 40, 1996-2017.

Beisdecker, A.E., & Beisdecker, T.D. Patient-information-seeking behaviors when communicating with doctors. Medical Care 28, 19-28.

Street, R.L. (1991). Information-giving in medical consultations: the influence of patients’ communicative styles and personal characteristics. Social Science and Medicine 32, 541-548.

Post, D.M., Cegala, D.J., & Miser, W.F. (2002). The other half of the whole: teaching patients to communicate with physicians. Family Medicine 34, 344-352.

Haskard, K.B., Williams, S.L., DiMatteo, M.R., Rosenthal, R., Whit,e M.K., & Goldstein, M.G. (2008). Physician and patient communication training in primary care: Effects on participation and satisfaction. Health Psychology 27, 513-522.

Leiter, P.M., Harvie, P., & Frizzell, C. (1998). The correspondence of patient satisfaction and nurse burn out. Social Science and Medicine 47, 1611-1617.