title: Use of an open-ended question to supplement a patient satisfaction questionnaire in a medical residents' clinic.
abstract: OBJECTIVE
  To determine (1) the proportion of responses to an open-ended question related to patient satisfaction that could be categorized into 1 or more of 9 previously developed domains of out-patient care and (2) whether any other important aspects of care could be identified by adding the open-ended question to a satisfaction questionnaire.
  
  
  METHODS
  A 3-month observational study was done at the internal medicine clinic of an urban teaching hospital.
  
  
  METHODS
  As part of a patient satisfaction study, 511 visitors were asked after their visit, "What are the 1 or 2 things that are most important to you when you see a doctor?" The responses were categorized independently by 2 raters into 1 or more of the 9 domains. When these 2 raters disagreed, the responses were read to a third rater. When either all 3 raters disagreed, or at least 1 rater thought a new domain was mentioned, those responses were categorized by consensus. Interobserver reliability between raters 1 and 2 was calculated by using Cohen's kappa statistic.
  
  
  RESULTS
  The 355 responses were categorized as follows: 303 (85.4%) identified one or more domains that were part of the previously developed taxonomy, 9 (2.5%) identified a new domain, 11 (3.1%) identified both old and new domains, and 32 (9.0%) could not be categorized. Cohen's kappa was 0.57 (P < .001). Cultural sensitivity and physician honesty were the additional domains identified, by 1.1% and 4.5% of respondents, respectively.
  
  
  CONCLUSIONS
  The previously developed taxonomy of domains can be used in this setting to categorize the large majority of open-ended responses. Such responses can identify important aspects of care that were either previously unidentified or were already identified but given low ratings. This information then can help improve quality of care.
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA. bbialor@intmed.wayne.edu
authors.forename: B D
authors.initials: BD
authors.lastname: Bialor
authors.forename: J L
authors.initials: JL
authors.lastname: Musial
authors.forename: G E
authors.initials: GE
authors.lastname: Rojas
authors.forename: M J
authors.initials: MJ
authors.lastname: Fagan
mesh_terms: D000328:Adult; D005260:Female; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration / Q000592:standards*; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D017060:Patient Satisfaction; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires; D017749:Total Quality Management; D014481:United States