title: Patient-reported service quality on a medicine unit.
abstract: OBJECTIVE
  Service quality, defined as patients' self-reported experience of care, is used as a metric for evaluating quality. Most studies rely on retrospective consumer surveys rather then more intensive data collection methods, possibly underestimating the incidence of service quality incidents.
  
  
  METHODS
  The objective of the study was to characterize patient-reported service quality deficiencies on a general medicine unit. We studied a cohort of 228 adult inpatients at a Boston teaching hospital. Investigators reviewed medical records and interviewed patients during the hospitalization and by telephone after discharge. Physician investigators classified patients' incident reports. We calculated the rate of service incidents, characterized incident types, and used multivariable Poisson and logistic regression models to examine factors associated with patient reporting and overall rating of the hospitalization.
  
  
  RESULTS
  Eighty-eight (38.6%) of 228 patients experienced 157 service quality incidents during the admission, for a rate of 68.9 incidents per 100 admissions. The most common service quality problems involved waits and delays (n = 45), problems with communication between staff and patients (n = 36), and environmental issues and amenities (n = 35). In the multivariable analysis, men (IRR 1.6, 95% CI 1.1-2.2), patients covered by hospitalists (1.5, 1.1-2.2), and patients with more medication allergies (1.1 per allergy, 1.1-1.2) reported more service incidents; patients with Medicaid or free care reported fewer (0.5, 0.3-0.9). Patients with service quality incidents were more likely to describe the hospitalization as other than excellent (adjusted OR 1.8 per incident, 95% CI 1.3-2.5).
  
  
  CONCLUSIONS
  Service quality deficiencies are common among medical inpatients, and are strongly associated with patients' dissatisfaction with the hospitalization.
authors.affiliation: Center for Patient Safety, Dana-Farber Cancer Institute, Boston, MA 02115, USA. saul_weingart@dfci.harvard.edu
authors.forename: Saul N
authors.initials: SN
authors.lastname: Weingart
authors.forename: Odelya
authors.initials: O
authors.lastname: Pagovich
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Sands
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Li
authors.forename: Mark D
authors.initials: MD
authors.lastname: Aronson
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Russell S
authors.initials: RS
authors.lastname: Phillips
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D015331:Cohort Studies; D005260:Female; D019538:Health Care Surveys; D006757:Hospital Units / Q000592:standards*; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007407:Interviews as Topic; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D018802:Patient-Centered Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care