Patients' experiences and clinicians' ratings of the quality of outpatient teams in psychiatric care units in Norway.
OBJECTIVE
Patients' experiences and satisfaction ratings are increasingly used to evaluate quality of care. This study assessed the extent to which outpatient teams, clinics, and health trusts contributed to patients' experiences and to what extent clinicians' evaluations of quality were related to patients' experiences.


METHODS
A questionnaire was mailed to 15,422 outpatients who attended Norwegian clinics in September 2004; 43% responded. Patients' experiences were measured on an 11-item index and three subscales: outcomes, interaction with clinicians, and information. Aggregated responses from clinicians were linked to the data on patients' experiences. Multilevel analyses were used to divide the variance between the different organizational levels and to assess the relationship with clinicians' opinions and individual-level factors.


RESULTS
Data were analyzed for 6,570 outpatients within 222 teams derived from 89 outpatient clinics within 33 health trusts. Differences in patients' scores were determined largely at the patient level, with teams accounting for 2% of the total variance and organizational levels of clinics and health trusts not contributing to patients' experiences. Team-level clinician quality scores were not significantly associated with patients' experiences. Better experiences were significantly associated with patients' female gender, older age, better self-perceived health, absence of an inpatient history, longer treatment episodes, frequent consultations, and waiting times perceived as acceptable.


CONCLUSIONS
The organizational contributions to patients' experience scores were minimal. Although clinicians' ratings of quality are not a substitute for patients' perceptions of quality, surveys of outpatients' experiences and satisfaction may not be appropriate for cross-sectional comparisons of health care providers.
Bjørngaard
Johan Håkon
JH
SINTEF-Health Services Research, Trondheim, 7465 Norway. jhb@sintef.no
Ruud
Torleif
T
Garratt
Andrew
A
Hatling
Trond
T
D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D008875:Middle Aged; D009664:Norway; D010348:Patient Care Team / Q000592:standards*; D017060:Patient Satisfaction; D011567:Psychiatric Department, Hospital / Q000592:standards*; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014850:Waiting Lists