Do patient experiences on priority aspects of health care predict their global rating of quality of care? A study in five patient groups.
BACKGROUND
Patient-given global ratings are frequently interpreted as summary measures of the patient perspective, with limited understanding of what these ratings summarize. Global ratings may be determined by patient experiences on priority aspects of care.


OBJECTIVE
(i) identify patient priorities regarding elements of care for breast cancer, hip- or knee surgery, cataract surgery, rheumatoid arthritis and diabetes, (ii) establish whether experiences regarding priorities are associated with patient-given global ratings, and (iii) determine whether patient experiences regarding priorities are better predictors of global ratings than experiences concerning less important aspects of care.


METHODS
Data collected for the development of five consumer quality index surveys - disease-specific questionnaires that capture patient experiences and priorities - were used.


RESULTS
Priorities varied: breast cancer patients for example, prioritized rapid access to care and diagnostics, while diabetics favoured dignity and appropriate frequency of tests. Experiences regarding priorities were inconsistently related to global ratings of care. Regression analyses indicated that demographics explain 2.4-8.4% of the variance in global rating. Introducing patient experiences regarding priorities increased the variance explained to 21.1-35.1%; models with less important aspects of care explained 11.8-23.2%.


CONCLUSIONS
Some experiences regarding priorities are strongly related to the global rating while others are poorly related. Global ratings are marginally dependent on demographics, and experiences regarding priorities are somewhat better predictors of global rating than experiences regarding less important elements. As it remains to be fully determined what global ratings summarize, caution is warranted when using these ratings as summary measures.
de Boer
Dolf
D
Patient Centered Care, NIVEL, Utrecht, The Netherlands. d.deboer@nivel.nl
Delnoij
Diana
D
Rademakers
Jany
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000458:organization & administration*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult