title: Impact of integration of clinical and outpatient units on cancer patient satisfaction.
abstract: OBJECTIVE
  There is an ongoing drive to measure and improve quality of care. Donabedians' quality framework with structure, process and outcome domains provides a useful hold to examine quality of care. The aim of this study was to address the effect of an intervention in hospital structure (integration of three units into one) with the purpose of improving processes (increase meeting, cooperation and communication between professionals and patients) and its effect on the outcome (cancer patient satisfaction).
  
  
  METHODS
  Pre-test-post-test.
  
  
  METHODS
  University Medical Center Utrecht, The Netherlands, Department of Medical Oncology.
  
  
  METHODS
  Cancer patients (n = 174, n = 97).
  
  
  METHODS
  Physical integration by bringing separately located units (outpatient clinic, day-care clinic, clinical ward) together in one wing of the hospital and adjustments in communication and coordination structures.
  
  
  METHODS
  Patient satisfaction questionnaire.
  
  
  RESULTS
  Satisfaction with care improved for six scales (27%) after integration. Effect sizes (ESs) ranged from 0.36 to 0.80, indicating a small to moderate effect. The most important improvement was found at the day-care clinic on aspects like 'the degree in which the nurses were informed about a patients situation', 'privacy', 'interior design', 'quality of hospital equipment', 'sanitary supplies' and 'waiting periods'. With regard to continuity and coordination of care, satisfaction increased for five items (28% of items concerning continuity and coordination of care). ESs ranged from 0.42 to 0.75.
  
  
  CONCLUSIONS
  Integration of three oncology units into one unit had a positive impact on care delivery processes and resulted in improved patient satisfaction concerning care and treatment.
authors.affiliation: Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Wessels
authors.forename: A
authors.initials: A
authors.lastname: de Graeff
authors.forename: G
authors.initials: G
authors.lastname: Groenewegen
authors.forename: K
authors.initials: K
authors.lastname: Wynia
authors.forename: M
authors.initials: M
authors.lastname: de Heus
authors.forename: J B H
authors.initials: JB
authors.lastname: Vos
authors.forename: P
authors.initials: P
authors.lastname: Tjia
authors.forename: C L J J
authors.initials: CL
authors.lastname: Kruitwagen
authors.forename: S C C M
authors.initials: SC
authors.lastname: Teunissen
authors.forename: Emile E
authors.initials: EE
authors.lastname: Voest
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000458:organization & administration*; D008875:Middle Aged; D009426:Netherlands; D009936:Organizational Innovation; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care / Q000458:organization & administration*