title: Development and validation of the Consumer Quality index instrument to measure the experience and priority of chronic dialysis patients.
abstract: BACKGROUND
  Patient experience is an established indicator of quality of care. Validated tools that measure both experiences and priorities are lacking for chronic dialysis care, hampering identification of negative experiences that patients actually rate important.
  
  
  METHODS
  We developed two Consumer Quality (CQ) index questionnaires, one for in-centre haemodialysis (CHD) and the other for peritoneal dialysis and home haemodialysis (PHHD) care. The instruments were validated using exploratory factor analyses, reliability analysis of identified scales and assessing the association between reliable scales and global ratings. We investigated opportunities for improvement by combining suboptimal experience with patient priority.
  
  
  RESULTS
  Sixteen dialysis centres participated in our study. The pilot CQ index for CHD care consisted of 71 questions. Based on data of 592 respondents, we identified 42 core experience items in 10 scales with Cronbach's α ranging from 0.38 to 0.88; five were reliable (α ≥ 0.70). The instrument identified information on centres' fire procedures as the aspect of care exhibiting the biggest opportunity for improvement. The pilot CQ index PHHD comprised 56 questions. The response of 248 patients yielded 31 core experience items in nine scales with Cronbach's α ranging between 0.53 and 0.85; six were reliable. Information on kidney transplantation during pre-dialysis showed most room for improvement. However, for both types of care, opportunities for improvement were mostly limited.
  
  
  CONCLUSIONS
  The CQ index reliably and validly captures dialysis patient experience. Overall, most care aspects showed limited room for improvement, mainly because patients participating in our study rated their experience to be optimal. To evaluate items with high priority, but with which relatively few patients have experience, more qualitative instruments should be considered.
authors.affiliation: 1Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. s.n.vanderveer@amc.nl
authors.forename: Sabine N
authors.initials: SN
authors.lastname: van der Veer
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.forename: Ella
authors.initials: E
authors.lastname: Visserman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Beekman
authors.forename: Els W
authors.initials: EW
authors.lastname: Boeschoten
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: de Keizer
authors.forename: Lara
authors.initials: L
authors.lastname: Heuveling
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006437:Hemodialysis, Home / Q000523:psychology / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D010530:Peritoneal Dialysis / Q000523:psychology / Q000592:standards*; D011785:Quality Assurance, Health Care; D006435:Renal Dialysis / Q000523:psychology / Q000592:standards*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult