title: The Global Rating Scale in clinical practice: a comprehensive quality assurance programme for endoscopy departments.
abstract: BACKGROUND
  The Global Rating Scale is an endoscopy quality assurance programme, successfully implemented in England. It remains uncertain whether it is applicable in another health care setting.
  
  
  OBJECTIVE
  To assess the applicability of the Global Rating Scale as benchmark tool in an international context.
  
  
  METHODS
  Eleven Dutch endoscopy departments were included for a Global Rating Scale-census, performed as a cross-sectional evaluation, July 2010. Two Global Rating Scale-dimensions - 'clinical quality' and 'patient experience' - were assessed across six items using a range of levels: from level-D (basic) to level-A (excellent). Construct validity was assessed by comparing department-specific colonoscopy audit data to GRS-levels.
  
  
  RESULTS
  For 'clinical quality', variable scores were achieved in items 'safety' (9%=B, 27%=C, 64%=D) and 'communication' (46%=A, 18%=C, 36%=D). All departments achieved a basic score in 'quality' (100%=D). For 'patient experience', variable scores were achieved in 'timeliness' (18%=A, 9%=B, 73%=D) and 'booking-choice' (36%=B, 46%=C, 18%=D). All departments achieved basic scores in 'equality' (100%=D). Departments obtaining level-C or above in 'information', 'comfort', 'communication', 'timeliness' and 'aftercare', achieved significantly better audit outcomes compared to those obtaining level-D (p<0.05).
  
  
  CONCLUSIONS
  The Global Rating Scale is appropriate to use outside England. There was significant variance across departments in dimensions. Most Global Rating Scale-levels were in line with departments' audit outcomes, indicating construct validity.
authors: The Departments of Gastroenterology and Hepatology of Erasmus MC University Medical Center, Rotterdam, The Netherlands. j.sintnicolaas@erasmusmc.nl
authors: Jerome
authors: J
authors: Sint Nicolaas
authors: Vincent
authors: V
authors: de Jonge
authors: Robert A
authors: RA
authors: de Man
authors: Frank
authors: F
authors: ter Borg
authors: Djuna L
authors: DL
authors: Cahen
authors: Willem
authors: W
authors: Moolenaar
authors: Mark F J
authors: MF
authors: Stolk
authors: Antonie J P
authors: AJ
authors: van Tilburg
authors: Roland M
authors: RM
authors: Valori
authors: Monique E
authors: ME
authors: van Leerdam
authors: Ernst J
authors: EJ
authors: Kuipers
mesh_terms: D019985:Benchmarking; D016145:Endoscopy, Digestive System / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods*