title: Exploring the relationships between patient characteristics and their dialysis care experience.
abstract: BACKGROUND
  Previous studies have shown that it is possible for patient experience to be influenced by factors that are not attributable to health-care. Therefore, if patient experience is to be used as an accurate indicator of clinical performance, then it is important to understand its determinants.
  
  
  METHODS
  We used data from 840 dialysis patients who completed a validated patient experience survey. We created a potential theoretical framework based on available clinical knowledge to hypothesize the relationships between 13 demographic, socio-economic and health status factors and three outcome measures: global rating of the dialysis centre and the patient experience with the nephrologist's and nurses' care. The theoretical framework guided the selection of confounding variables for each determinant, which were then entered as terms in multivariable linear regression models.
  
  
  RESULTS
  Patients who were of older age, of non-European decent, and who had a lower educational level, lower albumin level, with better self-rated health and who were without co-morbidities reported higher global ratings with the dialysis centre than their counterparts. Past myocardial infarction and better self-rated health were found to be determinants of a more positive experience while in the nephrologist's care. A more positive experience with nurses' care was associated with factors including older age, Dutch origin background, lower educational level, lower albumin levels and better self-rated health.
  
  
  CONCLUSIONS
  Several characteristics of dialysis patients influence the way they rate and experience their care. When using the patient experience and ratings as indicators of clinical performance, they should be adjusted for such factors as identified in our study. This will facilitate a meaningful comparison of dialysis centres, and enable informed decision making by patients, insurers and policy makers.
authors.affiliation: Department 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: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.forename: Ella
authors.initials: E
authors.lastname: Visserman
authors.forename: Hans A J
authors.initials: HA
authors.lastname: Bart
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: de Keizer
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
authors.forename: Lara M
authors.initials: LM
authors.lastname: Heuveling
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires