title: The ENDOCARE questionnaire guides European endometriosis clinics to improve the patient-centeredness of their care.
abstract: OBJECTIVE
  How patient-centered are two included specialized endometriosis clinics relative to each other and how can they improve the patient-centeredness of their care?
  
  
  CONCLUSIONS
  The validated ENDOCARE questionnaire (ECQ) reliably concluded that the adjusted overall patient-centeredness did not differ between the clinics, that each clinic was significantly more patient-centered for 2 out of 10 dimensions of patient-centered endometriosis care and that clinics 1 and 2 had to improve 8 and 13 specific care aspects, respectively.
  
  
  BACKGROUND
  Patient-centered endometriosis care is essential to high-quality care and is defined by 10 dimensions. The ECQ was developed, validated and proved to be reliable in a European setting of self-reported endometriosis patients but had not yet been used at a clinic level for quality management.
  
  
  METHODS
  A cross-sectional survey was disseminated in 2011 to all 514 women diagnosed with endometriosis during a laparoscopy indicated for pain and/or infertility during a retrospective 2-year period (2009-2010) in two university clinics from two different European countries.
  
  
  METHODS
  In total 337 patients completed the ECQ (216 and 121 per clinic). Respondents had a mean age of 34.3 years. Three in four reported a surgical diagnosis of moderate or severe endometriosis and the majority reported surgical treatment by a multidisciplinary team. The ECQ assessed the 10 dimensions of patient-centeredness, more specifically whether the health-care performance, as perceived by patients, measured up to what is important to patients in general.
  
  
  RESULTS
  The ECQ was completed by 337 respondents (response rate = 65.6%). Reliability and validity of the ECQ for use on clinic level were confirmed. Clinics did not differ in overall mean importance scores; importance rankings of the ECQ dimensions were almost identical. The overall patient-centeredness scores (PCS), adjusted for education level, did not discriminate between the clinics. However, the adjusted PCS for the dimensions 'clinic staff' and 'technical skills' were significantly better in clinic 1, whereas the dimensions 'physical comfort' and 'access to care' were significantly better in clinic 2. There were 8 (clinic 1) and 13 (clinic 2) targets identified for joint and cross-clinic improvement.
  
  
  CONCLUSIONS
  Response rates were relatively high. Recall bias was the most important limitation and research in more clinics is needed to define the statistical discriminative value of the ECQ.
  
  
  CONCLUSIONS
  European endometriosis clinics can use the validated ECQ for reliable assessment of their 'patient-centeredness', for comparison with others and for setting specific targets to improve the patient-centeredness of their endometriosis care, to plan interventions, and to evaluate their effectiveness.
  
  
  BACKGROUND
  This work was funded by KU Leuven and European Network of Endometriosis (ENE), supported by the European Commission (Public Health Executive Agency). No competing interests are declared.
authors.affiliation: Leuven University Hospital, Leuven University Fertility Centre, Herestraat 49, 3000, Leuven, Belgium. eline.dancet@uz.kuleuven.be
authors.forename: E A F
authors.initials: EA
authors.lastname: Dancet
authors.forename: S
authors.initials: S
authors.lastname: Apers
authors.forename: K B
authors.initials: KB
authors.lastname: Kluivers
authors.forename: J A M
authors.initials: JA
authors.lastname: Kremer
authors.forename: W
authors.initials: W
authors.lastname: Sermeus
authors.forename: C
authors.initials: C
authors.lastname: Devriendt
authors.forename: W L D M
authors.initials: WL
authors.lastname: Nelen
authors.forename: T M
authors.initials: TM
authors.lastname: D'Hooghe
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001530:Belgium; D003430:Cross-Sectional Studies; D004715:Endometriosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D009426:Netherlands; D010044:Outpatient Clinics, Hospital; D017060:Patient Satisfaction; D057285:Precision Medicine / Q000379:methods*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires