title: Patient-identified quality indicators for colonoscopy services.
abstract: BACKGROUND
  Current quality improvement tools for endoscopy services, such as the Global Rating Scale (GRS), emphasize the need for patient-centred care. However, there are no studies that have investigated patient expectations and/or perceptions of quality indicators in endoscopy services.
  
  
  OBJECTIVE
  To identify quality indicators for colonoscopy services from the patient perspective; to rate indicators of importance; to determine factors that influence indicator ratings; and to compare the identified indicators with those of the GRS.
  
  
  METHODS
  A two-phase mixed methods study was undertaken in Montreal (Quebec), Calgary (Alberta) and Hamilton (Ontario) among patients ≥18 years of age who spoke and read English or French. In phase 1, focus group participants identified quality indicators that were then used to construct a survey questionnaire. In phase 2, survey questionnaires, which were completed immediately after colonoscopy, prompted respondents to rate the 20 focus group-derived indicators according to their level of importance (low, medium, high) and to list up to nine additional items. Multiple logistic regression analysis was used to determine the factors that influenced focus group-derived indicator ratings. Patient-identified indicators were compared with those used in the GRS to identify novel indicators.
  
  
  RESULTS
  Three quality indicator themes were identified by 66 participants in 12 focus groups: communication, comfort and service environment. Of the 828 surveys distributed, 402 (48.6%) were returned and 65% of focus group-derived indicators were rated highly important by at least 55% of survey respondents. Indicator ratings differed according to age, sex, site and perceived colorectal cancer risk. Of the 29 patient-identified indicators, 17 (58.6%) were novel.
  
  
  CONCLUSIONS
  Patients identified 17 novel quality indicators, suggesting that patients and health professionals differ in their perspectives with respect to quality in colonoscopy services.
authors: Department of Medicine, McGill University, Montreal, Quebec. maida.sewitch@mcgill.ca
authors: Maida J
authors: MJ
authors: Sewitch
authors: Catherine
authors: C
authors: Dubé
authors: Stephanie
authors: S
authors: Brien
authors: Mengzhu
authors: M
authors: Jiang
authors: Robert J
authors: RJ
authors: Hilsden
authors: Alan N
authors: AN
authors: Barkun
authors: David
authors: D
authors: Armstrong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D003113:Colonoscopy / Q000379:methods / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D017144:Focus Groups; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011792:Quebec; D011795:Surveys and Questionnaires; D055815:Young Adult
references: CMAJ. 1994 Jun 1;150(11):1801-9
references: 8199957
references: Gastroenterology. 2007 Jun;132(7):2297-303
references: 17570204
references: Best Pract Res Clin Gastroenterol. 2002 Apr;16(2):187-99
references: 11969233
references: QRB Qual Rev Bull. 1992 Nov;18(11):356-60
references: 1465293
references: J Behav Med. 2003 Jun;26(3):245-64
references: 12845937
references: Am J Gastroenterol. 2011 Jul;106(7):1182-7
references: 21731014
references: Can J Gastroenterol. 2011 Oct;25(10):547-54
references: 22059159
references: Clin Gastroenterol Hepatol. 2010 Mar;8(3):275-9
references: 19879970
references: J Rheumatol. 2003 Jun;30(6):1326-34
references: 12784410
references: Can J Gastroenterol. 2007 Dec;21(12):797-801
references: 18080050
references: Annu Rev Public Health. 2005;26:513-59
references: 15760300
references: Can J Gastroenterol. 2008 Jan;22(1):17-22
references: 18209776
references: Cancer. 2000 May 15;88(10):2398-424
references: 10820364
references: Health Mark Q. 2006;23(3):59-77
references: 18681199
references: Am J Gastroenterol. 2006 Apr;101(4):873-85
references: 16635231
references: Health Serv Res. 2005 Dec;40(6 Pt 2):2018-36
references: 16316436
references: Can J Gastroenterol. 2006 Jun;20(6):405-10
references: 16779458
references: Can J Gastroenterol. 2011 Jan;25(1):13-20
references: 21258663
references: Can J Gastroenterol. 2008 Feb;22(2):155-60
references: 18299734
references: JAMA. 2010 Nov 17;304(19):2103-4
references: 21081716
references: Can J Gastroenterol. 2008 Feb;22(2):161-7
references: 18299735
references: Nurs Stand. 1992 Dec 2-8;7(11 Suppl QA):4-5
references: 1489693
references: BMJ. 2003 Apr 19;326(7394):877-9
references: 12702627
references: Best Pract Res Clin Gastroenterol. 2010 Aug;24(4):451-64
references: 20833349
references: Can J Gastroenterol. 2011 Dec;25(12):681-5
references: 22175059
references: Patient Educ Couns. 2012 Feb;86(2):137-46
references: 21640543