Involving patients in detecting quality gaps in a fragmented healthcare system: development of a questionnaire for Patients' Experiences Across Health Care Sectors (PEACS).
OBJECTIVE
The purpose of this study was to develop and validate a generic questionnaire to evaluate experiences and reported outcomes in patients who receive treatment across a range of healthcare sectors.


METHODS
Mixed-methods design including focus groups, pretests and field test.


METHODS
The patient questionnaire was developed in the context of a nationwide program in Germany aimed at quality improvements across the healthcare sectors.


METHODS
For the field test, 589 questionnaires were distributed to patients via 47 general practices.


METHODS
Descriptive item analyzes non-responder analysis and factor analysis (PCA). Retest coefficients (r) calculated by correlation of sum scores of PCA factors. Quality gaps were assessed by the proportion of responders choosing a response category defined as indicating shortcomings in quality of care.


RESULTS
The conceptual phase showed good content validity. Four hundred and seventy-four patients who received a range of treatment across a range of sectors were included (response rate: 80.5%). Data analysis confirmed the construct, oriented to the patient care journey with a focus on transitions between healthcare sectors. Quality gaps were assessed for the topics 'Indication', including shared-decision-making (6 items, 24.5-62.9%) and 'Discharge and Transition' (10 items; 20.7-48.2%). Retest coefficients ranged from r = 0.671 until r = 0.855 and indicated good reliability. Low ratios of item-non-response (0.8-9.3%) confirmed a high acceptance by patients.


CONCLUSIONS
The number of patients with complex healthcare needs is increasing. Initiatives to expand quality assurance across organizational borders and healthcare sectors are therefore urgently needed. A validated questionnaire (called PEACS 1.0) is available to measure patients' experiences across healthcare sectors with a focus on quality improvement.
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Stefan
S
Noest
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Sabine
S
Ludt
AQUA-Institute for Applied Quality Improvement and Research in Healthcare, Goettingen, Germany.
Anja
A
Klingenberg
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Katharina
K
Glassen
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Friederike
F
Heiss
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Dominik
D
Ose
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Justine
J
Rochon
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Kayvan
K
Bozorgmehr
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Michel
M
Wensing
Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany AQUA-Institute for Applied Quality Improvement and Research in Healthcare, Goettingen, Germany.
Joachim
J
Szecsenyi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005163:Factor Analysis, Statistical; D005260:Female; D017144:Focus Groups; D005858:Germany; D019981:Health Care Sector / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D015203:Reproducibility of Results; D012107:Research Design; D011795:Surveys and Questionnaires
measurement of quality; patient satisfaction; patient-centered care; quality improvement; quality management; quality measurement