title: A comparison of the quality of care in accident and emergency departments in England and the Netherlands as experienced by patients.
abstract: Measuring patients' experiences to determine health-care performance and quality of care from their perspective can provide valuable evidence for international improvements in the quality of care. We compare patients' experiences in Accident & Emergency departments (A&E) in England and the Netherlands and discuss the usefulness of this comparison.
  
  
  
  A cross-sectional survey was conducted among patients attending A&Es aged 18 years and older. In England, 134 A&Es were surveyed. In the Netherlands, nine hospitals participated in the study. Main outcome measures were patients' experiences represented by six domain scores aggregated on the country level or on the A&E level.
  
  
  
  In England, 43 892 completed questionnaires were received (40%). In the Netherlands, 1865 completed questionnaires were received (42%). Three of six domain scores were significantly higher for patients in the Netherlands: 'waiting time' [mean scores of 73.8 (NL) versus 67.2 (ENG)], 'doctors and nurses' [mean scores of 85.7 (NL) versus 80.6 (ENG)] and 'your care and treatment' [mean scores of 82.6 (NL) and 80.2 (ENG)]. The variance among the English A&Es was large. The best and worst practices on five domains were English.
  
  
  
  The mean quality of care in the A&E appeared to be better in the Netherlands on three domains, but the best practices were English A&Es. The within-country differences between A&Es were much larger than differences between countries. Healthcare performance in the A&E can be compared between countries by surveying patients' experiences, and there seems much to learn across A&Es both within and among countries.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Nanne
authors.initials: N
authors.lastname: Bos
authors.affiliation: Care Quality Commission, London, UK.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Seccombe
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Dutch Network for Acute Care, Tilburg, The Netherlands.
authors.forename: Leontien M
authors.initials: LM
authors.lastname: Sturms
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stellato
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Augustinus J P
authors.initials: AJ
authors.lastname: Schrijvers
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Henk F
authors.initials: HF
authors.lastname: van Stel
mesh_terms: D000059:Accidents; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010361:Patients; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D020379:Risk Adjustment; D013222:State Medicine; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: across-country comparison; emergency care; emergency service; hospital; patient satisfaction; patients’ experiences; quality indicators