title: Assessing overall patient satisfaction in inflammatory bowel disease using structural equation modeling.
abstract: OBJECTIVE
  Structural equation modeling (SEM) is a very popular data-analytic technique for the evaluation of customer satisfaction. We aimed to measure the overall satisfaction of inflammatory bowel disease (IBD) patients with healthcare in Portugal and to define its main determinants using SEM.
  
  
  METHODS
  The study included three steps: (i) specification of a patient satisfaction model that included the following dimensions: Image, Expectations, Facilities, Admission process, Assistant staff, Nursing staff, Medical staff, Treatment, Inpatient care, Outpatient care, Overall quality, Overall satisfaction, and Loyalty; (ii) sample survey from 2000 patients, members of the Portuguese Association of the IBD; and (iii) estimation of the satisfaction model using partial least squares (XLSTAT-PLSPM).
  
  
  RESULTS
  We received 498 (25%) valid questionnaires from 324 (66%) patients with Crohn's disease and 162 (33%) patients with ulcerative colitis. Our model provided a substantial explanation for Overall satisfaction (R=0.82). The mean index of overall satisfaction was 74.4 (0-100 scale). The main determinants of Overall satisfaction were the Image (β=0.26), Outpatient care (β=0.23), and Overall quality (β=0.21), whose mean indices were 83, 75, and 81, respectively. Facilities and Inpatient care were the variables with a significant impact on Overall satisfaction and the worst mean indices.
  
  
  CONCLUSIONS
  SEM is useful for the evaluation of IBD patient satisfaction. The Overall satisfaction of IBD patients with healthcare in Portugal is good, but to increase it, IBD services need to focus on the improvement of Outpatient care, Facilities, and Inpatient care. Our model could be a matrix for a global model of IBD patient satisfaction.
authors.affiliation: aGastroenterology Department, Hospital of Braga bSchool of Health Sciences, University of Minho, Braga cGastroenterology Department, Centro Hospitalar da Cova da Beira, Covilhã dGastroenterology Department, Centro Hospitalar São João eInstitute of Pharmacology and Therapeutics fCIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal gIBMC - Institute for Molecular and Cell Biology hMedInUP - Center for Drug Discovery and Innovative Medicines.
authors.forename: João-Bruno
authors.initials: JB
authors.lastname: Soares
authors.forename: Ana S
authors.initials: AS
authors.lastname: Marinho
authors.forename: Dália
authors.initials: D
authors.lastname: Fernandes
authors.forename: Bruno
authors.initials: B
authors.lastname: Moreira Gonçalves
authors.forename: Cláudia
authors.initials: C
authors.lastname: Camila-Dias
authors.forename: Raquel
authors.initials: R
authors.lastname: Gonçalves
authors.forename: Fernando
authors.initials: F
authors.lastname: Magro
mesh_terms: D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015233:Models, Statistical; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011174:Portugal; D058996:Quality Improvement / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires