title: Perception of quality of care of patients with potentially severe diseases evaluated at a distinct quick diagnostic delivery model: a cross-sectional study.
abstract: BACKGROUND
  Although hospital-based outpatient quick diagnosis units (QDU) are an increasingly recognized cost-effective alternative to hospitalization for the diagnosis of potentially serious diseases, patient perception of their quality of care has not been evaluated well enough. This cross-sectional study analyzed the perceived quality of care of a QDU of a public third-level university hospital in Barcelona.
  
  
  METHODS
  One hundred sixty-two consecutive patients aged ≥ 18 years attending the QDU over a 9-month period were invited to participate. A validated questionnaire distributed by the QDU attending physician and completed at the end of the first and last QDU visit evaluated perceived quality of care using six subscales.
  
  
  RESULTS
  Response rate was 98 %. Perceived care in all subscales was high. Waiting times were rated as 'short'/'very short' or 'better'/'much better' than expected by 69-89 % of respondents and physical environment as 'better'/'much better' than expected by 94-96 %. As to accessibility, only 3 % reported not finding the Unit easily and 7 % said that frequent travels to hospital for visits and investigations were uncomfortable. Perception of patient-physician encounter was high, with 90-94 % choosing the positive extreme ends of the clinical information and personal interaction subscales items. Mean score of willingness to recommend the Unit using an analogue scale where 0 was 'never' and 10 'without a doubt' was 9.5 (0.70). On multivariate linear regression, age >65 years was an independent predictor of clinical information, personal interaction, and recommendation, while age 18-44 years was associated with lower scores in these subscales. No schooling predicted higher clinical information and recommendation scores, while university education had remarkable negative influence on them. Having ≥4 QDU visits was associated with lower time to diagnosis and recommendation scores and malignancy was a negative predictor of time to diagnosis, clinical information, and recommendation.
  
  
  CONCLUSIONS
  It is worthy of note that the questionnaire evaluated patient perception and opinions of healthcare quality including recommendation rather than simply satisfaction. It has been argued that perception of quality of care is a more valuable approach than satisfaction. In addition to embracing an affective dimension, satisfaction appears more dependent on patient expectations than is perception of quality.
  
  
  CONCLUSIONS
  While appreciating that completing the questionnaire immediately after the visit and its distribution by the QDU physician may have affected the results, scores of perceived quality of care including recommendation were high. There were, however, significant differences in several subscales associated with age, education, number of QDU visits, and diagnosis of malignant vs. benign condition.
authors.affiliation: Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Biomedical Research Institute (IDIBELL), Consultas Externas, Area de Gestión Administrativa, c/Feixa Llarga s/n, 08907-L'Hospitalet de Llobregat, Barcelona, Spain. csanclemente@bellvitgehospital.cat.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sanclemente-Ansó
authors.affiliation: Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. asalazar@santpau.cat.
authors.forename: Albert
authors.initials: A
authors.lastname: Salazar
authors.affiliation: Department of Internal Medicine, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c/Villarroel 170, 08036, Barcelona, Spain. xavbosch@clinic.ub.es.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.affiliation: Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. ccapdevila@bellvitgehospital.cat.
authors.forename: Cristina
authors.initials: C
authors.lastname: Capdevila
authors.affiliation: Department of Quality, Bellvitge University Hospital, University of Barcelona, Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. agimenez@bellvitgehospital.cat.
authors.forename: Amparo
authors.initials: A
authors.lastname: Giménez-Requena
authors.affiliation: Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Biomedical Research Institute (IDIBELL), Consultas Externas, Area de Gestión Administrativa, c/Feixa Llarga s/n, 08907-L'Hospitalet de Llobregat, Barcelona, Spain. broson@bellvitgehospital.cat.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rosón-Hernández
authors.affiliation: Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Biomedical Research Institute (IDIBELL), Consultas Externas, Area de Gestión Administrativa, c/Feixa Llarga s/n, 08907-L'Hospitalet de Llobregat, Barcelona, Spain. xcorbella@bellvitgehospital.cat.|Global Institute of Public Health and Health Policy, School of Medicine, International University of Catalonia, Barcelona, Spain. xcorbella@bellvitgehospital.cat.
authors.forename: Xavier
authors.initials: X
authors.lastname: Corbella
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D006757:Hospital Units / Q000592:standards; D006760:Hospitalization / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010465:Perception; D010817:Physician-Patient Relations; D010820:Physicians / Q000592:standards; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment; D014850:Waiting Lists; D055815:Young Adult