title: Quality of care in the intensive care unit from the perspective of patient's relatives: development and psychometric evaluation of the consumer quality index 'R-ICU'.
abstract: The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient's relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index 'Relatives in Intensive Care Unit' (CQI 'R-ICU'). The CQI 'R-ICU' measures the perceived quality of care from the perspective of patients' relatives, and identifies aspects of care that need improvement.
  
  
  
  The CQI 'R-ICU' was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients' relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis.
  
  
  
  Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire's vocabulary. The response rate of patients' relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: 'Communication' (α = .80) and 'Participation' (α = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients' relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and involvement in decision-making on the medical treatment of the patient.
  
  
  
  The CQI 'R-ICU' evaluates quality of care from the perspective of relatives of intensive care patients and provides practical information for quality assurance and improvement programs. The development and psychometric evaluation of the CQI 'R-ICU' led to a draft questionnaire, sufficient to justify further research into the reliability, validity, and the discriminative power of the questionnaire.
authors.affiliation: Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands. ans.rensen@han.nl.
authors.forename: Ans
authors.initials: A
authors.lastname: Rensen
authors.affiliation: Department of Intensive Care, Erasmus MC, University Medical Center's, Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Margo M
authors.initials: MM
authors.lastname: van Mol
authors.affiliation: Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands.
authors.forename: Ilse
authors.initials: I
authors.lastname: Menheere
authors.affiliation: Faculty of Psychology and Educational Sciences-Open University of the Netherlands, Valkenburgerweg 177, 6419 AT, Heerlen, The Netherlands.
authors.forename: Marjan D
authors.initials: MD
authors.lastname: Nijkamp
authors.affiliation: Medical Center Spaarne Gasthuis, Vondelweg 999, 2026 BW, Haarlem, Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Verhoogt
authors.affiliation: Medical Center Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.
authors.forename: Bea
authors.initials: B
authors.lastname: Maris
authors.affiliation: Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands.
authors.forename: Willeke
authors.initials: W
authors.lastname: Manders
authors.affiliation: Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands.|IQ scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Lilian
authors.initials: L
authors.lastname: Vloet
authors.affiliation: Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Verharen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000458:organization & administration / Q000592:standards; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010549:Personal Satisfaction; D011594:Psychometrics / Q000295:instrumentation*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Consumer quality index; Consumer satisfaction; Family member; Intensive care unit; Quality of healthcare; Relative