title: Closing the patient experience chasm: A two-level validation of the Consumer Quality Index Inpatient Hospital Care.
abstract: Evaluation of patients' health care experiences is central to measuring patient-centred care. However, different instruments tend to be used at the hospital or departmental level but rarely both, leading to a lack of standardization of patient experience measures.
  
  
  
  To validate the Consumer Quality Index (CQI) Inpatient Hospital Care for use on both department and hospital levels.
  
  
  
  Using cross-sectional observational data, we investigated the internal validity of the questionnaire using confirmatory factor analyses (CFA), and the generalizability of the questionnaire for use at the department and hospital levels using generalizability theory.
  
  
  
  22924 adults hospitalized for ≥24 hours between 1 January 2013 and 31 December 2014 in 23 Dutch hospitals (515 department evaluations).
  
  
  
  CQI Inpatient Hospital Care questionnaire.
  
  
  
  CFA results showed a good fit on individual level (CFI=0.96, TLI=0.95, RMSEA=0.04), which was comparable between specialties. When scores were aggregated to the department level, the fit was less desirable (CFI=0.83, TLI=0.81, RMSEA=0.06), and there was a significant overlap between communication with doctors and explanation of treatment subscales. Departments and hospitals explained ≤5% of total variance in subscale scores. In total, 4-8 departments and 50 respondents per department are needed to reliably evaluate subscales rated on a 4-point scale, and 10 departments with 100-150 respondents per department for binary subscales.
  
  
  
  The CQI Inpatient Hospital Care is a valid and reliable questionnaire to evaluate inpatient experiences in Dutch hospitals provided sufficient sampling is done. Results can facilitate meaningful comparisons and guide quality improvement activities in individual departments and hospitals.
authors.affiliation: Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands.|Center for Evidence-Based Education, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Alina
authors.identifier: 0000-0003-4491-3007
authors.initials: A
authors.lastname: Smirnova
authors.affiliation: Center for Evidence-Based Education, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Kiki M J M H
authors.initials: KMJMH
authors.lastname: Lombarts
authors.affiliation: Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, USA.|Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, USA.
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.affiliation: Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: Cees P M
authors.initials: CPM
authors.lastname: van der Vleuten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration; D010817:Physician-Patient Relations; D011594:Psychometrics; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult
keywords: Confirmatory factor analysis; Consumer Quality Index (CQI); generalizability theory; national surveys; patient-centered care; quality assessment