Skip to main content
Top
Published in: BMC Health Services Research 1/2012

Open Access 01-12-2012 | Research article

The consumer quality index (CQ-index) in an accident and emergency department: development and first evaluation

Authors: Nanne Bos, Leontien M Sturms, Augustinus JP Schrijvers, Henk F van Stel

Published in: BMC Health Services Research | Issue 1/2012

Login to get access

Abstract

Background

Assessment of patients’ views are essential to provide a patient-centred health service and to evaluating quality of care. As no standardized and validated system for measuring patients’ experiences in accident and emergency departments existed, we have developed the Consumer Quality index for the accident and emergency department (CQI A&E).

Methods

Qualitative research has been undertaken to determine the content validity of the CQI A&E. In order to assess psychometric characteristics an 84-item questionnaire was sent to 653 patients who had attended a large A&E in the Netherlands. Also, fifty importance questions were added to determine relevance of the questions and for future calculations of improvement scores. Exploratory factor analysis was applied to detect the domains of the questionnaire.

Results

Survey data of 304 (47%) patients were used for the analysis. The first exploratory factor analysis resulted in three domains based on 13 items: ‘Attitude of the healthcare professionals’, ‘Environment and impression of the A&E’ and ‘Respect for and explanation to the patient’. The first two had an acceptable internal consistency. The second analysis, included 24 items grouped into 5 domains: ‘Attitude of the healthcare professionals’, ‘Information and explanation’, ‘Environment of the A&E’,’Leaving the A&E’ and ‘General information and rapidity of care’. All factors were internal consistent. According to the patients, the three most important aspects in healthcare performance in the A&E were: trust in the competence of the healthcare professionals, hygiene in the A&E and patients’ health care expectations. In general, the highest improvement scores concerned patient information.

Conclusions

The Consumer Quality index for the accident and emergency department measures patients’ experiences of A&E healthcare performance. Preliminary psychometric characteristics are sufficient to justify further research into reliability and validity.
Appendix
Available only for authorised users
Literature
1.
go back to reference Groenewold O, Klazinga N, Wagner C, Arah OA, Thompson A, Bruneau C, Sunol R: Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the ‘Deepening our Understanding of Quality Improvement in Europe (DUQuE)’ project. BMC Health Serv Res. 2010, 10: 281.CrossRef Groenewold O, Klazinga N, Wagner C, Arah OA, Thompson A, Bruneau C, Sunol R: Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the ‘Deepening our Understanding of Quality Improvement in Europe (DUQuE)’ project. BMC Health Serv Res. 2010, 10: 281.CrossRef
2.
go back to reference Zuidgeest M, Sixma H, Rademakers J: Measuring patients’ experiences with rheumatic care: the consumer quality index rheumatoid arthritis. Rheumatol Int. 2009, 30: 159-167. 10.1007/s00296-009-0926-3.CrossRefPubMed Zuidgeest M, Sixma H, Rademakers J: Measuring patients’ experiences with rheumatic care: the consumer quality index rheumatoid arthritis. Rheumatol Int. 2009, 30: 159-167. 10.1007/s00296-009-0926-3.CrossRefPubMed
3.
go back to reference Garrett A, Solheim E, Danielsen K: National and cross-national surveys of patient experiences: a structured review. 2008, Norwegian Knowledge Centre for the Health Services, Oslo Garrett A, Solheim E, Danielsen K: National and cross-national surveys of patient experiences: a structured review. 2008, Norwegian Knowledge Centre for the Health Services, Oslo
4.
go back to reference Cleary PD, Edgman-Levitan S: Health care quality. Incorporating consumer perspectives. JAMA. 1997, 278: 1608-1612. 10.1001/jama.1997.03550190072047.CrossRefPubMed Cleary PD, Edgman-Levitan S: Health care quality. Incorporating consumer perspectives. JAMA. 1997, 278: 1608-1612. 10.1001/jama.1997.03550190072047.CrossRefPubMed
5.
go back to reference Sixma HJ, Kerssens JJ, Campen CV, Peters L: Quality of care from the patients’ perspective: from theoretical concept to a new measuring instrument. Health Expect. 1998, 1: 82-95. 10.1046/j.1369-6513.1998.00004.x.CrossRefPubMed Sixma HJ, Kerssens JJ, Campen CV, Peters L: Quality of care from the patients’ perspective: from theoretical concept to a new measuring instrument. Health Expect. 1998, 1: 82-95. 10.1046/j.1369-6513.1998.00004.x.CrossRefPubMed
6.
go back to reference Stubbe JH, Brouwer W, Delnoij DM: Patients’ experiences with quality of hospital care: the Consumer Quality Index Cataract Questionnaire. BMC Ophthalmol. 2007, 7: 14-10.1186/1471-2415-7-14.CrossRefPubMedPubMedCentral Stubbe JH, Brouwer W, Delnoij DM: Patients’ experiences with quality of hospital care: the Consumer Quality Index Cataract Questionnaire. BMC Ophthalmol. 2007, 7: 14-10.1186/1471-2415-7-14.CrossRefPubMedPubMedCentral
7.
go back to reference Stubbe JH, Gelsema T, Delnoij DM: The Consumer Quality Index Hip Knee Questionnaire measuring patients’ experiences with quality of care after a total hip or knee arthroplasty. BMC Health Serv Res. 2007, 7: 60-10.1186/1472-6963-7-60.CrossRefPubMedPubMedCentral Stubbe JH, Gelsema T, Delnoij DM: The Consumer Quality Index Hip Knee Questionnaire measuring patients’ experiences with quality of care after a total hip or knee arthroplasty. BMC Health Serv Res. 2007, 7: 60-10.1186/1472-6963-7-60.CrossRefPubMedPubMedCentral
8.
go back to reference de Boer D, Delnoij D, Rademakers J: Do patient experiences on priority aspects of health care predict their global rating of quality of care? A study in five patient groups. Health Expect. 2010, 13: 285-297.PubMed de Boer D, Delnoij D, Rademakers J: Do patient experiences on priority aspects of health care predict their global rating of quality of care? A study in five patient groups. Health Expect. 2010, 13: 285-297.PubMed
9.
go back to reference Huibers L, Giesen P, Wensing M, Grol R: Out-of-hours care in western countries: assessment of different organizational models. BMC Health Serv Res. 2009, 9: 105-10.1186/1472-6963-9-105.CrossRefPubMedPubMedCentral Huibers L, Giesen P, Wensing M, Grol R: Out-of-hours care in western countries: assessment of different organizational models. BMC Health Serv Res. 2009, 9: 105-10.1186/1472-6963-9-105.CrossRefPubMedPubMedCentral
10.
go back to reference van Charante EP M, ter Riet G, Bindels P: Self-referrals to the A&E department during out-of-hours: patients’ motives and characteristics. Patient Educ Couns. 2008, 70: 256-265. 10.1016/j.pec.2007.10.012.CrossRef van Charante EP M, ter Riet G, Bindels P: Self-referrals to the A&E department during out-of-hours: patients’ motives and characteristics. Patient Educ Couns. 2008, 70: 256-265. 10.1016/j.pec.2007.10.012.CrossRef
11.
go back to reference Thijssen WA, Giesen PH, Wensing M: Emergency departments in The Netherlands. Emerg Med J. 2012, 29: 6-9. 10.1136/emermed-2011-200090.CrossRefPubMed Thijssen WA, Giesen PH, Wensing M: Emergency departments in The Netherlands. Emerg Med J. 2012, 29: 6-9. 10.1136/emermed-2011-200090.CrossRefPubMed
12.
go back to reference van Geloven AA, Luitse JS, Simons MP, Volker BS, Verbeek MJ, Obertop H: Emergency medicine in the Netherlands, the necessity for changing the system: results from two questionnaires. Eur J Emerg Med. 2003, 10: 318-322. 10.1097/00063110-200312000-00015.CrossRefPubMed van Geloven AA, Luitse JS, Simons MP, Volker BS, Verbeek MJ, Obertop H: Emergency medicine in the Netherlands, the necessity for changing the system: results from two questionnaires. Eur J Emerg Med. 2003, 10: 318-322. 10.1097/00063110-200312000-00015.CrossRefPubMed
13.
go back to reference Limbourn S, Celenza A: Patient perceptions of caring and association with emergency department activity and access block. Emerg Med Australas. 2011, 23: 169-180. 10.1111/j.1742-6723.2011.01387.x.CrossRefPubMed Limbourn S, Celenza A: Patient perceptions of caring and association with emergency department activity and access block. Emerg Med Australas. 2011, 23: 169-180. 10.1111/j.1742-6723.2011.01387.x.CrossRefPubMed
14.
go back to reference Delnoij DM, ten Asbroek G, Arah OA, de Koning JS, Stam P, Poll A, Vriens B, Schmidt P, Klazinga NS: Made in the USA: the import of American Consumer Assessment of Health Plan Surveys (CAHPS) into the Dutch social insurance system. Eur J Public Health. 2006, 16: 652-659. 10.1093/eurpub/ckl023.CrossRefPubMed Delnoij DM, ten Asbroek G, Arah OA, de Koning JS, Stam P, Poll A, Vriens B, Schmidt P, Klazinga NS: Made in the USA: the import of American Consumer Assessment of Health Plan Surveys (CAHPS) into the Dutch social insurance system. Eur J Public Health. 2006, 16: 652-659. 10.1093/eurpub/ckl023.CrossRefPubMed
15.
go back to reference Sixma H, Hendriks M, de Boer D, Delnoij D: Manual CQI instruments. An instruction for the development and use of Consumer Quality Index (CQI) questionnaires (in Dutch). 2008, The Dutch Centre for Consumer Experience in Healthcare, Utrecht Sixma H, Hendriks M, de Boer D, Delnoij D: Manual CQI instruments. An instruction for the development and use of Consumer Quality Index (CQI) questionnaires (in Dutch). 2008, The Dutch Centre for Consumer Experience in Healthcare, Utrecht
16.
go back to reference Stevens J: Exploratory and confirmatory factor analysis. Applied multivariate statistics for the social sciences. 1996, Lawrence Erlbaum Associates, Mahwah, 362-428. Stevens J: Exploratory and confirmatory factor analysis. Applied multivariate statistics for the social sciences. 1996, Lawrence Erlbaum Associates, Mahwah, 362-428.
17.
go back to reference Norman G: Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract. 2010, 15: 625-632. 10.1007/s10459-010-9222-y.CrossRefPubMed Norman G: Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract. 2010, 15: 625-632. 10.1007/s10459-010-9222-y.CrossRefPubMed
18.
go back to reference Bos N, Sturms LM, van HF S, Schrijvers AJP: Consumer Quality Index for the Accident and Emergency Department; measure in development (in Dutch). 2010, Julius Center for Health Sciences and Primary Care, Utrecht Bos N, Sturms LM, van HF S, Schrijvers AJP: Consumer Quality Index for the Accident and Emergency Department; measure in development (in Dutch). 2010, Julius Center for Health Sciences and Primary Care, Utrecht
19.
go back to reference Frank C, Asp M, Fridlund B, Baigi A: Questionnaire for patient participation in emergency departments: development and psychometric testing. J Adv Nurs. 2011, 67: 643-651. 10.1111/j.1365-2648.2010.05472.x.CrossRefPubMed Frank C, Asp M, Fridlund B, Baigi A: Questionnaire for patient participation in emergency departments: development and psychometric testing. J Adv Nurs. 2011, 67: 643-651. 10.1111/j.1365-2648.2010.05472.x.CrossRefPubMed
20.
go back to reference Damman OC, Hendriks M, Sixma HJ: Towards more patient centred healthcare: A new Consumer Quality Index instrument to assess patients’ experiences with breast care. Eur J Cancer. 2009, 45: 1569-1577. 10.1016/j.ejca.2008.12.011.CrossRefPubMed Damman OC, Hendriks M, Sixma HJ: Towards more patient centred healthcare: A new Consumer Quality Index instrument to assess patients’ experiences with breast care. Eur J Cancer. 2009, 45: 1569-1577. 10.1016/j.ejca.2008.12.011.CrossRefPubMed
21.
go back to reference van Empel I, Aarts JW, Cohlen BJ, Huppelschoten DA, Laven JS, Nelen WL, Kremer JA: Measuring patient-centredness, the neglected outcome in fertility care: a random multicentre validation study. Hum Reprod. 2010, 25: 2516-2526. 10.1093/humrep/deq219.CrossRefPubMed van Empel I, Aarts JW, Cohlen BJ, Huppelschoten DA, Laven JS, Nelen WL, Kremer JA: Measuring patient-centredness, the neglected outcome in fertility care: a random multicentre validation study. Hum Reprod. 2010, 25: 2516-2526. 10.1093/humrep/deq219.CrossRefPubMed
22.
go back to reference de Vet HC, Terwee CB, Bouter LM: Current challenges in clinimetrics. J Clin Epidemiol. 2003, 56: 1137-1141. 10.1016/j.jclinepi.2003.08.012.CrossRefPubMed de Vet HC, Terwee CB, Bouter LM: Current challenges in clinimetrics. J Clin Epidemiol. 2003, 56: 1137-1141. 10.1016/j.jclinepi.2003.08.012.CrossRefPubMed
23.
go back to reference Streiner DL: Clinimetrics vs. psychometrics: an unnecessary distinction. J Clin Epidemiol. 2003, 56: 1142-1145. 10.1016/j.jclinepi.2003.08.011.CrossRefPubMed Streiner DL: Clinimetrics vs. psychometrics: an unnecessary distinction. J Clin Epidemiol. 2003, 56: 1142-1145. 10.1016/j.jclinepi.2003.08.011.CrossRefPubMed
24.
go back to reference Coltman T, Devinney TM, Midgley DF, Venaik S: Formative versus reflective measurement models: Two applications of formative measurement. Journal of Business Research. 2008, 61: 1250-1262. 10.1016/j.jbusres.2008.01.013.CrossRef Coltman T, Devinney TM, Midgley DF, Venaik S: Formative versus reflective measurement models: Two applications of formative measurement. Journal of Business Research. 2008, 61: 1250-1262. 10.1016/j.jbusres.2008.01.013.CrossRef
25.
go back to reference Triemstra M, Winters S, Kool RB, Wiegers TA: Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care. BMC Health Serv Res. 2010, 10: 95-10.1186/1472-6963-10-95.CrossRefPubMedPubMedCentral Triemstra M, Winters S, Kool RB, Wiegers TA: Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care. BMC Health Serv Res. 2010, 10: 95-10.1186/1472-6963-10-95.CrossRefPubMedPubMedCentral
26.
go back to reference Kristensson J, Ekwall A: Psychometric properties of the consumer emergency care satisfaction scale: tested on persons accompanying patients in emergency department. J Nurs Care Qual. 2008, 23: 277-282. 10.1097/01.NCQ.0000324594.22332.9e.CrossRefPubMed Kristensson J, Ekwall A: Psychometric properties of the consumer emergency care satisfaction scale: tested on persons accompanying patients in emergency department. J Nurs Care Qual. 2008, 23: 277-282. 10.1097/01.NCQ.0000324594.22332.9e.CrossRefPubMed
Metadata
Title
The consumer quality index (CQ-index) in an accident and emergency department: development and first evaluation
Authors
Nanne Bos
Leontien M Sturms
Augustinus JP Schrijvers
Henk F van Stel
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2012
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-12-284

Other articles of this Issue 1/2012

BMC Health Services Research 1/2012 Go to the issue