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Classification of patients based on their evaluation of hospital outcomes: cluster analysis following a national survey in Norway.

Bjertnaes O, Skudal KE, Iversen HH - BMC Health Serv Res (2013)

Bottom Line: The response groups were significantly associated with nine patient-experience indicators (p < 0.001), and all groups were significantly different from each of the other groups on a majority of the patient-experience indicators.Clusters were significantly associated with age, education, self-perceived health, gender, and the degree to write open comments in the questionnaire.More research on patient clustering in patient evaluation is needed, as well as standardization of methodology to increase comparability across studies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department for Quality Measurement and Patient Safety, Norwegian Knowledge Centre for the Health Services, Oslo, Norway. oan@kunnskapssenteret.no

ABSTRACT

Background: A general trend towards positive patient-reported evaluations of hospitals could be taken as a sign that most patients form a homogeneous, reasonably pleased group, and consequently that there is little need for quality improvement. The objective of this study was to explore this assumption by identifying and statistically validating clusters of patients based on their evaluation of outcomes related to overall satisfaction, malpractice and benefit of treatment.

Methods: Data were collected using a national patient-experience survey of 61 hospitals in the 4 health regions in Norway during spring 2011. Postal questionnaires were mailed to 23,420 patients after their discharge from hospital. Cluster analysis was performed to identify response clusters of patients, based on their responses to single items about overall patient satisfaction, benefit of treatment and perception of malpractice.

Results: Cluster analysis identified six response groups, including one cluster with systematically poorer evaluation across outcomes (18.5% of patients) and one small outlier group (5.3%) with very poor scores across all outcomes. One-Way ANOVA with post-hoc tests showed that most differences between the six response groups on the three outcome items were significant. The response groups were significantly associated with nine patient-experience indicators (p < 0.001), and all groups were significantly different from each of the other groups on a majority of the patient-experience indicators. Clusters were significantly associated with age, education, self-perceived health, gender, and the degree to write open comments in the questionnaire.

Conclusions: The study identified five response clusters with distinct patient-reported outcome scores, in addition to a heterogeneous outlier group with very poor scores across all outcomes. The outlier group and the cluster with systematically poorer evaluation across outcomes comprised almost one-quarter of all patients, clearly demonstrating the need to tailor quality initiatives and improve patient-perceived quality in hospitals. More research on patient clustering in patient evaluation is needed, as well as standardization of methodology to increase comparability across studies.

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Survey flowchart.
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Figure 1: Survey flowchart.

Mentions: Non-respondents were sent up to two postal reminders, the first after 3 weeks and the second a few weeks later. In total, 23,420 patients were included in the study; 744 patients were not eligible (Figure 1). All hospitals transferred data about the included patients—including age, gender, admission type, length of stay and diagnosis—to the NOKC. The Data Inspectorate and the Norwegian Ministry of Health and Care Services approved the survey.


Classification of patients based on their evaluation of hospital outcomes: cluster analysis following a national survey in Norway.

Bjertnaes O, Skudal KE, Iversen HH - BMC Health Serv Res (2013)

Survey flowchart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643880&req=5

Figure 1: Survey flowchart.
Mentions: Non-respondents were sent up to two postal reminders, the first after 3 weeks and the second a few weeks later. In total, 23,420 patients were included in the study; 744 patients were not eligible (Figure 1). All hospitals transferred data about the included patients—including age, gender, admission type, length of stay and diagnosis—to the NOKC. The Data Inspectorate and the Norwegian Ministry of Health and Care Services approved the survey.

Bottom Line: The response groups were significantly associated with nine patient-experience indicators (p < 0.001), and all groups were significantly different from each of the other groups on a majority of the patient-experience indicators.Clusters were significantly associated with age, education, self-perceived health, gender, and the degree to write open comments in the questionnaire.More research on patient clustering in patient evaluation is needed, as well as standardization of methodology to increase comparability across studies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department for Quality Measurement and Patient Safety, Norwegian Knowledge Centre for the Health Services, Oslo, Norway. oan@kunnskapssenteret.no

ABSTRACT

Background: A general trend towards positive patient-reported evaluations of hospitals could be taken as a sign that most patients form a homogeneous, reasonably pleased group, and consequently that there is little need for quality improvement. The objective of this study was to explore this assumption by identifying and statistically validating clusters of patients based on their evaluation of outcomes related to overall satisfaction, malpractice and benefit of treatment.

Methods: Data were collected using a national patient-experience survey of 61 hospitals in the 4 health regions in Norway during spring 2011. Postal questionnaires were mailed to 23,420 patients after their discharge from hospital. Cluster analysis was performed to identify response clusters of patients, based on their responses to single items about overall patient satisfaction, benefit of treatment and perception of malpractice.

Results: Cluster analysis identified six response groups, including one cluster with systematically poorer evaluation across outcomes (18.5% of patients) and one small outlier group (5.3%) with very poor scores across all outcomes. One-Way ANOVA with post-hoc tests showed that most differences between the six response groups on the three outcome items were significant. The response groups were significantly associated with nine patient-experience indicators (p < 0.001), and all groups were significantly different from each of the other groups on a majority of the patient-experience indicators. Clusters were significantly associated with age, education, self-perceived health, gender, and the degree to write open comments in the questionnaire.

Conclusions: The study identified five response clusters with distinct patient-reported outcome scores, in addition to a heterogeneous outlier group with very poor scores across all outcomes. The outlier group and the cluster with systematically poorer evaluation across outcomes comprised almost one-quarter of all patients, clearly demonstrating the need to tailor quality initiatives and improve patient-perceived quality in hospitals. More research on patient clustering in patient evaluation is needed, as well as standardization of methodology to increase comparability across studies.

Show MeSH