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Objective: Patients' experiences and satisfaction ratings are increasingly used to evaluate quality of care. This study assessed the extent to which outpatient teams, clinics, and health trusts contributed to patients' experiences and to what extent clinicians' evaluations of quality were related to patients' experiences., Methods: A questionnaire was mailed to 15,422 outpatients who attended Norwegian clinics in September 2004; 43% responded. Patients' experiences were measured on an 11-item index and three subscales: outcomes, interaction with clinicians, and information. Aggregated responses from clinicians were linked to the data on patients' experiences. Multilevel analyses were used to divide the variance between the different organizational levels and to assess the relationship with clinicians' opinions and individual-level factors., Results: Data were analyzed for 6,570 outpatients within 222 teams derived from 89 outpatient clinics within 33 health trusts. Differences in patients' scores were determined largely at the patient level, with teams accounting for 2% of the total variance and organizational levels of clinics and health trusts not contributing to patients' experiences. Team-level clinician quality scores were not significantly associated with patients' experiences. Better experiences were significantly associated with patients' female gender, older age, better self-perceived health, absence of an inpatient history, longer treatment episodes, frequent consultations, and waiting times perceived as acceptable., Conclusions: The organizational contributions to patients' experience scores were minimal. Although clinicians' ratings of quality are not a substitute for patients' perceptions of quality, surveys of outpatients' experiences and satisfaction may not be appropriate for cross-sectional comparisons of health care providers.

Aim: To describe the development and evaluation of a parent completed questionnaire to measure parent experiences of inpatient paediatric care, the parent experiences of paediatric care (PEPC)., Methods: Literature review, parent interviews, pre-testing and a national survey of 6144 parents of children who were inpatients at one of the 20 paediatric departments within Norway in 2005., Results: Three thousand three hundred and eight (53.8%) parents responded to the questionnaire. Low levels of missing data suggest that the PEPC is acceptable. The questionnaire includes six scales as supported by the results of factor analysis: nursing services (seven items), doctor services (five items), organisation (four items), information--examinations and tests (two items), information--discharge (three items) and hospital facilities (four items). Cronbach's alpha and test-retest correlations ranged from 0.7 to 0.9. Comparisons of scale scores with several variables including overall satisfaction with care and pain control, supported validity., Conclusion: The PEPC questionnaire includes important aspects of hospital care from the perspective of the parent. It has good evidence for internal consistency, test-retest reliability and validity and is recommended in surveys of parent experiences of paediatric inpatient care.

Aims: This article describes the development of a questionnaire designed for comparisons of patient experiences of hospital care within the Nordic countries. The results of testing for data quality, reliability, and validity are presented following a Norwegian survey., Methods: Following a literature review and consultation within an expert group six items were developed measuring patient experiences together with two items assessing global satisfaction and perception of incorrect treatment. The questions were included in a questionnaire that was mailed to 500 patients randomly selected from patients receiving inpatient treatment at a large university hospital in Norway. Principal component analysis was used to assess dimensionality. Reliability was assessed by the internal consistency and test-retest methods. Construct validity was assessed by the scale's correlation with variables known to be related to patient experiences., Results: A total of 244 (48.8%) patients responded. Levels of missing data ranged from 0.4% to 2.5%. The six items in the questionnaire that measured important aspects of patient experiences with the services contributed to a single scale with item-total correlations in the range 0.59-0.71 and a Cronbach's alpha of 0.85. The test-retest intraclass correlation was 0.88., Conclusions: The NORPEQ is a brief measure of patient experiences that covers important aspects of the healthcare encounter. It shows good evidence of reliability and validity and is relatively easy to apply alongside existing national surveys.

Aims: To assess the association between patient experiences, aspects of healthcare delivery, and patient characteristics for adult somatic inpatients attending hospitals throughout Norway., Methods: The Patient Experiences Questionnaire (PEQ) was mailed to 26,938 patients attending inpatient clinics at 62 Norwegian hospitals during 2002 and 2003 within a six-week period. Reminders were mailed at four weeks. Scores for the PEQ were regressed on whether the patient felt that he/she had received incorrect treatment, had spent the night in a corridor bed, had been an emergency or routine admission, his/her number of previous admissions, hospital teaching status, hospital size and location, health status, and sociodemographic variables., Results: A total of 13,700 (50.9%) patients responded. Patients who felt that they had received incorrect treatment had significantly poorer scores for all 10 PEQ dimensions. Those spending the night in a corridor bed had significantly poorer scores for six dimensions. Emergency admissions and the previous number of inpatient stays were significantly associated with poorer experiences for 10 and 7 dimensions respectively. Hospital size and university status had negative relationships with scores for six and four dimensions respectively., Conclusions: Whether the patient felt that he/she had received the incorrect treatment had by far the strongest association with patient experiences. Future studies of patient experiences and satisfaction should include this variable. As found in previous research, patient experiences were significantly associated with age and health status.

Background: General practitioners' evaluation of Community Mental Health Centres (CMHC) has become a part of the Norwegian system of quality indicators. On the basis of a national survey, we present the way in which GPs have assessed the quality of 77 CMHCs., Material and Methods: A questionnaire was posted to every GP in Norway from November 2005 to March 2006. This was followed up with 2-3 reminders and telephone interviews. 2,415 out of 3,704 GPs (65%) responded., Results: GPs gave highest score for professional competence, the average being 55 on a scale of 0-100, where 100 is best. They gave lowest score for counselling (30) and staff situation (45). The average score given to the various CMHCs varied a lot for all dimensions, the largest difference being for counselling, with the highest average 58 and the lowest 8. There were many significant differences between various CMHCs' scores and the national average. When it came to counselling, the average score for 20 CMHCs was significantly different from that for the other CMHCs., Interpretation: As GPs are important collaborators and users of the CMHCs, their views are valuable. The present findings need to be discussed. Many of the community mental health centres received all in all positive feedback from the GPs, suggesting that they may have useful experiences to share.

Background: Questionnaires on patient experience are increasingly used as quality indicators in the health services. There is limited evidence relating to alternative approaches to surveying patients within this field. We wanted to assess the effect of different methods of data collection on response rates and scores produced by a self-administered questionnaire on patient experience for adult inpatients receiving mental health care., Material and Methods: Data were collected from adult inpatients treated at three community mental health centres affiliated with the psychiatric clinic at Stavanger University hospital in spring 2005. The inclusion period was nine weeks, with three designs at consecutive time periods: A, a postal survey following discharge; B, a clinical survey before discharge; and C, patients given the choice of A or B., Results: The response rate was highest with the postal design (38% vs. 24% and 23% respectively), but the differences were related to one additional reminder in the postal design. Out of the 11 questions, 4 had significantly poorer scores for the postal design. Questionnaire scores were significantly poorer with the postal design; 50 (on a scale from 0 to 100), vs. 59 and 63 in design B and C respectively., Interpretation: The choice of data collection methods influences the results in user surveys in mental health care. This is an important consideration in the planning of studies and in the interpretation of the results, and in the comparison of results between studies using different data collection methods.

Background: This study describes the development and testing of the Psychiatric In-Patient Experiences Questionnaire (PIPEQ)., Material and Methods: Questionnaire development was based on a literature review, qualitative interviews with patients, and expert opinion. The questionnaire was tested in a postal survey among inpatients at three community health centres affiliated with the psychiatric clinic of Stavanger University hospital during spring 2005. 244 patients received the questionnaire; either they got the questionnaire by mail after discharge or at the institution before discharge., Results: 68 (28%) patients responded to the questionnaire. Items had low levels of missing data. Factor analysis showed that 11 widely applicable items contribute to a measure of overall experiences. Item-total correlations ranged from 0.55 to 0.82. Cronbach's alpha exceeded the criterion of 0.9. Construct validity was supported by comparisons with variables related to patient experience, including overall satisfaction, extent of patient say in the medication decision, necessity of coercion, and mental health status., Interpretation: The PIPEQ is a brief instrument that covers important aspects of health care experience for psychiatric inpatients and has good evidence for internal reliability and construct validity.

Background: The purpose of this paper is to describe the development and evaluation of the patient experiences questionnaire (PEQ) for somatic outpatients., Material and Methods: Literature review, focus groups, interviews with patients and clinicians, and pre-testing of questionnaire items were used. A postal survey among 12,525 patients of 23 outpatient clinics for adults in two Norwegian health regions was conducted during 2003., Results: 6824 (55%) patients responded to the questionnaire. Low levels of missing data suggest that the questionnaire is acceptable to patients. Factor analysis of items deemed applicable to all patients produced three scales: clinic access (2 items), communication (6 items) and organisation (4 items). The remaining items contributed to the hypothesised scales of information (6 items), hospital standards (3 items), and pre-visit experience (3 items). With the exception of the pre-visit experience scale, the levels of Cronbach's alpha met the criterion of 0.7. The great majority of the results of validity testing were as hypothesised. Correlations between the scales ranged from 0.30 (clinic access and information) to 0.72 (communication and information). As hypothesised, scores were significantly related to responses to questions about overall satisfaction, general health, and age., Interpretation: The outpatient experience questionnaire is a self-administered instrument that includes the most important aspects of experience from the outpatients' perspective. Three core dimensions for use in a shortened version have been identified.

Introduction: As yet, there is no patient-assessed, condition-specific instrument for the assessment of health-related quality of life in intermittent claudication. We evaluated the intermittent claudication questionnaire (ICQ) for properties required of a measure of health outcome., Methods and Results: Interviews with patients with intermittent claudication and vascular specialist opinion produced a pool of statements used to itemize a self-completed ICQ. This was piloted in 20 patients for practicality and then administered to 124 stable claudicants. Reliability was assessed through a retest in 63 (51%) patients at 14 days and analysis of Cronbach's alpha for internal consistency. Spearman's correlation coefficient was used to assess construct validity in comparisons between the ICQ and ankle brachial pressure index, treadmill-walking distances, the walking impairment questionnaire, the EuroQol, and the Short Form-36. Responsiveness of the ICQ to changes in health was assessed in 60 patients treated conservatively and 40 patients undergoing angioplasty. The standardized response mean was used to identify the most responsive instrument in the study. A 16-item ICQ with a test-retest intraclass correlation of 0.95 and Cronbach's alpha of.94 was produced. One hundred twenty-one (98%) patients completed the ICQ (mean time, 3.7 minutes). The ICQ correlated better with the EuroQol (r = 0.58) and 7 out of 8 subscales of the Short Form-36 (r = 0.33-0.68) compared with the walking impairment questionnaire. The ICQ demonstrated the largest standardized response mean in relation to health transition compared with the other instruments., Conclusions: The patient-assessed ICQ is a practical, reliable, valid, and responsive measure of patient health-related quality of life in intermittent claudication.