Construction of a scale measuring inpatients' opinion on quality of care

Objective. To develop a reliable and valid measure of patient opinions on q uality of hospital care. Design. Issues of importance to patients and possible scale items were gene rated by literature review and non-structured interviews of patients, forme r patients, health care providers and researchers. Semi-structured intervie ws with inpatients and pilot studies were conducted to modify or remove amb iguous questions and reduce skewed responses. A study was then made to sele ct from these questions relevant items and variables correlated to patient evaluation of quality of care. A principal-components analysis was performe d to select items and assess construct validity Cronbach's a coefficients w ere calculated to estimate the reliability of the scale. Time reliability a nd concurrent validity were also considered. Setting.In 800-bed French short-stay teaching hospital in Paris. Study participants. Five-hundred and thirty-four consecutive patients hospi talized in eight medical and surgical wards. Results. A 26-item scale was developed. Component analysis indicated two su bscales: 'medical information' and 'relationship with staff and daily routi ne'. Levels of reliability were satisfactory: Cronbach's a coefficient exce eded 0.87 for overall scale and subscales. Concurrent validity and time rel iability were also satisfactory: Multivariate analysis showed that, taking into account patients and hospitalization characteristics linked to scores (age, health status, number of hospitalizations, comorbidity, time since di agnosis, admission pattern, private patient and difficulties reported by st aff), these scores differed among departments. Conclusion. A reliable, valid measure of inpatients' opinions on quality of care has been developed in a French hospital and variables that have to be taken into account to compare hospital departments have been selected. Ite ms selected in the scale emphasized the importance that patients give to re ceiving medical information.