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Aims and objectives. To assess the current use of patient satisfaction measures in home health care and to examine the reliability and validity of current measures of patient satisfaction in home health care. Background. Patient satisfaction has been one of the widely used measures in home health care as an indicator of quality of care. A few efforts have been made to develop psychometrically sound patient satisfaction scales for use in home health care. Design. A critical review of the literature. Methods. Electronic databases were systematically searched to identify the studies or publications that measured and addressed patient satisfaction and its measurement in home health care. Results. The review of the literature showed that patient satisfaction measures have been used in the evaluation of care programmes including rehabilitation programmes, discharge and home follow-up programmes, care process and management practices. Also, patient satisfaction measures were used to evaluate new care protocols and treatments. Conclusions. Home healthcare agencies need valid and reliable patient satisfaction scales. Frameworks of patient satisfaction are still in their early developmental stage. Only some of the variables related to patient satisfaction are explained by many frameworks. Relevance to clinical practice. Home healthcare mangers and researchers need to take in consideration the reliability and validity of measures and tools of patient satisfaction.
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Patient satisfaction in home health care
Said Abusalem, John A Myers and Yousef Aljeesh
Aims and objectives. To assess the current use of patient satisfaction measures in home health care and to examine the reliability
and validity of current measures of patient satisfaction in home health care.
Background. Patient satisfaction has been one of the widely used measures in home health care as an indicator of quality of care.
A few efforts have been made to develop psychometrically sound patient satisfaction scales for use in home health care.
Design. A critical review of the literature.
Methods. Electronic databases were systematically searched to identify the studies or publications that measured and addressed
patient satisfaction and its measurement in home health care.
Results. The review of the literature showed that patient satisfaction measures have been used in the evaluation of care
programmes including rehabilitation programmes, discharge and home follow-up programmes, care process and management
practices. Also, patient satisfaction measures were used to evaluate new care protocols and treatments.
Conclusions. Home healthcare agencies need valid and reliable patient satisfaction scales. Frameworks of patient satisfaction
are still in their early developmental stage. Only some of the variables related to patient satisfaction are explained by many
Relevance to clinical practice. Home healthcare mangers and researchers need to take in consideration the reliability and
validity of measures and tools of patient satisfaction.
Key words: measures of patient satisfactions, outcomes home health care, patient satisfaction home care, patient satisfaction
home health care
Accepted for publication: 8 April 2012
Patient satisfaction is one of the most widely used outcome
indicators of quality of health care (Mahon 1996). As a
result, patient satisfaction is an active area of research that is
increasingly being used to guide health care, because it
encompasses patients’ needs. Home healthcare agencies,
however, continue to be devoid of empirically valid and
reliable patient satisfaction scales. A few studies have
evaluated and developed psychometrically sound patient
satisfaction scales. This is particularly alarming given the
fact that home health care has become the fastest growing
sector in health care in the USA. This has lead to numerous
patient satisfaction scales being used by differing researchers,
which has made it difficult to make broad comparisons and
develop interventions to increase patient satisfaction. The
current article aims to describe the landscape of patient
satisfaction measures in home health care and discuss the
available measures of patient satisfaction scales. So, research-
ers aimed to increase patient satisfaction in home healthcare
agencies can make more broad comparisons and develop
more comprehensive interventions.
The concept of patient satisfaction was developed in 1957
by Adbellah and Levine (1957) who developed a measure of
Authors: Said Abusalem, PhD, RN, Assistant Professor, School of
Nursing, University of Louisville, Louisville, KY; John A Myers, PhD,
MSPH, Assistant Professor, University of Louisville, Louisville, KY,
USA; Yousef Aljeesh, PhD, RN, Associate Professor, I. University of
Gaza, Gaza, Gaza Strip
Correspondence: Said Abusalem, Assistant Professor, School of
Nursing, University of Louisville, Louisville, KY 40202, USA.
Telephone: +1 502 819 4052.
Ó2012 Blackwell Publishing Ltd
2426 Journal of Clinical Nursing,22, 2426–2435, doi: 10.1111/j.1365-2702.2012.04211.x
patient and personal satisfaction with nursing care. In 1980s,
hospitals and other healthcare areas started incorporating
patient satisfaction as on outcome measure to increase their
market share as the healthcare market became increasingly
more competitive. In 1990s, patient satisfaction became one
of the most important outcomes of care as patients starting
more explicitly weighting quality of life with quantity of life.
While the emphasis of clinicians has always been to maximise
quantity of life, patients (especially at the end of life) are now
focusing on quality of life. When the clinicians’ and patient’s
goals directly coincide, patient satisfaction will be maxi-
mised. As such, patient satisfaction needs to be incorporated
in the decision-making concerning the management of a
patient and eventually be involved in policy development.
The only way to ensure policy development and decision-
making is optimised to ensure we can make broad compar-
isons and provide valid/reliable measurements of patient
satisfaction, which can only be achieved by developing and
establishing valid/reliable instruments that are advocated by
the literature for use.
The increase in patient satisfaction has become a guiding
force for health care, and the Joint Commission on Accred-
itation of Healthcare Organizations (JCAHO) required facil-
ities to measure patient satisfaction as an outcome (Long
1999). Similarly, CMS required monitoring of patient satis-
faction and other outcomes of care for reimbursement.
Currently, patient satisfaction surveys are becoming routine
parts of every healthcare organisation. As such, there is a
mounting need for tools to reliably and validly measure
patient satisfaction. Without a comprehensive investigation of
the current tools used in the field, we will be unable to move
forward in empirically optimising patient satisfaction. Devel-
oping reliable and valid tools will not allow for more broad
comparisons, but lead to improvements in patient satisfaction.
Joint Commission on Accreditation of Healthcare Orga-
nizations has approved the ORYX accreditation system
that integrates outcome and performance measures into the
home health accreditation process. ORYX is not an
acronym but the name of a gazelle-like animal. ORYX
requires all home health agencies to collect outcome data
about patient care and submit it to JCAHO on a
continuous basis. Home health agencies are expected to
examine their delivery of care processes, including patient
satisfaction, and make changes to improve the quality and
results of care delivered.
All home healthcare agencies in the USA have developed
surveys that assess patient satisfaction. Still, a paucity of
published literature exists concerning the validity and reli-
ability of patient satisfaction scales in home health agencies.
Currently, the US Agency for Health Care and Quality is
developing a survey (HCAHPS) that will focus on patient’s
perspective on the process of care in home health care
including patient satisfaction. The survey has passed many
stages of development and is going through the pilot testing
Although patient satisfaction has been one of the many
measured care outcomes in home health and other healthcare
areas, it is still unclear what the concept of patient satisfac-
tion actually means and how to accurately capture this
outcome (Yellen 2003, Wagner & Bear 2009). Wilkin et al.
(1992) suggested that this may be explained by the large
number of studies that measure patient satisfaction without
explaining the concept measured. There is uncertainty about
what is the concept of patient satisfaction means (Mahon
1996, Comley & Beard 1998, Yellen 2003, Wagner & Bear
2009). This lack of clarity has led to the development of
inadequate measures of patient satisfaction (Lynn et al.
Patient satisfaction is a multidimensional concept and is
inversely related to patient expectations. Patient satisfaction
has been described to have elements of subjectivity, expec-
tations and perceptions. Patient satisfaction is a ‘complex
mixture of perceived needs, expectations of care, and the
experience of care’ (Wilkin et al. 1992) and is a predictor of
patients’ behaviours. Behaviours of dissatisfied patients
include premature termination of care, non-compliance with
prescribed treatment, and terminating membership and trying
another plan of care (Donabedian 1988b) and possibly a
response to care received. Satisfied customers have been
described by Steibert and Krowinski (1990) as loyal and may
be trusted to return for more business, care and refer patients,
which increases the organisation’s profits and market share,
and will most likely improve clinical outcomes.
While Huycke and All (2000) suggested that patients
evaluate quality of care based on interpersonal relation-
ships and that patient’s lack the sufficient knowledge and
are incapable of judging the quality of care itself, many
believe patients can easily identify characteristics of quality
of care. Still, the main premise of patient satisfaction that
most agree upon is that if the care provided meets the
healthcare goal, the patient will be satisfied. Healthcare
provider characteristics as well as patient characteristics
complicate the assessment of patient satisfaction. Huycke
and All (2000) described the following attributes of quality
that relate to a patient’s care, including patient satisfaction:
‘(1) Process/structure attributes that include access, avail-
ability, cost, continuity, equipment, fairness and justice; (2)
Interpersonal attributes such as humanness, responsiveness,
caring, respect, communication, beneficence, personality
type; (3) Technical attributes such as knowledge, skill,
Discursive papers Patient satisfaction in home health care
Ó2012 Blackwell Publishing Ltd
Journal of Clinical Nursing,22, 2426–2435 2427
competency, timely, prevention, normal efficiency; and (4)
Antecedents of quality attributes such as healthcare knowl-
edge, experience, expectation, physical and emotional
needs, values and believes, and perception of needs and
care’. Mrayyan (2006) operationally defined patient satis-
faction as ‘the degree to which nursing care meets patients
expectations in terms of art of care, technical quality,
physical environment, availability and continuity of care,
and the efficacy/outcomes of care’. What is more clear and
well established is that patient satisfaction is one important
predictor and indicator of quality of health care (Wagner
& Bear 2009).
Nurses provide the largest proportion of healthcare
services to patients in all healthcare sectors, particularly in
home health care. Adbellah and Levine (1957) were the first
to link patient satisfaction to more hours of professional
nursing service. Home health care has been targeted by many
researchers and in need of many changes that will hopefully
lead to decreases in the number of visits. Nurses are facing
different forces at the work site that challenge their abilities
to provide effective care for their patients. In this time of
uncertainty and change, it is essential to monitor patients’
satisfaction. Patient satisfaction is one of the indicators that
reflect the situation of quality of care in home health care and
is in need of reliable and valid measures to measure patient
Patient satisfaction applications
A review of the literature shows that patient satisfaction has
been used in the evaluation of many healthcare programmes
including rehabilitation programmes, discharge and home
follow-up programmes, care process, and management prac-
tices (Dansky et al. 1994, Rabiner et al. 1995, Gary &
Sedhom 1997, Smeenk et al. 1998, Tyson & Turner 2000,
Finkelstein et al. 2004, Tsai et al. 2005; Be’land et al. 2006,
Jones et al. 2007). Also, it has been used to evaluate new care
protocols and treatments (Herrmann et al. 1998, Armstrong
et al. 1999, Naylor et al. 1999, Mair & Whitten 2000,
Whitten 2000, Zadoroznyj 2006).
The use of patient satisfaction to evaluate healthcare
programmes is not an evaluation of care provided only by
a home healthcare agency. Care is usually provided by a
complementary team of multidisciplinary health service
providers, starting typically at either a hospital or a
specialty clinic and then the patient is referred to home
health care. Therefore, a comprehensive evaluation of the
care programme will include different types of services, not
all of them strictly related to nursing. In many cases, the
new programmes test the use of home health care as a
different way to improve the outcomes of care for a
specific disease or population of patients (Tyson & Turner
2000, Tsai et al. 2005, Brumley et al. 2007, Cross et al.
2008). Scales used to evaluate patient satisfaction are
routinely developed for the specific setting by the investi-
gators conducting the evaluation (Herrmann et al. 1998,
Smeenk et al. 1998, Naylor et al. 1999, Tyson & Turner,
1999, Planas et al. 2007). The patient satisfaction assess-
ment tools typically include only 1–4 items and focus on
the overall patient satisfaction as well as other specifically
selected elements of patient satisfaction. Traditionally, the
psychometric properties of the scales used are not provided
in many studies. Currently used patient satisfaction scales
in programme evaluation and randomised clinical trials do
not provide psychometric characteristics of patient satis-
faction measures. Although the abstracts of many rando-
mised clinical trials mentioned patient satisfaction, little
information has been provided throughout the associated
manuscripts (Armstrong et al. 1999, Naylor et al. 1999,
Cross et al. 2008). One of the issues in random clinical
trials is that the questions developed to assess patient
satisfaction are in the specific areas related to the study and
the interventions and do not allow for broad comparisons.
It is not well established whether the few developed and
advocated instruments are accurately measuring patient
Most of programme evaluation and randomised clinical
trial studies assessed the overall patient satisfaction. Heine-
ken (1998) found that patients who reported their overall
satisfaction in home health care reported routinely major
areas of dissatisfaction that they wanted to discuss, including
healthcare providers inconsistency (many providers within a
week of home care), different approaches of care by different
nurses, and some nurses showing no verbal or non-verbal
signs of caring.
Many clinical trial studies assess the patient satisfaction
after the treatment or the new programme of treatment being
evaluated. The goal of these studies is to confirm that the
patients are satisfied with the new care process (or the
feasibility/acceptability of the new process or intervention).
Developments in health care and the new methods of care
delivery are ways that would make patients more satisfied
with the new treatment than patients receiving alternative
methods of existing care or treatment. On the other hand,
clinical trial studies in home health care that compared
patient satisfaction between experimental and control groups
found small differences (Rabiner et al. 1995). It is a challenge
to develop responsive and sensitive tools that would convey
improved patient satisfaction and outcomes of care in
comparative design studies.
S Abusalem et al.
Ó2012 Blackwell Publishing Ltd
2428 Journal of Clinical Nursing,22, 2426–2435
Differing frameworks for measuring patient
Several approaches have been used to understand what lead
patients to become satisfied or dissatisfied with the care they
receive. Frameworks have focused on expectations theory
(Dansky et al. 1994, Westra et al. 1995) or healthcare service
attributes either from the economic theory or the holistic
approach (Bear et al. 1999, Crow et al. 2002, McCall et al.
2004, Kroposki & Alexander 2006, Leff et al. 2006). Yellen
& Davis 2001 used the systems theory as a framework to
assess patient satisfaction.
Obrest (1984) developed the expectation framework that
was used to develop the Home Care Client Satisfaction
Instrument (HCCSI) (Fig. 1). The framework views satisfac-
tion as ‘the congruency between client expectations of care
and perceptions of the care received’ (Westra et al. 1995).
The resulting domains in the HCCSI were interpersonal
relationship, technical competence, financial aspects, access/
convenience, continuity of care, and overall satisfaction. The
HCCSI, however, was used only in its published development
work and has not been subsequently used by others.
Rabiner et al. (1995), in the study of the relationship
between participation in two home- and community-based
long-term case management care (known as channelling),
tested a model of the determinants of medical care utilisation
and satisfaction by using structural equation modelling
techniques (LISREL). The model depicts the different direct
and indirect relationships among the following variables:
basic care, financial control, background factors, prior home
health experience, intensity of prior care, homeowner status,
and the model of determinants of medical care utilisation and
satisfaction that include utilisation of formal in-home care
and patient satisfaction. Model diagrams are usually used to
clarify the concepts and the relationship between the different
variables. However, this model is complicated and does not
have foundations in the behavioural or social sciences that
would predict or detect satisfaction.
Other researchers have used the qualitative approach to
develop patient satisfaction scales. Wilde et al. (1994) devel-
oped a patient centred questionnaire using the grounded
theory qualitative method. Still, frameworks for measuring
patient satisfaction are still underdeveloped and are in their
infancy. Huycke and All (2000) explained the many variables
that are related to patient satisfaction; however, unfortu-
nately only some of the variables related to patient satisfac-
tion are explained by these frameworks. Further development
of more comprehensive theories and frameworks of patient
satisfaction is needed and alludes to a very fruitful area of
A MEDLINE and CINAHIL search using the phrase
‘patient satisfaction’, ‘client satisfaction’, ‘consumer satisfac-
tion’ in home care resulted in the identification of n=23
home care patient satisfaction survey scales that were
published or referenced in published studies, demonstrating
an uncoordinated effort to measure patient satisfaction in
home health care, which does not allow for broad compar-
ison. In addition, Table 1 shows each instrument’s Chron-
bach’s alpha and construct validity statistics, when provided.
From Table 1 we can see that 39Æ1% (n= 9) of the studies
failed to report on internal consistency and 52Æ2% (n= 12) of
the studies failed to report on validity. Furthermore, Table 2
includes a list of the dimensions/domains of each instrument,
the number of items and the type of scale used.
Many scales are scored on a three-point Likert scale
ranging between unsatisfied (1) and satisfied (3) patients.
For more robust scale sensitivity, there is a need to increase
the number of choices on the Likert scales used in the
instruments. As mentioned earlier, there is an inherent need
for scale sensitivity when using these instruments in RCTs.
Patient improvements are usually obtained in small incre-
mental increases. Using tools’ results that stratify responses
into either satisfied or unsatisfied patients leads to such
small variances that unfeasible sample sizes are required to
Adherence to treatment
Continued use of services
Recommendation of services
to others
Figure 1 Framework of client satisfaction. Adopted from ‘Patients’
perceptions of care: Measurement of quality and satisfaction’ by
Obrest (1984). Copyright Ó1984 American Cancer Society. This
material is reproduced with permission of Wiley-Liss, Inc., a sub-
sidiary of John Wiley & Sons, Inc.
Discursive papers Patient satisfaction in home health care
Ó2012 Blackwell Publishing Ltd
Journal of Clinical Nursing,22, 2426–2435 2429
adequately power the associated studies. The following will
examine three different patient satisfaction scales.
The Human Resource Management Practices and Patient
Satisfaction Scale (HRPPSS) defined patient satisfaction as ‘a
construct that incorporates a personal evaluation of health-
care services and providers’. The items of the HRPPSS scale
are published and listed in a shortened way. It is not clear
whether the language used in the shortened list is the same
language used in the questionnaire. The published study did
not provide measures of validity and reliability of the new
developed HRPPSS scale.
Seibert et al. (1999) develop three questionnaires to mea-
sure patient satisfaction across the ambulatory continuum of
care. The three points of care were outpatient testing and
therapy services (TT), outpatient surgery (OS), and home
health care (HH). For this study, we are interested in the HH
Table 1 Surveys used to measure patient satisfaction in home health care
Name of
rate %)
Armstrong et al. (1999) Modified Patient Satisfaction
Questionnaire-III (PSQ-III)
181 (39) 0Æ84 NA
Bear et al. (1999) Service Coordinator Satisfaction
Measure (SCSM)
213 (NA) 0Æ86 Yes
Brumley et al. (2007) The Reid-Gundlach Satisfaction
with Services Instrument
166 (83) 0Æ95 NA*
Dana and Wambach (2002) KU Med/Maternal Child Home Care
Program Patient Satisfaction
1840 (24) 0Æ86 NA
Dansky et al. (1994) Human Resource Management
Practices and Patient Satisfaction
Scale (HRPPSS)
696 (38) NA Yes
Foley et al. (1995) Client Satisfaction Instrument
(Modified for HIV Clients)
50 (96) NA NA
Gary and Sedhom (1997) Gary’s Home Care Satisfaction
Scale (GHCSC)
NA 0Æ78 Yes
Geron et al. (2000) The Home Care Satisfaction
Measure (HCSM)
228 (61) 0Æ79 Yes
Holmqvist et al. (2000) NA 81 (94) NA NA
Jones et al. (2007) NA 21,350 (NA) 0Æ84 Yes
Laferriere (1993) Client Satisfaction Survey (CSS)
with Home Health Care Nursing (1993)
73 (75) 0Æ99 Yes
Leggin et al. (2006) The Penn Shoulder Score 73 (75) 0Æ93 Yes
McCall et al. (2004) NA 2588 (78) NA NA
Mylod and Kaldenberg
The Press Ganey Home Care Patient
Satisfaction Questionnaire
22,937 (NA) 0Æ98 Yes
Nakatani and Shimanouchi
Client satisfaction NA 0Æ89 Yes
Reeder and Chen (1990) Reeder and Chen’s Clients Satisfaction
Survey in Home Health Care (1990)
35 (NA) 0Æ93 NA
Seibert et al. (1999) Patient Satisfaction Care Specific Survey 16,772 (55) NA NA
Stomper (1998) NA 30 (80) NA NA
Struyk et al. (2006) Standardised Outcome and Assessment
Information Set for Home Health
Care – OASIS-B (with modifications)
300 (100) NA Yes
Tornkvist et al. (2000) Quality of Care from the Patient’s
Perspective (QPP)
168 (62) NA* NA*
Tsai et al. (2005) Service Satisfaction Instrument 80 (100) 0Æ94 NA
Westra et al. (1995) The Home Care Client Satisfaction
Instrument (HCCSI-R)
400 (45) 0Æ93 Yes
Wilson et al. (2002) NA 83 (91) NA Yes
*Reliability (alpha coefficient) and construct validity established in previous studies.
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2430 Journal of Clinical Nursing,22, 2426–2435
Table 2. Patient satisfaction survey dimensions, number of items and type of scale
Author (s) Dimensions
Number of
Number of
items in response
Armstrong et al. (1999) General satisfaction 18 Likert 5
Interpersonal manner
Time spent
Accessibility & convenience
Bear et al. (1999) Service delivery 19 Likert 5
Service sufficiency
Brumley et al. (2007) Relevance 12 Scale NA
Dana and Wambach (2002) Nurse friendliness 13 Likert 4
Technical skills
Infant care teaching
Individualised care
Dansky et al. (1994) Three overall measures NA Likert 5
Scheduling & arrangements
Nursing care
Home health aide services
Discharge arrangements
General measures of satisfaction
Foley et al. (1995) NA 34 Likert 5
Gary and Sedhom (1997) Caring 27 16 Likert & mixed 3
Amount of care/time spent
Geron et al. (2000) Care Management Services Sub-scale: 35 Likert 5
Service choice
Positive interpersonal
Negative interpersonal
Holmqvist et al. (2000) Art of care 18 Scale 5
Technical quality of care
Efficacy/outcome of care
Jones et al. (2007) Carer quality 60 Multiple choice 5
Service quality
Laferriere (1993) Technical quality of care 35 Scale 5
Personal relationships between
client & provider
Delivery of services
Leggin et al. (2006) One item Scale 4
McCall et al. (2004) Overall satisfaction 15 NA NA
Satisfaction with discharge experience
Satisfaction with agency staff
Discursive papers Patient satisfaction in home health care
Ó2012 Blackwell Publishing Ltd
Journal of Clinical Nursing,22, 2426–2435 2431
patient satisfaction scale. The Seibert home health scale
developed as part of assessing patient satisfaction across three
points of care had similar characteristics as other home health
patient satisfaction measures. The items contained words that
have a reading level higher than the six grade and included
words such as ‘perceived’, ‘dependability’, and ‘orientation’.
The sentences are not as simple such as ‘staff arrives in timely
manner’. A simple statement of this sentence would be ‘nurse
arrives on time’. Words such as ‘seems to’ and ‘questions/
services’ are not usually clear to respondents. Respondents
sometime believe I am asking for questions but not for services.
The published works on scale development did not include a
Table 2. (Continued)
Author (s) Dimensions
Number of
Number of
items in response
Mylod and Kaldenberg (2000) Arranging your home health care 35 Likert 5
Dealing with the home care office
Home health aides
Medical equipment
Overall ratings
Nakatani and Shimanouchi (2004) Client focus 46 Scale 4
Continuity of care
Coordination of services
Integration of services
Effectiveness and efficiency
Reeder and Chen (1990) Communication among
patient, family, provider
35 Likert 5
Competence of technical care
Provider, patient, and family
Seibert et al. (1999) Care process 27 Forced choice NA
Patient involvement education
Orientation to homecare
Perceived medical outcome
Stomper (1998) NA 5 Likert 5
Struyk et al. (2006) Services delivered 35 Likert 3
Services quality
Specific service satisfaction
General service satisfaction
Tornkvist et al. (2000) Medical–technical competence
of the care giver
34 Likert 4
The physical–technical conditions
of the care organisation
The degree of identity orientation
in the attitudes & actions of
the care givers
The socio-cultural atmosphere
of the care organisation
Tsai et al. (2005) Convenience 11 Scale NA
Time consumed
Nurses’ professional
Service content
Providers’ attitudes
Caregiver’s burden
Westra et al. (1995) Uni-dimensional scale 12 Likert 5
Wilson et al. (2002) NA 14 Scale 4
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2432 Journal of Clinical Nursing,22, 2426–2435
definition or a framework for satisfaction. There is no sum
score for the scale, which leads to the use of individual item
scores in validity and reliability assessment testing. Factor
analysis served as a support to construct validity.
The HCCSI was developed based on a review of the
literature, findings of quality improvement in home health,
nurse expert opinions, and three pilot studies (Westra et al.
1995). Also, the HCCSI is a modification of the Outpatient
Satisfaction Questionnaire (OSQ-37). The scale takes
10 minutes to complete. The final scale was called
HCCSI-R with 12 items rated on a five-point scale
(1 = very satisfied and 5 = very dissatisfied) and three
global satisfaction items rated on a 10-point Likert scale.
The survey took 10 minutes to be completed. The final
survey was uni-dimensional. The items used words such as
‘courteous’, ‘involvement’, and ‘consistently’. Compound
long sentences were used such as ‘Having the same people
consistently so they understood how you like care done’.
The instructions at the top of the questionnaire stated that,
‘if an item doesn’t apply, skip it and move to the next
item’. The instruction may be associated with the large
number of missing data. Clients could have been asked to
rate the importance of an item as well as their satisfaction.
One of the psychometric study criteria was that only
patients who have received care for at least two months
could participate in the study. According to the NHHCS
(1996), most of the patients received short visits and
tended to have a very short length of stay. In addition, the
patients’ satisfaction was evaluated during the care process.
There are many patient satisfaction assessment measures.
Nearly all scales did not define patient satisfaction and a few
used frameworks for patient satisfaction in home health care.
To develop patient satisfaction measures, the construct and
the theoretical frameworks of patient satisfaction in home
health need to be included in published studies. The current
situation of patient satisfaction measures limits the availabil-
ity of psychometric information and characteristics that could
help advance the measurement of patient satisfaction in home
health care. Patient satisfaction is a multidimensional concept
that requires psychometrically appropriate scales to be
measured, including reliability and validity assessment.
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Discursive papers Patient satisfaction in home health care
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Journal of Clinical Nursing,22, 2426–2435 2435
... Furthermore, these methods have been employed as suitable alternatives in some studies in the fields of hospitality, tourism, and consumer behavior [12,13]. However, due to the focus on service industries, for researching service quality gaps, the literature on experiential quality is limited among primary caregivers [14], and it is mainly directed toward patients receiving primary care in hospitals or homes [15,16]. Moreover, existing research has not investigated the relative importance of different service attributes-underperforming attributes acceptable to customers, attributes requiring higher performance, and those that must be prioritized for interventions-in facilitating user caregiver satisfaction. ...
... Impact-asymmetry analysis (IAA) grid. Attributes were categorized as delighters (12,14,15,18), satisfiers (2,11), hybrid (17), dissatisfiers (1,3,4,6,9,13,16), and frustrators (5,7,8,10,19,20) based on three levels of impact scores (high, medium, and low) ...
... Impact-range1-performance analysis (IRPA) grid. The most important attributes are 1, 5, 6, 9, 13, and 16 (with low APS and high RICS); the attributes of medium importance are 3, 10, and 20 (with high RICS and high APS); and the attributes of low importance are2,4,7,8,12,14,15, and 19 (with low RICS and high APS)Fig. 2 ...
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Background This study aimed to analyze family caregivers’ (FCs) dementia care service perceptions to identify the various attributes impacting FCs satisfaction and dissatisfaction. Methods This is a cross-sectional survey study using convenience sampling methods. A self-completion questionnaire was developed from the Service Quality scale and distributed using a convenience sampling method to family caregivers in community-based dementia care centers to determine their perceptions of service quality in dementia care. Both exploratory factor analysis and reliability analysis were conducted to confirm the validity and factor structure of the scale. This study employed Impact Range Performance Analysis (IRPA) and Impact Asymmetry Analysis (IAA) to analyze the data obtained from FCs across five attribute dimensions (Tangibles, Reliability, Responsiveness, Assurance, and Empathy). Priorities for service improvement were derived using a three-step analytical framework. Results This study reported that the overall perceived performance of service provided is high. The results indicated that practitioners should focus on attributes such as demand coordination, appropriate services, timely service, barrier-free environment, care-giving process, fire and safety compliance, professional knowledge, and reliable services, which have a higher range of impact on customer service and low impact-asymmetry and attribute performance scores. Conclusion This study used expectation and perceived performance to suggest that the priorities for improvement and resource allocation in dementia care centers vary across different attributes. Thus, attentiveness toward satisfying user demand could improve patient care and caregiver satisfaction. The dimensions and attributes identified by our study can serve as basic data for future research on the long-term care system.
... While healthcare institutions strive to gain an advantage over their competitors, they also need to prevent people from opting for other institutions or physicians while acknowledging the necessity of high-quality, effective service provision to satisfy the needs and demands of individuals (3,4). Within this scope, healthcare institutions must prioritize patient satisfaction in order to meet the needs of patients in an appropriate manner in addition to providing healthcare services effectively and accurately (5,6). ...
... Patient satisfaction is described as a complex combination of perceived needs, healthcare expectations, and care experience, which is an indicator of patient behavior (5). This concept has a multidimensional structure encompassing basic features such as techniques, functions, infrastructure, interactions, and the environment (7). ...
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The purpose of this study is to determine the effect of patient satisfaction on patient commitment and the mediating role of patient trust in this effect. The study was conducted with 595 patients receiving healthcare services from the city center of Sakarya in Turkey. The data were collected between March 30, 2017, and May 29, 2017, via questionnaire method. The Patient Satisfaction Scale by Chang et al, the Patient Commitment Scale by Torres et al, the Patient Trust Scale by Ozawa, and an Introductory Information Form were used as the data collection tools in the study. Descriptive statistical methods, exploratory factor analysis, reliability analysis, correlation analysis, and Model 4 within the Process Macro regression analysis for SPSS developed by Hayes in order to determine the mediating role were used for the data analysis. The analyses were made at a 95% confidence interval, and the variables of patient satisfaction, patient trust, and patient commitment have a strong positive correlation. The result of this study demonstrated that patient satisfaction affects patient trust and patient commitment. Another outcome of this study is that there is a mediating effect of patient trust in the impact of patient satisfaction on patient commitment. In conclusion, these related concepts might influence the beliefs and behavior of the patient concerning the healthcare institution in question or the services that they have received.
... receive some or all of their treatment at home (Abusalem, Myers, & Aljeesh, 2013;Candel, Julián-Jiménez & González-Del Castillo, 2016;Kieran et al, 2009). OPIVA services, also known as outpatient parenteral antimicrobial therapy services, are widely available due to their utility in the treatment of patients with a wide range of infectious diseases (Baker et al, 2012). ...
... OPIVA treatment enables patients to either avoid, or have a reduced period of hospitalisation while maintaining safe, structured follow-up care from a specialised infectious diseases team (Rucker & Harrison, 1974;Seaton & Barr, 2013;Upton et al, 2004). Some of the essential drivers of OPIVA are that it improves patients' quality of life and gives them the option of being treated at home, thus allowing shorter hospital stays, reduced inpatient costs, and fewer incidents of health-care associated infections (Abusalem et al, 2013;Ansari, 2013;Corwin et al, 2005;Davis & Woodhead, 2016;Dubois & Santos-Eggimann, 2001;Eron & Passos, 2001;Goodfellow et al, 2002;Hitchcock, Jepson, Main & Wickens, 2009;Kieran et al, 2009;Leff et al, 2006;Marra et al, 2005;Montalto, 1996;Sims et al, 2013;Wilson, Wynn, & Parker, 2002). The availability of newer antibiotics with prolonged half-lives, in conjunction with the development of more refined vascular access devices, have further facilitated OPIVA delivery . ...
Aim: The aim of this research was to survey patients' experience of the care provided by the outpatient intravenous antibiotic (OPIVA) service at Auckland City Hospital. Background: Research in Australia has demonstrated that OPIVA is a safe and effective option for managing selected patients who require a long period of intravenous antibiotic treatment. Methods: In this cross-sectional study, 101 patients were invited to participate, and 75 (74 percent) completed the questionnaire. Most of the respondents were male, New Zealand European, and most (73/75, 97percent) had received intravenous antibiotic therapy as an inpatient and then completed their antibiotic treatment in the community. Results: The survey responses were positive about the overall provision of OPIVA care (99 percent), communication with the OPIVA nurses (97 percent) and doctors (96 percent), and the written information provided about the OPIVA service (99 percent). Responses were mostly positive about the training for home antibiotic administration (90 percent) and the convenience of attending the OPIVA clinic (87 percent). Areas identified for improvement fell under two overarching themes: inconvenience associated with health-care delivery and issues about the management of central venous access devices (CVAD). Conclusion: OPIVA therapy was well-regarded and met the expectations of the majority of respondents in this survey. Improvement opportunities include better discharge information, more education opportunities for community nursing teams, collaboration between different teams, training sessions for staff and patients, and the availability of the service after hours.
... [10] Şimdiye kadar geliştirilmiş pek çok hasta memnuniyeti değerlendirme ölçütü olmasına rağmen bunların sadece birkaçı hasta memnuniyetini ESH çerçevesinde değerlendirir. [12] Bu çalışmada, hizmet kalitesinin yükseltilmesi için, memnuniyetin düşük olduğu konuların belirlenerek çalışmalar yapılması amacıyla evde sağlık hizmeti alan hasta ve yakınlarının memnuniyet düzeylerinin "Evde Sağlık Hizmetleri Hasta Deneyimi Anketi" uygulanarak ölçülmesi amaçlanmıştır. ...
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Results: The findings showed that 84% of the participants stated that the services provided met their expectations. No statistically significant difference was found in the satisfaction level of the respondents according to the sex and education level of the respondents and the subject (patient/patient relatives) (p=0.109; p=0.089 and p=0.916, respectively). However, there was a significant difference in satisfaction level among age groups (p=0.038). The age group with the highest satisfaction was 50-59 years old and the group with the lowest was 49 years old and below. The majority of the participants (91%) stated that they could recommend the service to other people. Conclusion: The findings obtained in this study suggest that the patients and their relatives are mostly satisfied with home healthcare. ÖZET Amaç: Kullanıcıların memnuniyetinin ölçümü, evde sağlık hizmetlerinde kalitenin değerlendirilmesi için kullanılan önemli göstergelerden biridir. Bu çalışmanın amacı, evde sağlık hizmeti alan hasta ve yakınlarının memnuniyetini değerlendirmektir. Yöntem: Bu çalışmada evde sağlık hizmeti alan hasta ve yakınlarının memnuniyeti Evde Sağlık Hizmetleri Hasta De-neyimi Anketi kullanılarak ölçülmüştür. Anket 375 kişiye uygulanmış ve elde edilen veri SPSS (Statistical Package for Social Sciences for Windows 22) programı kullanılarak analiz edilmiştir. Grupların sayısal olarak karşılaştırılmasında Mann Whitney U testi ve Kruskal Wallis testi kullanılmıştır. Bulgular: Katılımcıların %84'ü, sunulan hizmetlerin beklentilerini karşıladığını ifade etmiştir. Anket uygulanan kişilerin cinsiyeti ve eğitim seviyesi ve anket uygulanan kişiye göre (hasta/hasta yakını) değerlendirildiğinde memnuniyet düzeyinde istatistiksel olarak anlamlı bir farklılık bulunamamıştır (sırasıyla p=0,109; p=0,089 ve p=0,916). Ancak yaş grupları arasında memnuniyet düzeyinde anlamlı bir farklılık vardır (p=0,038). Memnuniyetin en yüksek olduğu yaş grubunun 50-59 yaş, en düşük olduğu grubun ise 49 yaş ve altı olduğu görülmüştür. Katılımcıların büyük çoğunluğu (%91) hizmeti başka insanlara tavsiye edebileceklerini ifade etmişlerdir. Sonuç: Çalışmamızın sonucuna göre hasta ve hasta yakınlarının evde sağlık hizmetinden büyük oranda memnun oldukları görülmektedir. Anahtar sözcükler: Evde sağlık hizmetleri; hasta; hasta yakını; memnuniyet.
... [10] Şimdiye kadar geliştirilmiş pek çok hasta memnuniyeti değerlendirme ölçütü olmasına rağmen bunların sadece birkaçı hasta memnuniyetini ESH çerçevesinde değerlendirir. [12] Bu çalışmada, hizmet kalitesinin yükseltilmesi için, memnuniyetin düşük olduğu konuların belirlenerek çalışmalar yapılması amacıyla evde sağlık hizmeti alan hasta ve yakınlarının memnuniyet düzeylerinin "Evde Sağlık Hizmetleri Hasta Deneyimi Anketi" uygulanarak ölçülmesi amaçlanmıştır. ...
INTRODUCTION[|]Measuring the users' satisfaction is one of the crucial indicators used in the evaluation of quality in home health services. In this study, we aimed to measure the satisfaction of patients and their relatives who received home health care.[¤]METHODS[|]In this study, the satisfaction of the patients and their relatives receiving health care at home was measured using the Home Health Services Patient Experience Questionnaire. The questionnaire was applied to 375 people and the data obtained were analyzed using the SPSS (Statistical Package for Social Sciences for Windows 22) program. In the numerical comparison of the groups, the Mann-Whitney U test and Kruskal Wallis test were used. [¤]RESULTS[|]The findings showed that 84% of the participants stated that the services provided met their expectations. No statistically significant difference was found in the satisfaction level of the respondents according to the sex and education level of the respondents and the subject (patient/patient relatives) (p=0.109; p=0.089 and p=0.916, respectively). However, there was a significant difference in satisfaction level among age groups (p=0.038). The age group with the highest satisfaction was 50-59 years old and the group with the lowest was 49 years old and below. The majority of the participants (91%) stated that they could recommend the service to other people.[¤]DISCUSSION AND CONCLUSION[|]The findings obtained in this study suggest that the patients and their relatives are mostly satisfied with home healthcare.[¤]
In recent years, palliative care practice has shifted toward community-based palliative care. The complex care needs of older adults and people requiring palliative care are increasing due to the increase in life expectancy. However, it remains limited in the Middle East, which has Muslim-majority populations. Various barriers to successful establishment of palliative care services in community settings were identified.
The increasing use of lasers in photodynamic therapy (PDT) for the treatment of cancer requires a better understanding of the effects of different laser parameters on the results of PDT. To minimize thermal damage and optimize healing benefits, we compared pulse, burst pulse, and continuous wave (CW) laser irradiation modes in PDT treatment of lung cancer in an in vivo animal model. Our results show that pulse and burst pulse modes, with high power density and short irradiation times relative to CW, improve the photodynamic reaction without thermal damage. In contrast, the CW irradiation mode induced thermal damage with the same radial profile as that of the laser beam and the temperature in the tissue.
In recent decades, non-communicable diseases, including cancer, have turned into a serious challenge for the health systems of various countries, such as Iran. With advances in the treatment of these diseases, the number of survivors has increased, and thus with the increasing demand for treatment and care services, the rising costs and limited resources of the health system, it would be necessary to shift care provision from hospitals and medical centers to different care settings including community. According to the World Health Organization’s (WHO) recommendation, the first step toward community-based palliative care (PC) services was to establish hospital-based clinics, the by-laws for establishing which are being made. On the other hand, due to the tendency of cancer patients and their families to receive home care, home care provision centers have been operational since about 5 years ago. Moreover, although studies show that patients’ families are reluctant to entrust their patients to hospices and care centers, some studies indicate that changes in people’s lifestyle make the establishment of long-term care facilities and hospices necessary. Despite the importance of community-based services, some barriers are also influential in shifting the PC services to the community. It is hoped that these barriers will be eliminated gradually, through changes in current structures.
Purpose This study aims to analyze the managerial levers previously considered in literature in the setting of the provision of primary care and community services (in particular for patients with long-term conditions being treated also at home) as well as those scarcely explored that could potentially be adopted in the future. Design/methodology/approach This study was a structured literature review. The authors retrieved papers, published from 2005–2020, from electronic databases (i.e. ABI/INFORM Complete, Jstor, PubMed and Scopus). Each selected paper was assigned to a framework category, and a thematic analysis was performed. Findings Topics scarcely explored in literature were related to logistics/supply chain, economic evaluations, performance management and customer satisfaction. Some papers embraced more than one management topic, confirming the multidisciplinary nature of territorial healthcare services. The majority of research, however, focused on only one aspect of primary care services, and a lack of an integrated view regarding the provision of those services emerged. Originality/value This study represents a first attempt to rationalize the fragmented body of knowledge on the topic of the provision of primary and community care services. This study enabled some light to be shed on the managerial levers already explored previously in literature and also identifies a number of trajectories for future research.
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Objectives: To determine whether an in-home palliative care intervention for terminally ill patients can improve patient satisfaction, reduce medical care costs, and increase the proportion of patients dying at home. Design: A randomized, controlled trial. Setting: Two health maintenance organizations in two states. Participants: Homebound, terminally ill patients (N=298) with a prognosis of approximately 1 year or less to live plus one or more hospital or emergency department visits in the previous 12 months. Intervention: Usual versus in-home palliative care plus usual care delivered by an interdisciplinary team providing pain and symptom relief, patient and family education and training, and an array of medical and social support services. Measurements: Measured outcomes were satisfaction with care, use of medical services, site of death, and costs of care. Results: Patients randomized to in-home palliative care reported greater improvement in satisfaction with care at 30 and 90 days after enrollment (P<.05) and were more likely to die at home than those receiving usual care (P<.001). In addition, in-home palliative care subjects were less likely to visit the emergency department (P=.01) or be admitted to the hospital than those receiving usual care (P<.001), resulting in significantly lower costs of care for intervention patients (P=.03). Conclusion: In-home palliative care significantly increased patient satisfaction while reducing use of medical services and costs of medical care at the end of life. This study, although modest in scope, presents strong evidence for reforming end-of-life care.
The purpose of this study was to compare the outcomes of a hospital-based home-care model with those of a conventional outpatient follow-up for mentally ill patients in Taiwan by means of cost-effectiveness analysis. The study design was a two group post hoc design. We interviewed 40 mentally ill patients who were followed up in the psychiatric outpatient department. Another 40 mentally ill patients who participated in a hospital based home care program were also interviewed. The outcome measures we used for interviews were disease maintenance behavior, psychotic symptoms, social function, service satisfaction, and cost. The cost for each patient was the sum of costs for all direct mental health services. The cost-effectiveness ratio showed that the costs of the hospital-based home care model (4.3) were lower than those of conventional outpatient follow-up (13.5) and that over a one-year period, the hospital-based home care model was associated with improvements in mental conditions, social functional outcomes, and service satisfaction. The improved outcomes and the lower costs in the hospital-based home care program support the view that it is the most cost-effective of the two. Policy makers may consider this analysis as they allocate resources and develop policy for the care of mentally ill patients.
Although we may believe we are inviting client feedback about care, it is clear from a recent study surveying home care providers and older adult care recipients that failures in communication continue to plague us. Inadequate communication can lead to misunderstandings, client and provider dissatisfaction, and even termination of the home care provider-client relationship. By strengthening communication skills, staff can see changes in client satisfaction, have greater success in resolving potential problems, and may ultimately experience more job performance satisfaction.
The purpose of this article is to describe tools (top box analysis, bottom box analysis, and segmentation analysis) that allow more thorough use and interpretation of patient satisfaction data. Techniques are demonstrated using data gathered from 22,937 home care patients at 174 agencies during the first quarter of 1999. Results provide unique insights into home care performance. Top box analysis revealed that nursing issues are most likely to be given the highest ratings. Bottom box analysis showed that very low ratings were most prevalent in explanations of billing and cost, resolution of problems, and involvement in decision making. Simple segmentation analysis showed significant differences in satisfaction based on patient characteristics. Complex segmentation analysis identified the most and least satisfied groups of patients using combinations of patient characteristics.
In a previous study (Wilde et al. 1993), we developed a model of quality of care from a patient perspective using a grounded theory approach. The aim of the present study was to derive an instrument from this model. A questionnaire, Quality from Patients' Perspective (QPP), was developed which consisted of 56 items. Each item was evaluated in two ways by the respondent; assessment of perceived reality and evaluation of subjective importance (Likert scales). A personal quality of care index was computed on the basis of the relationship between these two scores. The QPP was tested on two samples, patients with infectious diseases (n = 147, mean age: 60 years) and nursing students (n = 103, mean age; 27 years). Patient's scores were factor analysed (principal factoring with oblique rotation) and 17 factors were extracted. Subgroups of patients were compared and correlations were computed between factor scores and self-rated health and well-being. Students also responded to a short form of the QPP (41 items) and personality scales. Correlations between these sets of variables were computed. The QPP was discussed in relation to existing scales.
As the chronic illness population increases, health care organizations are looking for ways to help promote Wellness and prevent illness. The Chronic Disease Management Program (CDMP) was developed in a Midwest hospital's home care department to provide services. The target population was those chronically ill who were no longer eligible for skilled home care, but continued to require ongoing monitoring. Admission criteria and service provision protocols were developed. Patients were visited on an average of once a month by a nurse, free of charge, with a focus on the management of chronic disease. Outcome measurement included patient/physician satisfaction, quality of life measures, and a financial cost analysis. Results demonstrated a high level of satisfaction, stabilized or improved quality of life, and significant financial savings.
Home care services play a fundamental role in England in supporting older and disabled people in their own homes. In order to identify and monitor the degree to which these services are providing good quality services, in 2003 the government required all councils with social services responsibilities (CSSR) to undertake user experience surveys among older service users. The questionnaire was required to include four questions, two of which were designed to be used as Best Value Performance Indicators (BVPI) reflecting the quality of home care of older people. Thirty-four local authorities participated in an extension study providing data from 21 350 home care users. The aim of the study was to answer three questions: (1) Do the performance indicators reflect home care quality? (2) Are the performance indicators using the most appropriate cut-off points? (3) What are the underlying constructs of home care quality? Evidence was found to support the use of two of the performance indicators and the current cut-off point being used for the satisfaction indicator. Factor analysis identified indicators of important dimensions of quality that were associated with overall satisfaction.
In 1995, to meet the needs of mothers and newborns discharged early, a home care follow-up program using an advanced practice nurse was initiated at a Midwest academic medical center. Information about the program and elements of patient satisfaction, as measured from program inception, are presented in this article. The major correlates of satisfaction were nurse friendliness, technical skills, infant care teaching, and individualized care. Attending to these areas can facilitate existing program improvement and new program development.