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

OBJECTIVE: To develop a reliable and valid measure of patient opinions on quality of hospital care. DESIGN: Issues of importance to patients and possible scale items were generated by literature review and non-structured interviews of patients, former patients, health care providers and researchers. Semi-structured interviews with inpatients and pilot studies were conducted to modify or remove ambiguous questions and reduce skewed responses. A study was then made to select from these questions relevant items and variables correlated to patient evaluation of quality of care. A principal-components analysis was performed to select items and assess construct validity. Cronbach's alpha coefficients were calculated to estimate the reliability of the scale. Time reliability and concurrent validity were also considered. SETTING: An 800-bed French short-stay teaching hospital in Paris. STUDY PARTICIPANTS: Five-hundred and thirty-four consecutive patients hospitalized in eight medical and surgical wards. RESULTS: A 26-item scale was developed. Component analysis indicated two subscales: 'medical information' and 'relationship with staff and daily routine'. Levels of reliability were satisfactory: Cronbach's alpha coefficient exceeded 0.87 for overall scale and subscales. Concurrent validity and time reliability 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 diagnosis, admission pattern, private patient and difficulties reported by staff), 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. Items selected in the scale emphasized the importance that patients give to receiving medical information.