1. outcome research 1 Satisfaction/ behavioral indices Wei-Chu Chie

2. outcome research 2 Background Over the past decade/market- oriented care an indicator of quality of care multi-level performance assessment development of patient care models quality assurance, cost improvement, total quality management, cost- effectiveness

3. outcome research 3 Health care policy/management Structure Process Outcome –Donnabedian, 1966

4. outcome research 4 Anderson ’ s health behavior model Predisposing enabling need utilization satisfaction

5. outcome research 5 Rationales & arguments –Patient can play an important role in defining how health are is delivered. –Patients can play an important role in defining quality of care by determining what values should be associated with different outcomes. – The quality of physicians ’ interpersonal skills influences patient outcomes.

6. outcome research 6 Rationales & arguments –Satisfaction can affect outcomes through a placebo effect, which in some instances, has shown to contribute to up to one-third of the actual healing process. –As medical care increasingly becomes a consumer good, patient (consumer) satisfaction becomes more salient.

7. outcome research 7 Definition of patient satisfaction A health care recipient ’ s reaction to salient aspects of his or her service experience –Pascoe, 1983

8. outcome research 8 Definition of patient satisfaction A patient ’ s (affective or emotional) response to his or her (cognitive or knowledge-based) evaluation of the health care provider ’ s performance (perceived quality) during a health care consumption experience –Ross et al., 1987

9. outcome research 9 Basic components Emotional or cognitive evaluation of a health care provider ’ s performance based on relevant aspects of the experience

10. outcome research 10 Fields involved Marketing research clinical practice –information asymmetry –subjective in nature

11. outcome research 11 Aspects Interpersonal accessibility, availability & convenience continuity physical setting technical quality efficacy financial consideration

12. outcome research 12 Marketing models Multi-dimensional, dynamic construct vary across time emotional + cognitive comparison with expectations –physician may influence expectations

13. outcome research 13 Clinical models A distinct outcome of care closely related to health status outcomes overall (gestalt) + particular subjective, influenced by experiences based on investigator ’ s conception

14. outcome research 14 Measurement Problems of amorphous (abstract) concept measurement different dimensions can show different results –overall –specific: multi-dimensional Likert ’ s scale vs. visual analog scale

15. outcome research 15 Existing tools GHAA survey Picker/commonwealth patient satisfaction scale (PSS) CAHPS Oberst visual analog scale SAT32 (EORTC)

16. outcome research 16 GHAA survey Group Health Association of America 60 questions: multi- + single-item scales –provider –care (general) –health plan/health insurance –use of care –personal characteristics

17. outcome research 17 Picker/commonwealth Hospital satisfaction survey 52 questions –communication –financial information –patient ’ s needs and preferences –emotional support –physical support

18. outcome research 18 Picker/commonwealth –Pain management –education –family participation –discharge preparation/continuity of care

19. outcome research 19 Patient satisfaction scale (PSS) 27 questions –4 subscales/25 questions communication abilities affective behavior technical competence general satisfaction –2 questions: job and family

20. outcome research 20 CAHPS Consumer assessment of health plans study a future project –access, communication, interaction –continuity & coordination –preventive care –administrative burden –health plan ’ s customer service

21. outcome research 21 CAHPS –Enrollment –personal contribution toward the premium –health status –respondent characteristics

22. outcome research 22 Oberst VAS Visual analog between 1 and 0: –far expected my expectations/the best... and –did not meet my expectations at all/the worst.. six questions –the care: nursing/medical –information: self-care/illness –recommendation or not (Likert ’ s scale)

23. outcome research 23 EORTC-SAT32 Supplementary for EORTC QLQ-C30 Likert ’ s scale 32 questions/three parts –physician –nursing knowledge, skill, manner, attention,... –Organization accessibility, convenience, building,...

24. outcome research 24 Health education and health care intervention Health behaviors* Self-efficacy* Health status Health care utilization –Chronic diseases self-management program –Lorig et al., 1996

25. outcome research 25 Health behaviors –Primary prevention: Exercise, diet, smoking, alcohol, … Stress coping, injury prevention,... Immunization and chemoprophylaxis –Secondary prevention: screening cancer cardiovascular, … –Tertiary prevention compliance, disease management and self-care

26. outcome research 26 Health behaviors: nature Usually short-term directly associated with education less predictable to further outcomes sometimes abstract: –knowledge/cognition/perception –attitude/beliefs –practices

27. outcome research 27 Health behaviors: measurement Observation Questionnaire –frequency –intensity

28. outcome research 28 Self-efficacy Confidence to perform certain behaviors –health behaviors –disease management –compliance and self-care –community participation usually/special conditions

29. outcome research 29 Efficacy assessment Comparison of different groups –Direct comparison of outcome status/values compare and reassure the comparability of baseline adjust the baseline –Change of status/values: change from baseline Choice of methods of comparison –based on goals & hypothesis

30. outcome research 30 Efficacy assessment: examples Status –disease/well alive/death –change of status: event from well to disease from alive to death values –BP vs. BP change from baseline –Qol vs. QoL change from baseline