Intertemporal stability of patients' quality judgments

Abstract

The purpose of this research was to determine whether patients' judgments concerning quality of hospital care depend on when their judgments are assessed. To obtain patients' judgments about the quality of care, we measured their satisfaction as well their expectations over time. Theoretical constructs to measure patient satisfaction with hospital care were tested. Satisfaction was measured by using traditional Likert-type scale. To capture patients' expectations regarding such a complex phenomenon (quality of care) we used the multiattribute utility approach. This approach requires that we create a structured list of the attributes used by patients and that we elicit the relative importance of each attribute (weights) as well as the value of the different degrees of each attribute (utility functions). The current research had a within-subject design and was diagnosis-specific. Patients diagnosed with myocardial infarction were selected from nine community hospitaIs. Through self-administered questionnaires, data were collected from one hundred sixty-four patients at two points in time: one month and tive months after discharge. Analyses were conducted to study how stable satisfaction and expectations were over time. Results from univariate and multivariate analyses showed that, at least for myocardial infarction, patients' satisfaction and expectations are not necessarily stable over time. The time at which the assessment is administered during the patient's recovery process is crucial. One implication of this research is that hospitaIs must take the intertemporal stability of their patients' judgments into account. However -- and this is the major consequence of this study -- to fully address the intertemporal stability of patients' quality judgments, we need further research. We need to understand what kind of patients are unstable over time, and what implications that instability has on the effectiveness of efforts toward process improvement and decision making. We also need to replicate this study to other diagnoses. Interviews to build patients' models about quality of care as well as to understand why patients have changed their quality judgments are necessary. Finally, extensive research is essential to understand the attributes patients consider most relevant when assessing the quality of hospital care.