Satisfaction with children's medical care in six different ambulatory settings

Adolescent satisfaction in an urban pediatric emergency department

OBJECTIVES

We studied the satisfaction reported by adolescents when visiting a pediatric emergency department (ED) and elicited suggestions for improving the ED for teenage patients.

METHODS

A 33-question survey was developed for this study assessing adolescents' overall satisfaction with their ED care as well as their views on the waiting time and setting, medical staff, treatment and discharge plans, and comparisons to general hospital EDs. The survey was administered at discharge home or admission to the hospital.

RESULTS

Two hundred eighty-two patients completed the survey. Two hundred fifty-nine respondents (92%) rated their experience as good or better. A decreased level of satisfaction was reported among adolescents waiting to see a physician in excess of 2 hours. Satisfaction was not affected by age, diagnosis, procedure, or disposition. Respondents felt safe in our department and were satisfied with the physicians and nurses treating them and their treatment and discharge plans. One hundred seventy respondents offered suggestions for an improved ED setting. Of the 161 patients who had previously attended a general hospital ED, only 11 patients (7%) preferred the general hospital setting. It was concerning that 184 respondents (65% of total) reported not having an opportunity to meet with their physician alone.

CONCLUSIONS

Adolescents were satisfied with care in our pediatric ED. Long wait times are associated with decreased level of satisfaction among adolescents. The waiting room setting and meeting a physician alone were important to adolescents visiting our ED.

Actual time spent estimate--an index profile in management for pediatric outpatient care

OBJECTIVES

In this study we propose to develop and use an instrument to measure the individual actual time spent at each stop in an outpatient visit, on the basis of the perceived time spent and dissatisfaction level expressed by an accompanying adult (the subject) in a pediatric outpatient department.

METHODS

We shall use the exaggeration-appreciation level of the perceived time/actual time ratio as it relates to the subject's dissatisfaction level. This scheme allows for relationships between the exaggeration-appreciation level at each stop in the course of the visit and for the dissatisfaction levels for all stops prior to that one. Data were obtained from 191 of 197 randomly selected subjects visiting the pediatric outpatient department of a teaching hospital in Taiwan.

RESULTS

Geometric regression showed that the actual time spent per stop could be estimated on the basis of the perceived time and dissatisfaction level expressed by the subject at all stops up to the stop.

CONCLUSIONS

The index profile for the estimated actual time spent at each stop during a pediatric outpatient department visit can be generated from the perceived time for, and dissatisfaction with, each stop as expressed by the subjects. This profile may help the hospital managers evaluate the operation of the outpatient department and even provide the basis for adjustment of manpower.

The impact of having parents report about both their own and their children's experiences with health insurance plans

OBJECTIVES

The aim of this study was to determine whether parents rate their children's care differently when they also rate their own care than when they do not.

METHODS

Subjects were employees of Washington State who had been enrolled in a health plan for at least 6 months and who had at least one covered child. Subjects were randomly assigned to four study groups that were surveyed using different protocols. To assess the stability of responses over time, a follow-up telephone interview was conducted with individuals in two of the groups.

RESULTS

Parents or guardians who received both the Adult and Child Surveys were less likely to complete a survey than those who received only one survey. Responses to selected survey questions were quite stable between survey administrations. Parents who rated only their child's health care experiences generally gave more positive responses than those who also rated their own care, although few of these differences were statistically significant. This may have been due, in part, to the lower response rates in the latter group. The pairs of survey questions that ask about the adult's and child's experiences with the same aspects of care had moderate to high levels of association. The pair with the weakest association asked how clearly the doctor or nurse explained things to the adult or the child.

CONCLUSIONS

Sending both an adult and child survey to an adult could have an effect on the pattern of responses and result in lower response rates, but this might be a cost-effective way to collect reports about both adult and child health care.

Evaluating predictors and concomitants of patient health visit satisfaction: an empirical study focusing on methodological aspects of satisfaction research

We propose that the weak and conflicting results from various studies of satisfaction concomitants are due to the use of scales which sum scores from items that measure different types of satisfaction. The hypothesis is clearly supported, leading to the strong recommendation that different types of patient satisfaction be studied separately. Implications for studying and potentially increasing patient satisfaction are discussed.

[Consumer satisfaction with 2 models of primary care in operation in Andalucia]

A study was completed to investigate if any differences are observed in user satisfaction with health care centres, polyclinics and solo-practice, furthermore to identify user, organizational characteristics and doctors as variables that relate to user satisfaction in health care. A sample of users was chosen from the Andalusian cities of Granada, Málaga and Sevilla with an alpha = 5%, beta = 10% and d = 11%. The variables were collected trough the use of three questionnaires. Greater satisfaction was found between health care centre users than with polyclinics and solo-practice, with values being 62.4, 58.2 and 60.6 with a p < 0.001. The variables more strongly associated with user satisfaction in health care centres are those related with doctors and organization characteristics. Therefore several are capable of improvement in order to increase user satisfaction. On the contrary in polyclinics and solo-practice the most influential variables are those related with the user characteristics, which are not modifiable by the health services intervention.

Pediatric emergency department complaints: a three-year analysis of sources and trends

STUDY OBJECTIVE

To identify the incidence and major causes of patient and parental complaints in a pediatric emergency department.

DESIGN

Retrospective analysis of complaints received regarding patients seen between January 1987 and December 1989.

SETTING

ED of Children's Hospital of Pittsburgh.

PARTICIPANTS

All complaints received during the three-year period.

INTERVENTIONS

Complaints were reviewed for reason, validity, and location at which patient was seen.

MEASUREMENTS AND RESULTS

One hundred seventy-six complaints from a total of 154,648 ED visits yielded a frequency of 1.1 complaints per 1,000 patient visits. Main reasons for dissatisfaction were misdiagnosis, billing, and inadequate treatment; 49% of complaints were judged valid. There were 0.69 complaints per 1,000 patient visits in the nonurgent medical portion of the ED. Patients seen emergently (critical care and trauma) had a significantly lower complaint frequency of 0.08 per 1,000 patient visits (P less than .001 by chi 2 analysis).

CONCLUSION

Assessment of ED complaints is useful to highlight areas of patient dissatisfaction and develop plans for improving patient care.

Maternal satisfaction with primary care for children with selected chronic conditions

One hundred forty mothers of children with chronic illnesses seen in two pediatric specialty clinics of a major urban teaching hospital were surveyed regarding their primary care arrangements and satisfaction with care received. Three dimensions of maternal satisfaction were measured: general satisfaction, satisfaction with access to care and satisfaction with doctor conduct (physician humaneness and technical quality). Results of multivariate analyses indicate that receipt of anticipatory guidance, access to care during evening hours and having a child in excellent reported health status were significantly associated with at least two of the three dimensions of maternal satisfaction. Findings have implications for organizing comprehensive, accessible primary care in the community, which is consistent with recent trends in child health policy. Results supported the need for enrichment of primary care for children with chronic illnesses to allow for physician continuity, provision of information and advice to families and extended office hours.

Correlates of emergency room utilization in the first year of life

We conducted a case-control study to examine the correlates of emergency room use in the first year of life, particularly the role of parental health beliefs, among the families of inner-city children enrolled in a hospital-based primary care program. Data was collected by structured interviews and by medical record review. Emergency room users were more likely to have single mothers and to have acute, recurrent medical conditions than were non-users. Health beliefs differed between groups by maternal report of worry about the kinds of illnesses that her child acquires. Emergency room use was predicted by: maternal marital status, maternal worry and concern that illness interferes with her child's activity, acute recurrent illnesses, hospitalization. This model may be applicable to other populations in designing intervention strategies to modify emergency room utilization.

Mothers' satisfaction with the cost of children's care: the role of practice settings and actual expenses

This paper analyzes mothers' satisfaction with the cost of children's care in six widely-varying ambulatory settings: fee-for-service solo and group practices, a prepaid group, public clinics, hospital outpatient departments, and an emergency room. Data are from a household survey in Washington, DC and represent 638 children. Findings indicate significantly higher satisfaction with cost in public clinics than in solo practice, fee-for-service groups, and the emergency room, adjusting for patient characteristics, attitudes and financial coverage. In fee-for-service settings, both provider charges and out-of-pocket costs had a nonlinear relation to satisfaction with cost; to a point, increasing costs and charges were associated with decreasing satisfaction, but thereafter higher costs and charges appeared to lead, other things equal, to higher satisfaction. Out-of-pocket costs had a significantly greater negative effect on poor mothers' satisfaction than on the more affluent. Implications for current policy trends are discussed.

Emergency department complaints: a one-year analysis

We conducted an analysis of all complaints received in a busy suburban emergency department during 1985. All complaints were handled in a standardized fashion, and were categorized as billing, physician, nursing, or miscellaneous. Data were expressed as a "complaint frequency" (complaints per 1,000 patient visits). Complaints were analyzed for the following characteristics: reason, gender of the patient, gender of the complaining party, relationship of the complaining party to the patient, health care provider, patient age, and patient disposition. The chi-square method was used to identify characteristics associated with a high risk for complaints. There were a total of 244 complaints, arising from 64,910 patient visits, yielding an overall complaint frequency of 3.8. The largest number of complaints (135), involved billing (frequency, 2.0). The most common (60) was insurance carrier rejection of the bill as a nonemergency. The next most common billing complaint (25) was a charge mistakenly billed too high by the ED. There were 70 complaints regarding emergency physicians, for a complaint frequency of 1.1. Of these, 17 were due to a perceived lack of communication with the patient, the patient's family, or the patient's private physician. Eighteen complaints were regarding a perceived misdiagnosis. One physician had a significantly higher complaint frequency than the group as a whole (P less than .005). There were 17 complaints regarding the nursing staff, for a complaint frequency of 0.2. Twenty-two complaints were classified as miscellaneous. Expressing data as complaint frequencies allows comparison of trends in a department, staff members, and different EDs with varied patient populations.(ABSTRACT TRUNCATED AT 250 WORDS)