Patient experiences with interdisciplinary treatment for substance dependence: an assessment of quality indicators based on two national surveys in Norway
Received 16 November 2018
Accepted for publication 12 March 2019
Published 5 April 2019 Volume 2019:13 Pages 453—464
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Ms Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Mona Haugum,1,2 Hilde Hestad Iversen,1 Jon Helgeland,1 Anne Karin Lindahl,2,3 Oyvind Bjertnaes1
1Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway; 2Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; 3Division of Surgery, Akershus University Hospital, Lorenskog, Norway
Purpose: The quality of health care is often measured using quality indicators, which can be utilized to compare the performance of health-care providers. Conducting comparisons in a meaningful and fair way requires the quality indicators to be adjusted for patient characteristics and other individual-level factors. The aims of the study were to develop and test a case-mix adjustment model for quality indicators based on patient-experience surveys among inpatients receiving interdisciplinary treatment for substance dependence, and to establish whether the quality indicators discriminate between health care providers.
Patients and methods: Data were collected through two national surveys involving inpatients receiving residential treatment in Norway in 2013 and 2014. The same questionnaire was used in both surveys, and comprised three patient-experience scales. The scales are reported as national quality indicators, and associations between the scales and patient characteristics were tested through multilevel modeling to establish a case-mix model. The intraclass correlation coefficient was computed to assess the amount of variation at the hospital-trust level.
Results: The intraclass correlation coefficient for the patient-reported experience scales varied from 2.3% for “treatment and personnel” to 8.1% for “milieu”. Multivariate multilevel regression analyses showed that alcohol reported as the most frequently used substance, gender and age were significantly associated with two of the three scales. The length of stay at the institution, pressure to be admitted for treatment, and self-perceived health were significantly related to all three scales. Explained variance at the individual level was approximately 7% for all three scales.
Conclusion: This study identified several important case-mix variables for the patient-based quality indicators and systematic variations at the hospital-trust level. Future research should assess the association between patient-based quality indicators and other quality indicators, and the predictive validity of patient-experience indicators based on on-site measurements.
Keywords: quality of health care, health care quality indicator, case-mix adjustment, patient satisfaction, survey
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