Development of the physical therapy outpatient satisfaction survey (PTOPS).
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BACKGROUND AND PURPOSE: The purposes of this 3-phase study were (1) to identify the underlying components of outpatient satisfaction in physical therapy and (2) to develop a test that would yield reliable and valid measurements of these components. SUBJECTS: Three samples, consisting of 177, 257, and 173 outpatients from 21 facilities, were used in phases 1, 2, and 3, respectively. METHODS AND RESULTS: In phase 1, principal component analyses (PCAs), reliability checks, and correlations with social desirability scales were used to reduce a pool of 98 items to 32 items. These analyses identified a 5-component model of outpatient satisfaction in physical therapy. The phase 2 PCA, with a revised pool of 48 items, indicated that 4 components rather than 5 components represented the best model and resulted in the 34-item Physical Therapy Outpatient Satisfaction Survey (PTOPS). Factor analyses conducted with phase 2 and phase 3 data supported this conclusion and provided evidence for the internal validity of the PTOPS scores. The 4-component scales were labeled "Enhancers," "Detractors," "Location," and "Cost." Responses from subsamples of phase 3 subjects provided evidence for validity of scores in that the PTOPS components of "Enhancers," "Detractors," and "Cost" appeared to differentiate overtly satisfied patients from overtly dissatisfied patients. "Location" and "Enhancer" scores discriminated subjects with excellent attendance at scheduled physical therapy sessions from those with poor attendance. CONCLUSION AND DISCUSSION: In this study, we identified components of outpatient satisfaction in physical therapy and used them to develop a test that would yield valid and reliable measurements of these components. (+info)
Indigenous perceptions and quality of care of family planning services in Haiti.
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This paper presents a method for evaluating and monitoring the quality of care of family planning services. The method was implemented in Haiti by International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), the managerial agency for the Private Sector Family Planning Project (PSFPP), which is sponsored by the USAID Mission. The process consists of direct observations of family planning services and clinic conditions by trained Haitian housewives playing the role of 'mystery clients', who visit clinics on a random basis without prior notice. Observations conducted by mystery clients during one year, from April 1990 to April 1991, are presented and illustrate the use of the method. In addition, measurements for rating the acceptability of the services were developed, providing a quantitative assessment of the services based on mystery clients' terms. Statistical results demonstrate that simulated clients ranked some criteria of acceptability higher than others. These criteria are: the interaction provider/client, information adequacy, and competence of the promoter. Likewise, simulated clients' direct observations of the services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff; the lack of competence of promoters; and the lack of informed choice. Based on its reliability since its implementation in 1990 the method has proven to be a useful tool in programme design and monitoring. (+info)
Quality of primary care practice in a large HMO according to physician specialty.
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OBJECTIVE: To determine whether physician specialty was associated with differences in the quality of primary care practice and patient satisfaction in a large, group model HMO. DATA SOURCES/STUDY SETTING: 10,608 patients ages 35-85 years, selected using stratified probability sampling from the primary care panels of 60 family physicians (FPs), 245 general internists (GIMs), and 55 subspecialty internists (SIMs) at 13 facilities in the Kaiser Permanente Medical Care Program of Northern California. Patients were surveyed in 1995. STUDY DESIGN: A cross-sectional patient survey measured patient reports of physician performance on primary care measures of coordination, comprehensiveness, and accessibility of care, preventive care procedures, and health promotion. Additional items measured patient satisfaction and health values and beliefs. PRINCIPAL FINDINGS: Patients were remarkably similar across physician specialty groups in their health values and beliefs, ratings of the quality of primary care, and satisfaction. Patients rated GIMs higher than FPs on coordination (adjusted mean scores 68.0 and 58.4 respectively, p<.001) and slightly higher on accessibility and prevention; GIMs were rated more highly than SIMs on comprehensiveness (adjusted mean scores 76.4 and 73.8, p<.01). There were no significant differences between specialty groups on a variety of measures of patient satisfaction. CONCLUSIONS: Few differences in the quality of primary care were observed by physician specialty in the setting of a large, well-established group model HMO. These similarities may result from the direct influence of practice setting on physician behavior and organization of care or, indirectly, through the types of physicians attracted to a well-established group model HMO. In some settings, practice organization may have more influence than physician specialty on the delivery of primary care. (+info)
Noise in the postanaesthesia care unit.
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BACKGROUND: Although the postanaesthesia care unit (PACU) can be noisy, the effect of noise on patients recovering from anaesthesia is unknown. We studied the sources and intensity of noise in the PACU and assessed its effect on patients' comfort. METHODS: We measured noise in a five-bed PACU with a sound level meter. Noise levels were obtained using an A-weighted setting (dBA) and peak sound using a linear scale (dBL). Leq (average noise level at 5-s intervals), maximum Leq (LeqMax), minimum Leq (LeqMin) and noise peaks (Lpc) were calculated. During recording, an independent observer noted the origin of sounds from alarms and noise above 65 dB intensity (P65dB). Two hours after leaving the PACU, patients were asked about their experience and to rank their complaints on a visual analogue scale (VAS) using unstructured and structured questionnaires. RESULTS: We made 20,187 measurements over 1678 min. The mean Leq, LeqMax and LeqMin were 67.1 (SD 5.0), 75.7 (4.8) and 48.6 (4.1) dBA respectively. The mean Lpc was 126.2 (4.3) dBL. Five per cent of the noise was at a level above 65 dBA. Staff conversation caused 56% of sounds greater than 65 dB and other noise sources (alarm, telephone, nursing care) were each less than 10% of these sounds. Five patients reported disturbance from noise. There was no significant difference in Leq measured for patients who found the PACU noisy and those who did not [59.5 (3.1) and 59.4 (2.4) dBA respectively]. Stepwise multiple logistic regression indicated that only pain was associated with discomfort. CONCLUSIONS: Even though sound in the PACU exceeded the internationally recommended intensity (40 dBA), it did not cause discomfort. Conversation was the most common cause of excess noise. (+info)
Changing levels of quiet in an intensive care nursery.
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OBJECTIVES: To document low sound levels, the range and pattern of levels, and the relative effects of operational (staff and equipment generated) and facility (building generated) noise on the acoustic environment of a level III nursery. STUDY DESIGN: A quasi-experimental, prospective, longitudinal study of one bed space. Operational noise was reduced through staff behavior change while facility noise was reduced through renovation. RESULTS: Initial noise levels were typical of those in the literature and in recently measured nurseries. About 80% of sound levels were between 62 and 70 dBA. The lowest levels (L(min)) were 60 to 65 dBA. After staff behavior change, L(min) was about 56 dBA although the highest levels (L(max)) remained at 78 to 100 dBA. Levels following renovation were reduced to L(min)s of 47 to 51 dBA and L(max)s of 68 to 84 dBA, perceived as three or four times quieter than initially. CONCLUSIONS: Staff behavior as well as the acoustical characteristics of the facility determine the levels of noise and quiet in an intensive care nursery. (+info)
Can motivational signs prompt increases in incidental physical activity in an Australian health-care facility?
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This study aimed to evaluate whether a stair-promoting signed intervention could increase the use of the stairs over the elevator in a health-care facility. A time-series design was conducted over 12 weeks. Data were collected before, during and after displaying a signed intervention during weeks 4-5 and 8-9. Evaluation included anonymous counts recorded by an objective unobtrusive motion-sensing device of people entering the elevator or the stairs. Self-report data on stair use by hospital staff were also collected. Stair use significantly increased after the first intervention phase (P = 0.02), but after the intervention was removed stair use decreased back towards baseline levels. Moreover, stair use did not significantly change after the re-introduction of the intervention. Lastly, stair use decreased below the initial baseline level during the final weeks of evaluation. Furthermore, there was no significant change in self-reported stair use by hospital staff. Therefore, the signed intervention aimed at promoting an increase in incidental physical activity produced small brief effects, which were not maintained. Further research is required to find more effective 'point of choice' interventions to increase incidental physical activity participation with more sustainable impact. (+info)
Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).
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The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions. This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts. (+info)
Nurse-physician collaboration: solving the nursing shortage crisis.
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The current severe nursing shortage in the United States has many causes and its solution requires new strategies. Collaboration among the American Association of Critical-Care Nurses (AACN), the Society of Critical Care Medicine (SCCM) and the American College of Cardiology (ACC) has provided a model for the multidisciplinary approach needed. Nurse-physician collaboration is an important strategy to address the ongoing shortage. (+info)