Important Attributes Of Quality Health Care: Consumer Perspectives - Brief Article

IMPORTANT ATTRIBUTES OF QUALITY HEALTH CARE: CONSUMER PERSPECTIVES M H Oermann, T Templine Journal of Nursing Scholarship Vol 32 no 2 (1998) 167-172

Personnel at contemporary health care agencies are identifying patient outcomes to evaluate services and patient care. This research focuses on consumer perspectives of high quality health care. Consumer perspectives or expectations have been found to be based on demographic characteristics, health care experiences, and specific concerns related to consumers' unique health problems. Further, patients evaluate their experiences by comparing their expectations to actual events. Satisfaction occurs when events match expectations. The purpose of this research was to allow consumers to identify important attributes of quality health and nursing care and to examine the relationship of consumer perspectives to health status and selected demographic variables. Method and sample. This exploratory study examined a convenience sample of 239 health care consumers, of which 50% were recruited from homes in neighborhoods of a large metropolitan area (ie, urban and suburban) in the Midwest, and 50% were recruited from waiting rooms of clinics in the same neighborhoods. These participants included 149 women (63.1%) and 87 men (36.9%). These gender totals equal 236, whereas previously stated the sample size was 239. This discrepancy was not addressed in the article. The age range varied from 18 to 92 years of age. The mean age was 50.8 years. One-half of the subjects were married. Although half of the participants had a high school diploma, education levels ranged from less than high school to post-graduate education. Participants included 163 (71.2%) Caucasians and 66 (28.8%) African Americans. This totals 229. The ethnicity of the remainder of the participants was not identified. Participants were asked to complete a SF-36 Survey that measured health status in eight general areas, including * physical function, * role limitation due to physical health problems, * bodily pain, * general health, * vitality (ie, energy, fatigue), * social functioning, * role limitations due to emotional problems, and * mental health.

Additionally, a Quality Health Care Questionnaire (QHCQ) was given to the participants. The investigators developed this instrument, which included demographic information and 27 attributes of health care and nursing quality. Participants completed the QHCQ based on a Likert-type scale--rating the importance of each attribute on a scale from one (ie, not at all important) to five (ie, very important). This tool was developed from the literature regarding health care quality and research on consumers' perspectives of quality care, as well as research about patient satisfaction with nursing care. A factor analysis with Eigenvalues greater than one resulted in six factors, including medical care, teaching by the nurse, provider competence, choice of provider, nurse-patient interaction, and appointment convenience. Teaching by the nurse included such items as having a nurse teach about illness, medication, and treatment. Findings. A rating of the 27 items showed attributes of health and nursing care that participants deemed important. These attributes included understanding physicians' explanations, having access to specialists when necessary, having the opportunity to communicate with physicians, being included in making health care decisions, and having diagnostic tests performed for early identification of diseases. The most important indicators of quality nursing care included * being cared for by nurses who are up-to-date and well informed; * being able to communicate with the nurse; * spending enough time with the nurse and not feeling rushed during the visit; and * having the nurse teach about illnesses, medications, and treatments. Interestingly, responses differed significantly between these sampled Caucasians and African Americans. African Americans rated medical care as less important than Caucasians (F [1,229] = 9.95, P [is less than] .01); however, they rated teaching by the nurse as significantly more important (F [1,229] = 6.77, P [is less than] .01). Participants with a number of chronic illnesses rated the importance of teaching by the nurse (r = .25, P [is less than] .001), choice of provider (r = .24, P [is less than] .001), and convenience of appointments (r = .0145, P = .03) as important attributes of quality care. Additional findings showed that participants with less education and lower incomes rated teaching by the nurse as more important in their care than those with higher education and incomes. Discussion. The researchers believe the findings from this study are consistent with findings from other research exploring ambulatory care. Attributes of importance have included access to care, coordination of services, education, being treated with respect, and processes of care (eg, waiting times for appointments); however, few previous studies have examined the importance of nursing care in participants' views of quality. This study shows it is important to be cared for by nurses who are up-todate and well informed and have the ability to communicate in an unhurried atmosphere conducive to effective teaching. The study also shows that patients who were not well educated found nurse information more beneficial than participants with greater education.