Email: Iolie I C.utteling• , A de Man .
Quality Of health care and patient satisfaction in liver disease: the
development and preliminary results of the QUOTE-Liver
Jolie J Gutteling* 12, Robert A de Man2, Jan JV Busschbachl and Anne-
Sophie E Darlingtonl
Address; ofMedical psychology and Erasmus MC, Rotterdam. Netherlands and of and
This an the AttriEon
which md my origirnl w xk is preperIy eiæd.
Background: Consensus on how to adequately measure patient satisQtion with health care is limited.
and has led to the development Of many questionnaires with various methodological problems. The
Objective Of this Study was to develop a liver disease. and care-specific patient Satisfiction instnJment on
the basis of previously tested methodology in patient satisfaction measurement. the so called QUOTE.
series: Quality Of health care services Through the patients' Eyes. QUOTE methodology aims to
standardise the measurement of satisfaction as the discrepancy between patients' needs. and the extent
to which these needs are being met-
Methods; As part Of the QUOTE methOdOlCw routine, I patielt_s with Chronic liver disease the
Erasmus MC (Rotterdam, the Netherlands) participated in meetings on patient
with the provided service at the outpatient hepatology clinic. Twenty-eight other patients were invited
rank the items generated during the focus-W'up meetings according to importance. With this information.
the QUOTE-I_iver was constructed. Face validity. construct validity. content validity. and reliability Of the
newly questionnaire were assessed in test sample Of 1 52 patients with chronic liver disease.
Results: Two liver-disease specfic, and the 18 items ranked as most important were included in the
QUOTE•Liver. Face validity and content validity were acceptable: neither patients (n
psychologists (n 3) or a hepatologist sugested any extra items to be included. Construct validity was
good: the overall score correlated significantly with the Visual Analogue Scale (VAS) measuring cwerall
satishction (r 0.69. p 0.01). The reliability Of the Was excellent 0.90).
Conclusion: The QUOTE-Liver is an easy to complete instrument based on Standardized
art satisfaction measurement methodology. preliminary evidence for its validity and reliability was
demonstrated. The QUOTE-Iiver covers those aspects Of satisfaction that CLO patients consider to be
important when visiting the outpatient department of hepatology. Even though further substantiating of
the favourable psychometric findings is desirable. it seems to be a useful instrument that can be used to
identifr those aspects Of care that need improvement in order to optimise the provision Of health care for
patients with Chronic liver disease.
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