Care Experience Feedback Improvement Tool (CEFIT)

After reviewing a number of patient experience and satisfaction surveys, a British group generated a brief five-item survey called the Care Experience Feedback Improvement Tool (or CEFIT) to evaluate the hospital care experience in a valid and consistent way. The model they proposed included quality as a function of person-centered care that included five elements: safety, effectiveness, timeliness, caring, and system navigation and accessibility. The five elements were transformed into five statements that the patient would complete with responses ranging from Never to Always.

These elements were represented by the following statements:

Results suggested that this simplified tool could be considered to score patient experience in the hospital setting. Authors suggested expanded testing to assure its usability as a management tool through the ability to discriminate between different patient experiences at a ward or unit level. While this type of tool may be used for internal organization improvement, other tools are used to rank patient experience and care quality in an effort to provide transparency to consumers who may have a choice of health care providers.

Home Health Care Patient Satisfaction and Experience

There are many other tools used to evaluate patient satisfaction and experience. We will briefly describe some examples here.

Home Care Client Satisfaction Instrument (HCCSI/-R)

A review of 23 homecare satisfaction surveys was published in 2012. One such survey, the Home Care Client Satisfaction Instrument or HCCSI constructed in 1984, was based on a framework that reflects patient expectations alignment with their perceptions about the care received. This framework covered overall satisfaction and interpersonal relationships, technical competence, financial topics, convenience, access, and continuity of care. This is one of several frameworks that have been used in homecare patient satisfaction. However, of all the survey assessment tools that were reviewed in 2012, most did not define patient satisfaction in homecare and many did not publish the validity of their construct. Now that we have covered those issues, we can dive into some patient satisfaction survey tools. Our discussion will be narrowed to homecare surveys. The Home Care Client Satisfaction Instrument or HCCSI was revised in the 1990s as HCCSI-R. Early tests for validity suggested that the total score was related to the likeliness to recommend the agency to others.

Home Care Client Satisfaction Instrument (HCCSI)

The Patient Satisfaction Questionnaire or PSQ was designed in 1976. It contained 80 items. This was revised to a 50-item questionnaire referred to as the PSQ-III. This revision was designed to allow patient evaluation of global satisfaction with medical care along with specific satisfaction for technical quality of care, interpersonal interactions and communications, financial aspects of care, accessibility of care, and time spent with a physician. Another format of this survey is the PSQ-18, which is a shorter form of the PSQ-III. This shorter version was tested for reliability and consistency, and research suggests that the PSQ-18 and the PSQ-III correlate with each other. The PSQ-18 is especially nice because it can be administered in less than five minutes.

Home Care Satisfaction Measures (HCSM)

Research has been inconsistent in findings that satisfaction may relate to age or ethnicity. The Home Care Satisfaction Measure or HCSM was designed to overcome some of the limitations of other surveys through its basis on older patient-defined concepts and inclusion of perspectives of ethnic minority patients. The prototype survey was developed through focus groups representing various ethnicities. The field-tested survey looked at five service areas, including homemaker, home health aide, home-delivered meal, grocery, and care management services, that were rated on a scale from 0 to 100, with higher scores relating to higher satisfaction. The field test of the instrument surveyed 228 frail elderly low-income patients the reliability was high based on retesting and validity was demonstrated through comparison with overall satisfaction scores. In this field test, authors found that home care satisfaction was negatively related to physical disability and unrelated to gender, age, or race. Authors suggest conducting serial measures to evaluate differences in satisfaction over time within a single agency and differences between providers.

Press Ganey Home Care Patient Satisfaction Survey

The Press Ganey surveys cover specific areas of care provision, including provider friendliness/courtesy, explanations about the problem/condition, concern showed, efforts to include the patient in decision-making, information on medications, instructions about follow-up care, understandability, time spent, confidence in the provider, and likelihood of recommending the provider to others. This group developed surveys and have been refining them since 1985. Their work is to partner with health care organizations and others to provide an unbiased evaluation of patient satisfaction. As such, around 50% of hospitals partner with Press Ganey to provide these services.