Factors associated with outpatient experience of Chinese public hospitals: a cross-sectional study

• Published in: The Lancet (British edition) Vol. 390; p. S38
• Main Authors: Xie, Jinzhu, Hu, Yinhuan, Lu, Chuntao
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.12.2017; Elsevier Limited
• Subjects: Cross-sectional studies; Data collection; Data processing
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(17)33176-8

Patient experience is an important indicator of health-care quality from the patient's view and has a better evidence-based characteristic than patient satisfaction. In this study, we compared the experience among different outpatient groups and explored the influencing factors of the outpatient experience to improve outpatient experience and the health-service quality of public hospitals in China. Six comprehensive public hospitals in Hubei, China, were chosen by typical sampling method and including three tertiary hospitals and three secondary hospitals. In each hospital, 100 outpatients were invited to participate in the survey when they ended their visits. The questionnaire had good reliability and validity (the Cronbach's α coefficient of the overall questionnaire was 0·948). The inclusion criteria of participants were: (1) aged ≥18 years; (2) visit procedure were completed; and (3) ability to describe their experience accurately. A five-point Likert scale was used in the questionnaire. Outpatient experience score was calculated by transforming the five-point into hundred-marked system (score 5=100 points; score 4=75 points; score 3=50 points; scorer 2=25 points; score 1=0 points. 100 points means best experience, 0 points means worst experience. The cross-sectional survey was done by data collection. One-way Anova and independent t-test were used to assess the difference between demographic variables in outpatient experience. Multiple linear regression was used to assess how those demographic variables affected the experience. This study was approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (IORG number IORG0003571). Of the 600 participants who were eligible for inclusion, 17 were excluded because of missing data in the questionnaires and logical errors, and 583 eligible questionnaires were included for further analysis. 176 respondents had a poor experience (score<50) when they visited hospitals. The mean score of medical cost experience was the lowest (61·16 [SD 0·86]), whereas health information got the highest experience score (71·37 [0·79]). Age (β=0·213, p<0·0001), type of payment (β=0·159, p<0·0001), and the self-rated health status (β=0·261, p<0·0001) were associated with outpatient experience. Outpatients older than 65 years had the highest experience score (74·25 [1·88]), whereas outpatients paying out-of-pocket had the lowest experience score (64·68 [0·81]) among all participants. Outpatients with good self-rated health status had the highest experience score (72·63 [0·99]) among different self-rated health status groups. No association was found between sex, education, average income, residence, and marital status and experience score (p<0·0001). Young outpatients (younger than 45 years) who paid entirely out-of-pocket and who had poor self-rated health status should be particularly focused on to improve the outpatient experience. Outpatients with poor self-rated health status are more prone to discomfort, anxiety, fear, and other negative emotions when they visit hospitals, resulting in lower experience scores than outpatients with good self-rated health status when they receive the same health service. High medical expenditure results in the financial burden of patients and their family. Thus, expanding medical insurance coverage and reimbursement ratio can improve the outpatient experience effectively. Additionally, strengthening referral policy is warranted, which makes it possible for doctors to spend more energy on patients to improve their experience. Fundamental Research Funds for the Central Universities (2017WKYXQY004). The funders did not participate in study design, data collection, and analysis.