Benchmarking patient experiences in colonoscopy using the Global Rating Scale

 

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Introduction: The Global Rating Scale (GRS) is a quality assurance program that was developed in England to assess patient-centered care in endoscopy. The aim of the current study was to evaluate patient experiences of colonoscopy using the GRS in order to compare different departments and to provide benchmarks. The study also evaluated factors associated with patient satisfaction.

Methods: A GRS questionnaire was used both before and after the procedure in outpatients undergoing colonoscopy. The questionnaire assessed the processes associated with the colonoscopy, from making the appointment up until discharge. Mean values and ranges of 12 endoscopy departments were calculated together with P values in order to assess heterogeneity.

Results: In total, 1904 pre-procedure and 1532 (80 %) post-procedure questionnaires were returned from 12 endoscopy departments. The mean time patients had to wait for their procedure was 4.3 weeks (range 3.1 – 5.8 weeks), and 54 % (range 35 – 64 %; P < 0.001) reported being given a choice of appointment dates/times. Discomfort during colonoscopy was reported by 20 % (range 8 – 40 %; P < 0.001). Recovery room privacy was satisfactory for 76 % of patients (range 66 – 90 %; P < 0.05). The majority of patients reported being sufficiently informed about what to do in case of problems after discharge (79 %, range 43 – 98 %; P < 0.001), and 85 % of individuals stated that they would be willing to repeat the colonoscopy procedure (range 72 – 92 %; P < 0.001). Factors associated with a decreased willingness to return were the burdensome bowel preparation (odds ratio [OR] = 0.25; P < 0.001), “rushing staff” attitude (OR = 0.57; P < 0.05), low acceptance of the procedure (OR = 0.42; P < 0.01), and more discomfort than expected (OR = 0.54; P < 0.05).

Conclusion: Overall patient experiences with colonoscopy were satisfactory, but they also showed considerable variation. This study shows that use of a GRS patient questionnaire is feasible in the Dutch endoscopy setting for the assessment of patient experience. The significant variability between endoscopy units can be used to benchmark services and enable shortcomings to be identified.

• References

• 1 Ko HH, Zhang H, Telford JJ et al. Factors influencing patient satisfaction when undergoing endoscopic procedures. Gastrointest Endosc 2009; 69: 883-891
  CrossrefPubMedGoogle Scholar
• 2 Endoscopy Global Rating Scale (UK). Available from: www.grs.nhs.uk Accessed: 1 April 2011
  PubMedGoogle Scholar
• 3 Valori R, Sint Nicolaas J, de Jonge V. Quality assurance of endoscopy in colorectal cancer screening. Best Pract Res Clin Gastroenterol 2010; 24: 451-464
  CrossrefPubMedGoogle Scholar
• 4 de Jonge V, Sint Nicolaas J, Lalor EA et al. A prospective audit of patient experiences in colonoscopy using the Global Rating Scale: a cohort of 1187 patients. Can J Gastroenterol 2010; 24: 607-613
  PubMedGoogle Scholar
• 5 Valori RM, Barton R, Johnston DK. The English National Endoscopy Quality Assurance Programme: quality of care improves as waits decline. Gastrointest Endosc 2009; 69: AB221-221
  PubMedGoogle Scholar
• 6 Dubé C, Bridges R, Hilsden R et al. First-time use of the endoscopy Global Rating Scale in the Calgary Health Region. Can J Gastroenterol 2008; 22: 73-181 abstract 187
  PubMedGoogle Scholar
• 7 Ware JE, Davies-Avery A, Stewart AL. The measurement and meaning of patient satisfaction. Health Med Care Serv Rev 1978; 1: 1, 3-15
  PubMedGoogle Scholar
• 8 Yacavone RF, Locke GR 3rd et al. Factors influencing patient satisfaction with GI endoscopy. Gastrointest Endosc 2001; 53: 703-710
  CrossrefPubMedGoogle Scholar
• 9 Schoen RE, Weissfeld JL, Bowen NJ et al. Patient satisfaction with screening flexible sigmoidoscopy. Arch Intern Med 2000; 160: 1790-1796
  CrossrefPubMedGoogle Scholar
• 10 Pena LR, Mardini H, Nickl N. An instrument to predict endoscopy tolerance: a prospective randomized study. Dig Dis Sci 2007; 52: 2888-2891
  CrossrefPubMedGoogle Scholar
• 11 Johanson JF, Schmitt CM, Deas TM et al. Quality and outcomes assessment in gastrointestinal endoscopy. Gastrointest Endosc 2000; 52: 827-830
  CrossrefPubMedGoogle Scholar
• 12 Eckardt AJ, Swales C, Bhattacharya K et al. Open access colonoscopy in the training setting: which factors affect patient satisfaction and pain?. Endoscopy 2008; 40: 98-105
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 Cockburn J, Hill D, Irwig L et al. Development and validation of an instrument to measure satisfaction of participants at breast screening programmes. Eur J Cancer 1991; 27: 827-831
  PubMedGoogle Scholar
• 14 Ware JE, Snyder MK, Wright WR et al. Defining and measuring patient satisfaction with medical care. Eval Program Plann 1983; 6: 247-263
  CrossrefPubMedGoogle Scholar
• 15 Kline P. Handbook of psychological testing. 2nd. edn. London: Routledge; 1999: 720
  Google Scholar
• 16 Li B, Lingsma HF, Steyerberg EW et al. Logistic random effects regression models: a comparison of statistical packages for binary and ordinal outcomes. BMC Med Res Methodol 2011; 11: 77
  CrossrefPubMedGoogle Scholar
• 17 Lingsma HF, Roozenbeek B, Perel P et al. Between-centre differences and treatment effects in randomized controlled trials: a case study in Traumatic Brain Injury. Trials 2011; 12: 201
  CrossrefPubMedGoogle Scholar
• 18 Seip B, Bretthauer M, Dahler S et al. Patient satisfaction with on-demand sedation for outpatient colonoscopy. Endoscopy 2010; 42: 639-646
  Article in Thieme ConnectPubMedGoogle Scholar
• 19 Del Rio AS, Baudet JS, Fernandez OA et al. Evaluation of patient satisfaction in gastrointestinal endoscopy. Eur J Gastroenterol Hepatol 2007; 19: 896-900
  CrossrefPubMedGoogle Scholar
• 20 Lin OS, Schembre DB, Ayub K et al. Patient satisfaction scores for endoscopic procedures: impact of a survey-collection method. Gastrointest Endosc 2007; 65: 775-781
  CrossrefPubMedGoogle Scholar
• 21 Feld KA, Feld AD. Risk management and legal issues for colonoscopy. Gastrointest Endosc Clin N Am 2010; 20: 593-601
  CrossrefPubMedGoogle Scholar
• 22 Janssen NB, Oort FJ, Fockens P et al. Under what conditions do patients want to be informed about their risk of a complication? A vignette study.. J Med Ethics 2009; 35: 276-282
  CrossrefPubMedGoogle Scholar

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