Patient experiences with interdisciplinary treatment for substance dependence: an assessment of quality indicators based on two national surveys in Norway

• Published in: Patient preference and adherence 2019-01, Vol.13, p.453-464
• Main Authors: Haugum, Mona, Iversen, Hilde Hestad, Helgeland, Jon, Lindahl, Anne Karin, Bjertnaes, Oyvind
• Format: Article
• Language: English
• Subjects: Care and treatment; case-mix adjustment; Health care; Health care industry; healthcare quality indicator; Hospital patients; Interdisciplinary aspects; Intranets; Medical care discrimination; Medical care quality; Medical research; Original Research; Patient satisfaction; Public opinion; Quality; Quality control; Quality of health care; Social aspects; Substance abuse; survey; Surveys
• ISSN: 1177-889X; 1177-889X
• DOI: 10.2147/PPA.S194925

The quality of health care is often measured using quality indicators, which can be utilized to compare the performance of health-care providers. Conducting comparisons in a meaningful and fair way requires the quality indicators to be adjusted for patient characteristics and other individual-level factors. The aims of the study were to develop and test a case-mix adjustment model for quality indicators based on patient-experience surveys among inpatients receiving interdisciplinary treatment for substance dependence, and to establish whether the quality indicators discriminate between health care providers. Data were collected through two national surveys involving inpatients receiving residential treatment in Norway in 2013 and 2014. The same questionnaire was used in both surveys, and comprised three patient-experience scales. The scales are reported as national quality indicators, and associations between the scales and patient characteristics were tested through multilevel modeling to establish a case-mix model. The intraclass correlation coefficient was computed to assess the amount of variation at the hospital-trust level. The intraclass correlation coefficient for the patient-reported experience scales varied from 2.3% for "treatment and personnel" to 8.1% for "milieu". Multivariate multilevel regression analyses showed that alcohol reported as the most frequently used substance, gender and age were significantly associated with two of the three scales. The length of stay at the institution, pressure to be admitted for treatment, and self-perceived health were significantly related to all three scales. Explained variance at the individual level was approximately 7% for all three scales. This study identified several important case-mix variables for the patient-based quality indicators and systematic variations at the hospital-trust level. Future research should assess the association between patient-based quality indicators and other quality indicators, and the predictive validity of patient-experience indicators based on on-site measurements.