Patient and relative perspective regarding quality in hospital care for older people : Theory and Methods

Abstract: Although the elderly population consumes a relatively large proportion of health care, international research has focused little attention on older people and their perception of health care and its outcome. Information is also scanty concerning relatives in hospital care and their actions and the circumstances related to relatives' participation in the care process.The overall aim of this thesis is to contribute to a better knowledge and understanding of the perspectives of older patients and relatives regarding hospital care and how this knowledge can be used in measurements of quality of hospital care from the patient perspective.This thesis uses both qualitative and quantitative methods. Study I and II are based on semistructured interviews. In study I a midrange theory and a theoretical model of patients' evaluation process regarding the care was derived. In study II relatives' actions and the circumstances related to their participation in the care process were described. In study III the knowledge obtained in study I was used as a base for development of an instrument 'Patients perspectives on care and rehabilitation process' (POCR) containing structured questions for measuring patients' perceptions regarding the care process. The instrument was used in telephone-interviews for the data collection in study III and IV. In study IV analyses were conducted regarding the interrelation between some of the concepts in the model of patients' evaluation process.The patient and relative perspectives on hospital care, are based on complex processes that involve their past experiences, present situation and expectations of the of future regarding care and illness/health. The encounters patients and relatives have with staff and the organisation lay the foundations for their future expectations and experiences regarding a potential forthcoming care process. Relatives carry out a variety of actions and engagements based on their own knowledge and ability. Patients and relatives have disparate realities and needs. The three-part interaction between patient, relative and staff is an important factor in patients' and relatives' actions and participation in the care process and in how their needs are met.Patient perceived needs differ during the different phases of the care process. Patients' perception of needs and care are associated with patients' previous experiences with illness and care, their perception of themselves and the situation, and their expectations regarding health and care.Patient-perceived results of the care process include how needs were met as well as health outcome. Patients' evaluation of the hospital care is shown to be associated with their previous experiences of the care unit, perceived health outcome including their overall lifesituation post-discharge, as well as patients' expectations regarding their future health postdischarge. These aspects ought to be focused in measures regarding quality of care from patients' perspective.The POCR instrument was found to have adequate validity and reliability. The instrument reflects patients' different needs during the care process and measure patients' perceptions regarding fulfilment of needs and their importance. Using the telephone interview technique makes it possible for data collectors to learn more about the patient perspective and it resulted in high response rate.

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