The often conflicting results of research on subjective measures for assessing the quality of care are producing a very complex scientific debate. Findings of a recent study by Hartgerink and colleagues have shown the existence of a longitudinal relationship between patients' perceived quality of integrated care delivery, their experiences with hospital care and their quality of life after hospitalization. Some studies have indicated that the satisfaction expressed by the patient does not correspond to a high quality of care objectively, as others point out the importance of the subjective point of view, however, the user remains fundamental for a good adherence to prescribed treatments. In an editorial published in 2011 in The New England Journal of Medicine, Professor Manary and his colleagues at Duke University in Durham have identified the lack of basic medical knowledge as the main reason why patients would tend to give importance to aspects of care that do not concern its effectiveness. The involvement in the care process would affect in particular the perception of quality and lead to less use of resources. The judgment of the physician would improve much more based on the satisfaction of their expectations about the requirements that are dependent on their actual usefulness. Other researchers point out that subjective measures of quality of health care interventions are influenced by a more general feeling of well-being and quality of life (QOL), which in turn depend on a variety of biological, psychological and relational factors. Equally likely to be a partial assessment based solely on the perception of an external observer or objective dimensions. For these reasons, many medical studies on patient-centered outcome measures are increasingly recognizing the importance of integrating the views of the patient with those of its proxies, that is, people who know him well in his path in life, and most external evaluators, such as doctors and professionals who assist him in the process of diagnosis and treatment. This approach represents one of the main characteristics of the BASIQ (BAtteria di Strumenti per l’Indagine della Qualità di Vita), the Italian translation and adaptation of the QoL-IP (Quality of Life Instrument Package) of the Center for Public Health of 'University of Toronto. This battery is actually based on an interpretative model of QoL of the patient that combines both qualitative and quantitative, subjective and objective, while still leaving a central position on the relationship between individual perception and attribution of importance to satisfaction. The BASIQ consists of three questionnaires: an interview directly to the person, a questionnaire addressed to the proxy (caregiver, operator forefront of social welfare, etc..), and a questionnaire for the external evaluator (general practitioner, medical specialist, support administrator, etc.).
REFERENCES
- Bertelli M, Piva Merli M, Bianco A, Lassi S, La Malfa G, Placidi GF, Brown I (2011) La batteria di strumenti per l'indagine della Qualità di Vita (BASIQ): validazione dell'adattamento italiano del Quality of Life Instrument Package (QoL-IP). Giornale Italiano di Psicopatologia, 17(2), 205-212.
- Fenton JJ, Jerant AF, Bertakis KD, Franks P (2012) The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Archives of Internal Medicine, 172, 405-11.
- Hartgerink JM, Cramm JM, Bakker TJ, Mackenbach JP, Nieboer AP (2015) The importance of older patients' experiences with care delivery for their quality of life after hospitalization. BMC Health Services Research, 8(15), 311.
-Manary MP, Boulding W, Staelin R, Glickman SW (2013) The patient experience and health outcomes. New England Journal of Medicine, 368, 201-203.