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Objective: The aim of this study was to examine the extent to which socio-demographic variables affect women's satisfaction regarding antenatal and perinatal care., Design: To take into account the role of the context in shaping women's satisfaction, we used multilevel models, with women at the lower level, and the health districts of residence, or the hospitals in which the delivery took place, at the higher level., Setting: Tuscany (Italy)., Participants: The study is based on a representative survey focused on the satisfaction and experience of 4598 new mothers who gave birth in one of the 25 hospitals in Tuscany (Italy) in 2012., Main Outcome Measures: Women's overall satisfaction in the prenatal period and their overall satisfaction during hospitalization for delivery., Results: Regarding pregnancy, women's satisfaction increased with age, and was generally higher among foreign women coming from non-Western countries and among highly educated women. Regarding delivery, age proved insignificant, whereas citizenship and education maintained the same association with satisfaction. Contrary to our expectations, the number of previous pregnancies turned out to be insignificant., Conclusions: Our findings suggest that the quality of maternity services was perceived differently in different socio-demographic groups: women's expectations affected satisfaction, but in different ways, in various socio-demographic groups, both during pregnancy and at delivery. Keeping these socio-demographic factors into account in the analysis of satisfaction may help organisations to identify areas where pregnancy and delivery services can be better targeted and where increasing awareness among professionals in their everyday practice is most needed.

Background: Healthcare systems are increasingly focusing on outcomes that are the endpoints of care: patient health status and patient satisfaction. The availability of patient satisfaction (PS) data has encouraged research on its relationship with other outcomes, such as mortality. In Italy, an inter-regional performance evaluation system (IRPES) provides 13 regional healthcare systems with a multidimensional assessment of appropriateness, efficiency, financial sustainability, effectiveness, and equity. For university hospitals, IRPES includes the percentage of patients leaving hospital against medical advice (PLHAMA) and mortality rates at the ward level. This paper investigates the relationship between PS and PLHAMA across and within regional healthcare systems in Italy. Secondly, PLHAMA is used as a PS proxy to investigate its relationship with mortality at the ward level in the IRPES university hospitals., Methods: PLHAMA and mortality rates were gathered from administrative data, and PS scores from patient surveys. We explored the association between PS and PLHAMA through a correlation analysis, using data for the 13 IRPES regions. We tested this relationship also at the clinical directorate level in 28 hospitals in Tuscany (5482 interviewed patients in 100 clinical directorates). Secondly, we explored the association between PLHAMA and mortality at the ward level through correlation and regression analyses, using data of 405 wards of eight clinical specialties within 24 IRPES university hospitals., Results: Lower PLHAMA rates were associated with a higher PS in both regional and clinical directorate levels. A positive association between PLHAMA and mortality was shown at the ward level for IRPES university hospitals, with different results for medical and surgical clinical specialties., Conclusions: PS is an important performance dimension that provides healthcare managers and professionals with useful insights for improving care quality and effectiveness. Based on the study results, the PLHAMA rate could be regularly measured to highlight patient dissatisfaction. Due to the association between PLHAMA and mortality, this study also provides evidence of the importance of the patient perspective in assessing the quality of healthcare services. This relationship proved to be significant for surgical clinical units, suggesting the need for further analysing outcomes considering their different determinants in medical and surgical care.

Over the last several years, interest in benchmarking health services' quality--particularly patient satisfaction (PS)--across organizations has increased. Comparing patient experiences of care across hospitals requires risk adjustment to control for important differences in patient case-mix and provider characteristics. This study investigates the individual-level and organizational-level determinants of PS with public hospitals by applying hierarchical models. The analysis focuses on the effect of hospital characteristics, such as self-discharges, on overall evaluations and on across hospital variation in scores. Sociodemographics, admission mode, place of residence, hospitalization ward and continuity of care were statistically significant predictors of inpatient satisfaction. Interestingly, it was observed that hospitals with a higher percentage of Patients Leaving Against Medical Advice (PLAMA) received lower scores. The latter result suggests that the percentage of PLAMA may provide a useful measure of a hospital's inability to meet patient needs and a proxy indicator of PS with hospital care., (© 2013 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.)

Healthcare providers often look for feedback from patient surveys. Does health-professional awareness of patient survey results improve communication between patients and providers? To test this hypothesis, we analyzed the data of two surveys on organizational-climate and patient experience in Italy. The two surveys were conducted in 26 hospitals in the Tuscany region and involved 8942 employees and 5341 patients, respectively. Statistical analysis showed that the patient experience index significantly improved by 0.35 points (scale: 0-100) when the professionals' knowledge of the patient survey results increased by 1%. These findings suggest that the control systems should focus more on the dissemination phase of patient survey results among health professionals in order to improve the quality of services., (Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

Objectives: Both regression and optimization models were used to identify an efficient combination of aspects of care (e.g., comfort of waiting room) necessary to improve global emergency department (ED) patient satisfaction. The approach, based on patient survey data, tends to favor aspects of care with large regression coefficients and those whose current performance is low, because improvements produce a greater effect on global satisfaction., Methods: The authors used ED patient satisfaction survey data collected between September and October 2007 from a random sample of 5,277 adult patients who visited 43 EDs in Tuscany, Italy. Ordinal logistic regression models were run to predict overall ratings of care and willingness to return using 20 independent variables (i.e., aspects of care). An optimization model was run to increase these two global items to a maximum of 15%. This model minimizes the total combined percentage increase of the aspects of care. Models using all cases (n = 5,277), cases from local hospitals (n = 4,264), and cases from teaching hospitals (n = 1,013) were run., Results: Four aspects selected by the optimization algorithm were in all models: "satisfaction with waiting time,""comfort of the waiting room,""professionalism of physicians" (technical skills), and "level of collaboration between physicians and nursing staff." Most aspects needed a 15% increase to comply with the percentage increases set for the global satisfaction items. The model found that to increase overall ratings of care by 1, 2, or 8%, hospitals would need to focus only on one aspect: "level of collaboration between physicians and nursing staff." The total number of variables increased to six when the improvement in overall ratings of care was set at 15%. To increase 3 or 5% willingness to return, the optimization algorithm found that 6 or 14 aspects, respectively, are needed. An increase of 6% or more was unfeasible., Conclusions: This approach is only somewhat efficient, as a cost structure is absent. The optimization model assumes that the cost to increase each aspect by 1% is equivalent. By applying this modeling technique we have demonstrated that, at least, two elements are important to consider when developing efficient improvement strategies to increase global satisfaction: 1) the current level of satisfaction of the aspects of care and 2) the importance ascribed to the aspects of care. A third element, the cost to increase the aspects of care, might also be important. However, the impact of this element on the optimal solution is currently unknown.

Objectives: The shift toward more innovative and sustainable primary care models in Italy leads policy makers and clinicians to face difficult decisions between options that are all regarded as potentially beneficial. In this study, patient preferences for different primary care models in the Tuscany region of Italy were elicited. The relative importance of different attributes to the surveyed respondents was then examined, as well as the rate at which individuals trade between attributes and the relative value of different service configurations. Methods: A discrete choice experiment survey explored the following attributes in a stratified random sample of 6,970 adults: primary care provider, diagnostic facilities and waiting time for the visit. Results: Respondents (3,263) were likely to prefer a consultation by their own general practitioner (GP) and a practice with many diagnostic facilities. The predicted utilities of different service configurations have shown that a 'primary care centre' with many diagnostic facilities was preferable to a 'solo GP' model or a 'group general practice'. Conclusions: The study demonstrated how a patient choice model could be used by decision makers for developing successful policies that takes into account different healthcare needs, balancing responsiveness with care continuity, equity and appropriateness. Considering that a primary care centre would perform better than a 'solo GP', especially for younger respondents and for those with minor healthcare needs, for a more rapid diffusion of this model policymakers and managers could direct the care of primary care centres towards these targeted subgroups, at least in the first phase. [ABSTRACT FROM AUTHOR]