Patient Experience Monitor (PEM): The Development of New Short-Form Picker Experience Questionnaires for Hospital Patients with a Wide Range of Literacy Levels

Abstract

Purpose

Several patient-reported experience measures (PREMs) were developed through the years. These questionnaires are frequently found to be inappropriate for people with lower literacy levels. This paper describes the development of patient experience questionnaires for hospital patients with a wide range of literacy levels, while enabling the potential for quality improvement.

Methods

Mixed methods were used to adapt Picker Institute patient experience questionnaires: selection of items and adaptation towards language level B1 (the language level of which patients can express their own opinion and describe experiences, events and expectations) by expert panels, usability tests with patients, analysis of psychometric properties and member checking. A theory-driven approach was followed for definitive enrolment of items, meaning that the items eligible for exclusion had been carefully reviewed by the expert team and representatives of a patient council before definitive exclusion.

Results

A pilot study was performed in an University Medical Centre in the Netherlands among in- and outpatients after discharge. Two provisional questionnaires of 22 items, designed by an expert panel, were reduced towards a final selection of 14–15 items. This led to two short-form questionnaires, called Patient Experience Monitor (PEM) Adult Inpatient and PEM Adult Outpatient. To illustrate, the results of the PEM Adult Outpatient questionnaire are presented.

Conclusion

PEMs are short and valid questionnaires specifically developed to measure patient experiences of hospital patients with a wide range of literacy levels. Acceptance of the questionnaires for both lower and higher educated patients are confirmed by usability tests. The respondents of the pilot study represent both groups. The developed questionnaires should be seen as a dynamic entity and part of a continuous effort to evaluate and improve patient experiences. Future studies are needed to examine the usability of these new questionnaires for quality improvement.

Keywords:

• patient experiences
• quality in healthcare
• patient centered care
• PREM

Acknowledgments

The authors wish to thank all interviewees for their interest, contribution and time, and Hester Wessels, Nicole van der Eem, Barbara Sibbles and Vivi Buijs for their input in the expert panels. Special thanks to Elise Barendse, Karin Bakker, Pia Gutierrez Zarate and Ilona Gritter for their efforts in data collection, Ko Hagoort and Marjolijn van Leeuwen for translating and adapting the original questions and Joanne Oversier for back translating the questionnaires and editing the text.

Disclosure

Jan A Hazelzet reports grants from the Federation of Dutch University Medical Centers outside the submitted work. The authors have no conflict of interest that could have influenced this paper.

Additional information

Funding

This work was supported by the Dutch Federation of University Medical Centers (NFU) within the program “Sturen op Kwaliteit” of the Citrienfonds under guidance of the NFU consortium Quality of Care.