Involving patients in detecting quality gaps in a fragmented healthcare system: development of a questionnaire for Patients' Experiences Across Health Care Sectors (PEACS)

Int J Qual Health Care. 2014 Jun;26(3):240-9. doi: 10.1093/intqhc/mzu044. Epub 2014 Apr 23.


Objective: The purpose of this study was to develop and validate a generic questionnaire to evaluate experiences and reported outcomes in patients who receive treatment across a range of healthcare sectors.

Design: Mixed-methods design including focus groups, pretests and field test.

Setting: The patient questionnaire was developed in the context of a nationwide program in Germany aimed at quality improvements across the healthcare sectors.

Participants: For the field test, 589 questionnaires were distributed to patients via 47 general practices.

Main measurements: Descriptive item analyzes non-responder analysis and factor analysis (PCA). Retest coefficients (r) calculated by correlation of sum scores of PCA factors. Quality gaps were assessed by the proportion of responders choosing a response category defined as indicating shortcomings in quality of care.

Results: The conceptual phase showed good content validity. Four hundred and seventy-four patients who received a range of treatment across a range of sectors were included (response rate: 80.5%). Data analysis confirmed the construct, oriented to the patient care journey with a focus on transitions between healthcare sectors. Quality gaps were assessed for the topics 'Indication', including shared-decision-making (6 items, 24.5-62.9%) and 'Discharge and Transition' (10 items; 20.7-48.2%). Retest coefficients ranged from r = 0.671 until r = 0.855 and indicated good reliability. Low ratios of item-non-response (0.8-9.3%) confirmed a high acceptance by patients.

Conclusions: The number of patients with complex healthcare needs is increasing. Initiatives to expand quality assurance across organizational borders and healthcare sectors are therefore urgently needed. A validated questionnaire (called PEACS 1.0) is available to measure patients' experiences across healthcare sectors with a focus on quality improvement.

Keywords: measurement of quality; patient satisfaction; patient-centered care; quality improvement; quality management; quality measurement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Factor Analysis, Statistical
  • Female
  • Focus Groups
  • Germany
  • Health Care Sector / standards*
  • Humans
  • Male
  • Middle Aged
  • Patient Participation*
  • Patient Satisfaction*
  • Quality Indicators, Health Care
  • Quality of Health Care*
  • Reproducibility of Results
  • Research Design
  • Surveys and Questionnaires*