Closing the patient experience chasm: A two-level validation of the Consumer Quality Index Inpatient Hospital Care

Alina Smirnova*, Kiki M. J. M. H. Lombarts, Onyebuchi A. Arah, Cees P. M. van der Vleuten

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BackgroundEvaluation of patients' health care experiences is central to measuring patient-centred care. However, different instruments tend to be used at the hospital or departmental level but rarely both, leading to a lack of standardization of patient experience measures.

ObjectiveTo validate the Consumer Quality Index (CQI) Inpatient Hospital Care for use on both department and hospital levels.

DesignUsing cross-sectional observational data, we investigated the internal validity of the questionnaire using confirmatory factor analyses (CFA), and the generalizability of the questionnaire for use at the department and hospital levels using generalizability theory.

Setting and participants22924 adults hospitalized for 24hours between 1 January 2013 and 31 December 2014 in 23 Dutch hospitals (515 department evaluations).

Main variableCQI Inpatient Hospital Care questionnaire.

ResultsCFA results showed a good fit on individual level (CFI=0.96, TLI=0.95, RMSEA=0.04), which was comparable between specialties. When scores were aggregated to the department level, the fit was less desirable (CFI=0.83, TLI=0.81, RMSEA=0.06), and there was a significant overlap between communication with doctors and explanation of treatment subscales. Departments and hospitals explained 5% of total variance in subscale scores. In total, 4-8 departments and 50 respondents per department are needed to reliably evaluate subscales rated on a 4-point scale, and 10 departments with 100-150 respondents per department for binary subscales.

Discussion and conclusionsThe CQI Inpatient Hospital Care is a valid and reliable questionnaire to evaluate inpatient experiences in Dutch hospitals provided sufficient sampling is done. Results can facilitate meaningful comparisons and guide quality improvement activities in individual departments and hospitals.

Original languageEnglish
Pages (from-to)1041-1048
Number of pages8
JournalHealth Expectations
Issue number5
Publication statusPublished - Oct 2017


  • Confirmatory factor analysis
  • generalizability theory
  • Consumer Quality Index (CQI)
  • national surveys
  • patient-centered care
  • quality assessment

Cite this