Outcomes Management through Performance Management: Theory and Application

James R.. Zabora, M.S.W., Director, Patient and Family Services, Johns Hopkins Oncology Center

This article addresses an important area of research since insurance reimbursement in the future may be partially contingent upon consumer satisfaction with care. The review of the literature is extensive and comprehensive but needs major revision as it is much too long and wordy. The authors need to succinctly summarize the review of the literature and highlight the main points, drawing the reading into understanding the purpose of the research. Overall, the authors need to reduce the number of tables and find ways to condense the findings. A possible way to do this would be to first report on the development, reliability and validity of the scale, much in the way of a non-researcher developed scale. This would make the paper clearer and would separate the findings from the analysis done to support the scale itself. Also, the tables should be given only if they can substitute for data presented. The authors need to think about using either a table or narrative but not both. There are several major concerns about the design of this study which make the findings questionable. Important steps seem to have been omitted in the development of the questionnaire. It appears that even though experts suggested content and categories, there was no actual inter-rater reliability conducted on the items in the scale itself. The scale as printed lead to questions about the items and the way they are worded. The authors might do better to present the scale as a figure and show how the questions and items were actually presented in their written format. The authors do report factor analysis and internal consistency but these are reported in results and this would seem to be more appropriate for information about the scale. No pilot test was done. Even having a few parents read the items and give feedback would have been wise. The authors are to be commended on translating the scale into Spanish. However, translation of a scale like this and its administration require great rigor and understanding of culture in addition to language. Therefore, it would have been critically important to have the items read and evaluated by Spanish parents and other translators prior to administration. The results seem to support this as the Hispanic families were more satisfied. One would wonder about their desire to please versus their actual satisfaction with care. The second concern is that of combining data collected by two methods. Since parents who reported anonymously were less satisfied, it would seem that the anonymous responders were more open and honest than those collected in the clinic. Again, collecting in the clinic would not give the parents the same comfort with refusal as would a mailed out survey. Since results are only as strong as the tool used to collect data, the conclusions drawn may be overstated. I believe this tool is a strong beginning in collecting important information, particularly to psychosocial caregivers. However, the authors may need to report this study as the development of a questionnaire, complete further testing, then report on the satisfaction.

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