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Determining the interviewer effect on CQ Index outcomes: a multilevel approach.
Sjenny Winters1, Mathilde H Strating, Niek S Klazinga
1Kiwa Prismant, P,O, Box 85200, 3508 AE Utrecht, the Netherlands. sjenny.winters@prismant.nl
BMC Medical Research Methodology
|August 21, 2010
Summary
Interviewer differences significantly impact perceived healthcare quality in Dutch nursing homes, affecting five key dimensions. Standardized training and experience do not fully eliminate these effects, necessitating cautious interpretation of quality ratings.
Area of Science:
- Healthcare quality assessment
- Geriatric care research
- Survey methodology
Background:
- The CQ Index for the elderly assesses resident experiences in Dutch nursing homes via interviews.
- This study investigates inter-interviewer variability in perceived healthcare quality.
- It examines the magnitude of interviewer effects and characteristic influences on CQ Index dimensions for public reporting.
Purpose of the Study:
- To determine if inter-interviewer differences affect perceived healthcare quality.
- To quantify the impact of interviewer characteristics on CQ Index dimensions.
- To assess the implications for public reporting of quality data.
Main Methods:
- Utilized data from 4345 questionnaires.
- Performed correlation, reliability, and multilevel analyses, including Intra Class Correlation (ICC).
- Developed five models to assess interviewer effects and adjusted quality ratings (1-5 stars) for resident and interviewer characteristics.
Main Results:
- Multilevel analysis revealed significant variance in five quality dimensions due to interviewers.
- Previous interviewing experience, reason for interviewing, and general healthcare knowledge significantly influenced quality perceptions.
- Adjusting for interviewer characteristics had a minor effect on five dimensions (Shared decision-making, Meals, Professional competency, Autonomy, Availability of personnel) but not the overall star ratings for 7 of 12 dimensions.
Conclusions:
- Standardized training, experienced interviewers, and supervision do not entirely prevent interviewer effects.
- Findings can inform improvements in healthcare service quality.
- Certain CQ Index dimensions require cautious interpretation for external accountability and transparency due to interviewer variability.
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