[Immigrant perceptions of the Spanish National Healthcare System and its services]. / Percepciones de un grupo de inmigrantes sobre el Sistema Nacional de Salud y sus servicios.

OBJECTIVE: To analyse the perception, use and satisfaction of a group of immigrants living in Barcelona taking into account their gender, origin and social class. DESIGN: Cross sectional study. LOCATION: City of Barcelona, Spain. PARTICIPANTS: A group of 225 immigrant residents and users of social services in the city of Barcelona, from June to July 2012. MAIN MEASURES: the level of access and relationship with the public health system of immigrants living in Barcelona was analysed, based on a questionnaire. The responses were analysed in relation to: gender, age, social class, self-perceived health, national origin, time since arrival, and marital status. RESULTS: The large majority (89%) of the population surveyed declared that the most important aspect was «to have been treated with respect¼ in health services. However, 59.4% reported a perception of «discrimination against immigrants¼, and 68.4% said that cultural differences affect «totally or partially¼ the quality of care received. For 66.7% of the participants, health care received in Barcelona is better than in their home country, mainly for its scientific, technical quality, and universal access. CONCLUSIONS: Despite the good assessment of universal public health care system this study showed deficiencies of the system in terms of the psychosocial component of health care to immigrants in Barcelona. It is necessary to deepen the study of knowledge and perceptions of minority groups in the current context.

[Comparison of level of satisfaction of users of home care: integrated model vs. dispensaries model]. / Comparación de la satisfacción de los usuarios de atención domiciliaria: modelo integrado vs. modelo dispensarizado.

OBJECTIVE: To determine the level of satisfaction of users that receive home health care through two different models of primary health care: integrated model and dispensaries model. DESIGN: cross-sectional, observational study. LOCATION: Two primary care centers in the province of Barcelona. PARTICIPANTS: The questionnaire was administered to 158 chronic patients over 65 years old, of whom 67 were receiving health care from the integrated model, and 91 from the dispensaries model. MAIN MEASUREMENTS: The Evaluation of Satisfaction with Home Health Care (SATISFAD12) questionnaire was, together with other complementary questions about service satisfaction of home health care, as well as social demographic questions (age, sex, disease, etc). RESULTS: The patients of the dispensaries model showed more satisfaction than the users receiving care from the integrated model. There was a greater healthcare continuity for those patients from the dispensaries model, and a lower percentage of hospitalizations during the last year. The satisfaction of the users from both models was not associated to gender, the health perception,or independence of the CONCLUSIONS: The user satisfaction rate of the home care by primary health care seems to depend of the typical characteristics of each organisational model. The dispensaries model shows a higher rate of satisfaction or perceived quality of care in all the aspects analysed. More studies are neede to extrapolate these results to other primary care centers belonging to other institutions.

Perceived quality in patients with gout treated in a rheumatology clinic with a clinical nurse specialist.

INTRODUCTION: Gout is a crystal arthropathy that is associated with significant loss of quality of life. A treat-to-target approach and proactive monitoring yield superior outcomes to standard care. The Clinical Nurse Specialist enhances follow-up and adherence to treatment in patients with gout, improving their perceived healthcare quality. OBJECTIVE: To determine the factors that affect the perceived quality and satisfaction of patients with gout treated in a rheumatology clinic and to identify areas for improvement, as well as to explore the influence of nurses' work in the care and management of these patients. METHODS: Cross-sectional observational study in patients with gout monitored in a monographic clinic by anonymous survey based on the SERVQUAL quality model, with demographic data and questions about aspects of care. RESULTS: 71 completed surveys were collected from the 80 delivered between August 2019 and January 2020. Most of the participants were males over 45 years of age. A total of 39% were satisfied with the care received, and 55% were very satisfied. All the respondents were satisfied with the face-to-face consultation with the Clinical Nurse Specialist and 66% considered the telephone consultation with the nurse to be good. Possible areas for improvement (referral time to consultation, identification, and availability of health providers) were identified. CONCLUSION: We found high overall satisfaction perceived by the patients attended in a gout consultation with the Clinical Nurse Specialist. Understanding and systematizing the patients' opinion is essential to improve clinical care.

Perceived Quality in Patients With Gout Treated in a Rheumatology Clinic With a Clinical Nurse Specialist. / Estudio de calidad percibida en pacientes con gota atendidos en una consulta de reumatología con enfermería especializada.

INTRODUCTION: Gout is a crystal arthropathy that is associated with significant loss of quality of life. A treat-to-target approach and proactive monitoring yield superior outcomes to standard care. The Clinical Nurse Specialist enhances follow-up and adherence to treatment in patients with gout, improving their perceived healthcare quality. OBJECTIVE: To determine the factors that affect the perceived quality and satisfaction of patients with gout treated in a rheumatology clinic and to identify areas for improvement, as well as to explore the influence of nurses' work in the care and management of these patients. METHODS: Cross-sectional observational study in patients with gout monitored in a monographic clinic by anonymous survey based on the SERVQUAL quality model, with demographic data and questions about aspects of care. RESULTS: 71 completed surveys were collected from the 80 delivered between August 2019 and January 2020. Most of the participants were males over 45years of age. A total of 39% were satisfied with the care received, and 55% were very satisfied. All the respondents were satisfied with the face-to-face consultation with the Clinical Nurse Specialist and 66% considered the telephone consultation with the nurse to be good. Possible areas for improvement (referral time to consultation, identification, and availability of health providers) were identified. CONCLUSION: We found high overall satisfaction perceived by the patients attended in a gout consultation with the Clinical Nurse Specialist. Understanding and systematizing the patients' opinion is essential to improve clinical care.

Self-management model in the scheduling of successive appointments in rheumatology. / El modelo de autogestión en la agenda de consultas sucesivas en reumatología.

INTRODUCTION: The rheumatology service of Ciudad Real Hospital, located in an autonomous community of that same name that is nearly in the center of Spain, implemented a self-management model of successive appointments more than 10 years ago. Since then, the physicians of the department schedule follow-up visits for their patients depending on the disease, its course and ancillary tests. The purpose of this study is to evaluate and compare the self-management model for successive appointments in the rheumatology service of Ciudad Real Hospital versus the model of external appointment management implemented in 8 of the hospital's 15 medical services. MATERIAL AND METHODS: A comparative and multivariate analysis was performed to identify variables with statistically significant differences, in terms of activity and/or performance indicators and quality perceived by users. The comparison involved the self-management model for successive appointments employed in the rheumatology service of Ciudad Real Hospital and the model for external appointment management used in 8 hospital medical services between January 1 and May 31, 2016. RESULTS: In a database with more than 100,000 records of appointments involving the set of services included in the study, the mean waiting time and the numbers of non-appearances and rescheduling of follow-up visits in the rheumatology department were significantly lower than in the other services. The number of individuals treated in outpatient rheumatology services was 7,768, and a total of 280 patients were surveyed (response rate 63.21%). They showed great overall satisfaction, and the incidence rate of claims was low. CONCLUSION: Our results show that the self-management model of scheduling appointments has better results in terms of activity indicators and in quality perceived by users, despite the intense activity. Thus, this study could be fundamental for decision making in the management of health care organizations.

Perceived quality in a dementia unit: patients' caregivers as information providers. / Calidad percibida en una unidad de demencias: el portavoz del paciente como proveedor de información.

INTRODUCTION: Dementia units (DU) provide comprehensive and specialised care to patients with dementia. However, assessment in these units normally focuses on patient management. The aim of this study was to determine satisfaction of the caregivers of patients managed in a DU and how they rated DU care. METHODS: We created a self-administered questionnaire which was completed by 236 caregivers visiting the DU in 2015. The questionnaire included 6 dimensions (accessibility, organisation, professionalism, relationship with staff, information, and facilities); data were analysed using problem rates. RESULTS: A total of 53.4% caregivers completed the questionnaire; most were women, patients' spouses, or first-degree relatives. The overall problem rates was 15.0% (95% CI, 13.9-16.1), with sizeable differences between dimensions: from 0.1% (95% CI, 0.0-0.4) for 'relationship with staff' and 'professionalism' to 49.3% (95% CI, 45.4-53.2) for 'information'. Waiting times over 30minutes were perceived as excessive. Information problems were not directly related to patient management. Satisfaction was scored 8.29/10 (median 8; SD 1.45); 77.3% (95% CI, 69.8-74.8) of respondents were highly satisfied. Ninety-nine percent of the caregivers stated that they would recommend the DU. CONCLUSIONS: This questionnaire provides interesting data on care quality as perceived by patients' caregivers. Our results have allowed us to identify problems and implement corrective actions. Our questionnaire has proved to be a useful tool for evaluating and improving care quality in DUs.

[Sociodemographic characteristics and geographic variability associated with patient satisfaction in Primary Care]. / Características sociodemográficas y variabilidad geográfica relacionada con la satisfacción del paciente en Atención Primaria.

BACKGROUND: Patient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. MATERIAL AND METHODS: The data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. RESULTS: About one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. CONCLUSIONS: Satisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous.

Percepción del paciente ante el acto anestésico: desarrollo de una encuesta breve en español para medir satisfacción / Patient perception of the anesthetic act: development of a brief survey in Spanish to measure satisfaction

Resumen: Introducción: El desarrollo de encuestas representa un proceso complejo que requiere la verificación de su utilidad antes de su aplicación. A nivel internacional existen pocos instrumentos para medir la percepción de la atención anestésica en cirugías electivas, sin olvidar que, en su mayoría, se crearon en inglés; por lo que el propósito de este estudio fue desarrollar una encuesta breve sobre la atención anestésica como un indicador de calidad en la población mexicana. Material y métodos: Se trata de un estudio cualitativo que implica la fase de la construcción de una encuesta en la que se realizó una revisión de la literatura internacional y local de los instrumentos para medir satisfacción en anestesiología. Posteriormente, se realizaron entrevistas informales aleatorias a 82 pacientes sobre temas asociados al acto anestésico para la construcción de ítems. Resultados: La propuesta incluye 16 ítems divididos en tres secciones correspondientes a las tres valoraciones anestésicas básicas en una cirugía electiva y que exploran seis dominios: trato adecuado, comunicación, autonomía, atención oportuna, efectos secundarios y satisfacción. Conclusiones: La propuesta presentada es un potencial instrumento que podría reflejar la calidad percibida de la atención anestésica en nuestra población, por lo que, para fortalecer este proceso, se requerirá continuar con sus respectivas validaciones.

Abstract: Introduction: Survey development represents a complex process that requires verification of its usefulness before its application. At an international level, there are few instruments to measure the perception of anaesthetic care in elective surgeries, without forgetting that most of them were created in English; therefore, the purpose of this study was to develop a brief survey on anaesthetic care as an indicator of quality in the Mexican population. Material and methods: This is a qualitative study that involves the construction phase of a survey in which a review of the international and local literature of the instruments to measure satisfaction in anesthesiology was carried out. Subsequently, informal random interviews were conducted with 82 patients on the most sensitive issues associated with the anaesthetic act for the construction of items. Results: The proposal consists of 16 items divided into three sections corresponding to the three basic anaesthetic evaluations in elective surgery and that explore five domains: communication, autonomy, timely care, adequate treatment, and satisfaction. Conclusions: The proposal made in this project is a potential instrument that could reflect the perceived quality of anaesthetic care in our population, so to strengthen this process it will be necessary to continue with their respective validations.

Assessment of the knowledge and perception of support of patients with heart failure SOPICA study IN SPAIN.

OBJECTIVE: To understand the perceptions of patients with heart failure (HF) concerning their disease, treatment and support, as well as the specialists who provide care after a decompensation, and to determine whether there is a relationship between the type of specialist involved in the follow-up and the medium-term prognosis. METHODS: A multicentre, prospective cohort study consecutively included patients with acute HF in the emergency department. The patients were interviewed by telephone 91-180days after their emergency department visit. We investigated the relationship between the type of specialist who performed the follow-up and the emergency department visits or hospitalisations using Cox regression models, with progressive adjustment by groups of potential confounders of these relationships. RESULTS: We interviewed 785 patients. Thirty-three percent (95%CI: 30%-36%) considered their disease mild, 64% (60%-67%) required help from third parties for daily activities, 65% (61%-68%) had no recent therapeutic changes, and 69% (67%-72%) received the same treatment in the exacerbations. The perceived support varied significantly depending on the factor under consideration (from greater to lesser: family, hospital, emergency department, health centre, religion and patient associations; p<.05 in all comparisons). Thirty-nine percent (36%-43%) of the patients with decompensations consulted directly with the emergency department, with no prior changes in treatment. At discharge, general practitioners (74%, 71%-77%) and cardiologists (74%, 70%-77%) were the most involved in the follow-up, although the specialty was not related to the prognosis. CONCLUSION: There are various aspects of the perception of patients with HF concerning their disease that are susceptible to future interventions. Patient follow-up involves various specialties, but all achieve similar results in the medium term.

Discrepancies on quality perceived by the patients versus professionals on the quality of a nuclear medicine department.

PURPOSE: To evaluate the discrepancies between the professionals and outpatients on quality perceived of a Nuclear Medicine Department (NMD). MATERIAL AND METHODS: This cross-sectional study has been carried out using two questionnaires: a validated patient experience questionnaire and a quality perception questionnaire for professionals. Both questionnaires use the same 25 categorical items to measure service quality, 2 Likert scale items to measure satisfaction and willingness to recommend the NMD and 1 open-ended question. The patient questionnaire included 6 socio-demographic items and one job-related question (professionals). The categorical items were classified as "conformity" or "non-conformity." RESULTS: The response rate was 36.7% for outpatients and 100% for professionals. Mean value for satisfaction with the NMD was 9 points for patients and 6.9 points for professionals. Mean number of non-conformity items per person was 2.8 for the patient group and 8.7 for the professional group. Cohen's Kappa value was 0.112, indicating poor agreement in the classification of items as strong points and areas for improvement. Of the 25 items, the professionals and patients coincided on 12 (48%). CONCLUSION: Agreement was low between the quality perception of patients and professionals. The patients scored quality of service higher than the NMD professionals did. These instruments are useful aid to help health organizations detect areas for improvement, and to improve the quality of the service provided to patients.

Job quality indicators and perceived job quality: the moderating roles of individual preferences and gender / Indicadores de qualidade do trabalho e qualidade percebida do trabalho: os papéis moderadores das preferências individuais e do gênero / Indicadores de calidad del empleo y calidad percibida del trabajo: los roles moderadores de las preferencias individuales y el género

Job quality is critical for policy makers, but little is known about the factors that shape perceived job quality among employees. This study aimed to explore the importance of several traditional job quality indicators: employment characteristics (type of contract, employment relationship, schedule predictability) and educational misfit (horizontal, vertical) in predicting perceived job quality. Additionally, the moderating roles of preferred employment characteristics and gender were tested. A hierarchical multiple regression analysis was conducted in a sample of 562 Spanish employees. The results demonstrated that all the indicators, except schedule predictability, were related (and contributed equally) to perceived job quality. Gender moderated the interaction effect between the current and preferred employment relationship. For women, the full-time preference boosted the effect of full-time jobs on perceived job quality, whereas for men, the part-time preference boosted this effect. The findings indicate the importance of adopting a contextual approach to perceived job quality, considering individuals’ preferred employment characteristics and gender.

A qualidade do trabalho é crítica para os formuladores de políticas, mas pouco se sabe sobre os fatores que moldam a percepção da qualidade do trabalho entre os funcionários. Este estudo teve como objetivo explorar a importância de vários indicadores tradicionais de qualidade do emprego: características do emprego (tipo de contrato, relação de trabalho, previsibilidade de horário) e desajuste educacional (horizontal, vertical) na previsão da qualidade percebida do emprego. Além disso, os papéis moderadores de características de emprego preferenciais e gênero foram testados. Uma análise de regressão múltipla hierárquica foi realizada em uma amostra de 562 funcionários espanhóis. Os resultados demonstraram que todos os indicadores, exceto a previsibilidade do cronograma, estavam relacionados (e contribuíam igualmente) para a qualidade percebida do trabalho. O gênero moderou o efeito da interação entre a relação de trabalho atual e a preferencial. Para as mulheres, a preferência de tempo integral impulsionou o efeito dos empregos de tempo integral na percepção da qualidade do trabalho, enquanto para os homens, a preferência de meio período aumentou esse efeito. Os resultados indicam a importância de adotar uma abordagem contextual para a percepção da qualidade do trabalho, considerando as características de emprego preferidas dos indivíduos e gênero.

La calidad del trabajo es fundamental para los responsables de la formulación de políticas, pero se sabe poco sobre los factores que dan forma a la calidad del trabajo percibida entre los empleados. Este estudio tuvo como objetivo explorar la importancia de varios indicadores tradicionales de calidad del trabajo: características del empleo (tipo de contrato, relación laboral, previsibilidad del horario) y desajuste educativo (horizontal, vertical) para predecir la calidad del trabajo percibida. Además, se probaron los roles moderadores de las características laborales preferidas y el género. Se realizó un análisis de regresión múltiple jerárquica en una muestra de 562 empleados españoles. Los resultados demostraron que todos los indicadores, excepto la previsibilidad del horario, estaban relacionados (y contribuían por igual) a la calidad del trabajo percibida. El género moderó el efecto de interacción entre la relación laboral actual y la preferida. Para las mujeres, la preferencia a tiempo completo impulsó el efecto de los trabajos a tiempo completo sobre la calidad percibida del trabajo, mientras que para los hombres, la preferencia a tiempo parcial aumentó este efecto. Los hallazgos indican la importancia de adoptar un enfoque contextual de la calidad del trabajo percibida, considerando las características laborales preferidas de las personas y el género.

[Personalizing the reference level: gold standard to evaluate the quality of service perceived]. / Personalización del nivel de referencia: patrón oro para evaluar la calidad de servicio percibida.

OBJECTIVE: To know the cutoff point at which in-house Nuclear Medicine Department (MND) customers consider that the quality of service is good (personalized cutoff). MATERIAL AND METHOD: We conducted a survey of the professionals who had requested at least 5 tests to the Nuclear Medicine Department. A total of 71 doctors responded (response rate: 30%). A question was added to the questionnaire for the user to establish a cutoff point for which they would consider the quality of service as good. The quality non-conformities, areas of improvement and strong points of the six questions measuring the quality of service (Likert scale 0 to 10) were compared with two different thresholds: personalized cutoff and one proposed by the service itself a priori. Test statistics: binomial and Student's t-test for paired data. RESULTS: A cutoff value of 7 was proposed by the service as a reference while 68.1% of respondents suggested a cutoff above 7 points (mean 7.9 points). The 6 elements of perceived quality were considered strong points with the cutoff proposed by the MND, while there were 3 detected with the personalized threshold. Thirteen percent of the answers were nonconformities with the service cutoff versus 19.2% with the personalized one, the differences being statistically significant (difference 95% CI 6.44%:0,83-12.06). CONCLUSIONS: The final image of the perceived quality of an in-house customer is different when using the cutoff established by the Department versus the personalized cutoff given by the respondent.

Propuesta de instrumento para evaluar la calidad percibida por pacientes tratados por cirugía de mínimo acceso / Proposition of a questionnaire to evaluate the patient-perceived quality on minimal access surgery

RESUMEN Introducción: La cirugía de mínimo acceso ha tenido un desarrollo importante en las últimas dos décadas en Cuba. La satisfacción de la población con estos servicios, de innegable predilección por su efectividad e inocuidad, es cada vez mayor, sin embargo en la actualidad el nivel de satisfacción de los pacientes sobre bases científicas no se conoce. Objetivo: Elaborar y validar por expertos un instrumento para medir la percepción de la calidad de la atención médica que tienen los pacientes operados por cirugía de mínimo acceso. Métodos: Se elaboró y validó por expertos, un instrumento de medición, incluida la encuesta y estándares, para evaluar la calidad de la atención médica percibida por los pacientes operados, en las dimensiones de estructura, proceso y resultado. Resultados: El 100 por ciento de las preguntas fueron consideradas por los expertos justificables y pertinentes en el instrumento. Tres preguntas no cumplieron alguno de los requisitos de Moriyama y fueron modificadas. Fueron incorporados nuevos ítems relacionados fundamentalmente con procesos de atención médica. Se modificó la escala ordinal de Likert de cinco pasos por una de cuatro pasos. Se fijaron los estándares de calidad iguales o superiores al 80 por ciento, para cada uno de los tres niveles: por cada dimensión, por cada criterio para el conjunto de evaluados y por cada paciente según todos los criterios. Conclusión: El estudio aporta un instrumento validado por expertos, para evaluar la satisfacción de los pacientes en el ámbito de la cirugía de mínimo acceso(AU)

ABSTRACT Introduction: In the last two decades Minimal Access Surgery has had an important development in Cuba. Patient satisfaction with these services is higher, nevertheless today it is not well knows on a scientific basis. Objective: design and validate by experts a measurement instrument to assess the patient-perceived quality of patients operated by minimal access surgery. Methods: A measurement instrument, including questionnaire and standards, was developed and validated by experts, to evaluate the patient-perceived quality in the dimensions structure, process and results. Results: The experts considered the one hundred percent of questions in the instrument justified and relevant. Only three questions no fulfilled with one of the Moriyama's requirement and were improved. New items related with processes criteria were included. The ordinal 5-point Likert scale was modified to 4-point scale. Quality standards were fixed to 80 percent or higher for each of three levels: each dimension, each criterion for all evaluated and each patient according to all criteria. Conclusion: The study shows a validated instrument by experts to evaluate the patient's satisfaction in minimal access surgery(AU)

Validación de la versión reducida del CECASDEP en usuarios de servicios deportivos / Validation of a short version of CECASDEP in sports services users

El objetivo planteado consistió en desarrollar una versión reducida del CECASDEP y obtener evidencias de su validez y fiabilidad en 2 muestras diferentes. Participaron 882 personas con un rango de edad que oscilaba entre 14 y 81 años (M = 34.89; DT = 12.57), de los que 432 eran hombres y 440 mujeres. Se examinó la estructura interna mediante análisis factorial confirmatorio y la validez cruzada mediante análisis multigrupo, obteniendo un buen ajuste en los distintosíndices. El modelo resultante está compuesto por 25 ítems y 5 dimensiones, con propiedades psicométricas que mostraron buena consistencia interna, validez convergente y discriminante. El análisis factorial confirmatorio mostró buen ajuste en los distintosíndices y el análisis multigrupo ofreció una estructura estable en 2 muestras independientes. Los resultados indican que el modelo propuesto supone una herramienta válida para evaluar la calidad percibida en servicios deportivos.

The aim of this study was to develop a short version of CECASDEP and to obtain evidence of its validity and reliability in two different samples. A total of 882 individuals, 432 male and 440 female aged 14 to 81 (M = 34.89; DT = 12.57) were included in the study. Internal structure was examined, using confirmatory factor analysis, and a good adjustment of the model to the data was obtained. Besides, cross-validity was evaluated through multi-group analysis. The resulting model is composed of 25 items and 5 dimensions, with psychometric properties reflecting good internal consistency, convergent validity and discriminant validity. Confirmatory factor analysis showed an acceptable adjustment of the model to the data and multi-group analysis reflected that the structure factor is stable in two independent samples. The results confirm that the proposed model is a valid tool to assess the perceived quality in sports services.

Generalizabilidad y optimización en la evaluación de la calidad de los Centros de Atención Infantil Temprana (CAIT) / Generalizability and Optimization for Quality Assesment in Early Intervention Centers

El propósito de este trabajo fue optimizar una nueva herramienta de evaluación de la calidad de servicio percibida en los Centros de Atención Temprana, desarrollada ad hoc, que permitiera analizar distintas dimensiones desde la perspectiva de la Teoría de la Generalizabilidad. El objetivo fue desglosar la variabilidad real de la variabilidad del error. Se estimaron los componentes de varianza de las facetas centros, usuarios, ítems y escalas. Se utilizó una estructura de diseño multifaceta parcialmente anidado, analizando distintas categorías independientemente y en interacción, obteniendo excelentes resultados tanto de los índices de fiabilidad como de generalizabilidad. Se realizó una optimización del diseño de medida para optimizar los tamaños muestrales, pudiendo ser considerado un análisis coste-beneficio.

The purpose of this work was to optimize a new tool for evaluation of quality perceived in the Early Intervention Centers, developed ad hoc, allowing to analyze different dimensions of quality service in these kind of centres from the perspective of the Generalizability Theory. The aim was to break down the actual variability of the variability of the error. The variance of the facets centers, users, items and scales components were estimated. We used a structure of multifaceted partially nested design, analyzing different categories independently and in interaction, obtaining excellent results both indexes of reliability and generalizability. Measure design optimization to optimize sample sizes, and can be considered a cost-benefit analysis was conducted.

Calidad de las clases de pediatría comunitaria desde la percepción del estudiante, luego de la aplicación de conocimientos neurocientíficos / Medical students' perception of community pediatrics lessons quality following application of neuroscientific knowledge

Introducción: Las investigaciones realizadas en las últimas décadas sobre el rol del cerebro en el proceso educativo han aportado las bases neuronales del aprendizaje y otras funciones cerebrales que son estimuladas en el aula. Objetivos: Evaluar la calidad del servicio educativo en la rotación de Pediatría Comunitaria desde la perspectiva del estudiante luego de la aplicación de conocimientos neurocientíficos. Diseño: Estudio transversal, descriptivo de diseño cuantitativo. Lugar: Departamento de Pediatría, Facultad de Medicina San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú. Participantes: Estudiantes de Pediatría Comunitaria. Intervenciones: Aplicación de la encuesta ServPerf. Resultados: La satisfacción global para todas las dimensiones fue de satisfacción, siendo el nivel de insatisfacción mínima. La satisfacción media para todas las dimensiones fue de satisfacción, a excepción de la dimensión entorno del aprendizaje, que fue de insatisfacción. El atributo el conocimiento brindado en clase, tuvo conexión evidente con la realidad; fue el de mayor prioridad. Conclusiones: La utilización de los conocimientos neurocientíficos mejora la percepción de la calidad del servicio educativo. La dimensión que alcanzó más alta satisfacción media fue materiales didácticos seguidos por información recibida e integrada. El conocimiento brindado en clase tiene conexión evidente con la realidad, tuvo la más alta prioridad...

Introduction: In the last few decades research on the role of the brain in the educational process has provided the neuronal basis of learning and other brain functions that are stimulated in the classroom. Objectives: To determine the quality of education service from the perspective of the student on the application of neuroscientific knowledge during Community Pediatrics rotation. Design: Cross sectional, descriptive quantitative study. Setting: Pediatrics Department, San Fernando Medical School, Universidad Nacional Mayor de San Marcos, Lima, Peru. Participants: Students of Community Pediatrics. Interventions: Application of Servperf survey. Results: Overall satisfaction and minimum level of dissatisfaction for all dimensions of satisfaction was found, with the exception of dissatisfaction in the learning environment dimension. The attribute knowledge provided in class had clear connection with reality; it showed the highest priority. Conclusions: The use of neuroscience enhances the perception of educational service quality. The dimension obtaining highest average satisfaction was teaching materials, followed by received and integrated information. The highest priority was obtained by knowledge provided in class has clear connection with the reality...

Satisfacción y calidad: análisis de la equivalencia o no de los términos / Satisfaction and quality: analysis of the equivalence or not of the terms

El objetivo del presente artículo es ubicar las mediciones de la calidad percibida, que efectuó el DANE en las encuestas de calidad de vida de 1997 y 2003, en relación con el concepto de satisfacción del paciente. Para el efecto, primero se muestra, en forma breve, qué se entiende por calidad en salud en general y se indica que al hablar de la calidad de la atención médica se remite al problema de la satisfacción. Luego se aborda, con cierto detenimiento, el concepto de satisfacción y se explora la forma de relación entre los dos conceptos, la cual resulta de establecer en qué medida uno de los dos puede representar al otro. Desde esta perspectiva, las mediciones de la calidad se pueden interpretar bien como indicadores de la satisfacción, o como el uso de un método directo para medir esta última. Por último, se presentan las teorías que, de alguna manera, incorporan a la calidad percibida en la determinación de la satisfacción, y se resalta que ésta no constituye la totalidad de la explicación. Se trata de las teorías que ponen de presente el papel de las expectativas y su mayor o menor corroboración mediante las percepciones de los atributos de los productos, la cual es la forma usual de entender la calidad percibida. Se concluye que, si bien la calidad percibida de los cuidados de salud, como indicador, dice algo de los grados de satisfacción que alcanza el paciente, no parece ser, de todos modos, un buen representante, en la medida en que si bien las expectativas son un factor importante en la explicación, y aun si fueran el principal, hay acuerdo en la muy relevante intervención de otros factores.

The purpose of this article is to place perceived quality measurements, carried out by DANE in their Quality of Life surveys of 1997 and 2003, in relation to the concept of patient satisfaction. What is understood as health quality in general is shown briefly first and it is indicated thatwhen quality medical attention is mentioned it is in light of a problem of satisfaction. Then, inmore detail, the concept of satisfaction is considered and the shape of the relationship betweenthe two concepts is explored, resulting from establishing the measure in which one of them can represent the other. From this perspective, quality measurements can be interpreted either as satisfaction indicators or as its direct measurement. Finally, the theories that somehow incorporate perceived quality in the determination of satisfaction are presented indicating that it doesn’tconstitute the totality of the explanation. These are theories that describe the paper played byexpectations and their varying corroboration through the product attribute perception, which is the usual way of understanding perceived quality. It is concluded that although perceived quality of health care as an indicator, says something about the degree of satisfaction reached by the patient, it doesn’t appear anyways, a good representative, as even if the expectations are an important factor in the explanation, and even if they were the principal one, there is agreementabout the very relevant intervention of other factors.