Medisinsk utvikling samt krav til kostnadseffektivitet i Norge har bidratt til et stort fokus på hvordan man kan redusere kostnadene, samtidig som man opprettholder/forbedrer kvaliteten på behandlingstilbudet. Pasienthotell omtales som en god driftsform for økt fleksibilitet og kostnadseffektivitet. Det er et tilbud for pasienter som er oppegående og selvhjulpne pasienter som har behov for innleggelse i sykehus. Pasienthotell har en salutogen tilnærming mens sengeposter tradisjonelt har hatt en patogenesetilnærming. Det er lite forskning på om omgjøring av ordinære senger til pasienthotell er kostnadseffektivt, spesielt når hotellsengen er et alternativ til ordinær sengepost. Hensikten er å studere hvilke pasienter som er innlagt i ordinære sengeposter, men egner seg for internt pasienthotell. Det benyttes tverrsnittsundersøkelse for å samle informasjon. Spørreskjemaet er utarbeidet med fokus på kriterier for å være i pasienthotellet, komplementerende behandling og observasjonsbehov samt medarbeidernes oppfatning om pasienten egner seg for pasienthotell.   Kartleggingen er gjennomført ved Sørlandet sykehus, Kristiansand. Alle innlagte pasienter i ordinære sengeposter og pasienthotell er inkludert i kartleggingen. Pasienter i palliativpost, barselpost og observasjonsposten er ekskludert fra undersøkelsen. Kartleggingen ble gjennomført over en to ukers periode høsten 2007, og omfatter 951 pasientregistreringer. Flere pasienter ble registrert flere dager, noe som var hensikten fordi pasientene ble vurdert ut fra funksjonsnivå.   Resultatet viser at ca 18 % av pasientene som er innlagt i sengepostene fyller kriteriene for pasienthotell. Fordelingen mellom Medisinsk og Kirurgisk klinikk er lik, men det er variasjoner per enhet. En stor andel av pasientene får komplementerende behandling og det er en overvekt i Kirurgisk klinikk. En stor andel av pasientene som fyller kriteriene har behov for spesielle observasjoner. Undersøkelsen viser en variasjon mellom pasientene som fyller kriteriene og medarbeidernes vurdering av hvilke pasienter som egner seg pasienthotellet. Det er liten variasjon mellom det faktiske resultat og medarbeidernes oppfatning av andel pasienter som fyller kriteriene når det er korrigert for komplementerende behandling og behov for spesielle observasjoner. På bakgrunn av resultatene er det grunnlag for å overføre flere pasienter fra sengepost til Pasienthotell. Det er kostnadseffektivt, og vil trolig ikke svekke kvaliteten. / Medical advances and demands for improved cost-effectiveness in Norway have contributed to a major focus on how to reduce costs while maintaining/improving the quality of treatment. A patient hotel is described as a way of achieving both increased flexibility and cost-effectiveness by offering more or less self-reliant patients an alternative to traditional hospitalization. Treatment in a patient hotel is based on a salutogenetic approach, while traditional hospital wards usually approach treatment pathogenetically. There is little research on whether converting traditional ward beds  to the patient hotel model is indeed cost-effective, especially when patient hotel beds are considered an alternative to traditional ward beds. This study sought to determine which patients in traditional wards were suitable for admittance to an internal patient hotel. The study used a cross-sectional survey/questionnaire to collect data and focused on (i) the criteria for admission to a patient hotel, (ii) supplementary treatment, (iii) the patient’s need for special observation, and (iv) the employee’s perception of the patient suitability for the patient hotel. Our survey included 951 patients and was conducted at Sørlandet Sykehus, Kristiansand, Norway, during a two-week period in the autumn of 2007. The survey included all patients admitted to traditional wards and to the patient hotel, except patients in the palliative, maternity, and observation wards. Because we evaluated the patients according to their functional level, we intentionally recorded several patients over a span of several days. We determined that about 18% of patients admitted to traditional wards met the admission criteria for the patient hotel. Patient distribution between the Medical and Surgical Clinic was even, but there were variations per unit. A large proportion of the patients received supplementary treatment, including many from the Surgical Clinic. Many patients who fulfilled the criteria for admission to the patient hotel required special observation. The survey revealed a variation in the employees’ evaluation of which patients were suitable for the patient hotel. However, there was little variation between the actual results and the employees' perception of the proportion of patients who met the criteria when adjusted for supplementary treatment and the need for special observation. Based on the results of the study, it is reasonable to transfer patients from traditional wards to a patient hotel. Furthermore, this option is cost-effective and will not reduce the overall quality of patient care. / <p>ISBN 978-91-85721-77-1</p>

Background: Patient evaluation of primary health care (PHC) as a recognised means of obtaining important information for quality improvement can be enhanced with the availability and use of acceptable, reliable and valid questionnaires. This research reports the development and validation of the patients' evaluation scale (PES) for assessment of the quality of primary health care in Nigeria. Methods: Mixed methods design was used to develop and validate items, response scale and domains in the Patients' Evaluation Scale. Items were derived from literature review and content analysis of interviews with patients. Face and content validity were established with primary health care experts and patients while quantitative pilots were conducted to determine questionnaire's acceptability across groups and appropriate response format. The conduct of a large multi-centre psychometric validation survey was used to determine the internal structure (exploratory factor analysis), reliability (internal consistency), construct, criterion and discriminative validities (Pearson's correlation coefficient, structural equation modelling using regression equation method) and acceptability (scale and item response pattern) of the questionnaire. The discriminatory properties were assessed by questionnaire's ability to differentiate population groups' scores in line with 'a priori' hypotheses. Results: The development resulted in the long and shortened forms of PES containing 27 and 18-items respectively. Both showed good indices for validity and acceptability among various population groups in Nigeria. PES-SF resulted from the deletion of items in PES that didn't meet recommended Eigen value < 1, factor loading < 0.5, item-total, item-domain correlation < 0.4 and item-item correlation within domains of < 0.2. PES-SF has Cronbach's alpha of 0.87 for entire questionnaire and 0.78, 0.79 and 0.81 respectively for the three domains (codenamed 'facility', 'organisation', and 'health care'). The three components solution from the Scree plot explained 56.6% of the total variance of perceived quality. Items correlated significantly higher with domain identified through factor analysis than with other domains. In line with 'a priori' hypothesis, scale and domains scores of PES-SF could differentiate population groups based on patients' clinical and socio-demographic characteristics. PES-SF scores also showed significant correlation with patient general satisfaction and likelihood of returning or recommending others to the PHC centres. Conclusion: The patient evaluation scale designed for exit assessment of patients' experiences with PHC in Nigeria shows good measurement properties. It will be useful to clinicians, researchers and policy makers for patient-focused quality improvement activities in Nigeria. Further research will involve translation to major Nigerian languages and to assess PES validity against observed quality criteria.