ZAP questionnaire on satisfaction in outpatient care - quality from the patient's perspective
Eva-Maria Bitzer, Marie-Luise Dierks, Friedrich-Wilhelm Schwartz
The ZAP questionnaire (satisfaction in outpatient care - quality from the patient's perspective) as a standardized instrument for measuring process-related patient satisfaction was developed on the basis of a mixed-methods design*. The results of an extensive qualitative preliminary study on patients' expectations of outpatient care were incorporated into the design, and the psychometric testing was carried out in two phases: first phase 969 patients from 54 practices of registered physicians in northern Germany, main study 1,387 patients from 60 practices. The survey instrument has good psychometric properties in terms of reliability, validity and discriminatory ability. It consists of a questionnaire with a total of 23 items, which are assigned to four scales, as well as three global questions. The 23 items describe four different dimensions of patient satisfaction with the service and process quality in the physician's practice. As the areas of "physician-patient interaction" and "information" are highly relevant for patients, they were considered in greater detail (i.e. with a larger number of items) when constructing the survey instrument. The global items ask about "overall satisfaction with the physician", "trust in the physician" and an "assessment of the quality of treatment". When formulating the items, emphasis was placed on simple, clearly understandable questions and instructions and neutral wording was chosen. All items comprise four-level response categories.
As part of quality management, the patient questionnaire is currently being made available to registered physicians in German and seven other languages as an eZAP or in paper form via the National Association of Statutory Health Insurance Physicians; a further development for surveying parents of underage patients is also available here. https://www.kbv.de/html/6332.php.
Interested researchers can request the instrument including a detailed manual from the authors.
* The development and psychometric testing of the ZAP questionnaire was funded by the Federal Ministry of Health as part of the joint project "Quality Management in Medical Practice" in sub-project 3 "Patient Expectations and Patient Satisfaction as Indicators of Process Quality in Outpatient Medical Care".
Contact address
Prof. Dr. med. Eva Bitzer MPH, Freiburg University of Education
evamaria.bitzer@ph-freiburg.de
Prof. Dr. Dr., Marie-Luise Dierks, Hannover Medical School
dierks.marie-luise@mh-hannover.de
Literature on the ZAP questionnaire
- Bitzer EM, Volkmer S, Petrucci M, Weissenrieder N, Dierks ML. Patient satisfaction in pediatric outpatient settings from the parents' perspective - The Child ZAP: A psychometrically validated standardized questionnaire. BMC Health Serv Res. 2012 Oct 2;12(1):347.
- Bitzer EM, Volkmer ST, Petrucci M. Weissenrieder N, Dierks ML. Satisfaction in pediatric and adolescent medical practices from the parents' perspective - survey and analysis with the Kinder-ZAP. Pediatrics and Adolescent Medicine, 2012 (43);6: 315-319
- Scholl I, Hölzel L, Härter M, Dierks ML, Bitzer EM, Kriston L. Questionnaire on satisfaction in outpatient care - focus on patient participation (ZAPA). Clinical diagnostics and evaluation. 2011;(4):50-62.
- Dierks ML, Bitzer EM, Schwartz FW. Patient surveys in the medical practice - practicability, acceptance and relevance from the perspective of office-based physicians. Z Arztl Fortbild Qualitatssich 2000;94(8):389-95.
- Bitzer EM, Dierks ML, Dörning H, Schwartz FW. Satisfaction in the medical practice from the patient's perspective - Psychometric testing of a standardized survey instrument. Journal of Health Sciences 1999;7(3):196-209.
- Dierks ML, Bitzer E, Haase I, Schwartz FW. Focus-group-discussions - A method to survey patient needs in primary care from the patient's perspective. Z Allg Med 1994 Nov;70(22):921-24.