Open Access Open Access  Restricted Access Subscription or Fee Access

Patient experience as measured with the brief CQI: an evaluation

David F E Linszen, Edwin de Beurs


Rationale, aims and objectives: The psychometric qualities of the brief Consumer Quality-Index (CQI), a shortened version of the regular CQI, which measures patient experience, were tested in a large dataset.

Method: The brief CQI for mental healthcare (MHC) is aimed at measuring patient experience through a self-report questionnaire. It consists of 19 items, distributed over 8 factors. The reliability and validity (dimensional structure) of the questionnaire were examined, as well as the effect of completing the test anonymously. Also, several indicators of the CQI were compared on their concurrent validity: the total score, the Net Promoter Score (NPS) and the overall judgment (a single item score). The study uses observational data, collected through ROM at the post-test, after the treatment was concluded, by MHC institutes and provided on a monthly basis to the Foundation of Benchmarking Mental Health Care (Stichting Benchmark GGZ), our national benchmark institute. The data set consists of N = 38,131 respondents. The population is composed of patients with common mental disorders and behavioral or addictive disorders.

Results: The results show that the CQI total score has satisfactory psychometric properties, but some subscales require improvement as only 2 showed a desired alpha-value. The reliability of the other subscales may be improved by adding extra items. The total score proved to be a better indicator of the CQI than the overall judgment and the NPS. Anonymous completion resulted in somewhat lower scores than non-anonymous completion, although the effect size of this difference was small.

Conclusions: Based on the results of this study several improvements for the brief CQI are recommended. Further research should investigate the question as to whether patient characteristics are predictive for the judgment on the CQI. Also, differences between MHC providers in patient experience according to the CQI should be examined.


Addiction disorders, clinical outcomes, Consumer Quality-Index (CQI), evaluation, health insurers, mental health problems, patient experience, performance indicators, performance measurement, person-centered healthcare, psychometrics, public health, trea

Full Text:



Delnoij, D.M.J., Rademakers, J.J.D.J.M. & Groenewegen, P.P. (2010). The Dutch Consumer Quality Index: an example of stakeholder involvement in indicator development. BMC Health Services Research 10, 1-12.

Krol, M.W. (2015). Numbers telling the tale? On the validity of patient experience surveys and the usability of their results. Zutphen: CPI Koninklijk Wöhrmann.

Hays, R.D., Shaul, J.A., Williams, V.S.L., Lubalin, J.S., Harris-Kojetin, L.D., Sweeney, S.F. & Cleary, P.D. (1999). Psychometric properties of the CAHPS 1.0 Survey Measures: Consumer Assessment of Health Plans Study. Medical Care 37 (Supplement 3) MS22-MS31.

Delnoij, D.M.J., Ten Asbroek, A.H., Arah, O.A., de Koning, J.S., Stam, P., Poll, A., Vriens, B., Schmidt, P. & Klazinga, N.S. (2006). Made in the USA: the import of American Consumer Assessment of Health Plan Surveys (CAHPS) into the Dutch social insurance system. European Journal of Public Health 16 (6) 652-659.

Sixma, H.J., Kerssens, J.J., van Campen, C. & Peters, L. (1998). Quality of care from the patients’ perspective: from theoretical concept to a new measuring instrument. Health Expectations 1, 82-95.

Triemstra, M., Hendriks, M., Delnoij, D. & Rademakers, J. (2008). Doelspecifieke versies van CQ-index meetinstrumenten: korter, krachtiger, en specifieker meten? TSG 86, 486-493.

De Beurs, E., den Hollander-Gijsman, M.E., van Rood, Y.R. van der Wee, N.J., Giltay, E.J., van Noorden, M.S., van der Lem, R., van Fenema, E. & Zitman, F.G. (2011). Routine outcome monitoring in the Netherlands: practical experiences with a web-based strategy for the assessment of treatment outcome in clinical practice. Clinical Psychology & Psychotherapy 18, 1-12.

Boonen, L., Appelman, M., Koolman, X., Otter, B. & Zuidgeest, M. (2012). Pilot GGZ 2011-2012: Online afnemen van cliëntervaringen binnen de ROM Cyclus. Available at: Accessed June 22, 2017.

Krol, M.W., de Boer, D., Delnoij, D.M. & Rademakers, J.J. (2014). The Net Promoter Score–an asset to patient experience surveys? Health Expectations 18, 3099-3109.

Paulhus, D.L. (2002). Socially Desirable Responding: The Evolution of a Construct. In: The role of constructs in psychological and educational measurement. Braun, H.I., Jackson, D.N. & Wiley, D.E. (Eds.) pp. 49-69. Mahwah, NJ: Erlbaum.

De Beurs, E., Barendregt, M., de Heer, A., van Duijn, E., Goeree, B., Kloos, M., Kooiman, K., Lionarons, H. & Merks, A. (2016). Comparing methods to denote treatment outcome in clinical research and benchmarking mental health care. Clinical Psychology & Psychotherapy 23 (4) 308-318.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. 2nd edn. Hillsdale, NJ: Lawrence Erlbaum Associates.

Derogatis, L.R. (1975). The Brief Symptom Inventory. Baltimore, MD: Clinical Psychometric Research.

Carlier, I., Schulte-Van Maaren, Y., Wardenaar, K., Giltay, E., Van Noorden, M., Vergeer, P. & Zitman, F. (2012). Development and validation of the 48-item Symptom Questionnaire (SQ-48) in patients with depressive, anxiety and somatoform disorders. Psychiatry Research 200 (2-3) 904-910.

De Jong, K., Nugter, A., Polak, M., Wagenborg, H., Spinhoven, P. & Heiser, W. (2008). De Nederlandse versie van de Outcome Questionnaire (OQ-45): een crossculturele validatie. Psychologie & Gezondheid 36, 35-45.

Streiner, D.L. (2003). Starting at the beginning: an introduction to coefficient alpha and internal consistency. Journal of Personality Assessment 80, 99-103.

English, T. & Keeley, J.W. (2015). Internal Consistency Approach to Test Construction. In: Encyclopedia of Clinical Psychology. Cautin ,R, & Lilienfield, S. (Eds.), pp. 1509-1512. Malden, MA: Wiley-Blackwell.

Dawes, J. (2008). Do data characteristics change according to the number of scale points used? An experiment using 5-point, 7-point and 10-point scales. International Journal of Market Research 50, 61-77.

Damman, O.C., Stubbe, J.H., Hendriks, M., Arah, O.A., Spreeuwenberg, P., Deinoij, D.M. & Groenewegen, P.P. (2009). Using multilevel modeling to assess case-mix adjusters in consumer experience surveys in health care. Medical Care 47 (4) 496-503.

Black, N., Varaganum, M. & Hutchings, A. (2014). Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Quality & Safety 23 (7) 534-542.



  • There are currently no refbacks.