Validation of You're Welcome Quality Criteria for Adolescent Health Services Using Data From National Inpatient Surveys in England

doi:10.1016/j.jadohealth.2012.04.005

Journal of Adolescent Health

Volume 52, Issue 1, January 2013, Pages 50-57.e1

https://doi.org/10.1016/j.jadohealth.2012.04.005 Get rights and content

Abstract

Purpose

Revised You're Welcome (YW) quality criteria for adolescent health services were published by the English Department of Health in 2011. These are the first national standards to include inpatient services and the first of their kind to be endorsed by the World Health Organization. This article investigates the relationship between the YW criteria and young people's overall satisfaction in national inpatient surveys.

Methods

We identified the most recent national surveys that contain adolescent data: the Inpatient Survey (IS) 2009 (ages 16–19 years) and the Young Patient Survey (YPS) 2004 (ages 12–17 years). Logistic regression was used to calculate the odds of increased overall satisfaction when YW criteria were met, adjusting for sex and use of health services. Spearman rank correlation coefficients were used to identify the 10 questions in each survey that best correlated with overall satisfaction. We assessed the degree to which these 10 items were included in the YW criteria.

Results

In all, 7,657 (12–17 years old) and 988 (16–19 years old) adolescents completed the YPS and the IS, respectively. Twenty-eight of 29 questions that mapped to YW criteria were significantly associated with overall satisfaction (IS = 14/15; YPS = 25/25; all p < .01). Of the 10 questions that best correlated with overall care rating, 9 mapped directly to YW criteria in the YPS, as did all 10 in the IS. Provider characteristics were the strongest correlates of the overall care rating.

Conclusion

Although limited by lack of data relating to access, publicity, and confidentiality, our study provides strong support for the face validity and content validity of the remaining YW quality criteria in inpatient settings.

Section snippets

Aims

1
To study the relationship between individual elements of the YW criteria and overall adolescent rating of care in national inpatient surveys.
2
To investigate whether there are other factors strongly related to young people's satisfaction in the national surveys that are not included in the YW criteria.

Sources of data

The most recent English national surveys for which data were available in the 11–19 age-group were identified: the IS 2009 (ages 16–19 years) and the Young Patient Survey (YPS) 2004 (ages 12–17 years). Both surveys were carried out by the Picker Institute Europe [18] on behalf of the Department of Health.

Results

Table 1 shows the 29 questions that best matched individual YW criteria. Eleven questions were common to both surveys, 14 were included in the YPS only, and four were in the IS only.

Baseline characteristics and the number of responses analyzed for each question are presented in Appendix.

Table 2 presents the satisfaction rates for questions relating to the inpatient environment. YW considers the environment to include the overall atmosphere and approach to care as well as the physical

Discussion

A validated tool to assess and benchmark inpatient services for adolescents is particularly important in view of the increasing numbers of hospital admissions in this age-group [22]. Although limited by lack of data on the criteria addressing access, publicity, and confidentiality, our study provides strong support for the face validity and content validity of the remaining YW quality criteria [1] in inpatient settings. Of 29 questionnaire items that matched YW, 28 were significantly associated

Conclusions

Data covering the majority of YW criteria show that they function well as a measure of quality for adolescent inpatient services. Provider characteristics are more important predictors of adolescents' satisfaction with care than facility or process characteristics. In addition to validation of the access, publicity, and confidentiality criteria, further work is needed to validate YW criteria outside the United Kingdom and investigate whether youth-friendly health services influence health

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As outlined in Appendix 1, the responses were aggregated to create a dichotomous variable, with positive experiences coded as “1” and negative or neutral experiences coded as “0.” The patient experience measures were adapted from questions that had been used in previous surveys and are consistent with the wider literature on measuring the quality of health care for adolescents [6,18,19]. Demographics including age, gender, ethnicity, and social economic status (SES) were included.
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Of 5,335 students, 4,149 reported having visiting their GP within the past year. Of these, 91.8% felt treated with respect, 78.7% felt at ease, 85.7% were satisfied with explanation, and 53.9% felt able to discuss personal matters. After adjusting for ethnicity, age, gender, and family affluence score, poor experience on any indicator was strongly associated with increased risk of self-harm (adjusted odds ratio range, 2.01–2.70; all p < .001); feeling low (AOR range, 1.53–2.11; all p < .001); and sleeping problems (AOR range, 1.49–1.91; all p ≤ .001). Poor experience on all indicators, except discussing personal matters, was associated with worse self-reported health.
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Although concerns have been raised about young adults experiencing greater barriers to accessing health care than other age groups, the NHS continues to provide a service that is free at the point of delivery for patients of all ages. Similarly, the United Kingdom Government has published universal, validated standards for young people friendly care (although this was developed for adolescents aged 11–19 years [30], it has subsequently influenced services development and redesign for young adult services) [31]. However, there is no room for complacency as mortality trends among young adults in the United Kingdom have deteriorated relative to other Western European countries in recent years, with particular concern about the high rate of deaths from noncommunicable diseases [32].
Young adults (18–24 years) frequently report poorer health care access and experience than older adults. We aimed to investigate how differences between young and older adults vary across 11 high-income countries.
A total of 20,045 participants from 11 high-income countries (i.e., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, United States) participating in the Commonwealth Fund 2013 International Health Policy Survey. We compared young adults (18–24 years) with older adults (25–34; 35–49; 50–64; 65+ years) on three aspects of health care: overall satisfaction, cost barriers to access, and four indicators of consultation quality relating to adequate information, time, involvement, and explanation.
Across all participants, young adults reported significantly worse overall satisfaction (63.6% vs. 70.3%; p < .001) and more frequent cost barriers (21.3% vs. 15.2%; p < .001) than older adults. Country-level analyses showed that young adults reported lower overall satisfaction than older adults in five of 11 countries (Australia, Canada, Norway, Switzerland, United States) and more frequent cost barriers in six of 11 countries (Canada, France, Germany, Switzerland, Norway, United States). In five countries (Australia, Canada, France, Norway, Switzerland), most patient experience indicators were less positive among young adults than those among older adults. In three countries (Netherlands, New Zealand, United Kingdom), there was no significant difference between young and older adults on any indicator.
Associations between age and health care access/experience varied markedly between countries, suggesting that poor access and experience among young adults is not inevitable and may be amenable to policy/practice interventions.
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Despite growing interest in measurement of health care quality and patient experience, the current evidence base largely derives from adult health settings, at least in part because of the absence of appropriately developed measurement tools for adolescents. To rectify this, we set out to develop a conceptual framework and a set of indicators to measure the quality of health care delivered to adolescents in hospital.
A conceptual framework was developed from the following four elements: (1) a review of the evidence around what young people perceive as “adolescent-friendly” health care; (2) an exploration with adolescent patients of the principles of patient-centered care; (3) a scoping review to identify core clinical practices around working with adolescents; and (4) a scoping review of existing conceptual frameworks. Using criteria for indicator development, we then developed a set of indicators that mapped to this framework.
Embedded within the notion of patient- and family-centered care, the conceptual framework for adolescent-friendly health care (quality health care for adolescents) was based on the constructs of experience of care (positive engagement with health care) and evidence-informed care. A set of 14 indicators was developed, half of which related to adolescents' and parents' experience of care and half of which related to aspects of evidence-informed care.
The conceptual framework and indicators of quality health care for adolescents set the stage to develop measures to populate these indicators, the next step in the agenda of improving the quality of health care delivered to adolescents in hospital settings.
Everybody's business: Transition and the role of adult physicians
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The outcome of transition from paediatric to adult care is often judged by what happens after transfer. Young people at the point of transfer are reported to have low levels of knowledge and independence. These observations could be interpreted in one of two ways: either that the transition process before transfer is inadequate or that the transition process needs to continue into young adulthood and therefore adult care. The second interpretation is further supported by brain development continuing into the third decade. There is also growing evidence for the effectiveness of young adult clinics in the process of transition. To optimise transition, adult physicians need not only to work with paediatricians to achieve continuity during transfer, but also to look critically at their service as to how it can be changed to meet the needs of young people. In addition, they need to develop knowledge, skills and attitudes to communicate effectively and address a young person’s developmental and health needs.
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: D.H. was a clinical adviser at the English Department of Health 2009–2011 and was the clinical lead for the project to revise the You're Welcome criteria. This article was written as part of an MD (Res) degree, which was partially funded by the Department of Health. The Department of Health had no influence on the study design, data analysis, drafting or submission of this article.

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Original articleValidation of You're Welcome Quality Criteria for Adolescent Health Services Using Data From National Inpatient Surveys in England

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Aims

Sources of data

Results

Discussion

Conclusions

Lancet

Lancet

Lancet

J Adolesc Health

You're welcome: Quality criteria for young people friendly services

UNICEF State of the World's Children 2011–Adolescence: An age of opportunity

Under their skins: Tackling the health of the teenage nationChief Medical Officer's Annual Report 2007

Adolescent friendly health services: An agenda for change

Meeting on youth-friendly health policies and services, Edinburgh, Scotland

Regional strategy for improving adolescent and youth health

Patient satisfaction in relation to age, health status and other background factors: A model for comparisons of care units

Int J Qual Health Care

Getting it right for young people: Developing adolescent rheumatology services

Future Rheumatol

You're Welcome quality criteria: Making health services young people friendly

Smoothing the transition to adult health careEyes on Evidence [22]. 2011. NHS Evidence

Revised you're welcome criteria and future developments in adolescent healthcare

J Clin Res Pediatr Endocrinol

You're Welcome—Quality criteria for young people friendly health services

Original article
Validation of You're Welcome Quality Criteria for Adolescent Health Services Using Data From National Inpatient Surveys in England