Transforming the Patient's Voice into Action: Four Years of Continuous Assessment of Perceptions of Care in Hemodialysis

Background: Perceptions of care are a key indicator for assessing quality of healthcare services, especially in chronic patients such as hemodialysis(HD), who face physical-emotional, and social challenges due to the burden of the disease. Assessing using tools such as the Patient Care Perception Survey (PPC) allows us to identify strengths and areas for improvement, humanize care, and guide more effective clinical strategies. We analyzed the evolution of the PPC in HD in outpatient centers over four years. Methods: A multicenter, retrospective observational study based on anonymous and voluntary responses to the annual PPC survey to HD patients between 2021-2024. The consists of 39 items in 12 domains related to the care received. Two main scales were analyzed: Global Score(GS; 0–7), by domain, and Patient Global Experience(PGE; 0–10), as an overall assessment, in addition to the Net Promoter Score(NPS) and the participation rate. General and specific trends were identified by domain. Results: Of the 49 centers: Average participation rate: 94.45%.16,187 surveys were collected: 3,703 (93%) in 2021, 4,154 (97%) in 2022, 4,201 (98.7%) in 2023, and 4,129 (96.7%) in 2024. The GS showed a progressive improvement from 6.30 to 6.48, and the PGE increased from 8.67 to 8.81, reflecting a growing perception of quality of care. The NPS, a key indicator of satisfaction, remained above the threshold for excellence (>50) throughout the period, reaching its peak in 2024 (61.98). Notable improvements were observed in the domains of “Communication” (6.26 to 6.47) and “Fluid intake and diet” (6.40 to 6.53). Item level analysis revealed steady progress in perceived comfort and access to additional support. However, the “Support” dimension showed variability between years, suggesting areas for continuous improvement. Conclusion: The continuous assessment of PPC in HD consolidates its value as a strategic tool. The results reflect sustained excellence (NPS >50), progressive improvement, and real clinical utility. This model transforms the patient's voice into an objective and actionable indicator that can be integrated into quality management systems and is key to guiding organizational decisions with a direct impact on care, even in highly complex and demanding contexts.