Routine measurement of patient experience

Impact of digital health interventions on patient satisfaction in outpatient gastrointestinal endoscopy: a systematic review

OBJECTIVES

The integration of digital health technologies in gastrointestinal (GI) endoscopy presents opportunities to enhance patient experience, an important dimension of care quality. This systematic review aims to evaluate the impact of digital health interventions on patient satisfaction and experience in outpatient endoscopy settings.

DESIGN

A systematic review and narrative synthesis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and the Grading of Recommendations Assessment, Development and Evaluation approach.

DATA SOURCES

PubMed/Medline, EMBASE, PsycInfo, and Cochrane databases were searched through 9 March 2023.

ELIGIBILITY CRITERIA

Studies were eligible if they involved adult patients (≥18 years) undergoing outpatient colonoscopy or gastroscopy and in English. Interventions included any form of educational digital health technology aimed at enhancing healthcare delivery. Telehealth studies were not included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and assessed risk of bias, using the Mixed Methods Appraisal Tool. A mixed-method approach was employed for the narrative synthesis, focusing on the primary outcome of patient experience and satisfaction.

RESULTS

Nine studies met the inclusion criteria, all assessing patient satisfaction rather than experience. Five studies reported improved satisfaction associated with digital interventions, three showed no significant change, and one lacked statistical analysis. Interventions ranged from smartphone applications to online educational resources, and satisfaction measurement tools varied significantly. Overall, the evidence was characterised by heterogeneity and very low methodological quality.

CONCLUSION

Digital health interventions may have a positive impact on patient satisfaction in GI endoscopy, although evidence quality is very low and outcome measurement is inconsistent. Future research should focus on standardising measures of patient experience and satisfaction, ensuring robust study designs to inform the integration of digital health tools into endoscopy practice.

PROSPERO REGISTRATION NUMBER

CRD42023428609.

Towards Global Health Equity: A Prototype for Standardizing Patient Satisfaction Measurement in Alignment with the United Nations' Sustainable Development Goals

Background/Objectives: Global patient satisfaction is vital for healthcare quality, yet no survey enables effective cross-country comparisons. Existing tools are limited in scope, focusing on aspects like Patient-Reported Experience Measures, Patient-Reported Outcome Measures, or systemic factors within individual settings. This study introduces the Morico International Healthcare Satisfaction Survey prototype to facilitate global comparisons, aligning with the United Nations' Sustainable Development Goals. Methods: We developed the prototype by reviewing existing surveys to identify relevant question formats, thematic focuses, and distribution methods. Surveys were chosen for their relevance and established use in healthcare settings. Our analysis highlighted common elements and gaps, guiding the design of a comprehensive tool that integrates Patient-Reported Experience Measures, Patient-Reported Outcome Measures, and systemic factors for global comparisons. Results: Existing surveys varied significantly in length and focus, revealing a lack of standardization. Best practices emphasized concise, clear surveys with standardized responses and online distribution. Our prototype includes 25 questions across eight sections, adapted for global use and broader healthcare systems. It provides a comprehensive framework for international comparisons. Conclusions: No standardized survey exists for cross-country healthcare comparisons. The Morico International Healthcare Satisfaction Survey prototype addresses this gap, paving the way for future refinement and implementation to enhance global healthcare quality and policy development.

Access to Care and Health-Related Quality of Life in Multiple Sclerosis

Background and Objectives

Despite their high health care use, it is unclear whether the health care needs of people with MS are being met and what their priorities are. We assessed priorities for access to, and affordability of care, by people living with MS in the United States. We also tested the association between perceived inadequate access to care and health-related quality of life (HRQoL).

Methods

In Fall 2022, we conducted a cross-sectional survey of participants in the North American Research Committee on Multiple Sclerosis Registry about access to care and HRQoL (Health Utilities Index Mark III). We used multivariable polytomous logistic regression to test sociodemographic and clinical factors associated with access to care. We used multivariable linear regression analysis to test the association between access to care and HRQoL.

Results

We included 4,914 respondents in the analysis, of whom 3,974 (80.9%) were women, with a mean (SD) age 64.4 (9.9) years. The providers who were most reported as needed but inaccessible were complementary providers (35.5%), followed by allied health providers (24.2%), occupational therapists (22.7%), and mental health providers (20.7%). Over 80% of participants reported that it was important or very important to be able to get an appointment with their primary MS health care provider when needed, to have sufficient time in their appointments to explain their concerns, to see their neurologist if their status changed, and that their health care providers communicated to coordinate their care. Participants who reported needing to see the provider but not having access or seeing the provider but would like to see them more often had lower HRQOL (ranging from -0.059 to -0.176) than participants who saw the provider as much as needed.

Discussion

Gaps in access to care persist for people with MS in the United States and substantially affect HRQoL. Improving access to care for people with MS should be a health system priority.

Gaining Insights Into Patients' Experiences of Remote Diagnostic Screening for Chronic Kidney Disease in Patients With Diabetes

Introduction: Chronic kidney disease (CKD) affects a significant portion of the UK population and is a pressing public health issue. Current screening methods have a low patient uptake rate. This retrospective study explores the patient experience of remote diagnostic screening. Objective: This article retrospectively analyses patient-reported experiences, focusing on at-home urinary screening to detect CKD. Intervention: Our primary care network commissioned a remote diagnostic service for adult patients with diabetes (Types I and II) who had not taken urinary albumin: creatinine ratio test within 12 months. Patients were provided with an at-home kit and guided by a smartphone application. Qualitative clinical data was collected during screening, with a questionnaire capturing patients' experiences. Impact: A total of 60% of eligible patients performed testing, and 35% were detected to have abnormal results. A total of 80% of patients preferred remote screening. Conclusions: This study provides evidence for remote CKD screening and opens avenues for innovation. Most patients reported a positive experience, underscoring the potential of this approach to improve health outcomes, especially in higher-risk populations.

The Maternal Voice: Exploration of Mothers and Birthing Individuals' Voices in Patient Safety Event and Feedback Reports

Background

There is a growing body of research highlighting that Black women have more adverse maternal health events. Instead of only focusing on severe maternal morbidity and mortality events, patient safety events (PSEs) and feedback reports are data sources that can offer insights into a broader spectrum of maternal safety, including near misses, and unsafe conditions. In this work, we explore the racial differences in the representation of mothers and birthing individuals' (MBIs) voices in PSE and feedback reports.

Materials and Methods

We analyze patient experience themes, dissatisfaction, and disrespect in PSE and patient feedback reports from two large birthing hospitals. We compare racial differences in how the voices of MBIs are represented in these reports. Reports were manually coded for the presence of MBIs' voices, patient experience themes, dissatisfaction, and disrespect by staff.

Results

In total, 866 reports were reviewed, of which 271 had explicit mentions of MBIs' voices. A statistically significant association (p < 0.001) was observed between patient experience themes and report type, driven by clinical safety event themes in PSE reports. A statistically significant association (p = 0.030) was observed between race and report type in 190 reports explicitly mentioning dissatisfaction.

Discussion

Delays with handoff and transfer, pain management, patient staff violence, and procedural harm were proportionally more commonly reported among Black MBIs, supporting prior research in pain management and procedural harm disparities. We also identified themes of positive feedback and good catches by patients, which are key components to patient-centered care and promoting resilience in the care process.

Conclusions

PSE reports tended to capture predominantly clinical themes from Black MBIs, while feedback reports captured predominantly administrative themes from White MBIs. Important perspectives of the safety narrative can be missed when only PSE reports or feedback reports are considered.

Patient-Reported Outcome and Experience Measures (PROM/PREM) in Patients Undergoing Liver Surgery with Enhanced Recovery after Surgery (ERAS®): An Exploratory Study

BACKGROUND

ERAS® (Enhanced Recovery after Surgery) is an evidence-based multidisciplinary approach focusing on optimizing outcomes after surgery through structured clinical pathways. This study aimed to assess patient-reported outcome and experience measures (PROM/PREM), which are not routinely assessed after liver surgery within an ERAS® protocol.

METHODS

Routine outcome parameters were extracted from clinical documentation. Using qualitative content analysis, PROM and PREM were retrospectively identified in 13 case records. In a prospective survey of 10 participants, PROM was assessed at three timepoints using the EQ-5D-5L questionnaire. PREM were collected at discharge.

RESULTS

The following PROM categories occurred in the retrospective content analysis: appetite (84.6%), pain/discomfort (76.9%), mobility (69.2%), wound condition (69.2%), and weight (61.5%). The categories of continuity of care (92.0%) and information, communication, education (69.0%) emerged as PREM. Descriptive changes in health state were shown for all EQ-5D-5L dimensions and timepoints. At discharge, mobility, selfcare, usual activities, and pain/discomfort tended to be worse, whereas anxiety/depression decreased gradually from preoperatively to the 4 week follow-up. There was high satisfaction with interprofessional care services and experienced cooperation between professionals.

CONCLUSIONS

PROM and PREM are helpful to incorporate patients' perspectives after liver surgery within an ERAS® pathway and should be collected routinely in clinical practice.

Informal carers' experiences with their children's care during hospitalization in Italy: Child HCAHPS results from RN4CAST@IT-Ped cross-sectional study

PURPOSE

To examine informal carers' experiences during their child's hospitalization and evaluate the associations with care received and care context.

DESIGN AND METHODS

What is described in this article is only a part of the larger study, RN4CAST@IT-Ped, a multicenter cross-sectional study, with multi-level data collection through convenience sampling, the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to collect data from informal carers of pediatric patients, applying the "top box" approach.

RESULTS

Nine hospitals, 1472 nurses, and 635 children's parents were involved. A correlation was found between patient safety and satisfaction outcomes and nursing staff characteristics. Adequate workloads for nurses improved carers' assessment of their experience in the hospital.

CONCLUSION

Adequate staffing management could significantly improve informal carers' satisfaction with the care provided to their children during hospitalization.

PRACTICE IMPLICATIONS

Children's informal carers greatly value the care they receive in pediatric hospitals. Adequate workloads for nurses improve carers' overall evaluation of the care their children receive during hospitalization. Nursing management should consider improving these aspects to ensure high-quality care in children's hospitals.

Why it is hard to use PROMs and PREMs in routine health and care

Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) show the results of healthcare activities as rated by patients and others. Patients or their proxies record feedback using questionnaires. These can enhance quality for all and tailored care for individuals. This paper describes obstacles that inhibit widespread use of PROMs and PREMs and some potential solutions.Implementation is a prerequisite for any innovation to succeed. Health and care services are complex and people need to be engaged at every level. Most people are cautious about proven innovations such as PROMs and PREMs but champions and leaders can help them engage. The NASSS framework (reasons for Non-adoption, Abandonment and failure to Scale up, Spread or Sustain digital health innovations) helps indicate that implementation is complex why it may be resisted.The Plan-Do-Study-Act (PDSA) approach aids implementation and helps ensure that everyone knows who should do what, when, where, how and why. Noise is an under-appreciated problem, especially when tracking patients over time such as before and after treatment. Interoperability of PROMs and PREMs with electronic health records should use Fast Health Interoperability Resources and internationally accepted coding schemes such as SNOMED CT and LOINC.Most projects need multiple measures to meet the needs of everyone involved. Measure selection should focus on their relevance, ease of use, and response rates.If these problems are avoided or mitigated, PROMs and PREMs can help deliver better patient outcomes, patient experience, staff satisfaction and health equity.

Patient satisfaction with advanced physiotherapy practice internationally: Protocol for a systematic mixed studies review

RATIONALE

Patient satisfaction is a complex construct consisting of human and system attributes. Patient satisfaction can afford insight into patient experience, itself a key component of evaluating healthcare quality. Internationally, advanced physiotherapy practice (APP) extends across clinical fields and is characterised as a higher level of practice with a high degree of autonomy and complex decision making. Patient satisfaction with APP appears positive. While evidence synthesis of patient satisfaction with APP exists, no systematic review has synthesised evidence across clinical fields. Therefore, the objectives of this systematic review are 1) to evaluate patient satisfaction with APP internationally, and 2) to evaluate human and system attributes of patient satisfaction with APP.

MATERIALS AND METHODS

A systematic mixed studies review using a parallel-results convergent synthesis design will be conducted. Searches of Medline, Embase, Web of Science, CINAHL, Cochrane, PEDro and grey literature databases will be conducted from inception to 18/7/2023. Studies of APP (World Physiotherapy definition) whereby practitioners a) have advanced clinical and analytical skills that influence service improvement and provide clinical leadership, b) have post-registration masters level specialisation (or equivalence), c) deliver safe, competent care to patients with complex needs and d) may use particular occupational titles; that measure patient satisfaction across all clinical fields and countries will be included. Two reviewers will screen studies, extract data, assess methodological quality of included studies (mixed methods appraisal tool), and contribute to data synthesis. Quantitative data will undergo narrative synthesis (textual descriptions) and qualitative data thematic synthesis (analytical themes). Integration of data syntheses will inform discussion.

IMPLICATIONS

This systematic review will provide insight into patient satisfaction with APP internationally, exploring attributes that influence satisfaction. This will aid design, implementation, or improvement of APP and facilitate the delivery of patient-centred, high-quality healthcare. Lastly, this review will inform future methodologically robust research investigating APP patient satisfaction and experience.