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Beckett MK, Quigley DD, Cohea CW, Lehrman WG, Russ C, Giordano LA, Goldstein E, Elliott MN. Trends in HCAHPS Survey Scores, 2008-2019: A Quality Improvement Perspective. Med Care 2024; 62:416-422. [PMID: 38728680 DOI: 10.1097/mlr.0000000000002001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND HCAHPS' 2008 initial public reporting, 2012 inclusion in the Hospital Value-Based Purchasing Program (HVBP), and 2015 inclusion in Hospital Star Ratings were intended to improve patient experiences. OBJECTIVES Characterize pre-COVID-19 (2008-2019) trends in hospital consumer assessment of healthcare providers and systems (HCAHPS) scores. RESEARCH DESIGN Describe HCAHPS score trends overall, by phase: (1) initial public reporting period (2008-2013), (2) first 2 years of HVBP (2013-2015), and (3) initial HCAHPS Star Ratings reporting (2015-2019); and by hospital characteristics (HCAHPS decile, ownership, size, teaching affiliation, and urban/rural). SUBJECTS A total of 3909 HCAHPS-participating US hospitals. MEASURES HCAHPS summary score (HCAHPS-SS) and 9 measures. RESULTS The mean 2007-2019 HCAHPS-SS improvement in most-positive-category ("top-box") responses was +5.2 percentage points/pp across all hospitals (where differences of 5pp, 3pp, and 1pp are "large," "medium," and "small"). Improvement rate was largest in phase 1 (+0.8/pp/year vs. +0.2pp/year and +0.1pp/year for phases 2 and 3, respectively). Improvement was largest for Overall Rating of Hospital (+8.5pp), Discharge Information (+7.3pp), and Nurse Communication (+6.5pp), smallest for Doctor Communication (+0.8pp). Some measures improved notably through phases 2 and 3 (Nurse Communication, Staff Responsiveness, Overall Rating of Hospital), but others slowed or reversed in Phase 3 (Communication about Medicines, Quietness). Bottom-decile hospitals improved more than other hospitals for all measures. CONCLUSIONS All HCAHPS measures improved rapidly 2008-2013, especially among low-performing (bottom-decile) hospitals, narrowing the range of performance and improving scores overall. This initial improvement may reflect widespread, general quality improvement (QI) efforts in lower-performing hospitals. Subsequent slower improvement following the introduction of HVBP and Star Ratings may have reflected targeted, resource-intensive QI in higher-performing hospitals.
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Beckett MK, Quigley DD, Lehrman WG, Giordano LA, Cohea CW, Goldstein EH, Elliott MN. Interventions and Hospital Characteristics Associated With Patient Experience: An Update of the Evidence. Med Care Res Rev 2024; 81:195-208. [PMID: 38238918 DOI: 10.1177/10775587231223292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Patient experience is a key hospital quality measure. We review and characterize the literature on interventions, care and management processes, and structural characteristics associated with better inpatient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Prior reviews identified several promising interventions. We update these previous efforts by including more recent peer-reviewed literature and expanding the review's scope to include observational studies of HCAHPS measures with process measures and structural characteristics. We used PubMed to identify U.S. English-language peer-reviewed articles published in 2017 to 2020 and focused on hospital patient experience. The two HCAHPS domains for which we found the fewest potential quality improvement interventions were Communication with Doctors and Quietness. We identified several modifiable processes that could be rigorously evaluated in the future, including electronic health record patient engagement functionality, care management processes, and nurse-to-patient ratios. We describe implications for future policy, practice, and research.
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Gotschall JW, Fitzsimmons R, Shin DB, Takeshita J. Race, Ethnicity, and Other Patient and Clinical Encounter Characteristics Associated with Patient Experiences of Access to Care. J Patient Exp 2024; 11:23743735241241178. [PMID: 38529206 PMCID: PMC10962025 DOI: 10.1177/23743735241241178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
The Press Ganey (PG) Outpatient Medical Practice Survey measures patients' experiences of healthcare access in the U.S. We aimed to identify differences in experiences of access to care by patient race, ethnicity, and other sociodemographic characteristics, an important first step in informing health policy and ensuring equitable healthcare delivery. We performed a cross-sectional analysis of PG surveys for adult outpatient visits within the University of Pennsylvania Health System from 2014-2017, including 119,373 unique patients. Compared with White patients, Black (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.80-0.87), Asian (OR 0.62; 95% CI 0.58-0.66), and other/unknown race patients (OR 0.83; 95% CI 0.72-0.94) were each less likely to report the maximum score for timely access to care. Patients of all minoritized groups, as well as those whose primary language was not English, reported lower scores in secondary access measures related to communication and respect, compared to White and primarily English-speaking patients, respectively. Efforts to improve the experience of access to care among racial and ethnic minoritized patients are imperative to achieve equity in healthcare delivery.
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Affiliation(s)
- Jeromy W. Gotschall
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel B. Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Shannon EM, Steers WN, Washington DL. Investigation of the role of perceived access to primary care in mediating and moderating racial and ethnic disparities in chronic disease control in the veterans health administration. Health Serv Res 2024; 59:e14260. [PMID: 37974469 PMCID: PMC10771907 DOI: 10.1111/1475-6773.14260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To examine the role of patient-perceived access to primary care in mediating and moderating racial and ethnic disparities in hypertension control and diabetes control among Veterans Health Administration (VA) users. DATA SOURCE AND STUDY SETTING We performed a secondary analysis of national VA user administrative data for fiscal years 2016-2019. STUDY DESIGN Our primary exposure was race or ethnicity and primary outcomes were binary indicators of hypertension control (<140/90 mmHg) and diabetes control (HgbA1c < 9%) among patients with known disease. We used the inverse odds-weighting method to test for mediation and logistic regression with race and ethnicity-by-perceived access interaction product terms to test moderation. All models were adjusted for age, sex, socioeconomic status, rurality, education, self-rated physical and mental health, and comorbidities. DATA COLLECTION/EXTRACTION METHODS We included VA users with hypertension and diabetes control data from the External Peer Review Program who had contemporaneously completed the Survey of Healthcare Experience of Patients-Patient-Centered Medical Home. Hypertension (34,233 patients) and diabetes (23,039 patients) samples were analyzed separately. PRINCIPAL FINDINGS After adjustment, Black patients had significantly lower rates of hypertension control than White patients (75.5% vs. 78.8%, p < 0.01); both Black (81.8%) and Hispanic (80.4%) patients had significantly lower rates of diabetes control than White patients (85.9%, p < 0.01 for both differences). Perceived access was lower among Black, Multi-Race and Native Hawaiian and Other Pacific Islanders compared to White patients in both samples. There was no evidence that perceived access mediated or moderated associations between Black race, Hispanic ethnicity, and hypertension or diabetes control. CONCLUSIONS We observed disparities in hypertension and diabetes control among minoritized patients. There was no evidence that patients' perception of access to primary care mediated or moderated these disparities. Reducing racial and ethnic disparities within VA in hypertension and diabetes control may require interventions beyond those focused on improving patient access.
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Affiliation(s)
- Evan Michael Shannon
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & PolicyVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- Division of General Internal Medicine and Health Services ResearchUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - W. Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & PolicyVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Donna L. Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & PolicyVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- Division of General Internal Medicine and Health Services ResearchUCLA David Geffen School of MedicineLos AngelesCaliforniaUSA
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Elliott MN, Brown JA, Hambarsoomian K, Parast L, Beckett MK, Lehrman WG, Giordano LA, Goldstein EH, Cleary PD. Survey Protocols, Response Rates, and Representation of Underserved Patients: A Randomized Clinical Trial. JAMA Health Forum 2024; 5:e234929. [PMID: 38241055 PMCID: PMC10799262 DOI: 10.1001/jamahealthforum.2023.4929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/15/2023] [Indexed: 01/22/2024] Open
Abstract
Importance Surveys often underrepresent certain patients, such as underserved patients. Methods that improve their response rates (RRs) would help patient surveys better represent their experiences and assess equity and equity-targeted quality improvement efforts. Objective To estimate the effect of adding an initial web mode to existing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey protocols and extending the fielding period on RR and representativeness of underserved patient groups. Design, Setting, and Participants This randomized clinical trial included 36 001 patients discharged from 46 US hospitals from May through December 2021. Data analysis was performed from May 2022 to September 2023. Exposures Patients were randomized to 1 of 6 survey protocols: 3 standard HCAHPS protocols (mail only, phone only, mail-phone) plus 3 web-enhanced protocols (web-mail, web-phone, web-mail-phone). Main Outcomes and Measures RR and number of respondents per 100 survey attempts (yield) were calculated and compared for each of the 6 survey protocols, overall, and by patient age, service line, sex, and race and ethnicity. Results A total of 34 335 patients (median age range, 55-59 years; 59.3% female individuals and 40.7% male individuals) were eligible and included in the study. Of the respondents, 6.9% were Asian American or Native Hawaiian or Other Pacific Islander, 0.7% were American Indian or Alaska Native, 11.5% were Black, 17.4% were Hispanic, 61.0% were White, and 2.6% were multiracial. Of the 6 protocols, RRs were highest in web-mail-phone (36.5%), intermediate for the 3 two-mode survey protocols (mail-phone, web-mail, web-phone, 30.3%-31.1%), and lowest for the 2 single-mode protocols (mail only, phone only, 22.1%-24.3%). Web-mail-phone resulted in the highest yield for 3 racial and ethnic groups (Black, Hispanic, and White patients) and second highest for another (multiracial patients). Otherwise, the highest or second highest yield was almost always a 2-mode protocol. Mail only was the lowest-yield protocol for Black, Hispanic, and multiracial patients and phone-only was the lowest-yield protocol for White patients; these 2 protocols tied for lowest-yield for Asian American or Native Hawaiian or Other Pacific Islander patients. Gains from multimode approaches were often 2 to 3 times as large for Asian American or Native Hawaiian or Other Pacific Islander, Black, Hispanic, and multiracial patients as for White patients. Web-mail-phone had the highest RR for 6 of 8 age groups and 4 of 5 combinations of service line and sex. Conclusions and Relevance In this randomized clinical trial, web-first multimode survey protocols significantly improved the RR and representativeness of patient surveys. The best-performing protocol based on RR and representativeness was web-mail-phone. Web-phone performed well for young and diverse patient populations, and web-mail for older and less diverse patient populations. The US Centers for Medicare & Medicaid Services will allow hospitals to use the web-mail, web-phone, and web-mail-phone protocols for HCAHPS administration beginning in 2025.
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Nila S, Dutta E, Prakash SS, Korula S, Oommen AM. Patient and caregiver perspectives of select non-communicable diseases in India: A scoping review. PLoS One 2024; 19:e0296643. [PMID: 38180969 PMCID: PMC10769076 DOI: 10.1371/journal.pone.0296643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patient-reported measures of encounters in healthcare settings and consideration of their preferences could provide valuable inputs to improve healthcare quality. Although there are increasing reports of user experiences regarding health care in India in recent times, there is a lack of evidence from Indian healthcare settings on the care provided for patients with chronic diseases. METHODS We selected diabetes mellitus and cancer as representatives of two common conditions requiring different care pathways. We conducted a scoping review of studies reporting experiences or preferences of patients/caregivers for these conditions, in PubMed, Global Index Medicus and grey literature, from the year 2000 onwards. Both published and emergent themes were derived from the data and summarised as a narrative synthesis. RESULTS Of 95 included studies (49 diabetes, 46 cancer), 73% (65) were exclusively quantitative surveys, 79% included only patients (75), and 59.5% (44) were conducted in government centres. Studies were concentrated in a few states in India, with the underrepresentation of vulnerable population groups and representative studies. There was a lack of standardised tools and comprehensive approaches for assessing experiences and preferences of patients and caregivers, concerning diabetes and cancers in India. The commonest type of care assessed was therapeutic (74), with 14 cancer studies on diagnosis and nine on palliative care. Repeated visits to crowded centres, drug refill issues, unavailability of specific services in government facilities, and expensive private care characterised diabetes care, while cancer care involved delayed diagnosis and treatment, communication, and pain management issues. CONCLUSIONS There is a need for robust approaches and standardised tools to measure responsiveness of the healthcare system to patient needs, across geographical and population subgroups in India. Health system reforms are needed to improve access to high-quality care for treatment and palliation of cancer and management of chronic diseases such as diabetes.
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Affiliation(s)
- Sindhu Nila
- KEM Hospital Research Centre, Rasta Peth, Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
| | - Eliza Dutta
- Indian Institute of Public Health, Shillong, Pasteur Hills, Lawmali, Shillong, Meghalaya, India
| | - S. S. Prakash
- Department of Biochemistry, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Department of Paediatrics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Anu Mary Oommen
- Department of Community Health, Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Cermak CA, Bruno F, Jeffs L. Evaluating Skill-Mix Models of Care: A Rapid Scoping Review of Measures and Outcomes. J Nurs Adm 2024; 54:25-34. [PMID: 38051826 DOI: 10.1097/nna.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To synthesize the literature on measures and outcomes for skill-mix models of care. BACKGROUND To address the human health resource crisis, changes to skill mix within models of care are being implemented emphasizing the need to synthesize evaluation methods for skill-mix models in the future. METHODS A scoping review of the literature using a rigorous search strategy and selection process was completed to identify articles that examined skill-mix models in an effort to identify related concepts. RESULTS Ten studies examined skill-mix models. Areas of measurement in assessing the impact of skill-mix models included patient outcomes, patient satisfaction, nurse satisfaction, cost, and nurse perceptions of role changes, model effectiveness, and quality of care. Studies examining nurse satisfaction, patient satisfaction, and/or cost generally reported improvements upon skill-mix model implementation. Studies examining patient outcomes related to skill mix were inconsistent. CONCLUSIONS Factors for consideration upon implementation of a skill-mix change include education of role clarity, the number of unregulated staff who require supervision, and professional practice support.
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Affiliation(s)
- Carly A Cermak
- Author Affiliations: Postdoctoral Fellow (Dr Cermak), Doctoral Candidate (Bruno), and Scientific Director (Dr Jeffs), Science of Care Institute, and Senior Clinician Scientist (Dr Jeffs), Lunenfeld Tanenbaum Research Institute, Sinai Health; and Doctoral Candidate (Bruno) and Associate Professor (Dr Jeffs), Institute of Health Policy, Management and Evaluation, and Associate Professor (Dr Jeffs), Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
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Benson T. Why it is hard to use PROMs and PREMs in routine health and care. BMJ Open Qual 2023; 12:e002516. [PMID: 38135303 DOI: 10.1136/bmjoq-2023-002516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
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.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Newbury, UK
- Institute of Health Informatics, UCL, London, UK
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Claessens F, Seys D, Van der Auwera C, Jans A, Castro EM, Jacobs L, De Ridder D, Bruyneel L, Leenaerts Z, Van Wilder A, Brouwers J, Lachman P, Vanhaecht K. Measuring in-hospital quality multidimensionally by integrating patients', kin's and healthcare professionals' perspectives: development and validation of the FlaQuM-Quickscan. BMC Health Serv Res 2023; 23:1426. [PMID: 38104060 PMCID: PMC10725024 DOI: 10.1186/s12913-023-10349-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Measuring quality is essential to drive improvement initiatives in hospitals. An instrument that measures healthcare quality multidimensionally and integrates patients', kin's and professionals' perspectives is lacking. We aimed to develop and validate an instrument to measure healthcare quality multidimensionally from a multistakeholder perspective. METHODS A multi-method approach started by establishing content and face validity, followed by a multi-centre study in 17 Flemish (Belgian) hospitals to assess construct validity through confirmatory factor analysis, criterion validity through determining Pearson's correlations and reliability through Cronbach's alpha measurement. The instrument FlaQuM-Quickscan measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). This bipartite instrument mirrors 15 quality items and 3 general items (the overall quality score, recommendation score and intention-to-stay score). A process evaluation was organised to identify effective strategies in instrument distribution by conducting semi-structured interviews with quality managers. RESULTS By involving experts in the development of quality items and through pilot testing by a multi-stakeholder group, the content and face validity of instrument items was ensured. In total, 13,615 respondents (5,891 Patients/kin and 7,724 Professionals) completed the FlaQuM-Quickscan. Confirmatory factor analyses showed good to very good fit and correlations supported the associations between the quality items and general items for both instrument parts. Cronbach's alphas supported the internal consistency. The process evaluation revealed that supportive technical structures and approaching respondents individually were effective strategies to distribute the instrument. CONCLUSIONS The FlaQuM-Quickscan is a valid instrument to measure healthcare quality experiences multidimensionally from an integrated multistakeholder perspective. This new instrument offers unique and detailed data to design sustainable quality management systems in hospitals. Based on these data, hospital management and policymakers can set quality priorities for patients', kin's and professionals' care. Future research should investigate the transferability to other healthcare systems and examine between-stakeholders and between-hospitals variation.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Laura Jacobs
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Zita Leenaerts
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Peter Lachman
- Lead Faculty Quality Improvement Programme- Royal College of Physicians of Ireland, Dublin, Ireland
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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Neve O, van Buchem M, Kunneman M, van Benthem P, Boosman H, Hensen E. The added value of the artificial intelligence patient-reported experience measure (AI-PREM tool) in clinical practise: Deployment in a vestibular schwannoma care pathway. PEC Innov 2023; 3:100204. [PMID: 37693727 PMCID: PMC10483065 DOI: 10.1016/j.pecinn.2023.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/06/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
Objectives Patient-reported experience measures (PREMs) can be used for the improvement of quality of care. In this study, the outcome of an open-ended question PREM combined with computer-assisted analysis is compared to the outcome of a closed-ended PREM questionnaire. Methods This survey study assessed the outcome of the open-ended questionnaire PREM and a close-ended question PREM of patients with unilateral vestibular schwannoma in a tertiary vestibular schwannoma expert centre. Results The open-ended questions PREM, consisting of five questions, was completed by 507 participants and resulted in 1508 positive and 171 negative comments, categorised into 27 clusters. The close-ended questions PREM results were mainly positive (overall experience graded as 8/10), but did not identify specific action points. Patients who gave high overall scores (>8) on the close-ended question provided points for improvement in the open-ended question PREM, which would have been missed using the close-ended questions only. Conclusions Compared to the close-ended question PREM, the open-ended question PREM provides more detailed and specific information about the patient experience in the vestibular schwannoma care pathway. Innovation Automated analysis of feedback with the open-ended question PREM revealed relevant insights and identified topics for targeted quality improvement, whereas the close-ended PREM did not.
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Affiliation(s)
- O.M. Neve
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, the Netherlands
| | - M.M. van Buchem
- Information Technology & Digital Innovation Department, Leiden University Medical Centre, the Netherlands
| | - M. Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States of America
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - P.P.G. van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, the Netherlands
| | - H. Boosman
- Morgens consultancy, Leiden, the Netherlands
| | - E.F. Hensen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, the Netherlands
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Chan B, Edwards ST, Srikanth P, Mitchell M, Devoe M, Nicolaidis C, Kansagara D, Korthuis PT, Solotaroff R, Saha S. Ambulatory Intensive Care for Medically Complex Patients at a Health Care Clinic for Individuals Experiencing Homelessness: The SUMMIT Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2342012. [PMID: 37948081 PMCID: PMC10638646 DOI: 10.1001/jamanetworkopen.2023.42012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023] Open
Abstract
Importance Intensive primary care interventions have been promoted to reduce hospitalization rates and improve health outcomes for medically complex patients, but evidence of their efficacy is limited. Objective To assess the efficacy of a multidisciplinary ambulatory intensive care unit (A-ICU) intervention on health care utilization and patient-reported outcomes. Design, Setting, and Participants The Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT) randomized clinical trial used a wait-list control design and was conducted at a health care clinic for patients experiencing homelessness in Portland, Oregon. The first patient was enrolled in August 2016, and the last patient was enrolled in November 2019. Included patients had 1 or more hospitalizations in the prior 6 months and 2 or more chronic medical conditions, substance use disorder, or mental illness. Data analysis was performed between March and May 2021. Intervention The A-ICU included a team manager, a pharmacist, a nurse, care coordinators, social workers, and physicians. Activities included comprehensive 90-minute intake, transitional care coordination, and flexible appointments, with reduced panel size. Enhanced usual care (EUC), consisting of team-based primary care with access to community health workers and mental health, addiction treatment, and pharmacy services, served as the comparator. Participants who received EUC joined the A-ICU intervention after 6 months. Main Outcomes and Measures The main outcome was the difference in rates of hospitalization (primary outcome), emergency department (ED) visits, and primary care physician (PCP) visits per person over 6 months (vs the prior 6 months). Patient-reported outcomes included changes in patient activation, experience, health-related quality of life, and self-rated health at 6 months (vs baseline). We performed an intention-to-treat analysis using a linear mixed-effects model with a random intercept for each patient to examine the association between study group and outcomes. Results This study randomized 159 participants (mean [SD] age, 54.9 [9.8] years) to the A-ICU SUMMIT intervention (n = 80) or to EUC (n = 79). The majority of participants were men (102 [65.8%]) and most were White (121 [76.1%]). A total of 64 participants (41.0%) reported having unstable housing at baseline. Six-month hospitalizations decreased in both the A-ICU and EUC groups, with no difference between them (mean [SE], -0.6 [0.5] vs -0.9 [0.5]; difference, 0.3 [95% CI, -1.0 to 1.5]). Emergency department use did not differ between groups (mean [SE], -2.0 [1.0] vs 0.9 [1.0] visits per person; difference, -1.1 [95% CI, -3.7 to 1.6]). Primary care physician visits increased in the A-ICU group (mean [SE], 4.2 [1.6] vs -2.0 [1.6] per person; difference, 6.1 [95% CI, 1.8 to 10.4]). Patients in the A-ICU group reported improved social functioning (mean [SE], 4.7 [2.0] vs -1.1 [2.0]; difference, 5.8 [95% CI, 0.3 to 11.2]) and self-rated health (mean [SE], 0.7 [0.3] vs -0.2 [0.3]; difference, 1.0 [95% CI, 0.1 to 1.8]) compared with patients in the EUC group. No differences in patient activation or experience were observed. Conclusions and Relevance The A-ICU intervention did not change hospital or ED utilization at 6 months but increased PCP visits and improved patient well-being. Longer-term studies are needed to evaluate whether these observed improvements lead to eventual changes in acute care utilization. Trial Registration ClinicalTrials.gov Identifier: NCT03224858.
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Affiliation(s)
- Brian Chan
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
- Central City Concern, Portland, Oregon
| | - Samuel T. Edwards
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Priya Srikanth
- Biostatistics Design Program, Oregon Health & Science University, Portland
| | | | - Meg Devoe
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
- Central City Concern, Portland, Oregon
| | - Christina Nicolaidis
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
- School of Social Work, Portland State University, Portland, Oregon
| | - Devan Kansagara
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - P. Todd Korthuis
- Section of Addiction Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University–Portland State University, Portland
| | | | - Somnath Saha
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
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Yan L, Liu L, Wang F, Hu X. Construction and validation of safe care theory for older inpatients from the perspective of socio-ecological model: a study protocol. BMJ Open 2023; 13:e072770. [PMID: 37852758 PMCID: PMC10603482 DOI: 10.1136/bmjopen-2023-072770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION In an ageing society, older adults are the main users of healthcare services, and Chinese healthcare systems have been struggling to meet the care demand of older adults. Due to the illness, many older inpatients cannot finish daily activities independently and require healthcare from caregivers. Evaluating the care needs of older adults and exploring the factors affecting safe care at multiple levels are conducive to providing systematic care services for older inpatients. This study aims to examine which and how factors impact safe care for older inpatients and propose a safe care theory to provide directions on improving the safe care system in the hospital. METHODS AND ANALYSIS A mixed-methods study with three interrelated research streams will be designed. (1) A safe care concept model: we will conduct a scoping review to extract the facilitators and barriers influencing the safe care of older inpatients and construct a concept model based on the socio-ecological model and the Yorkshire Contributory Factors Framework. (2) A safe care theory model: we will conduct a qualitative study with thematic analysis (aimed at older inpatients, caregivers and nurses) to define the concept connotations and propose a theory model. (3) A safe care theory: we will use the scales related to the theory model to test the concepts and statements. We will revise the theory model and derive a safe care theory based on the mixed-methods study results. This study will start in October 2023 and end in October 2025. ETHICS AND DISSEMINATION This study was approved by the ethics committee (No. 20221598). All participants will be provided with consent forms prior to data collection. The study will be disseminated via peer-reviewed manuscripts and conferences. TRIAL REGISTRATION NUMBER ChiCTR2300067421.
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Affiliation(s)
- Lupei Yan
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Li Liu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Fang Wang
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiuying Hu
- Innovation Center of Nursing Research and Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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13
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Pei C, Han X, Liu Q, Hu G. Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric. Pediatr Res 2023; 94:1562-1569. [PMID: 36690747 DOI: 10.1038/s41390-023-02488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/25/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China. METHODS This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment. RESULTS A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7-15%. The child's global health status and the respondent being the child's mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall's τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00. CONCLUSIONS Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China. IMPACT Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings. Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients' experience measures in a Chinese population. This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China.
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Affiliation(s)
- Chenyang Pei
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xueyan Han
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Qiannan Liu
- National Institute of Hospital Administration, NHC, Beijing, China
| | - Guangyu Hu
- Institute of Medical Information/Center for Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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14
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McDaniel CE, Lowry SJ, Ziniel SI, Freyleue S, Acquilano SC, Leyenaar JK. Development of the Pediatric Hospitalization Admission Survey of Experience (PHASE) Measure. Pediatrics 2023; 152:e2023061522. [PMID: 37584105 DOI: 10.1542/peds.2023-061522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Although significant research is devoted to transitions of care at discharge, few measures assess the quality of transitions into the hospital. Our objective was to develop a caregiver-reported quality measure to evaluate the pediatric hospital admission experience. METHODS Measure development included: (1) adapting items from existing instruments; (2) an expert-consensus process to prioritize survey items; (3) cognitive pretesting with caregivers (n = 16); and (4) pilot testing revised items (n = 27). Subsequently, the survey was administered to caregivers at 2 children's hospitals and 1 general hospital from February 2020 through November 2021. Item reduction statistics and exploratory factor analysis were performed followed by confirmatory factor analysis. Domain scores were calculated using a top-box approach. Known-group validity and indices of model fit were evaluated. RESULTS The initial survey included 25 items completed by 910 caregivers. Following item reduction and the exploratory factor analysis, 14 items were mapped to 4 domains: (1) Patient and Family Engagement, (2) Information Sharing, (3) Effectiveness of Care Delivery, and (4) Timeliness of Care. The confirmatory factor analysis and validity testing supported the factor structure. Domain scores ranged from 49% (95% confidence interval, 46-53) for Timelines of Care to 81% (95% confidence interval, 65-84) for Patient and Family Engagement, with significant differences between general and children's hospitals in Information Sharing and Effectiveness of Care Delivery. CONCLUSIONS A 4-domain caregiver-reported hospital admission experience measure demonstrated acceptable validity and psychometric properties across children's and general hospitals. This measure can be used to evaluate the quality of transitions into the hospital and to focus quality improvement efforts.
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Affiliation(s)
- Corrie E McDaniel
- Seattle Children's Hospital, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Sarah J Lowry
- Seattle Children's Hospital, Seattle, Washington
- University of Washington, Seattle, Washington
- Center for Biostatistics Epidemiology and Analytics, Seattle Children's Research Institute, Seattle, Washington
| | - Sonja I Ziniel
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Seneca Freyleue
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Stephanie C Acquilano
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Dartmouth Health Children's, Lebanon, New Hampshire
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15
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Wingo E, Sarnaik S, Michel M, Hessler D, Frederiksen B, Kavanaugh ML, Dehlendorf C. The status of person-centered contraceptive care in the United States: Results from a nationally representative sample. Perspect Sex Reprod Health 2023; 55:129-139. [PMID: 37654244 DOI: 10.1363/psrh.12245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
CONTEXT The Person-Centered Contraceptive Care measure (PCCC) evaluates patient experience of contraceptive counseling, a construct not represented within United States surveillance metrics of contraceptive care. We explore use of PCCC in a national probability sample and examine predictors of person-centered contraceptive care. METHODS Among 2228 women from the 2017-2019 National Survey of Family Growth who reported receiving contraceptive care in the last year, we conducted univariate and multivariable linear regression to identify associations between individual characteristics and PCCC scores. RESULTS PCCC scores were high (x ¯ : 17.84, CI: 17.59-18.08 on a 4-20 scale), yet varied across characteristics. In adjusted analyses, Hispanic identity with Spanish language primacy and non-Hispanic other or multiple racial identities were significantly associated with lower average PCCC scores compared to those of non-Hispanic white identity (B = -1.232 [-1.970, -0.493]; B = -0.792 [-1.411, -0.173]). Gay, lesbian, or bisexual identity was associated with lower average PCCC scores compared to heterosexual (B = -0.673 [-1.243, -0.103]). PCCC scores had a positive association with incomes of 150%-299% and ≥300% of the federal poverty level compared to those of income <150% (150%-299%: B = 0.669 [0.198, 1.141]; ≥300%: B = 0.892 [0.412, 1.372]). Cannabis use in the past year was associated with lower PCCC scores (B = -0.542 [-0.971, -0.113]). CONCLUSIONS The PCCC can capture differential experiences of contraceptive care to monitor patient experience and to motivate and track care quality over time. Differences in reported quality of care have implications for informing national priorities for contraceptive care improvements.
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Affiliation(s)
- Erin Wingo
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Shashi Sarnaik
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Martha Michel
- Health Service Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | | | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
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Khalife J, Ekman B, Ammar W, El-Jardali F, Al Halabi A, Barakat E, Emmelin M. Exploring patient perspectives: A qualitative inquiry into healthcare perceptions, experiences and satisfaction in Lebanon. PLoS One 2023; 18:e0280665. [PMID: 37590268 PMCID: PMC10434906 DOI: 10.1371/journal.pone.0280665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Patient perspectives have received increasing importance within health systems over the past four decades. Measures of patient experience and satisfaction are commonly used. However, these measures do not capture all the information that is available through engaging with patients. An improved understanding of the various types of patient perspectives and the distinctions between them is needed. The lack of such knowledge limits the usefulness of including patient perspectives as components within pay-for-performance initiatives. This study aimed to explore patient perspectives on hospital care in Lebanon. It also aimed to contribute insights that may improve the national pay-for-performance initiative and to the knowledge on engaging patients towards person-centered health systems. METHODS We conducted a qualitative study using focus group discussions with persons recently discharged after hospitalization under the coverage of the Lebanese Ministry of Public Health. This study was implemented in 2017 and involved 42 participants across eight focus groups. Qualitative content analysis was used to analyze the information provided by participants. RESULTS Five overall themes supported by 17 categories were identified, capturing the meaning of the participants' perspectives: health is everything; being turned into second class citizens; money and personal connections make all the difference; wanting to be treated with dignity and respect; and tolerating letdown, for the sake of right treatment. The most frequently prioritized statement in a ranking exercise regarding patient satisfaction was regular contact with the patient's doctor. CONCLUSIONS Patient perspectives include more than what is traditionally incorporated in measures of patient satisfaction and experience. Patient valuing of health and their perceptions on each of the health system, and access and quality of care should also be taken into account. Hospital pay-for-performance initiatives can be made more responsive through a broader consideration of these perspectives. More broadly, health systems would benefit from wider engagement of patients. We propose a framework relating patient perspectives to value-based healthcare and health system performance.
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Affiliation(s)
- Jade Khalife
- Social Medicine and Global Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Björn Ekman
- Social Medicine and Global Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Walid Ammar
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Abeer Al Halabi
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elise Barakat
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maria Emmelin
- Social Medicine and Global Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
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Gyselinck I, Ramakrishnan S, Vermeersch K, Halner A, Pott H, Dobbels F, Coleman C, Collis P, Watz H, Greulich T, Franssen FM, Burgel PR, Bafadhel M, Janssens W. Patients' acceptance of outcome and experience measurements during hospitalisation for COPD exacerbations: a CICERO Clinical Research Collaboration-European Lung Foundation online patient survey. ERJ Open Res 2023; 9:00148-2023. [PMID: 37404845 PMCID: PMC10316033 DOI: 10.1183/23120541.00148-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/18/2023] [Indexed: 07/06/2023] Open
Abstract
Background The lack of standardised outcome assessments during hospitalisation and follow-up for acute COPD exacerbations has hampered scientific progress and clinical proficiency. The objective of the present study was to evaluate patients' acceptance of selected outcome and experience measurements during hospitalisations for COPD exacerbations and follow-up. Methods An online survey was held amongst COPD patients in France, Belgium, The Netherlands, Germany and the UK. The European Lung Foundation COPD Patient Advisory Group was involved in the conceptualisation, development and dissemination of the survey. The survey was complementary to a previously obtained expert consensus. We assessed patients' views and acceptance of selected patient-reported outcomes or experiences and corresponding measurement instruments (for dyspnoea, frequent productive cough, health status and hospitalisation experience), and of selected clinical investigations (blood draw, pulmonary function test, 6-min walk test, chest computed tomography, echocardiography). Findings 200 patients completed the survey. All selected outcomes and experiences were deemed important, and acceptance of their methods of assessment was high. The modified Medical Research Council scale and a numerical rating scale to address dyspnoea, the COPD Assessment Test for quality of life and frequent productive cough, and the Hospital Consumer Assessment of Healthcare Providers and Systems for hospital experiences were the instruments preferred by patients. Consensus on importance of blood draw and spirometry was higher compared with the other investigations. Interpretation The survey results endorse the use of the selected outcome and experience measurements during hospitalisations for COPD exacerbations. They can be used to optimise standardised and patient-centred care and facilitate multicentric data collection.
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Affiliation(s)
- Iwein Gyselinck
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- BREATHE Lab, CHROMETA Department, KU Leuven, Leuven, Belgium
| | - Sanjay Ramakrishnan
- Respiratory Medicine Unit, Nuffield Department of Medicine – Experimental Medicine, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Kristina Vermeersch
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- BREATHE Lab, CHROMETA Department, KU Leuven, Leuven, Belgium
| | - Andreas Halner
- Respiratory Medicine Unit, Nuffield Department of Medicine – Experimental Medicine, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Hendrik Pott
- Philipps-University Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg; Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
| | - Fabienne Dobbels
- Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | | | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Grosshansdorf, Germany
- Airway Research Center North and DZL, Grosshansdorf, Germany
| | - Timm Greulich
- Philipps-University Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg; Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
| | - Frits M.E. Franssen
- Department of Research and Education, CIRO, Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Pierre-Régis Burgel
- Assistance Publique Hôpitaux de Paris, Department of Respiratory Medicine, Hopital Cochin Pneumologie, Paris, France
- Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Wim Janssens
- Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- BREATHE Lab, CHROMETA Department, KU Leuven, Leuven, Belgium
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Shin JW, Choi BR. Effect of patient-related factors on hospitalization service satisfaction and recommendation intention of medical institutions in Korea. BMC Health Serv Res 2023; 23:716. [PMID: 37391768 DOI: 10.1186/s12913-023-09754-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/26/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE This study examined the factors that influence the 'Overall Satisfaction' and 'Intention to Recommend' of medical institutions used using the Korea Medical Service Experience Survey (2019-2021). DATA SOURCES This study used the data of Medical Service Experience Survey in Korea. The data collected for data analysis were from 2019 to 2021 (Medical service period: 2018.07.01. ~ 2021.06.30). STUDY DESIGN The 2019 Medical Service Experience Survey was conducted from July 8 to September 20, 2019, and a total of 12,507 people (Medical service period: 2018.07.01. ~ 2019.06.30) were collected. The 2020 survey was conducted from July 13 to October 9, 2020, and a total of 12,133 people (Medical service period: 2019.07.01 ~ 2020.06.30.) were collected. The 2021 survey was conducted from July 19 to September 17, 2021), and a total of 13,547 people were collected (Medical service period: 2020.07.01. ~ 2021.06.30). Overall satisfaction and recommendation intentions for medical institutions consist of a Likert 5-point scale. At this time, the Top-box rating model used in the United States was applied. DATA COLLECTIONS/EXTRACTION METHODS In this study, only those who used inpatient services (15 years of age or older) were included because they spent a long time in a medical institution and had an intensive experience, and a total of 1,105 subjects were included in the analysis. PRINCIPAL FINDINGS Self-rated health and the type of bed influenced overall satisfaction with medical institutions. In addition, the type of economic activity, living area, self-rated health, the type of bed, and the type of nursing service affected the intention to recommend. And it was confirmed that overall satisfaction with medical institutions and intention to recommend them were higher in the 2021 survey than in 2019. CONCLUSIONS These results suggest that government policy on resources and systems is important. Through the case of Korea, it was found that the policy of reducing multi-person beds and expansion of integrated nursing service had a significant impact on patients' experience of using medical institutions and improving the quality of care.
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Affiliation(s)
- Jeong Woo Shin
- Korea Institute for Health and Social Affairs, 370 Sicheong-Daero, Sejong, South Korea
| | - Bo Ram Choi
- Department of Health Administration, Hanyang Cyber University, 220 Wangsimni-Ro, Seongdong-Gu, Seoul, South Korea.
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Rosenthal JL, Tancredi DJ, Marcin JP, Ketchersid A, Horath ET, Zerda EN, Bushong TR, Merriott DS, Romano PS, Young HM, Hoffman KR. Virtual family-centered hospital rounds in the neonatal intensive care unit: protocol for a cluster randomized controlled trial. Trials 2023; 24:331. [PMID: 37194089 DOI: 10.1186/s13063-023-07340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/29/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Family-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child's bedside during hospital rounds is a promising solution. We aim to evaluate the impact of virtual family-centered hospital rounds in the neonatal intensive care unit on parental and neonatal outcomes. METHODS This two-arm cluster randomized controlled trial will randomize families of hospitalized infants to have the option to use telehealth for virtual hospital rounds (intervention) or usual care (control). The intervention-arm families will also have the option to participate in hospital rounds in-person or to not participate in hospital rounds. All eligible infants who are admitted to this single-site neonatal intensive care unit during the study period will be included. Eligibility requires that there be an English-proficient adult parent or guardian. We will measure participant-level outcome data to test the impact on family-centered rounds attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. DISCUSSION The findings from this trial will increase our understanding about virtual family-centered hospital rounds in the neonatal intensive care unit. The mixed methods implementation evaluation will enhance our understanding about the contextual factors that influence the implementation and rigorous evaluation of our intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05762835. Status: Not yet recruiting. First posted: March 10, 2023; last update posted: March 10, 2023.
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Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA.
- Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA.
| | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - James P Marcin
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
- Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA
| | - Audriana Ketchersid
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Elva T Horath
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Erika N Zerda
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Trevor R Bushong
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Daniel S Merriott
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Patrick S Romano
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
- Department of Internal Medicine and Center for Healthcare Policy and Research, University of California Davis, 4150 V St, Sacramento, CA, 95817, USA
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis, 2570 48Th St, Sacramento, CA, 95817, USA
| | - Kristin R Hoffman
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
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20
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Stanley J, Hensley M, King R, Baum N. The Relationship between Internet Patient Satisfaction Ratings and COVID-19 Outcomes. Healthcare (Basel) 2023; 11:healthcare11101411. [PMID: 37239695 DOI: 10.3390/healthcare11101411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/07/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Our prior research showed that patient experience-as reported by Google, Yelp, and the Hospital Consumer Assessment of Healthcare Providers and Systems survey-is associated with health outcomes. Upon learning that COVID-19 mortality rates differed among U.S. geographic areas, we sought to determine if COVID-19 outcomes were associated with patient experience. We reviewed daily, U.S.-county-level-accrued COVID-19 infections and deaths during the first year of the pandemic using each locality's mean online patient review rating, correcting for county-level demographic factors. We found doctor star ratings were significantly associated with COVID-19 outcomes. We estimated the absolute risk reduction (ARR) and relative risk reduction (RRR) for each outcome by comparing the real-world-observed outcomes, observed with the mean star rating, to the outcomes predicted by our model with a 0.3 unit higher average star rating. Geographic areas with higher patient satisfaction online review ratings in our models had substantially better COVID-19 outcomes. Our models predict that, had medical practices nationwide maintained a 4-star average online review rating-a 0.3-star increase above the current national average-the U.S may have experienced a nearly 11% lower COVID-19 infection rate and a nearly 17% lower death rate among those infected.
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Affiliation(s)
| | | | - Ronald King
- Vanguard Communications, Denver, CO 80205, USA
| | - Neil Baum
- Tulane Medical School, Tulane University, New Orleans, LA 70112, USA
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21
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Rosenthal J, Tancredi D, Marcin J, Ketchersid A, Horath E, Zerda E, Bushong T, Merriott D, Romano P, Young H, Hoffman K. Virtual Family-Centered Rounds in the Neonatal Intensive Care Unit: Protocol for a Cluster Randomized Controlled Trial. Res Sq 2023:rs.3.rs-2644794. [PMID: 37131689 PMCID: PMC10153303 DOI: 10.21203/rs.3.rs-2644794/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background: Family-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child’s bedside during rounds is a promising solution. We aim to evaluate the impact of virtual family-centered rounds in the neonatal intensive care unit on parental and neonatal outcomes. Methods: This two-arm cluster randomized controlled trial will randomize families of hospitalized infants to have the option to use telehealth for virtual rounds (intervention) or usual care (control). The intervention-arm families will also have the option to participate in rounds in-person or to not participate in rounds. All eligible infants who are admitted to this single-site neonatal intensive care unit during the study period will be included. Eligibility requires that there be an English-proficient adult parent or guardian. We will measure participant-level outcome data to test the impact on family-centered rounds attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Discussion: The findings from this trial will increase our understanding about virtual family-centered rounds in the neonatal intensive care unit. The mixed methods implementation evaluation will enhance our understanding about the contextual factors that influence the implementation and rigorous evaluation of our intervention. Trial registration: ClinicalTrials.gov Identifier: NCT05762835. Status: Not yet recruiting. First Posted: 3/10/2023; Last Update Posted: 3/10/2023.
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22
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Hickey MD, Sergi F, Zhang K, Spinelli MA, Black D, Sola C, Blaz V, Nguyen JQ, Oskarsson J, Gandhi M, Havlir DV. Pragmatic randomized trial of a pre-visit intervention to improve the quality of telemedicine visits for vulnerable patients living with HIV. J Telemed Telecare 2023; 29:187-195. [PMID: 33342328 PMCID: PMC8214632 DOI: 10.1177/1357633x20976036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has required a shift of many routine primary care visits to telemedicine, potentially widening disparities in care access among vulnerable populations. In a publicly-funded HIV clinic, we aimed to evaluate a pre-visit phone-based planning intervention to address anticipated barriers to telemedicine. METHODS We conducted a pragmatic randomized controlled trial of patients scheduled for a phone-based HIV primary care visit at the Ward 86 HIV clinic in San Francisco from 15 April to 15 May 2020. Once reached by phone, patients were randomized to either have a structured pre-visit planning intervention to address barriers to an upcoming telemedicine visit versus a standard reminder call. The primary outcome was telemedicine visit attendance. RESULTS Of 476 scheduled telemedicine visits, 280 patients were reached by a pre-visit call to offer enrollment. Patients were less likely to be reached if virally unsuppressed (odds ratio (OR) 0.11, 95% confidence intervals (CI) 0.03-0.48), CD4 < 200 (OR 0.24, 95% CI 0.07-0.85), or were homeless (OR 0.24, 95% CI 0.07-0.87). There was no difference between intervention and control in scheduled visit attendance (83% v. 78%, OR 1.38, 95% CI 0.67-2.81). CONCLUSIONS A structured phone-based planning call to address barriers to telemedicine in a public HIV clinic was less likely to reach patients with poorly-controlled HIV and patients experiencing homelessness, suggesting additional interventions may be needed in this population to ensure access to telemedicine-based care. Among patients reachable by phone, telemedicine visit attendance was high and not improved with a structured pre-visit intervention, suggesting that standard reminders may be adequate in this population.
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Affiliation(s)
- Matthew D Hickey
- Division of HIV, ID and Global Medicine, University of California, USA
| | | | - Kevin Zhang
- Feinberg School of Medicine, Northwestern University, USA
| | | | - Douglas Black
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Cyril Sola
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Vanessa Blaz
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Janet Q Nguyen
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Jon Oskarsson
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Monica Gandhi
- Division of HIV, ID and Global Medicine, University of California, USA
| | - Diane V Havlir
- Division of HIV, ID and Global Medicine, University of California, USA
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23
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Friedel AL, Siegel S, Kirstein CF, Gerigk M, Bingel U, Diehl A, Steidle O, Haupeltshofer S, Andermahr B, Chmielewski W, Kreitschmann-andermahr I. Measuring Patient Experience and Patient Satisfaction—How Are We Doing It and Why Does It Matter? A Comparison of European and U.S. American Approaches. Healthcare (Basel) 2023; 11:797. [PMID: 36981454 PMCID: PMC10048416 DOI: 10.3390/healthcare11060797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/12/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: Patients’ experiences and satisfaction with their treatment are becoming increasingly important in the context of quality assurance, but the measurement of these parameters is accompanied by several disadvantages such as poor cross-country comparability and methodological problems. The aim of this review is to describe and summarize the process of measuring, publishing, and utilizing patient experience and satisfaction data in countries with highly developed healthcare systems in Europe (Germany, Sweden, Finland, Norway, the United Kingdom) and the USA to identify possible approaches for improvement. (2) Methods: Articles published between 2000 and 2021 that address the topics described were identified. Furthermore, patient feedback in social media and the influence of sociodemographic and hospital characteristics on patient satisfaction and experience were evaluated. (3) Results: The literature reveals that all countries perform well in collecting patient satisfaction and experience data and making them publicly available. However, due to the use of various different questionnaires, comparability of the results is difficult, and consequences drawn from these data remain largely unclear. (4) Conclusions: Surveying patient experience and satisfaction with more unified as well as regularly updated questionnaires would be helpful to eliminate some of the described problems. Additionally, social media platforms must be considered as an increasingly important source to expand the range of patient feedback.
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24
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Liu M, Hu L, Xu Y, Wang Y, Liu Y. Patient healthcare experiences of cancer hospitals in China: A multilevel modeling analysis based on a national survey. Front Public Health 2023; 11:1059878. [PMID: 36908411 PMCID: PMC9992183 DOI: 10.3389/fpubh.2023.1059878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
Importance Patient satisfaction is a crucial indicator for assessing quality of care in healthcare settings. However, patient satisfaction benchmark for cancer hospitals in China is not established. Objective To examine patient satisfaction levels in tertiary cancer hospitals in China, and inter-hospital variations after case-mix adjustment. Design A nationwide cross-sectional hospital performance survey conducted from January to March 2021. Settings At 30 tertiary cancer hospitals in China. Participants A total of 4,847 adult inpatients consecutively recruited at 30 tertiary cancer hospitals were included. Exposures Patient characteristics included demographic characteristics (sex, age, education, and annual family income), clinical characteristics (cancer type, cancer stage, self-reported health status, and length of stay), and actual respondents of questionnaire. Main outcomes and measures Patient satisfaction was measured using 23 items covering five aspects, administrative process, hospital environment, medical care, symptom management, and overall satisfaction. Responses to each item were recorded using a 5-point Likert scale. Patient satisfaction level for each aspect was described at individual and hospital levels. Using multilevel logistic regression, patient characteristics associated with patient satisfaction were examined as case-mix adjusters and inter-hospital variation were determined. Results The satisfaction rates for symptom management, administrative process, hospital environment, overall satisfaction, and medical care aspects were 74.56, 81.70, 84.18, 84.26, and 90.86% with a cut-off value of 4, respectively. Significant predictors of patient satisfaction included sex, age, cancer type, cancer stage, self-reported health status, and actual respondent (representative or patient) (all P < 0.05). The ranking of the hospitals' performance in satisfaction was altered after the case-mix adjustment was made. But even after the adjustment, significant variation in satisfaction among hospitals remained. Conclusions and relevance This study pointed to symptom management as a special area, to which a keen attention should be paid by policymakers and hospital administrators. Significant variation in satisfaction among hospitals remained, implying that future studies should examine major factors affecting the variation. In review, target interventions are needed in low-performing hospitals.
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Affiliation(s)
| | - Linlin Hu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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25
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Clark CM, Kardong-Edgren S, Willhaus J. Pilot Study Using Cognitive Rehearsal, Simulation, and Biomarker Data to Address Workplace Incivility. J Contin Educ Nurs 2023; 54:79-88. [PMID: 36720094 DOI: 10.3928/00220124-20230113-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Workplace incivility poses a threat to patient safety. This intervention pilot study used simulation and biomarker data with newly graduated nurses to explore the impact of incivility on patient care and tested whether cognitive rehearsal could mitigate the effects of workplace incivility. METHOD A clinical scenario and script were used by actors to deliver either an uncivil or a hurried but not uncivil handoff report to participants before they conducted a focused patient assessment and administered medications to a standardized patient. RESULTS Participants identified gaps in understanding of both handoff reports that resulted in compromised patient care. Quantitative trends showed lower resilience scores and higher stress appraisal scores for participants who received the uncivil handoff report. CONCLUSION Although participants expressed confidence using cognitive rehearsal as an intervention before the simulation, responses indicated that a 60-minute session was insufficient to adequately prepare them to effectively address an uncivil nurse encounter. [J Contin Educ Nurs. 2023;54(2):79-88.].
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26
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Beckett MK, Hambarsoomian K, Martino SC, Agniel D, Hudson Scholle S, Maksut JL, Mathews M, Orr N, Elliott MN. Measuring Equity in the Hospital Setting: An HCAHPS Application of the Health Equity Summary Score. Med Care 2023; 61:3-9. [PMID: 36038518 DOI: 10.1097/MLR.0000000000001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Health care quality varies by patient factors, including race-and-ethnicity and preferred language. Addressing inequities requires identifying them and incentivizing equity. OBJECTIVES We apply an approach first implemented in the Medicare Advantage setting to measure equity in patient experiences by race-and-ethnicity [Asian American and Native Hawaiian or Pacific Islander (AA and NHPI), Black, Hispanic, vs. White] and language preference (English-preferring vs. another-language-preferring). We identify characteristics of hospitals providing high-quality equitable care. RESEARCH DESIGN We estimated, standardized, and combined performance measures into a Health Equity Summary Score (HESS) using 2016-2019 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. The HCAHPS HESS considered current cross-sectional performance, within-hospital improvement, and overall improvement by race-and-ethnicity and language preference. SUBJECTS A total of 3333 US hospitals with 2019 HCAHPS Star Ratings. RESULTS The HCAHPS HESS was calculable for 44% of hospitals. High-scoring (4-5 diamonds on a 1-diamond to 5-diamond scale) hospitals tended to be smaller than intermediate-scoring [3 diamonds (14% of high-scoring hospitals had <100 beds vs. 7% of intermediate-scoring hospitals, P <0.001) and were less often for-profit (20% vs. 31%, P <0.001)]. While a significant percentage (29%) of patients served by high-scoring hospitals were AA and NHPI, Black, or Hispanic, and 9% were another-language-preferring, there were smaller proportions of Black and Hispanic patients in high-scoring versus other hospitals. HESS performance was negatively associated with the percentage of patients preferring another language to English. HESS scores were moderately correlated with overall Star Ratings ( r =0.70). CONCLUSIONS The HCAHPS HESS and practices of high-scoring hospitals could promote more equitable patient experiences.
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27
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Marcin JP, Tancredi DJ, Galante JM, Rinderknecht TN, Haus BM, Leshikar HB, Zwienenberg M, Rosenthal JL, Grether-Jones KL, Hamline MY, Hoch JS, Kuppermann N. Measuring the impact of a "Virtual Pediatric Trauma Center" (VPTC) model of care using telemedicine for acutely injured children versus the standard of care: study protocol for a prospective stepped-wedge trial. Trials 2022; 23:1051. [PMID: 36575536 PMCID: PMC9793356 DOI: 10.1186/s13063-022-06996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The current standard of care in the treatment of children with physical trauma presenting to non-designated pediatric trauma centers is consultation with a pediatric trauma center by telephone. This includes contacting a pediatric trauma specialist and transferring any child with a potentially serious injury to a regionalized level I pediatric trauma center. This approach to care frequently results in medically unnecessary transfers and may place undue burdens on families. A newer model of care, the "Virtual Pediatric Trauma Center" (VPTC), uses telemedicine to make the expertise of a level I pediatric trauma center virtually available to any hospital. While the use of the VPTC model of care is increasing, there have been no studies comparing the VPTC to standard care of injured children at non-designated trauma centers with respect to patient- and family-centered outcomes. The goal of this study is to compare the current standard of care to the VPTC with respect to family-centered outcomes developed by parents and community advisory boards. METHODS We will use a stepped-wedge trial design to enroll children with physical trauma presenting to ten hospitals, including level II, level III, and non-designated trauma centers. The primary outcome measures are parent/family experience of care and distress 3 days following injury. Secondary aims include 30-day healthcare utilization, parent/family out-of-pocket costs at 3 days and 30 days after injury, transfer rates, and parent/family distress 30 days following injury. We expect at least 380 parents/families of children will be eligible for the study following an emergency department physician's request for a level I pediatric trauma center consultation. We will evaluate parent/family experience of care and distress using previously validated instruments, healthcare utilization by family recollection and medical record abstraction, and out-of-pocket costs using standard economic analyses. DISCUSSION We expect that the findings from this study will inform other level I pediatric trauma centers and non-pediatric trauma centers on how to improve their systems of care for injured children. The results will help to optimize communication, confidence, and shared decision-making between parents/families and clinical staff from both the transferring and receiving hospitals. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04469036. Registered July 13, 2020 before start of inclusion.
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Affiliation(s)
- James P. Marcin
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA
| | - Daniel J. Tancredi
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA
| | - Joseph M. Galante
- grid.27860.3b0000 0004 1936 9684Department of Surgery, University of California, Davis, Sacramento, CA USA
| | - Tanya N. Rinderknecht
- grid.27860.3b0000 0004 1936 9684Department of Surgery, University of California, Davis, Sacramento, CA USA
| | - Brian M. Haus
- grid.27860.3b0000 0004 1936 9684Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA USA
| | - Holly B. Leshikar
- grid.27860.3b0000 0004 1936 9684Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA USA
| | - Marike Zwienenberg
- grid.27860.3b0000 0004 1936 9684Department of Neurological Surgery, University of California, Davis, Sacramento, CA USA
| | - Jennifer L. Rosenthal
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA
| | - Kendra L. Grether-Jones
- grid.27860.3b0000 0004 1936 9684Department of Emergency Medicine, University of California, Davis, Sacramento, CA USA
| | - Michelle Y. Hamline
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA
| | - Jeffrey S. Hoch
- grid.27860.3b0000 0004 1936 9684Department of Public Health Sciences, University of California, Davis, Sacramento, CA USA
| | - Nathan Kuppermann
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA ,grid.27860.3b0000 0004 1936 9684Department of Emergency Medicine, University of California, Davis, Sacramento, CA USA
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28
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Anhang Price R, Quigley DD, Hargraves JL, Sorra J, Becerra-Ornelas AU, Hays RD, Cleary PD, Brown J, Elliott MN. A Systematic Review of Strategies to Enhance Response Rates and Representativeness of Patient Experience Surveys. Med Care 2022; 60:910-918. [PMID: 36260705 PMCID: PMC9645551 DOI: 10.1097/mlr.0000000000001784] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data from surveys of patient care experiences are a cornerstone of public reporting and pay-for-performance initiatives. Recently, increasing concerns have been raised about survey response rates and how to promote equity by ensuring that responses represent the perspectives of all patients. OBJECTIVE Review evidence on survey administration strategies to improve response rates and representativeness of patient surveys. RESEARCH DESIGN Systematic review adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. STUDY SELECTION Forty peer-reviewed randomized experiments of administration protocols for patient experience surveys. RESULTS Mail administration with telephone follow-up provides a median response rate benefit of 13% compared with mail-only or telephone-only. While surveys administered only by web typically result in lower response rates than those administered by mail or telephone (median difference in response rate: -21%, range: -44%, 0%), the limited evidence for a sequential web-mail-telephone mode suggests a potential response rate benefit over sequential mail-telephone (median: 4%, range: 2%, 5%). Telephone-only and sequential mixed modes including telephone may yield better representation across patient subgroups by age, insurance type, and race/ethnicity. Monetary incentives are associated with large increases in response rates (median increase: 12%, range: 7%, 20%). CONCLUSIONS Sequential mixed-mode administration yields higher patient survey response rates than a single mode. Including telephone in sequential mixed-mode administration improves response among those with historically lower response rates; including web in mixed-mode administration may increase response at lower cost. Other promising strategies to improve response rates include in-person survey administration during hospital discharge, incentives, minimizing survey language complexity, and prenotification before survey administration.
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Affiliation(s)
| | | | - J. Lee Hargraves
- Center for Survey Research, University of Massachusetts Boston, Boston, MA
| | | | | | - Ron D. Hays
- David Geffen School of Medicine, UCLA, Los Angeles, CA
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29
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Elliott MN, Beckett MK, Cohea C, Lehrman WG, Russ C, Cleary PD, Giordano LA, Goldstein E, Saliba D. The hospital care experiences of older patients compared to younger patients. J Am Geriatr Soc 2022; 70:3570-3577. [PMID: 35984089 PMCID: PMC10087850 DOI: 10.1111/jgs.18003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/14/2022] [Accepted: 07/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hospitals may provide less positive patient experiences for older than younger patients. METHODS We used 2019 HCAHPS data from 4358 hospitals to compare patient-mix adjusted HCAHPS Survey scores for 19 experience of care items for patients ages 75+ versus 55-74 years and tested for interactions of age group with patient and hospital characteristics. We contrasted the age patterns observed for inpatient experiences with those among respondents to the 2019 Medicare CAHPS (MCAHPS) Survey of overall experience. RESULTS Patients 75+ years (31% of all HCAHPS respondents) reported less-positive experiences than those 55-74 (46% of respondents) for 18 of 19 substantive HCAHPS items (mean difference -3.3% points). Age differences in HCAHPS top-box scores were large (>5 points) for 1 of 3 Nurse Communication items, 1 of 3 Doctor Communication, 2 of 2 Communication about Medication items, 1 of 2 Discharge Information items, and 2 of 3 Care Transition items. In contrast, for MCAHPS, those 75+ reported similar experiences to younger adults. The magnitude of age differences varied considerably across hospitals; some hospitals had very large age disparities for older patients (age 75+ vs. ages 55-74), while others had none. These age differences were generally smaller for patients in government and non-profit than in for-profit hospitals, and in the Pacific region than in other parts of the United States. This variation in age disparities across hospitals may help to identify best practices. CONCLUSIONS Patients ages 75+ reported less-positive experiences than patients ages 55-74, especially for measures of communication. These differences may be specific to inpatient care. Further study should investigate the effectiveness of hospital staffs' communication with older patients. Hospital protocols designed for younger patients may need to be adjusted to meet the needs of older patients. There may also be opportunities to learn from outpatient interactions with older patients.
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Affiliation(s)
| | | | | | | | - Chelsea Russ
- Health Services Advisory Group, Phoenix, Arizona, USA
| | - Paul D Cleary
- Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | | | | | - Debra Saliba
- RAND Corporation, Santa Monica, California, USA.,University of California Los Angeles Borun Center, Los Angeles, California, USA.,Los Angeles Veterans Administration GRECC, Los Angeles, California, USA
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30
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Rosenthal JL, Albano AD, Tancredi DJ, Perez SL, Young HM, Romano PS. Development and Psychometric Evaluation of a Caregiver Survey to Assess Family-Centered Care in the Emergency Department. Acad Pediatr 2022:S1876-2859(22)00555-1. [PMID: 36283624 PMCID: PMC10122697 DOI: 10.1016/j.acap.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To develop and evaluate the psychometric properties of a family caregiver-reported survey that assesses family-centeredness of care in the context of pediatric emergency department (ED) encounters. METHODS We created a caregiver-reported scale, incorporated content expert feedback, and iteratively revised it based on cognitive interviews with caregivers. We then field tested the scale in a survey with caregivers. We dichotomized items using top-box scoring and obtained a summary score per respondent. Using a sample of 191 caregivers recruited from 9 EDs, we analyzed internal consistency reliability, dimensionality via item response theory modeling, and convergent validity with the ED Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. RESULTS Feedback from the 9 experts led us to remove 4 items. We conducted 16 cognitive interviews and revised the survey in 4 rounds. An 11-item survey was field tested. Mean (standard deviation) respondent 11-item summary score was 77.2 (26.6). We removed 2 items given inconsistent response patterns, poor variability, and poor internal consistency, which increased coefficient alpha from 0.85 to 0.88 for the final scale. A multidimensional model fit the data best, but factor scores correlated strongly with summary scores, suggesting the latter are sufficient for quality improvement and future research. Regarding convergent validity, adjusted partial correlation between our scale's 9-item summary score and the ED CAHPS summary score was 0.75 (95% confidence interval 0.67-0.81). CONCLUSIONS Psychometric analyses demonstrated strong item performance, reliability, and convergent validity for the 9-item scale. This survey can be used to assess family-centered care in the ED for research and quality improvement purposes.
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Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California Davis (JL Rosenthal, DJ Tancredi, and PS Romano), Sacramento, Calif.
| | | | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis (JL Rosenthal, DJ Tancredi, and PS Romano), Sacramento, Calif
| | - Susan L Perez
- Department of Kinesiology and Health Science, California State University (SL Perez), Sacramento, Calif
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis (HM Young), Sacramento, Calif
| | - Patrick S Romano
- Department of Pediatrics, University of California Davis (JL Rosenthal, DJ Tancredi, and PS Romano), Sacramento, Calif; Department of Internal Medicine and Center for Healthcare Policy and Research, University of California Davis (PS Romano), Sacramento, Calif
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Sutak AK, Ryan SP, Hong CS, Vovos TJ, Wellman SS, Jiranek WA, Seyler TM. The Effect of Medical Education on Patient Satisfaction: An Asset or a Liability? Orthopedics 2022; 45:276-280. [PMID: 35576485 DOI: 10.3928/01477447-20220511-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have investigated the influence of trainee involvement on inpatient satisfaction scores in the postoperative joint arthroplasty setting. This study compares Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores at academic and private health care centers to assess the impact of trainees on patient satisfaction. From 2013 to 2017, 3454 HCAHPS surveys were collected at the investigating institution from patients who underwent primary total hip and total knee arthroplasty. Surveys were categorized based on the inpatient practice setting-academic hospitals included orthopedic residents and medical students who were involved in perioperative care, whereas private settings did not have trainee involvement. Patient demographics, including age, body mass index, sex, and American Society of Anesthesiologists score, were retrospectively collected. A total of 2454 HCAHPS surveys from 2 academic hospitals and 1000 surveys from a private hospital were collected. Patients at the academic hospitals were more likely to report that symptoms to look out for were clearly explained (odds ratio, 1.882; P=.001), whereas patients from the private hospital were more likely to report that the hospital was always quiet at night (odds ratio, 1.271; P=.005). The overall satisfaction score was not significantly different between the academic and private settings (78.9 vs 80.2, respectively; P=.111). The overall hospital satisfaction score for patients undergoing primary total hip and knee arthroplasty was not significantly different between private and academic medical facilities. Thus, this study supports the idea that training future orthopedic surgeons will not negatively impact patient satisfaction scores in a way that affects reimbursement. [Orthopedics. 2022;45(5):276-280.].
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Martinez KA, Rothberg MB. Physician Gender and Its Association With Patient Satisfaction and Visit Length: An Observational Study in Telemedicine. Cureus 2022; 14:e29158. [PMID: 36258932 PMCID: PMC9572933 DOI: 10.7759/cureus.29158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Female physicians conduct longer visits than male physicians, with negative implications for their compensation. Yet patients often report higher satisfaction with female physicians. It is unknown whether satisfaction scores for female physicians are associated with their visit lengths. Our objective was to characterize the role of the physician and patient gender with respect to visit length and patient satisfaction. Methods We conducted an observational cohort study with patients and physicians of a nationwide telemedicine service between 2016 and 2018. Visit length was measured by the telemedicine system. Patients rated physicians on scales of one to five stars, with five considered “top box” satisfaction. We used logistic regression to estimate differences in patient satisfaction and linear regression to estimate differences in visit length by the physician and patient gender. We tested interactions between physician and patient gender and accounted for clustering by the physician. Results Among 102,664 visits with 405 physicians, the mean visit length was 5.8 minutes. Visits with male physicians were 1.11 minutes shorter than those with female physicians (95% CI:-1.58, -0.65). Controlling for visit length, male physicians were less likely than female physicians to receive top-box satisfaction scores (OR: 0.72; 95% CI: 0.61, 0.85). Visits between female physicians and male patients were the longest and visits between male physicians and female patients were the shortest. Female physicians had longer visits than male physicians but this did not explain their higher satisfaction scores. Conclusions To reduce inequity in compensation resulting from differences in visit length, female physicians could shorten their visits without negative consequences for their satisfaction ratings.
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Orr N, Zaslavsky AM, Hays RD, Cleary PD, Haviland AM, Brown JA, Dembosky JW, Martino SC, Gaillot S, Elliott MN. Development, methodology, and adaptation of the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) patient experience survey, 2007–2019. Health Serv Outcomes Res Method. [DOI: 10.1007/s10742-022-00277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractThe Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys collect standardized information about patient experiences of care from nationally representative samples of people with Medicare to support consumers’ enrollment choices and enable the Centers for Medicare & Medicaid Services to monitor care quality and incentivize high quality patient-centered care. Since 2007, protocols for data collection, analysis, and reporting have evolved to address expanded Medicare coverage options and a shift from a single survey vendor to a model in which health plans hire approved vendors to administer the survey. During that time, response rates for all types of surveys have declined; increasing effort has gone toward increasing survey participation, especially among people whose preferred language is not English. In this paper, we describe the history, goals, and current use of the Medicare CAHPS surveys. We also summarize key methodological issues, such as sample design, field implementation and data cleaning, adjustment, scoring, and report production. Additionally, we discuss issues that may arise more generally in managing a large, annual national survey that has direct impact on policy, and consider how a long-running survey of this nature may need to evolve to reflect changes in health care delivery and promote standardization in survey administration while maintaining survey content.
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Catalano MA, Hemli JM, Yu PJ, Scheinerman SJ, Hartman AR, Patel NC. Patient Satisfaction Scores After Cardiac Surgery: Should They Be Risk-Adjusted? Semin Thorac Cardiovasc Surg 2022; 35:696-704. [PMID: 35779848 DOI: 10.1053/j.semtcvs.2022.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022]
Abstract
The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) is a survey tool that quantifies patient satisfaction after hospitalization. We sought to interrogate our HCAHPS results in order to identify any association between preoperative health, type of operation, and postoperative outcomes, with patient satisfaction after cardiac surgery. Of 12,572 patients who underwent cardiac surgery between December 2012 and December 2019, 2587 patients (20.6%) completed the HCAHPS survey. Patient satisfaction was quantified using HCAHPS responses, focused on 'top-box' rating in nursing care, physician care, hospital environment, and overall hospital rating, as primary endpoints. Multivariable logistic regression was used to identify those variables associated with top-box scores. Elevated patient risk, as measured by the Society of Thoracic Surgeons (STS) risk score in 2112 patients, was predictive of lower rates of top-box responses in nursing care (OR 0.963, P = 0.003), physician care (OR 0.96, P = 0.002), and overall hospital rating (OR 0.97, P = 0.007). Major postoperative complications were associated with lower patient satisfaction for nursing care (OR 0.67, P = 0.038), physician care (OR 0.59, P = 0.012), and overall hospital rating (OR 0.64, P = 0.035); length of stay ≥ 6 days was associated with increased patient satisfaction for nursing care (OR 1.45, P < 0.001). Increased preoperative risk and postoperative complications are associated with lower rates of top-box patient satisfaction scores after cardiac surgery. When assessing patient satisfaction after cardiac surgery, we suggest that a preoperative risk profile be considered.
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Affiliation(s)
- Michael A Catalano
- Department of Cardiovascular & Thoracic Surgery, North Shore University Hospital / Northwell Health, Manhasset, New York
| | - Jonathan M Hemli
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, New York
| | - Pey-Jen Yu
- Department of Cardiovascular & Thoracic Surgery, North Shore University Hospital / Northwell Health, Manhasset, New York
| | - S Jacob Scheinerman
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, New York
| | - Alan R Hartman
- Department of Cardiovascular & Thoracic Surgery, North Shore University Hospital / Northwell Health, Manhasset, New York
| | - Nirav C Patel
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, New York..
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Anhang Price R, Bradley MA, Ye F, Schlang D, DeYoreo M, Cleary PD, Elliott MN, Montemayor CK, Timmer M, Tolpadi A, Teno JM. Reliable and Valid Survey-Based Measures to Assess Quality of Care in Home-Based Serious Illness Programs. J Palliat Med 2022; 25:864-872. [PMID: 34936490 PMCID: PMC9145570 DOI: 10.1089/jpm.2021.0424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: There is a pressing need for standardized measures to assess the quality of home-based serious illness care. Currently, there are no validated quality measures that are specific to home-based serious illness programs (SIPs) and the unique needs of their patients. Objective: To develop and evaluate standardized survey-based measures of serious illness care experiences for assessing and comparing quality of home-based serious illness care programs. Methods: From October 2019 through January 2020, we administered a survey to patients who received care from 32 home-based SIPs across the United States. Using the 2263 survey responses, we assessed item performance and constructed composite measures via factor analysis, evaluated item-scale correlations, estimated reliability, and examined validity by regressing overall ratings and willingness to recommend care on each composite. Results: The overall survey response rate was 36%. Confirmatory factor analyses supported five composite quality measures: Communication, Care Coordination, Help for Symptoms, Planning for Care, and Support for Family and Friends. Cronbach's alpha estimates for the composite measures ranged from 0.69 to 0.85, indicating adequate internal consistency in assessing their underlying constructs. Interprogram reliability ranged from 0.67 to 0.80 at 100 completed surveys per measure, meeting common standards for distinguishing between programs' performance. Together, the composites explained 45% of the variance in patients' overall care ratings. Communication, Care Coordination, and Planning for Care were the strongest predictors of overall ratings. Conclusion: Our analyses provide evidence of the feasibility, reliability, and validity of proposed survey-based measures to assess the quality of home-based serious illness care from the perspective of patients and their families.
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Affiliation(s)
- Rebecca Anhang Price
- RAND Corporation, Arlington, Virginia, USA
- Address correspondence to: Rebecca Anhang Price, PhD, RAND Corporation, 1200 S Hayes Street, Arlington, VA 22202, USA
| | | | - Feifei Ye
- RAND Corporation, Pittsburgh, Pennsylvania, USA
| | | | | | - Paul D. Cleary
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | | | | | - Joan M. Teno
- Oregon Health and Science University, Portland, Oregon, USA
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Christalle E, Zeh S, Hahlweg P, Kriston L, Härter M, Zill J, Scholl I. Development and content validity of the Experienced Patient-Centeredness Questionnaire (EPAT)-A best practice example for generating patient-reported measures from qualitative data. Health Expect 2022; 25:1529-1538. [PMID: 35446991 PMCID: PMC9327838 DOI: 10.1111/hex.13494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction To effectively foster patient‐centeredness (PC), it is crucial to measure its implementation. So far, there is no German measure to assess PC comprehensively. The aim of this study is to develop and select items for the Experienced Patient‐Centeredness (EPAT) Questionnaire, a patient‐reported experience measure (PREM). The EPAT intends to assess PC from the perspective of adult patients treated for different chronic diseases in inpatient and outpatient settings in Germany. Furthermore, we aim at providing a best‐practice example for developing PREMs from qualitative data. Methods The development process comprised a three‐phase mixed‐method design: (1) preparation, (2) item generation and (3) item selection and testing of content validity. We generated items using qualitative content analysis based on information from focus groups, key informant interviews and literature search. We selected items using relevance rating and cognitive interviews. Participants were patients from four chronic disease groups (cancer, cardiovascular disease, mental disorder, musculoskeletal disorder) and healthcare experts (e.g., clinicians, researchers, patient representatives). Results We conducted six focus groups with a total of 40 patients, key informant interviews with 10 experts and identified 48 PREMs from international literature. After team discussion, we reached a preliminary pool of 152 items. We conducted a relevance rating with 32 experts and 34 cognitive interviews with 21 patients. We selected 125 items assessing 16 dimensions of PC and showed high relevance and comprehensibility. Conclusions The EPAT questionnaire is currently undergoing psychometric testing. The transparent step‐by‐step report provides a best practice example that other researchers may consider for developing PREMs. Integrating literature and experts with a strong focus on patient feedback ensured good content validity. The EPAT questionnaire will be helpful in assessing PC in routine clinical practice in inpatient and outpatient settings for research and quality improvement. Patient or Public Contribution Patients were not involved as active members of the research team. While developing the funding proposal, we informally reached out to several patient organizations who all gave us positive feedback on the study aims, thereby confirming their relevance. Those patient organizations endorsed the funding proposal with formal letters of support and supported recruitment by disseminating advertisements for study participation.
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Affiliation(s)
- Eva Christalle
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Zeh
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jördis Zill
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
The big data revolution presents an exciting frontier to expand public health research, broadening the scope of research and increasing the precision of answers. Despite these advances, scientists must be vigilant against also advancing potential harms toward marginalized communities. In this review, we provide examples in which big data applications have (unintentionally) perpetuated discriminatory practices, while also highlighting opportunities for big data applications to advance equity in public health. Here, big data is framed in the context of the five Vs (volume, velocity, veracity, variety, and value), and we propose a sixth V, virtuosity, which incorporates equity and justice frameworks. Analytic approaches to improving equity are presented using social computational big data, fairness in machine learning algorithms, medical claims data, and data augmentation as illustrations. Throughout, we emphasize the biasing influence of data absenteeism and positionality and conclude with recommendations for incorporating an equity lens into big data research.
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Affiliation(s)
- Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Yulin Hswen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Gilmer Valdes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - Kristefer Stojanovski
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Department of Medicine, University of California, San Francisco, California, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Partnerships for Research in Implementation Science for Equity (PRISE), University of California, San Francisco, California, USA
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Chambergo-Michilot D, Corcuera-Ciudad R, Runzer-Colmenares FM, Navarrete-Reyes AP, Parodi JF. Pain management, activities of daily living and the assessment of the WHOQOL-OLD module: results of a cross-sectional analysis of a cohort of older men with oncological diagnoses. JGG 2022. [DOI: 10.36150/2499-6564-n395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Dorsey R, Claudio D, Velázquez MA, Petersen P. Identifying service quality gaps between patients and providers in a Native American outpatient clinic. BMC Health Serv Res 2022; 22:165. [PMID: 35135537 PMCID: PMC8826682 DOI: 10.1186/s12913-022-07538-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Native American communities in Montana reservations have reported low-level satisfaction in health services. This research explored if the services provided at a Blackfeet Indian Reservation outpatient clinic were designed to meet patient expectations. Methods Staff and patient interviews and surveys allowed service expectations to be assessed according to the clinic’s ability to meet those expectations. A total of 48 patients and ten staff members (83% of the staff at this clinic) participated in the study voluntarily. Results We found a disconnect between what patients anticipate for care and what staff think they are anticipating. We also found a discontent between what staff believes patients need versus what the patients feel is needed. Conclusions These gaps combine to increase the breach between patient expectations and perceptions of their healthcare services. With better insight that captures what patients are looking for from a service, the potential to meet those needs increases, and patients feel that their voice is respected and valued.
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Affiliation(s)
- Robert Dorsey
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT, USA
| | - David Claudio
- Department of Mechanical Engineering, University of Massachusetts Lowell, Lowell, MA, USA.
| | - María A Velázquez
- Department of Mechanical Engineering, University of Massachusetts Lowell, Lowell, MA, USA
| | - Polly Petersen
- College of Nursing, Montana State University, Bozeman, MT, USA
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Mercier MR, Galivanche AR, Pathak N, Mets EJ, Molho DA, Elaydi AH, Grauer JN, Rubin LE. Revision Total Hip and Knee Arthroplasty are Associated With Lower Hospital Consumer Assessment of Healthcare Providers and Systems Patient Satisfaction Scores Compared With Primary Arthroplasty. J Am Acad Orthop Surg 2022; 30:e336-46. [PMID: 34851861 DOI: 10.5435/JAAOS-D-21-00839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/10/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION As rates of primary total joint arthroplasty continue to rise, so do rates of revision. Revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) are more frequently done at larger centers, are associated with higher morbidity, and may have different patient satisfaction outcomes. This study compares the survey results of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) between patients who underwent primary versus revision THA or TKA. METHODS All adult patients who underwent inpatient, elective, primary, and revision THA or TKA at a single institution were selected for retrospective analysis. Patient demographics, comorbidities, functional status, surgical variables, 30-day outcomes, and HCAHPS scores were assessed. Univariate and multivariate analyses were done to determine correlations between the aforementioned variables and top-box HCAHPS survey scores for primary versus revision THA and TKA. RESULTS Of 2,707 patients who met the inclusion criteria and had returned the HCAHPS survey, primary THA was documented in 1,075 patients (39.71%), revision THA in 75 (2.77%), primary TKA in 1,497 (55.30%), and revision TKA in 60 (2.22%). Revision THA patients were more functionally dependent, and TKA patients had higher American Society of Anesthesiologists score than their primary comparators. Revisions had longer hospital length of stay for both procedures. For THA, revision THA patients demonstrated lower total top-box rates compared withprimary THA patients (71.64% versus 75.67% top-box, P < 0.001) and lower scores on the care from doctors subsection (76.26% versus 85.34%, P < 0.001) of the HCAHPS survey. Similarly, for TKA, revision TKA patients demonstrated lower total top-box rates (76.13% versus 79.22%, P < 0.013) and lower scores on the care from doctors subsection (66.28% versus 83.65%, P < 0.001) of the HCAHPS survey. DISCUSSION For both THA and TKA, revision procedures were associated with lower total HCAHPS scores and rated care from doctors. This suggests that HCAHPS scores may be biased by factors outside the surgeon's control, such as the complexity associated with revision procedures. LEVEL OF EVIDENCE Level III.
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Keebler JR, Rosen MA, Sittig DF, Thomas E, Salas E. Human Factors and Ergonomics in Healthcare: Industry Demands and a Path Forward. Hum Factors 2022; 64:250-258. [PMID: 35000407 DOI: 10.1177/00187208211073623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This article reviews three industry demands that will impact the future of Human Factors and Ergonomics in Healthcare settings. These demands include the growing population of older adults, the increasing use of telemedicine, and a focus on patient-centered care. Following, we discuss a path forward through improved medical teams, error management, and safety testing of medical devices and tools. Future challenges are discussed.
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Affiliation(s)
- Joseph R Keebler
- Department of Human Factors and Behavioral Neurobiology, 2830Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Michael A Rosen
- Department of Anesthesiology, Armstrong Institute for Patient Safety, Johns Hopkins University, Baltimore, MD, USA
| | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Eric Thomas
- UT Health Memorial Center for Healthcare Quality and Safety, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, USA
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Nabeel M, Prasad RM, Kemnic T, Wang L, Khan NNS. Structured, Timely, and Individualized Patient Feedback to Residents and its Effect on HCAHPS Scores. J Patient Exp 2022; 9:23743735221112583. [PMID: 35836777 PMCID: PMC9274411 DOI: 10.1177/23743735221112583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Physician communication is integral for improving patients’ experience and
clinical outcomes. Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) scores are used by the Centers for Medicare & Medicaid
Services to assess the quality of care provided to the patients. We conducted a
prospective pre–post-intervention study from March 2018 to March 2020 and
included patients and residents of the community-based university-affiliated
Internal Medicine Residency Program. Residents’ communication was evaluated
through resident surveys and results were shared with them and attending
physicians within 48 h. To correlate with the effect over a 4-year period, 839
HCAHPS surveys were obtained for attending physicians as an outcome measure. The
mean overall HCAHPS score and doctor's communication scores increased by 8.52
and 6.06 points post-intervention. The doctor's performance score for respect
increased by 6.18 points, listening increased by 3.12 points, and explanation
increased by 8.23 points. This study demonstrates that timely, structured, and
individualized resident feedback in an academic medicine service can result in a
sustainable increase in the attendings’ overall HCAHPS and doctor's
communication scores.
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Affiliation(s)
| | | | - Tyler Kemnic
- Michigan State University, East Lansing, MI, USA
| | - Ling Wang
- Michigan State University, East Lansing, MI, USA
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Parast L, Mathews M, Martino S, Lehrman WG, Stark D, Elliott MN. Racial/Ethnic Differences in Emergency Department Utilization and Experience. J Gen Intern Med 2022; 37:49-56. [PMID: 33821410 PMCID: PMC8021298 DOI: 10.1007/s11606-021-06738-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous work has demonstrated racial/ethnic differences in emergency department (ED) utilization, but less is known about racial/ethnic differences in the experience of care received during an ED visit. OBJECTIVE To examine differences in self-reported healthcare utilization and experiences with ED care by patients' race/ethnicity. DESIGN Adult ED patients discharged to community (DTC) were surveyed (response rate: 20.25%) using the Emergency Department Patient Experience of Care (EDPEC) DTC Survey. Linear regression was used to estimate case-mix-adjusted differences in patient experience between racial/ethnic groups. PARTICIPANTS 3122 survey respondents who were discharged from the EDs of 50 hospitals nationwide January-March 2016. MAIN MEASURES Six measures: getting timely care, doctor and nurse communication, communication about medications, receipt of sufficient information about test results, whether hospital staff discussed the patient's ability to receive follow-up care, and willingness to recommend the ED. KEY RESULTS Black and Hispanic patients were significantly more likely than White patients to report visiting the ED for an ongoing health condition (40% Black, 30% Hispanic, 28% White, p<0.001), report having visited an ED 3+ times in the last 6 months (26% Black, 25% Hispanic, 19% White, p<0.001), and report not having a usual source of care (19% Black, 19% Hispanic, 8% White, p<0.001). Compared with White patients, Hispanic patients more often reported that hospital staff talked with them about their ability to receive needed follow-up care (+7.2 percentile points, p=0.038) and recommended the ED (+7.2 points, p=0.037); Hispanic and Black patients reported better doctor and nurse communication (+6.4 points, p=0.008; +4 points, p=0.036, respectively). CONCLUSIONS Hispanic and Black ED patients reported higher ED utilization, lacked a usual source of care, and reported better experience with ED care than White patients. Results may reflect differences in care delivery by staff and/or different expectations of ED care among Hispanic and Black patients.
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Affiliation(s)
- Layla Parast
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Megan Mathews
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Steven Martino
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | | | - Debra Stark
- Centers for Medicare & Medicaid Services, Baltimore, MD, 21244, USA
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
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Pompili C, Scheenstra B, Zirafa C, Melfi F, De Rosis S, Vainieri M, Lau K, Sardari Nia P. The role of patient-reported outcome and experience measures in cardio-thoracic surgery. Interdiscip Cardiovasc Thorac Surg 2022; 38:ivae025. [PMID: 38490192 PMCID: PMC11032704 DOI: 10.1093/icvts/ivae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/08/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Affiliation(s)
| | - Bart Scheenstra
- Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, Netherlands
| | - Carmelina Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Sabina De Rosis
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Milena Vainieri
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Kelvin Lau
- Barts Thorax Centre, St Bartholomew Hospital, London, UK
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, Netherlands
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Rahim AIA, Ibrahim MI, Chua SL, Musa KI. Hospital Facebook Reviews Analysis Using a Machine Learning Sentiment Analyzer and Quality Classifier. Healthcare (Basel) 2021; 9:1679. [PMID: 34946405 PMCID: PMC8701188 DOI: 10.3390/healthcare9121679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 02/05/2023] Open
Abstract
While experts have recognised the significance and necessity of social media integration in healthcare, no systematic method has been devised in Malaysia or Southeast Asia to include social media input into the hospital quality improvement process. The goal of this work is to explain how to develop a machine learning system for classifying Facebook reviews of public hospitals in Malaysia by using service quality (SERVQUAL) dimensions and sentiment analysis. We developed a Machine Learning Quality Classifier (MLQC) based on the SERVQUAL model and a Machine Learning Sentiment Analyzer (MLSA) by manually annotated multiple batches of randomly chosen reviews. Logistic regression (LR), naive Bayes (NB), support vector machine (SVM), and other methods were used to train the classifiers. The performance of each classifier was tested using 5-fold cross validation. For topic classification, the average F1-score was between 0.687 and 0.757 for all models. In a 5-fold cross validation of each SERVQUAL dimension and in sentiment analysis, SVM consistently outperformed other methods. The study demonstrates how to use supervised learning to automatically identify SERVQUAL domains and sentiments from patient experiences on a hospital's Facebook page. Malaysian healthcare providers can gather and assess data on patient care via the use of these content analysis technology to improve hospital quality of care.
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Affiliation(s)
- Afiq Izzudin A. Rahim
- Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (A.I.A.R.); (K.I.M.)
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (A.I.A.R.); (K.I.M.)
| | - Sook-Ling Chua
- Faculty of Computing and Informatics, Multimedia University, Persiaran Multimedia, Cyberjaya 63100, Selangor, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Science, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; (A.I.A.R.); (K.I.M.)
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Kemp KA, Norris CM, Steele B, Fairie P, Santana MJ. Sex Differences in the Care Experiences of Patients Hospitalized Due to Ischemic Heart Disease in Alberta, Canada. CJC Open 2021; 3:S36-S43. [PMID: 34993432 PMCID: PMC8712602 DOI: 10.1016/j.cjco.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Women with heart disease experience disparities in the diagnosis, treatment, and management of their condition. However, it is unknown whether these sex differences exist with respect to in-hospital patient experience. We examined the comprehensive experience of patients hospitalized due to ischemic heart disease (IHD) across Alberta, Canada, according to sex. METHODS Patients completed a modified version of the Canadian Patient Experiences Survey-Inpatient Care (CPES-IC) within 6 weeks of discharge. We examined 37 questions, including 33 regarding specific care processes and 4 global rating scales. Survey responses were reported as raw "top-box" percentages, that is, the most-positive answer choice to each question. Odds and corresponding 95% confidence intervals of women reporting a top-box response were then calculated for each question, while controlling for demographic and clinical factors. RESULTS From April 2014 to March 2020, a total of 5795 surveys (1612 women, 4183 men) were completed. Taking the survey margin of error into account, women had lower top-box percentages on 26 of 37 questions. Similar results were obtained for the adjusted odds of reporting a top-box response. Women did not have a higher percentage of top-box responses on any of the questions studied. CONCLUSIONS This study is a Canadian first, which stratified the experiences of hospitalized patients living with ischemic heart disease according to sex. Our results highlighted important sex differences. Future research to understand the mechanisms associated with these observed sex differences in patient-reported experiences is warranted.
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Affiliation(s)
- Kyle A. Kemp
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research (SPOR), Calgary, Alberta, Canada
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Brian Steele
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Paul Fairie
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research (SPOR), Calgary, Alberta, Canada
| | - Maria J. Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research (SPOR), Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Pollock JR, Arthur JR, Smith JF, Mujahed T, Brinkman JC, Moore ML, Chhabra A. The Majority of Complaints About Orthopedic Sports Surgeons on Yelp Are Nonclinical. Arthrosc Sports Med Rehabil 2021; 3:e1465-72. [PMID: 34746847 DOI: 10.1016/j.asmr.2021.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose To examine and characterize extremely negative Yelp reviews of orthopedic sports surgeons in the United States. Methods A search for reviews was performed using the keywords “Orthopedic Sports Medicine” on Yelp.com for 8 major metropolitan areas. Single-star reviews were isolated for analysis, and individual complaints were then categorized as clinical or nonclinical. The reviews were classified as surgical or nonsurgical. Results A total of 11,033 reviews were surveyed. Of these, 1,045 (9.5%) were identified as 1-star, and 289 were ultimately included in the study. These reviews encompassed 566 total complaints, 133 (23%) of which were clinical, and 433 (77%) of which were nonclinical in nature. The most common clinical complaints concerned complications (32 complaints; 6%), misdiagnosis (29 complaints; 5%), and uncontrolled pain (21 complaints; 4%). The most common nonclinical complaints concerned physicians’ bedside manner (120 complaints; 21%), unprofessional staff (98 complaints; 17%), and finances (78 complaints; 14%). Patients who had undergone surgery wrote 47 reviews that resulted in 114 complaints (20.5% of total complaints), whereas nonsurgical patients were responsible for 242 reviews and a total of 452 complaints (81.3% of total complaints). The difference in the number of complaints by patients after surgery and patients without surgery was statistically significant (P < 0.05) for all categories except for uncontrolled pain, delay in care, bedside manner of midlevel staff, and facilities. Conclusion Our study of extremely negative Yelp reviews found that 77% of negative complaints were nonclinical in nature. The most common clinical complaints were complications, misdiagnoses and uncontrolled pain. Only 16% of 1-star reviews were from surgical patients. Clinical Relevance Patients use online review platforms when choosing surgeons. A comprehensive understanding of factors affecting patient satisfaction and dissatisfaction is needed. The results of our study could be used to guide future quality-improvement measures and to assist surgeons in maintaining favorable online reputations.
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Abstract
BACKGROUND Health care organizations strive to improve patient care experiences. Some use one-on-one provider counseling (shadow coaching) to identify and target modifiable provider behaviors. OBJECTIVE We examined whether shadow coaching improves patient experience across 44 primary care practices in a large urban Federally Qualified Health Center. RESEARCH DESIGN Seventy-four providers with "medium" (ie, slightly below average) overall provider ratings received coaching and were compared with 246 uncoached providers. We fit mixed-effects regression models with random effects for provider (level of treatment assignment) and fixed effects for time (linear spline with a knot and "jump" at coaching date), patient characteristics and site indicators. By design, coached providers performed worse at selection; models account for the very small (0.2 point) regression-to-the-mean effects. We assessed differential effects by coach. SUBJECTS A total of 46,452 patients (from 320 providers) who completed the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) Visit Survey 2.0. MEASURES CAHPS overall provider rating and provider communication composite (scaled 0-100). RESULTS Providers not chosen for coaching had a nonsignificant change in performance during the period when selected providers were coached. We observed a statistically significant 2-point (small-to-medium) jump among coached providers after coaching on the CAHPS overall provider rating and provider communication score. However, these gains disappeared after 2.5 years; effects differed by coach. CONCLUSIONS Shadow coaching improved providers' overall performance and communication immediately after being coached. Regularly planned shadow coaching "booster" sessions might maintain or even increase the improvement gained in patient experience scores, but research examining additional coaching and optimal implementation is needed.
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Affiliation(s)
| | | | | | - Q Burkhart
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | - Alex Y. Chen
- Health Net, 21650 Oxnard St, Woodland Hills, CA 91367
| | | | - Ron D. Hays
- UCLA David Geffen School of Medicine & Department of Medicine, 1100 Glendon Avenue, Los Angeles, CA 90024-1736
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Larsen EN, Byrnes J, Marsh N, Rickard CM. Patient-reported outcome and experience measures for peripheral venous catheters: a scoping review protocol. Br J Nurs 2021; 30:S30-S35. [PMID: 34723667 DOI: 10.12968/bjon.2021.30.19.s30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this scoping review is to conduct a systematic search and establish the current state of evidence for tools and instruments used to measure self-reported outcomes and experiences, including satisfaction scores, specifically for peripheral venous access devices (PVADs). METHODS A systematic search of the literature will be conducted using medical databases including: MEDLINE (Ovid); CINAHL (EbscoHost); PubMed (NCBI); and Scopus (Elsevier); Google (Scholar); and the Cochrane Central Register of Controlled Trials. Experimental, and observational studies, published in English, after 1990 will be eligible for inclusion if they: consist of (i) a survey, instrument or tool that is designed to (ii) collect outcome, experience and/or satisfaction data, relating to PVAD insertion, care, maintenance and/or removal, among (iii) adult and paediatric participants. CONCLUSIONS PVAD-specific patient-reported outcome and experience measures are necessary for researchers, clinicians and policy decision makers to explore more thoroughly the quality of PVAD care provided, and further inform health economic analyses in the context of quality improvement interventions for vascular access devices. This scoping review will establish the existence-or paucity-of instruments to measure these selfreported outcomes and experiences of PVADs, in order to guide value-based healthcare delivery into the future.
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Pujalte GGA, Effiong II, Bertasi TGO, Bertasi RAO, Rothstein SS, Cudahy R, Hernandez LO, Davlantes TM. Do patients' characteristics influence their healthcare concerns?-A hospital care survey. PLoS One 2021; 16:e0258618. [PMID: 34648582 PMCID: PMC8516281 DOI: 10.1371/journal.pone.0258618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hospital performance is often monitored by surveys that assess patient experiences with hospital care. Certain patient characteristics may shape how some aspects of hospital care are viewed and reported on surveys. Objective The aim of the study was to examine factors considered important to patients and determine whether there were differences in answers based on age, gender, or educational level. Methods Cross-sectional study based on a hospital survey developed via literature review and specialist recommendations. This study included randomly selected patients 18 years or older who were recently admitted to the hospital or admitted more than 50 days before the survey was being applied. Survey domains included age, gender, educational level, factors considered important for the health care in a hospital setting and sources of information about hospital quality used by each subject. Answers description and statistical analysis using Fisher exact test were performed. Results The survey was applied to 262 patients who were admitted under different services. The most important concern reported was the risk of getting a hospital-acquired infection (67.18%), followed by understanding explanation from the doctors’ plans (64.12%) and doctors’ ability to listen carefully (58.78%). Women are more concerned about their risk of falling (p = 0.03). Patients older than 65 years find important that the doctors explain everything in a way they can easily understand (p = 0.02), while lower educated patients consider most if the doctor treats them with courtesy and respect (p = 0.0027). Conclusion Patient characteristics have an effect on how hospital care is perceived. Regardless of the characteristics of the population, the risk of getting an infection was the main concern overall, so it is important that hospitals promote actions to prevent it and share them with patients.
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Affiliation(s)
- George G. A. Pujalte
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Isaac I. Effiong
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Tais G. O. Bertasi
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
- * E-mail:
| | - Raphael A. O. Bertasi
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Susannah S. Rothstein
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Ryan Cudahy
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Lorenzo O. Hernandez
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Timothy M. Davlantes
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
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