1
|
Jesus TS, Struhar J, Zhang M, Lee D, Stern BZ, Heinemann AW, Jordan N, Deutsch A. Near real-time patient experience feedback with data relay to providers: a systematic review of its effectiveness. Int J Qual Health Care 2024; 36:mzae053. [PMID: 38907579 DOI: 10.1093/intqhc/mzae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/14/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024] Open
Abstract
Near Real-Time Feedback (NRTF) on the patient's experience with care, coupled with data relay to providers, can inform quality-of-care improvements, including at the point of care. The objective is to systematically review contemporary literature on the impact of the use of NRTF and data relay to providers on standardized patient experience measures. Six scientific databases and five specialty journals were searched supplemented by snowballing search strategies, according to the registered study protocol. Eligibility included studies in English (2015-2023) assessing the impact of NRTF and data relay on standardized patient-reported experience measures as a primary outcome. Eligibility and quality appraisals were performed by two independent reviewers. An expert former patient (Patient and Family Advisory Council and communication sciences background) helped interpret the results. Eight papers met review eligibility criteria, including three randomized controlled trials (RCTs) and one non-randomized study. Three of these studies involved in-person NRTF prior to data relay (patient-level data for immediate corrective action or aggregated and peer-compared) and led to significantly better results in all or some of the experience measures. In turn, a kiosk-based NRTF achieved no better experience results. The remaining studies were pre-post designs with mixed or neutral results and greater risks of bias. In-person NRTF on the patient experience followed by rapid data relay to their providers, either patient-level or provider-level as peer-compared, can improve the patient experience of care. Reviewed kiosk-based or self-reported approaches combined with data relay were not effective. Further research should determine which approach (e.g. who conducts the in-person NRTF) will provide better, more efficient improvements and under which circumstances.
Collapse
Affiliation(s)
- Tiago S Jesus
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave, Columbus, OH 43210, United States
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
| | - Jan Struhar
- Nerve, Muscle and Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL 60611, United States
| | - Manrui Zhang
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
| | - Dongwook Lee
- Center for Child Development & Research, Sensory EL, ROK; Dept. of Physical Medicine and Rehabilitation Medicine, Korehab Clinic, Building 64 - Ground Floor, F Block - Dubai Healthcare City, Dubai, UAE
| | - Brocha Z Stern
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL 60611, United States
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 5th Ave, Hines, IL 60141, United States
| | - Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL 60611, United States
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
- Center for Health Care Outcomes, RTI International, 10 S. Riverside Plaza #875, Chicago, IL 60606, United States
| |
Collapse
|
2
|
Kitson A, Carr D, Feo R, Conroy T, Jeffs L. The ILC Maine statement: Time for the fundamental care [r]evolution. J Adv Nurs 2024. [PMID: 38379317 DOI: 10.1111/jan.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
AIM The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice. DESIGN Position paper. METHODS This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice. RESULTS The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership. CONCLUSION The ILC Maine Statement calls for ongoing action - [r]evolution - from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems. IMPACT Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally. PATIENT OR PUBLIC CONTRIBUTION Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.
Collapse
Affiliation(s)
- Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Devin Carr
- The International Learning Collaborative, Adelaide, South Australia, Australia
- Maine Medical Center, Portland, Maine, USA
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Lianne Jeffs
- The International Learning Collaborative, Adelaide, South Australia, Australia
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Keshtkar L, Madigan CD, Ward A, Ahmed S, Tanna V, Rahman I, Bostock J, Nockels K, Wang W, Gillies CL, Howick J. The Effect of Practitioner Empathy on Patient Satisfaction : A Systematic Review of Randomized Trials. Ann Intern Med 2024; 177:196-209. [PMID: 38285985 DOI: 10.7326/m23-2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Practitioners who deliver enhanced empathy may improve patient satisfaction with care. Patient satisfaction is associated with positive patient outcomes ranging from medication adherence to survival. PURPOSE To evaluate the effect of health care practitioner empathy on patient satisfaction, using a systematic review of randomized trials. DATA SOURCES Ovid MEDLINE, CINAHL, PsycInfo, Cochrane Central Register of Controlled Trials, and Scopus to 23 October 2023. STUDY SELECTION Randomized trials published in any language that evaluated the effect of empathy on improving patient satisfaction as measured on a validated patient satisfaction scale. DATA EXTRACTION Data extraction, risk-of-bias assessments, and strength-of-evidence assessments were done by 2 independent reviewers. Disagreements were resolved through consensus. DATA SYNTHESIS Fourteen eligible randomized trials (80 practitioners; 1986 patients) were included in the analysis. Five studies had high risk of bias, and 9 had some concerns about bias. The trials were heterogeneous in terms of geographic locations (North America, Europe, Asia, and Africa), settings (hospital and primary care), practitioner types (family and hospital physicians, anesthesiologists, nurses, psychologists, and caregivers), and type of randomization (individual patient or clustered by practitioner). Although all trials suggested a positive change in patient satisfaction, inadequate reporting hindered the ability to draw definitive conclusions about the overall effect size. LIMITATIONS Heterogeneity in the way that empathy was delivered and patient satisfaction was measured and incomplete reporting leading to concerns about the certainty of the underpinning evidence. CONCLUSION Various empathy interventions have been studied to improve patient satisfaction. Development, testing, and reporting of high-quality studies within well-defined contexts is needed to optimize empathy interventions that increase patient satisfaction. PRIMARY FUNDING SOURCE Stoneygate Trust. (PROSPERO: CRD42023412981).
Collapse
Affiliation(s)
- Leila Keshtkar
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | - Claire D Madigan
- Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom (C.D.M.)
| | - Andy Ward
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | | | - Vinay Tanna
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, United Kingdom (V.T.)
| | - Ismail Rahman
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | | | - Keith Nockels
- Library and Learning Services, University of Leicester, Leicester, United Kingdom (K.N.)
| | - Wen Wang
- School of Business, University of Leicester, Leicester, United Kingdom (W.W.)
| | - Clare L Gillies
- Leicester Real World Evidence Unit, University of Leicester, Leicester, United Kingdom (C.L.G.)
| | - Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| |
Collapse
|
4
|
Surani A, Hammad M, Agarwal N, Segon A. The Impact of Dynamic Real-Time Feedback on Patient Satisfaction Scores. J Gen Intern Med 2023; 38:361-365. [PMID: 35476239 PMCID: PMC9905394 DOI: 10.1007/s11606-022-07614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Providers' communication skills have a significant impact on patients' satisfaction. Improved patients' satisfaction has been positively correlated with various healthcare and financial outcomes. Patients' satisfaction in the inpatient setting is measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In this study, we evaluated the impact of dynamic real-time feedback to the providers on the HCAHPS scores. METHODS This was a randomized study conducted at our 550-bed level-1 tertiary care center. Twenty-six out of 27 hospitalists staffing our 12 medicine teams (including teams containing advanced practice providers (APPs) and house-staff teams) were randomized into intervention and control groups. Our research assistant interviewed 1110 patients over a period of 7 months and asked them the three provider communication-specific questions from the HCAHPS survey. Our intervention was a daily computer-generated email which alerted providers to their performance on HCAHPS questions (proportions of "always" responses) along with the performance of their peers and Medicare benchmarks. RESULTS The intervention and control groups were similar with regard to baseline HCAHPS scores and clinical experience. The proportion of "always" responses to the three questions related to provider communication was statistically significantly higher in the intervention group compared to the control group (86% vs 80.5%, p-value 0.00001). It was also noted that the HCAHPS scores were overall lower on the house-staff teams and higher on the teams with APPs. CONCLUSION Real-time patients' feedback to inpatient providers with peer comparison via email has a positive impact on the provider-specific HCAHPS scores.
Collapse
Affiliation(s)
- Asif Surani
- Medical College of Wisconsin, Milwaukee, USA
| | | | | | - Ankur Segon
- UT Health San Antonio-Long School of Medicine, San Antonio, USA
| |
Collapse
|
5
|
Oakman N, Driver D, Berlacher M, Warsi M, Chu ES. The inpatient experience of emerging adults in the United States. Hosp Pract (1995) 2022; 50:400-406. [PMID: 36154533 DOI: 10.1080/21548331.2022.2129176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES : Emerging adults transitioning from pediatric to adult care experience worse outcomes including increased mortality. Improved patient experience (PEX) correlates with decreased inpatient mortality and better adherence to quality guidelines. We aimed to evaluate trends in the PEX of inpatients aged 14-29 years in the United States (US). METHODS : We performed a retrospective cohort study using a national, de-identified PEX survey obtained from hospitalized patients aged 14-29 years between 2017 and 2019. We described and compared survey responses across 10 domains. Composite mean scores for each health facility were converted to percentile rankings, which were then compared by age group to determine differences in percentile ranking (■PR). RESULTS We evaluated the results of 174,174 PEX surveys across a national sample of 1519 US hospitals. The PEX percentile rankings for ages 18-21 were lower than ages 14-17 in almost every domain including experience with nurses (■PR=43.4, p<0.001), physicians (■PR=31.1, p<0.001), treatment (■PR=12.3, p<0.001), and overall experience (■PR=26.5, p<0.001). Similarly, 22-25-year-olds reported a worse PEX across nearly all domains when compared to 26-29-year-olds. CONCLUSION : In a national sample of PEX surveys, hospitalized emerging adults aged 18-25 reported worse PEX when compared to both older children and established adults. These lower ratings were most strongly attributed to people, processes, and relationships as opposed to differences in the hospital environment. By ages 26-29, PEX returned to levels similar to those reported by ages 14-17. These results suggest that further investigation to elucidate the unique needs of hospitalized emerging adults may be warranted.
Collapse
Affiliation(s)
- Nicole Oakman
- Department of Pediatrics, Division of Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Daniel Driver
- Department of Internal Medicine, Division of Hospital Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Michelle Berlacher
- Department of Pediatrics, Division of Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Maryam Warsi
- Department of Internal Medicine, Division of Hospital Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390.,Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, 1100 Fairview Ave. N., Seattle, Washington 98109
| | - Eugene S Chu
- Department of Internal Medicine, Division of Hospital Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| |
Collapse
|
6
|
Kynoch K, Ameen M, Ramis MA, Khalil H. Use of Patient-Reported Data within the Acute Healthcare Context: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11160. [PMID: 36141433 PMCID: PMC9517657 DOI: 10.3390/ijerph191811160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
Patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs) and patient satisfaction surveys provide important information on how care can be improved. However, data collection does not always translate to changes in practice or service delivery. This scoping review aimed to collect, map and report on the use of collected patient-reported data used within acute healthcare contexts for improvement to care or processes. Using JBI methods, an extensive search was undertaken of multiple health databases and trial registries for published and unpublished studies. The concepts of interest included the types and characteristics of published patient experience and PROMs research, with a specific focus on the ways in which data have been applied to clinical practice. Barriers and facilitators to the use of collected data were also explored. From 4057 records, 86 papers were included. Most research was undertaken in North America, Canada or the UK. The Hospital Consumer Assessment of Healthcare Providers and Systems tool (HCAHPS) was used most frequently for measuring patient satisfaction. Where reported, data were applied to improve patient-centred care and utilization of health resources. Gaps in the use of patient data within hospital services are noticeable. Engaging management and improving staff capability are needed to overcome barriers to implementation.
Collapse
Affiliation(s)
- Kathryn Kynoch
- Mater Health and Queensland Centre for Evidence Based Nursing and Midwifery, A JBI Centre of Excellence, Brisbane 4006, Australia
| | - Mary Ameen
- Faculty of Medicine, Nursing and Health Sciences, Monash Rural Health Churchill, Monash University, Churchill 3842, Australia
| | - Mary-Anne Ramis
- Mater Health and Queensland Centre for Evidence Based Nursing and Midwifery, A JBI Centre of Excellence, Brisbane 4006, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia
| |
Collapse
|
7
|
Collins HK. When Listening is Spoken. Curr Opin Psychol 2022; 47:101402. [DOI: 10.1016/j.copsyc.2022.101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/03/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
|
8
|
Arditi C, Peytremann-Bridevaux I. Quality of Cancer Care in Switzerland: Going Beyond Traditional Quality Indicators by Collecting Patient-Reported Experiences of Cancer Care. Public Health Rev 2022; 43:1604813. [PMID: 35655961 PMCID: PMC9153851 DOI: 10.3389/phrs.2022.1604813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background: High-quality cancer care should be effective, safe, accessible, efficient, equitable, and responsive to patients’ needs. In Switzerland, information on the safety and effectiveness of cancer care is available, but not on responsiveness. Systematic and comprehensive reports from patients on cancer care are missing and needed to complete the assessment of the quality of cancer care. Evidence: Patient-reported experiences of cancer care are key to evaluate responsiveness of care and drive quality improvement initiatives in oncology practice. Studies have found that responsive care leads to more positive experiences of care, which can lead to more effective treatments and health benefits. Policy Options and Recommendations: Our first recommendation is to develop a position statement on the importance and value of patient-reported experiences of cancer care. Our second recommendation is to systematically collect patients’ experiences of cancer care at the national level, through a dedicated national cancer-specific measurement program or through the integration of patient-reported experiences measures in cancer registries. Conclusion: The systematic collection of patient-reported experiences of cancer care provides essential information on what matters to patients in addition to traditional clinical information, including patients as partners of the overall assessment of healthcare performance.
Collapse
|
9
|
Emmamally W, Erlingsson C, Brysiewicz P. In-hospital interventions to promote relational practice with families in acute care settings: A scoping review. Health SA 2022; 27:1694. [PMID: 35281289 PMCID: PMC8905429 DOI: 10.4102/hsag.v27i0.1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/29/2021] [Indexed: 11/05/2022] Open
Abstract
Relational practice is characterised by genuine interaction between families and healthcare professionals that promotes trust and empowerment. Positive clinical outcomes have been associated with relational practice. To assess and examine in-hospital interventions designed to promote relational practice with families in acute care settings of emergency departments, intensive care units and high care units. The preferred reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the design of this scoping review. To identify relevant studies, databases (Academic Search Complete; CINAHL; PubMed; PsyInfo) and the search engine Google Scholar were searched using terms for core elements of relational practice and family engagement. Of the 117 articles retrieved, eight interventional studies met the search criteria. The interventions focused on relational practice elements of collaborating with and creating safe environments for families, whilst only one addressed healthcare professionals being respectful of families’ needs and differences. In relation to the nature of engagement of families in interventions, the focus was mainly on improving family functioning. Family engagement in the interventions was focused on involving families in decision-making. The scoping review revealed a limited number of in-hospital interventions designed to promote relational practice with families in acute care settings. Further research is encouraged to develop such interventions.
Collapse
Affiliation(s)
- Waheedha Emmamally
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Christen Erlingsson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Petra Brysiewicz
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
10
|
Merker VL, Knight P, Radtke HB, Yohay K, Ullrich NJ, Plotkin SR, Jordan JT. Awareness and agreement with neurofibromatosis care guidelines among U.S. neurofibromatosis specialists. Orphanet J Rare Dis 2022; 17:44. [PMID: 35144646 PMCID: PMC8832755 DOI: 10.1186/s13023-022-02196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/30/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The neurofibromatoses (NF) are a group of rare, genetic diseases sharing a predisposition to develop multiple benign nervous system tumors. Given the wide range of NF symptoms and medical specialties involved in NF care, we sought to evaluate the level of awareness of, and agreement with, published NF clinical guidelines among NF specialists in the United States. Methods An anonymous, cross-sectional, online survey was distributed to U.S.-based NF clinicians. Respondents self-reported demographics, practice characteristics, awareness of seven NF guideline publications, and level of agreement with up to 40 individual recommendations using a 5-point Likert scale. We calculated the proportion of recommendations that each clinician rated “strongly agree”, and assessed for differences in guideline awareness and agreement by respondent characteristics. Results Sixty-three clinicians (49% female; 80% academic practice) across > 8 medical specialties completed the survey. Awareness of each guideline publication ranged from 53%-79% of respondents; specialists had higher awareness of publications endorsed by their medical professional organization (p < 0.05). The proportion of respondents who “strongly agree” with individual recommendations ranged from 17%-83%; for 16 guidelines, less than 50% of respondents “strongly agree”. There were no significant differences in overall agreement with recommendations based on clinicians’ gender, race, specialty, years in practice, practice type (academic/private practice/other), practice location (urban/suburban/rural), or involvement in NF research (p > 0.05 for all). Conclusions We identified wide variability in both awareness of, and agreement with, published NF care guidelines among NF experts. Future quality improvement efforts should focus on evidence-based, consensus-driven methods to update and disseminate guidelines across this multi-specialty group of providers. Patients and caregivers should also be consulted to proactively anticipate barriers to accessing and implementing guideline-driven care. These recommendations for improving guideline knowledge and adoption may also be useful for other rare diseases requiring multi-specialty care coordination. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02196-x.
Collapse
Affiliation(s)
- Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, 55 Fruit St, Yawkey 9E, Boston, MA, 02144, USA.,Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Pamela Knight
- Children's Tumor Foundation, New York, NY, 10017, USA
| | - Heather B Radtke
- Children's Tumor Foundation, New York, NY, 10017, USA.,Division of Genetics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Kaleb Yohay
- Department of Neurology, NYU Langone Health, New York, NY, 10017, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, 55 Fruit St, Yawkey 9E, Boston, MA, 02144, USA
| | - Justin T Jordan
- Department of Neurology and Cancer Center, Massachusetts General Hospital, 55 Fruit St, Yawkey 9E, Boston, MA, 02144, USA.
| |
Collapse
|
11
|
Kluger AN, Itzchakov G. The Power of Listening at Work. ANNUAL REVIEW OF ORGANIZATIONAL PSYCHOLOGY AND ORGANIZATIONAL BEHAVIOR 2022. [DOI: 10.1146/annurev-orgpsych-012420-091013] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Listening is associated with and a likely cause of desired organizational outcomes in numerous areas, including job performance, leadership, quality of relationships (e.g., trust), job knowledge, job attitudes, and well-being. To advance understanding of the powerful effects of listening on organizational outcomes, we review the construct of listening, its measurement and experimental manipulations, and its outcomes, antecedents, and moderators. We suggest that listening is a dyadic phenomenon that benefits both the listener and the speaker, including supervisor-subordinate and salesperson-customer dyads. To explain previous findings and generate novel and testable hypotheses, we propose the episodic listening theory: listening can lead to a fleeting state of togetherness, in which dyad members undergo a mutual creative thought process. This process yields clarity, facilitates the generation of novel plans, increases well-being, and strengthens attachment to the conversation partner.
Collapse
Affiliation(s)
- Avraham N. Kluger
- Jerusalem School of Business Administration, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Guy Itzchakov
- Department of Human Services, University of Haifa, Haifa, Israel
| |
Collapse
|
12
|
Khanbhai M, Flott K, Manton D, Harrison-White S, Klaber R, Darzi A, Mayer E. Identifying factors that promote and limit the effective use of real-time patient experience feedback: a mixed-methods study in secondary care. BMJ Open 2021; 11:e047239. [PMID: 34880009 PMCID: PMC8655585 DOI: 10.1136/bmjopen-2020-047239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The Friends and Family Test (FFT) is commissioned by the National Health Service (NHS) in England to capture patient experience as a real-time feedback initiative for patient-centred quality improvement (QI). The aim of this study was to create a process map in order to identify the factors that promote and limit the effective use of FFT as a real-time feedback initiative for patient-centred QI. SETTING This study was conducted at a large London NHS Trust. Services include accident and emergency, inpatient, outpatient and maternity, which routinely collect FFT patient experience data. PARTICIPANTS Healthcare staff and key stakeholders involved in FFT. INTERVENTIONS Semi-structured interviews were conducted on 15 participants from a broad range of professional groups to evaluate their engagement with the FFT. Interview data were recorded, transcribed and analysed for using deductive thematic analysis. RESULTS Concerns related to inefficiency in the flow of FFT data, lack of time to analyse FFT reports (with emphasis on high level reporting rather than QI), insufficient access to FFT reports and limited training provided to understand FFT reports for frontline staff. The sheer volume of data received was not amenable to manual thematic analysis resulting in inability to acquire insight from the free text. This resulted in staff ambivalence towards FFT as a near real-time feedback initiative. CONCLUSIONS The results state that there is too much FFT free text for meaningful analysis, and the output is limited to the provision of sufficient capacity and resource to analyse the data, without consideration of other options, such as text analytics and amending the data collection tool.
Collapse
Affiliation(s)
- Mustafa Khanbhai
- Imperial College London, NIHR Patient and Safety Translational Research Centre, London, UK
| | - Kelsey Flott
- Imperial College London, NIHR Patient and Safety Translational Research Centre, London, UK
| | - Dave Manton
- Imperial College London, NIHR Patient and Safety Translational Research Centre, London, UK
| | | | - Robert Klaber
- Strategy, Research and Innovation, Imperial College Healthcare NHS Trust, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Erik Mayer
- Imperial College London, NIHR Patient and Safety Translational Research Centre, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
13
|
Ryan MC, Ryan WJ, Castro GI, Khlat M, Ryan JG. The Ability of Patients to Correctly Identify Their Hospitalist on a Patient Satisfaction Survey and the Impact of This Factor on Hospitalist Scores. Hosp Top 2021; 101:192-198. [PMID: 34807811 DOI: 10.1080/00185868.2021.2002221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Patient evaluations of their physician have been utilized to evaluate physician performance and calculate hospital reimbursement. Despite the routine use of these evaluations, little research has been done to evaluate the accuracy of these evaluations. We assessed patient's ability to correctly identify the hospitalist providing their care and whether identification of the hospitalist affected the cumulative satisfaction scores. Methods: This prospective observational study was conducted at a suburban voluntary hospital. Hospitalists were evaluated anonymously by their patients over a 4-month period on a questionnaire designed to assess patient satisfaction. Results: One hundred fifty-eight patients evaluated 16 hospitalists yielding an average of 9.9 evaluations per hospitalist. Forty Nine (31%) patients were able to identify their hospitalist. The top score (3) accounted for 76% of patient responses across all questions. Significant differences (p = .0007) existed in the distribution of these scores when patients who could identify their hospitalist was compared with those who couldn't. The variables for effective communication and hospitalist introduction were scored significantly higher by patients who could identify their hospitalist (2.77 vs 2.55; p = .027 and 2.90 vs 2.67; p = .005). Patients of younger age and female gender were more likely identify their hospitalist. Conclusions: Less than one-third of patients were able to correctly identify their hospitalist. The variables for effective communication and hospitalist introduction to the patient were scored significantly higher by patients who could identify their hospitalist. The elimination of scores by patients who could not correctly identify their provider resulted in marked changes in the percentile ranking of these providers.
Collapse
Affiliation(s)
- Michele C Ryan
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - William J Ryan
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Gabriela I Castro
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Mickel Khlat
- RPh-CMO Saint Catherine of Siena Medical Center, Smithtown, NY, USA
| | - James G Ryan
- Emergency Department, Saint Catherine of Siena Medical Center, Smithtown, NY, USA
| |
Collapse
|
14
|
Gibbons C, Porter I, Gonçalves-Bradley DC, Stoilov S, Ricci-Cabello I, Tsangaris E, Gangannagaripalli J, Davey A, Gibbons EJ, Kotzeva A, Evans J, van der Wees PJ, Kontopantelis E, Greenhalgh J, Bower P, Alonso J, Valderas JM. Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice. Cochrane Database Syst Rev 2021; 10:CD011589. [PMID: 34637526 PMCID: PMC8509115 DOI: 10.1002/14651858.cd011589.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.
Collapse
Affiliation(s)
| | - Ian Porter
- Health Services & Policy Research, University of Exeter Medical School, Exeter, UK
| | - Daniela C Gonçalves-Bradley
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stanimir Stoilov
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Elizabeth J Gibbons
- PROM Group, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Kotzeva
- Health Technology Assessment Department, Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Jonathan Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jordi Alonso
- CIBER Epidemiologia y Salud Publica (CIBERESP), IMIM-Hospital del mar, Barcelona, Spain
| | - Jose M Valderas
- Health Services & Policy Research, Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research, NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| |
Collapse
|
15
|
Vilendrer SM, Kling SMR, Wang H, Brown-Johnson C, Jayaraman T, Trockel M, Asch SM, Shanafelt TD. How Feedback Is Given Matters: A Cross-Sectional Survey of Patient Satisfaction Feedback Delivery and Physician Well-being. Mayo Clin Proc 2021; 96:2615-2627. [PMID: 34479736 DOI: 10.1016/j.mayocp.2021.03.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate how variation in the way patient satisfaction feedback is delivered relates to physician well-being and perceptions of its impact on patient care, job satisfaction, and clinical decision making. PARTICIPANTS AND METHODS A cross-sectional electronic survey was sent to faculty physicians from a large academic medical center in March 29, 2019. Physicians reported their exposure to feedback (timing, performance relative to peers, or channel) and related perceptions. The Professional Fulfillment Index captured burnout and professional fulfillment. Associations between feedback characteristics and well-being or perceived impact were tested using analysis of variance or logistic regression adjusted for covariates. RESULTS Of 1016 survey respondents, 569 (56.0%) reported receiving patient satisfaction feedback. Among those receiving feedback, 303 (53.2%) did not believe that this feedback improved patient care. Compared with physicians who never received feedback, those who received any type of feedback had higher professional fulfillment scores (mean, 6.6±2.1 vs 6.3±2.0; P=.03) but also reported an unfavorable impact on clinical decision making (odds ratio [OR], 2.9; 95% CI, 1.8 to 4.7; P<.001). Physicians who received feedback that included one-on-one discussions (as opposed to feedback without this channel) held more positive perceptions of the feedback's impact on patient care (OR, 2.0; 95% CI, 1.3 to 3.0; P=.003), whereas perceptions were less positive in physicians whose feedback included comparisons to named colleagues (OR, 0.5; 95% CI, 0.3 to 0.8; P=.003). CONCLUSION Providing patient satisfaction feedback to physicians was associated with mixed results, and physician perceptions of the impact of feedback depended on the characteristics of feedback delivery. Our findings suggest that feedback is viewed most constructively by physicians when delivered through one-on-one discussions and without comparison to peers.
Collapse
Affiliation(s)
- Stacie M Vilendrer
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford, CA.
| | - Samantha M R Kling
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford, CA
| | - Hanhan Wang
- Stanford Medicine WellMD Center, Stanford School of Medicine, Stanford, CA
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford, CA
| | | | - Mickey Trockel
- Stanford Medicine WellMD Center, Stanford School of Medicine, Stanford, CA; Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA
| | - Steven M Asch
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford, CA; VA Center for Innovation to Implementation, Menlo Park, CA
| | - Tait D Shanafelt
- Stanford Medicine WellMD Center, Stanford School of Medicine, Stanford, CA
| |
Collapse
|
16
|
Brett A, Foster H, Joseph M, Warrington JS. Patient-Centered Telehealth Solution for Observed Urine Collections in Substance Use Disorder Care Delivery During COVID-19 and Beyond. J Patient Exp 2021; 8:23743735211033128. [PMID: 34377769 PMCID: PMC8330461 DOI: 10.1177/23743735211033128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with substance use disorder (SUD) rely upon urine drug testing to support treatment adherence and to mitigate relapse. Before the onset of coronavirus 2019 (COVID-19), the logistical challenges of randomized observed collections for urine drug testing for the patient were significant. During COVID-19, these barriers were often insurmountable. Since SUD patients represent a population at a higher risk for complications from COVID-19, an alternative strategy to support COVID-19 testing was urgently needed. We designed and deployed a telehealth-based solution in which patients could use mobile devices to connect with trained collection professionals to perform observed urine collections, often referred to a UA (urinalysis). The solution was designed with patient-centered best practices for telehealth, stigma prevention, trauma-informed, empathy and compassion, and to remove barriers to access to care. This approach demonstrated high patient satisfaction scores thereby proving that it is possible to provide urine collection services in the patient's home via a telehealth technology, while still upholding SUD testing integrity best practices. This study lays the path for a more patient-centered way to support this population.
Collapse
Affiliation(s)
| | | | | | - Jill S Warrington
- Aspenti Health, South Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, VT, USA
| |
Collapse
|
17
|
Indovina KA, Keniston A, Manchala V, Burden M. Predictors of a Top-Box Patient Experience: A Retrospective Observational Study of HCAHPS Data at a Safety Net Institution. J Patient Exp 2021; 8:23743735211034342. [PMID: 34377774 PMCID: PMC8320559 DOI: 10.1177/23743735211034342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Hospitals commonly seek to improve patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, yet there are limited data to guide improvement efforts. The HCAHPS survey was developed for interhospital comparisons, whereas its use in intrahospital comparisons has not been validated. We sought to better understand the validity of utilizing intrahospital score comparisons and to identify the factors that may predict top-box HCAHPS scores. We performed a retrospective observational cohort study at an academic urban safety-net hospital examining 4898 HCAHPS surveys completed by hospitalized patients. We found that while most Patient-Mix Adjustment factors for which HCAHPS scores are adjusted were associated with top-box scores on intrahospital comparisons, few additional variables were associated with top-box scores. Further, HCAHPS questions pertaining to nurse and doctor communication were highly correlated with overall hospital rating, suggesting that communication-related factors may influence a patient’s hospital experience more strongly than do administrative factors.
Collapse
Affiliation(s)
- Kimberly A Indovina
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Venkata Manchala
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
18
|
Segon A, Segon Y, Kumar V, Kato H. A Qualitative Exploration to Understand Hospitalists' Attitude Toward the Patient Experience Scoring System. J Patient Exp 2021; 7:1036-1043. [PMID: 33457543 PMCID: PMC7786727 DOI: 10.1177/2374373520942418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patient’s perception of their inpatient experience is measured by the Center for Medical Services’ (CMS) administered Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) survey. There is scant existing literature on physicians’ perceptions toward the HCAHPS scoring system. Understanding hospitalist knowledge and attitude toward the HCAHPS survey can help guide efforts to impact HCAHPS survey scores by improving the patient’s perception of their hospital experience. The goal of this study is to explore hospitalists’ knowledge and perspective of the physician communication domain of the HCAHPS survey at an academic medical center. Seven hospitalists at an academic medical center were interviewed for this report using a semistructured interview. Thematic analysis approach was used to analyze data. Open, line-by-line coding was performed on all 7 transcripts. Categories were derived in an inductive fashion. Categories were refined using the techniques of constant comparison and axial coding. We generated themes reflecting hospitalists’ knowledge of the HCAHPS scoring system, their perception of the HCAHPS scoring system and the impact of the HCAHPS scoring system on their practice. While hospitalists acknowledged physician–patient communication is a challenging area to study, they are unlikely to embrace the feedback provided by HCAHPS surveys. There is a need to deploy tactics that provide timely and actionable feedback to providers on their bedside communication skills.
Collapse
Affiliation(s)
- Ankur Segon
- Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Ankur Segon, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Yogita Segon
- Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vivek Kumar
- Digestive Disease Center, UPMC Susquehana Health, Williamsport, PA, USA
| | - Hirotaka Kato
- Division of Hospital Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| |
Collapse
|
19
|
Kumar P, Follen M, Huang CC, Cathey A. Using Laddering Interviews and Hierarchical Value Mapping to Gain Insights Into Improving Patient Experience in the Hospital: A Systematic Literature Review. J Patient Exp 2021; 7:1740-1747. [PMID: 33457638 PMCID: PMC7786779 DOI: 10.1177/2374373520942425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hospitals are continuously facing pressures to mitigate the gap between patient’s expectations and the quality of services provided. Now with Medicare reimbursements tied to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, institutions are attempting interventions to increase satisfaction scores. However, a standard framework to understand patient values and perceptions and subsequently translate it into reliable measures of patient satisfaction does not exist, particularly in the inpatient settings. This article highlights opportunity for the addition of qualitative customer value research to augment the information providers gain from HCAHPS scores and provide additional indicators that can be used in improving the patient experience. In this article, patient laddering interviews and hierarchical value mapping are reviewed as methodologies to understand patient core satisfaction values during their hospital stay. A systematic literature search was performed to identify articles addressing laddering interviews and hierarchical value mapping as applied to health care. Inclusion criteria involved studies relating to health care and using laddering interviews. Exclusion criteria included non-health-care studies. Only 3 studies were found eligible for this review. Our systematic review of literature revealed only few studies which may help to guide us to improve patient experience using laddering interviews. These interviews can help compose a personalized bedside survey which may be more meaningful than current widely used HCAHPS survey.
Collapse
Affiliation(s)
- Pankaj Kumar
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Michele Follen
- Department of Obstetrics and Gynecology, Kings County Hospital, New York City Health and Hospital Corporation, NY, USA
| | - Chi-Cheng Huang
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Amy Cathey
- Haslam College of Business, University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
20
|
Khateeb R, Keniston A, Moore A, Hrach C, Indovina KA, Kneeland P, Rudolph M, Burden M. Perspectives on Patient Experience: A National Survey of Hospitalists. J Patient Exp 2020; 7:1482-1490. [PMID: 33457605 PMCID: PMC7786688 DOI: 10.1177/2374373520948669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite efforts to improve patient experience (PX), little is known about the perspective of hospitalists regarding PX initiatives and priorities. A survey was distributed to hospitalist groups across the country assessing involvement in PX initiatives and their perceived effectiveness, what PX means to providers, and facilitators/barriers in improving PX. Ninety-nine percent of respondents had encountered some improvement activity around PX. The most prevalent were communication training, group Hospital Consumer Assessment of Healthcare Providers and Systems data, and interdisciplinary bedside rounding. Respondents rated most initiatives a 5 to 6 out of 10 for their effectiveness, with the perception of effectiveness increasing with respondents' assessment of patient experience priority. Learning about others' experiences in improving PX and learning about potential collaborations for quality improvement or research in these areas were areas of interest for future work. Qualitative work highlighted potential barriers in improving PX such as workload and staffing constraints, uncontrollable environmental factors, and unrealistic patient expectations. Improving PX is a priority, and there are many initiatives in place with perceived variable success and perceived barriers in improving PX.
Collapse
Affiliation(s)
- Rafina Khateeb
- Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amber Moore
- Division of Hospital Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christine Hrach
- Division of Hospitalist Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kimberly A Indovina
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Denver Health, Denver, CO, USA
| | - Patrick Kneeland
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
21
|
Emmamally W, Erlingsson C, Brysiewicz P. Describing healthcare providers' perceptions of relational practice with families in the emergency department: A qualitative study. Curationis 2020; 43:e1-e7. [PMID: 33179946 PMCID: PMC7670033 DOI: 10.4102/curationis.v43i1.2155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/06/2020] [Accepted: 08/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background Emergency departments are regarded as stressful working environments, associated with staff shortages, increased patient numbers and long waiting times. Increased organisational demands for performance can compromise genuine interactions between families and healthcare providers working in emergency departments. A relational practice approach in caring for families can enhance the capability of healthcare providers to simultaneously overcome these difficulties and provide emergency healthcare of high quality. Objectives The purpose of the study was to describe healthcare providers’ perceptions of relational practice with families in three emergency departments in KwaZulu-Natal, South Africa. Method Using a qualitative descriptive approach data were collected through semi-structured interviews with healthcare providers working in emergency departments. The data were analysed and categorised using qualitative content analysis. Results Four categories emerged from data analysis: (1) families and healthcare providers connecting; (2) recognising the uniqueness of families; (3) caring interactions; and (4) taking charge when necessary. Conclusion The study elicited that healthcare providers working in emergency departments perceived that despite high patient volumes and resource constraints, collaborative relationships with families were important. However, these collaborative relationships cannot be willed into practice, instead training workshops are needed to develop relational skills of healthcare providers which can facilitate family and healthcare professional collaboration.
Collapse
Affiliation(s)
- Waheedha Emmamally
- Discipline of Nursing, College of health Sciences, University of KwaZulu-Natal, Durban.
| | | | | |
Collapse
|
22
|
Dow AW, Chopski B, Cyrus JW, Paletta-Hobbs LE, Qayyum R. A STEEEP Hill to Climb: A Scoping Review of Assessments of Individual Hospitalist Performance. J Hosp Med 2020; 15:599-605. [PMID: 32966195 DOI: 10.12788/jhm.3445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although ensuring high-quality care requires assessment of individual hospitalist performance, current assessment approaches lack consistency and coherence. The Institute of Medicine's STEEEP framework for quality healthcare conceptualizes quality through domains of "Safe," "Timely," "Effective," "Efficient," "Equitable," and "Patient Centered." This framework may be applicable to assessing individual hospitalists. OBJECTIVE This scoping review sought to identify studies that describe variation in individual hospitalist performance and to code this data to the domains of the STEEEP framework. METHODS Via a systematic search of peer-reviewed literature that assessed the performance of individual hospitalists in the Medline database, we identified studies that described measurement of individual hospitalist performance. Forty-two studies were included in the final review and coded into one or more domains of the STEEEP framework. RESULTS Studies in the Safe domain focused on transitions of care, both at discharge and within the hospital. Many studies were coded to more than one domain, especially Timely, Effective, and Efficient. Examples include adherence to evidence-based guidelines or Choosing Wisely recommendations. The Patient Centered domain was most frequently coded, but approaches were heterogeneous. No included studies addressed the domain Equitable. CONCLUSIONS Applying the STEEEP framework to the published literature on assessment of individual hospitalist performance revealed strengths and weaknesses. Areas of strength were assessments of transitions of care and application of consensus guidelines. Other areas, such as equity and some components of safe practice, need development. All domains would benefit from more practical approaches. These findings should stimulate future work on feasibility of multidimensional assessment approaches.
Collapse
Affiliation(s)
- Alan W Dow
- Division of Hospital Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Benjamin Chopski
- Division of Hospital Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - John W Cyrus
- Tompkins-McCaw Library for the Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Laura E Paletta-Hobbs
- Division of Hospital Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Rehan Qayyum
- Division of Hospital Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
23
|
Krouss M, Bedell D, Solly T, Phillips G, Hermele J, Ojo A, Fasihuddin F, Atreja A, Dunn A, Cho HJ. Project TOPS: Team-Based Oversight of Patient Satisfaction Through Real-Time Interdisciplinary Feedback. Jt Comm J Qual Patient Saf 2020; 46:427-430. [DOI: 10.1016/j.jcjq.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
|
24
|
Robillard JM, Bourne SC, Tam MT, Page PM, Lamb EA, Gogal C, Skarsgard ED, Afshar K. Improving the paediatric surgery patient experience: an 8-year analysis of narrative quality data. BMJ Open Qual 2020; 9:bmjoq-2020-000924. [PMID: 32381597 PMCID: PMC7223344 DOI: 10.1136/bmjoq-2020-000924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/20/2020] [Accepted: 04/21/2020] [Indexed: 12/03/2022] Open
Abstract
Background Narrative data about the patient experience of surgery can help healthcare professionals and administrators better understand the needs of patients and their families as well as provide a foundation for improvement of procedures, processes and services. However, units often lack a methodological framework to analyse these data empirically and derive key areas for improvement. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is aimed at improving the quality of surgical care by collecting patient data and reporting risk-adjusted surgical outcomes for each participant hospital in the programme. Though qualitative data about patient experience are captured as part of the NSQIP database, to date no framework or methodology has been proposed, or reported on, to analyse these data for the purposes of quality improvement. The goal of this study was to demonstrate the feasibility of using content analysis to empirically derive key areas for quality improvement from a sample of 3601 narrative comments about paediatric surgery from patients and families at British Columbia Children’s Hospital. Study design Thematic content analysis conducted on a total of 3601 patient and family narratives received between 2011 and 2018. Results Overall satisfaction with care was high and experiences with healthcare providers at the hospital were positive. Areas for improvement were identified in the themes of health outcomes, communication and surgery timelines. Results informed follow-up interprofessional quality improvement initiatives. Conclusions Recording and analysing patient experience data as part of validated quality improvement programmes such as ACS NSQIP can provide valuable and actionable information to improve quality of care.
Collapse
Affiliation(s)
- Julie M Robillard
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada .,BC Children's & Women's Hospitals, Vancouver, British Columbia, Canada
| | - Stephanie C Bourne
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's & Women's Hospitals, Vancouver, British Columbia, Canada
| | - Mallorie T Tam
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's & Women's Hospitals, Vancouver, British Columbia, Canada
| | - Patricia M Page
- Department of Procedures and Surgical Services, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Elizabeth A Lamb
- Department of Procedures and Surgical Services, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Carmina Gogal
- Department of Procedures and Surgical Services, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Erik D Skarsgard
- Department of Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Kourosh Afshar
- Department of Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
25
|
Zakare-Fagbamila RT, Howell E, Choi AY, Cheng TZ, Clement M, Neely M, Gottfried ON. Clinic Satisfaction Tool Improves Communication and Provides Real-Time Feedback. Neurosurgery 2020; 84:908-918. [PMID: 29669027 DOI: 10.1093/neuros/nyy137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported assessments of the clinic experience are increasingly important for improving the delivery of care. The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is the current standard for evaluating patients' clinic experience, but its format gives 2-mo delayed feedback on a small proportion of patients in clinic. Furthermore, it fails to give specific actionable results on individual encounters. OBJECTIVE To develop and assess the impact of a single-page Clinic Satisfaction Tool (CST) to demonstrate real-time feedback, individualized responses, interpretable and actionable feedback, improved patient satisfaction and communication scores, increased physician buy-in, and overall feasibility. METHODS We assessed CST use for 12 mo and compared patient-reported outcomes to the year prior. We assessed all clinic encounters for patient satisfaction, all physicians for CG-CAHPS global rating, and physician communication scores, and evaluated the physician experience 1 yr after implementation. RESULTS During implementation, 14 690 patients were seen by 12 physicians, with a 96% overall CST utilization rate. Physicians considered the CST superior to CG-CAHPS in providing immediate feedback. CG-CAHPS global scores trended toward improvement and were predicted by CST satisfaction scores (P < .05). CG-CAHPS physician communication scores were also predicted by CST satisfaction scores (P < .01). High CST satisfaction scores were predicted by high utilization (P < .05). Negative feedback dropped significantly over the course of the study (P < .05). CONCLUSION The CST is a low-cost, high-yield improvement to the current method of capturing the clinic experience, improves communication and satisfaction between physicians and patients, and provides real-time feedback to physicians.
Collapse
Affiliation(s)
| | | | - Ashley Y Choi
- School of Medicine, Duke University, Durham, North Carolina
| | - Tracy Z Cheng
- School of Medicine, Duke University, Durham, North Carolina
| | - Mary Clement
- Department of Musculoskeletal and Spine Services, Duke University Medical Center, Durham, North Carolina
| | - Megan Neely
- Depart-ment of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Oren N Gottfried
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
26
|
Adelman D, Truong Thanh XM, Feuilly M, Houchard A, Cella D. Evaluation of Nurse Preferences Between the Lanreotide Autogel New Syringe and the Octreotide Long-Acting Release Syringe: An International Simulated-Use Study (PRESTO). Adv Ther 2020; 37:1608-1619. [PMID: 32157626 PMCID: PMC7140743 DOI: 10.1007/s12325-020-01255-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Somatostatin analogues are used to treat symptoms and slow tumour progression in patients with neuroendocrine tumours (NETs) and carcinoid syndrome and to reduce hormone secretion and pituitary tumour volume in patients with acromegaly. A new syringe for lanreotide autogel/depot (LAN) was developed following feedback from a human factors study to improve ease of injection compared with previous syringes. PRESTO aimed to assess preferences of nurses between the LAN new syringe and the octreotide long-acting release (LAR) syringe. METHODS PRESTO, a multinational, multicentre, prospective, noninterventional, simulated-use study, enrolled nurses with ≥ 2 years' experience injecting LAN and/or octreotide LAR in patients with NETs and/or acromegaly. Nurses administered injections into pads using the LAN new syringe and octreotide LAR syringe in a randomised sequence. In an anonymous web-based questionnaire, nurses reported their overall preference ('strong' or 'slight'; primary endpoint) and rated and ranked the importance of nine attributes for each syringe (1 [not at all] to 5 [very much]). RESULTS Overall, 90 nurses attended sessions and completed valid questionnaires. Most nurses (97.8%) expressed a preference (85.6% 'strong', 12.2% 'slight') for the LAN new syringe versus the octreotide LAR syringe (P < 0.0001). Attribute performance ratings (1 [not at all] to 5 [very much]) were consistently higher for the LAN new syringe versus the octreotide LAR syringe, with the greatest differences in 'fast administration' and 'confidence the syringe will not be clogged' (mean difference [SD]: 2.6 [1.2] and 2.3 [1.5], respectively; P < 0.0001). The attribute ranked most important was 'confidence the syringe will not be clogged' (24.4%); least important was 'convenience of syringe format, including packaging, from preparation to injection' (34.4%). CONCLUSIONS Nurses preferred the user experience of the LAN new syringe compared with the octreotide LAR syringe, with a particular preference for attributes related to product delivery with the LAN new syringe.
Collapse
Affiliation(s)
- Daphne Adelman
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Marion Feuilly
- Health Economics and Outcomes Research, Ipsen, Boulogne-Billancourt, France
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
27
|
Apker J, Shank S, Baker M, Hatten K, VanSweden S. Observing and Identifying Hospitalist Best Communication Practices in Patient Interactions. Hosp Top 2019; 97:156-164. [PMID: 31530239 DOI: 10.1080/00185868.2019.1667284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study identifies actual hospitalist best communication practices that optimize patient interactions in a busy hospital context. We observed and rated 36 hospitalists and 206 patient encounters using the Kalamazoo Essential Elements of Communication Checklist-Adapted (KEECC-A). We collected descriptive statistics of checklist scores and thematically analyzed fieldnotes to identify communication patterns. Results show hospitalists score highest and most frequently use three of seven KEECC-A dimensions: builds a relationship, shares information, and gathers information. We first identify exemplar behaviors and then provide statistical comparisons by professional and hospital tenure, gender, and day of rounding observed for these three dimensions. Male hospitalists scored higher than females for shares information and significant differences were found for gender between cross-sex patient-hospitalist interactions. Hospitalists early in their professional and hospital tenure received significantly lower ratings than mid-to-late career hospitalists in the three KEECC dimensions. Hospitalists observed on the first day of rounding received significantly higher ratings than those observed on a middle or last day. We offer interpretations to explain study findings and suggest interventions to help hospitalists with less-than-desirable communication skills.
Collapse
Affiliation(s)
- Julie Apker
- School of Communication, Western Michigan University , Kalamazoo, Michigan , USA
| | - Scott Shank
- School of Communication, Western Michigan University , Kalamazoo, Michigan , USA
| | - Maggie Baker
- School of Communication, Western Michigan University , Kalamazoo, Michigan , USA
| | - Kristen Hatten
- School of Communication, Western Michigan University , Kalamazoo, Michigan , USA
| | - Sally VanSweden
- Internal Medicine Hospital Specialists, Bronson HealthCare Group , Kalamazoo, Michigan , USA
| |
Collapse
|
28
|
Abstract
BACKGROUND Treating patients with courtesy and respect has quality, ethical, and fiscal ramifications. PURPOSE This qualitative study revealed meanings of nurse courtesy and respect as imbedded in nurse and patient stories. METHODS Audio-recorded interviews were collected from 15 registered nurses and 17 patients on a medical-surgical unit in a 377-bed, nonprofit, Magnet-recognized facility. RESULTS Six themes related to courtesy and respect emerged during descriptive content analysis by 2 researchers: (1) being attentive (with subthemes taking time, physical care, and proactive engagement); (2) giving empathetic support; (3) honoring culture and beliefs; (4) recognizing the family; (5) recognizing patient space; and (6) recognizing personhood (with subthemes of showing ordinary politeness and recognizing the individual and honoring choices). CONCLUSIONS Informants' stories contributed toward a better understanding of what it means to treat patients with courtesy and respect; and they created context for interpreting HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) numerical results. Further research is warranted.
Collapse
|
29
|
Xiao M, St Hill CA, Vacquier M, Patel L, Mink P, Fernstrom K, Kirven J, Jeruzal J, Beddow D. Retrospective Analysis of the Effect of Postdischarge Telephone Calls by Hospitalists on Improvement of Patient Satisfaction and Readmission Rates. South Med J 2019; 112:357-362. [PMID: 31282963 DOI: 10.14423/smj.0000000000000994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The influence of postdischarge telephone call interventions preventing hospital readmissions is unclear. A novel approach of the discharging hospitalist providing this intervention may improve overall patient satisfaction. Our objective was to assess the impact of postdischarge telephone calls from discharging hospitalists on readmissions and patients' ratings of hospital care and hospitalist communication. METHODS Data were retrospectively collected from patients' electronic health records at a 167-bed hospital in Fridley, Minnesota and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients were 18 years old or older and diagnosed as having nonpsychiatric conditions. Telephone calls were made by the discharging hospitalist to adult patients discharged to home with or without home care services between February 28, 2015 and February 29, 2016. Multivariate logistic regression models were used to evaluate associations of postdischarge telephone calls with global hospital care rating and hospitalist communication from HCAHPS, and 30-day readmission rates from electronic health records. RESULTS Of 4490 eligible patients, 1067 had completed telephone calls (23.8%). The intervention was associated with a statistically significant improvement in the responses to HCAHPS overall hospital rating and HCAHPS doctor communication questions (adjusted odds ratio 1.52, P = 0.04 and adjusted odds ratio 1.56, P = 0.021) that varied by patient age at first admission (P = 0.001 and P = 0.101). With longer inpatient lengths of stay, 30-day readmission rates improved after patients received a postdischarge telephone call, but this outcome was not statistically significant. CONCLUSIONS This study revealed that postdischarge telephone calls from discharging hospitalists increased patient satisfaction. Further research is needed to understand the causal relationships among the intervention, 30-day hospital readmission rates, and inpatient length of stay.
Collapse
Affiliation(s)
- Mengli Xiao
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Catherine A St Hill
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Marc Vacquier
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Love Patel
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Pamela Mink
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Karl Fernstrom
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Justin Kirven
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - Jessica Jeruzal
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| | - David Beddow
- From Care Delivery Research, Allina Health, Minneapolis, Abbott Northwestern Hospital, Allina Health, Minneapolis, and Unity Campus of Mercy Hospital, Allina Health, Fridley, Minnesota
| |
Collapse
|
30
|
McCaffrey R, Hale D, Kunupakaphun S, Kaufman L, Eamranond P. A Multifaceted Approach to Improve Physician Communication Scores. J Patient Exp 2019; 7:522-526. [PMID: 33062873 PMCID: PMC7534122 DOI: 10.1177/2374373519860041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Improving patient satisfaction scores has become a key focus of health-care organizations nationwide but can be a struggle for community hospitals with constrained resources, and particularly challenging for hospitalist programs due to provider variance and turnover. Using the framework of appreciative inquiry, we implemented a multipronged intervention including a rounding model whereby hospitalist leaders rounded on patients and relayed commentary back to their hospitalist providers. We communicated positive feedback preferentially over negative feedback to the entire hospitalist group through regular communication. Providers were encouraged to employ best practices including sitting with the patient, reviewing recommendations using teach back, and providing business cards. Scores improved in the physician communication category by approximately 1% annually from fiscal year 2015 through 2018, with our percentile rank improving 35 percentile points during that time. These findings indicate that a multifaceted approach including best practices is associated with improved patient experience regarding communication with physicians.
Collapse
Affiliation(s)
| | - Dane Hale
- Lawrence General Hospital, Lawrence, MA, USA
| | | | - Laura Kaufman
- Lawrence General Hospital, Lawrence, MA, USA.,Greater Lawrence Family Health Center, Lawrence, MA, USA
| | - Pracha Eamranond
- Lawrence General Hospital, Lawrence, MA, USA.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
31
|
Bastemeijer CM, Boosman H, van Ewijk H, Verweij LM, Voogt L, Hazelzet JA. Patient experiences: a systematic review of quality improvement interventions in a hospital setting. Patient Relat Outcome Meas 2019; 10:157-169. [PMID: 31191062 PMCID: PMC6535098 DOI: 10.2147/prom.s201737] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/09/2019] [Indexed: 01/17/2023] Open
Abstract
Purpose: In the era of value-based healthcare, one strives for the most optimal outcomes and experiences from the perspective of the patient. So, patient experiences have become a key quality indicator for healthcare. While these are supposed to drive quality improvement (QI), their use and effectiveness for this purpose has been questioned. The aim of this systematic review was to provide insight into QI interventions used in a hospital setting and their effects on improving patient experiences, and possible barriers and promoters for QI work. Methods: Prisma guidelines were used to design this review. International academic literature was searched in Embase, Medline OvidSP, Web of Science, Cochrane Central, PubMed Publisher, Scopus, PsycInfo, and Google Scholar. In total, 3,289 studies were retrieved and independently screened by the first two authors for eligibility and methodological quality. Data was extracted on the study purpose, setting, design, targeted patient experience domains, QI strategies, results of QI, barriers, and promotors for QI. Results: Twenty-one pre-post intervention studies were included for review. The methodological quality of the included studies was assessed using a Critical Appraisal Skills Program (CASP) Tool. QI strategies used were staff education, patient education, audit and feedback, clinician reminders, organizational change, and policy change. Twenty studies reported improvement in patient experience, 14 studies of the 21 included studies reported statistical significance. Most studies (n=17) reported data-related barriers (eg, questionnaire quality), professional, and/or organizational barriers (eg, skepticism among staff), and 14 studies mentioned specific promoters (eg, engaging staff and patients) for QI. Conclusions: Several patient experience domains are targeted for QI using diverse strategies and methodological approaches. Most studies reported at least one improvement and also barriers and promoters that may influence QI work. Future research should address these barriers and promoters in order to enhance methodological quality and improve patient experiences.
Collapse
Affiliation(s)
- Carla M Bastemeijer
- MMT, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hileen Boosman
- Department of Quality & Patient Safety, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans van Ewijk
- Department of Normative Professionalization, University of Humanistic Studies, Utrecht, the Netherlands
| | - Lisanne M Verweij
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lennard Voogt
- Department of Physical Therapy Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
32
|
Khanbhai M, Flott K, Darzi A, Mayer E. Evaluating Digital Maturity and Patient Acceptability of Real-Time Patient Experience Feedback Systems: Systematic Review. J Med Internet Res 2019; 21:e9076. [PMID: 31344680 PMCID: PMC6682271 DOI: 10.2196/jmir.9076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 04/24/2018] [Accepted: 09/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background One of the essential elements of a strategic approach to improving patients’ experience is to measure and report on patients’ experiences in real time. Real-time feedback (RTF) is increasingly being collected using digital technology; however, there are several factors that may influence the success of the digital system. Objective The aim of this review was to evaluate the digital maturity and patient acceptability of real-time patient experience feedback systems. Methods We systematically searched the following databases to identify papers that used digital systems to collect RTF: The Cochrane Library, Global Health, Health Management Information Consortium, Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, Web of Science, and CINAHL. In addition, Google Scholar and gray literature were utilized. Studies were assessed on their digital maturity using a Digital Maturity Framework on the basis of the following 4 domains: capacity/resource, usage, interoperability, and impact. A total score of 4 indicated the highest level of digital maturity. Results RTF was collected primarily using touchscreens, tablets, and Web-based platforms. Implementation of digital systems showed acceptable response rates and generally positive views from patients and staff. Patient demographics according to RTF responses varied. An overrepresentation existed in females with a white predominance and in patients aged ≥65 years. Of 13 eligible studies, none had digital systems that were deemed to be of the highest level of maturity. Three studies received a score of 3, 2, and 1, respectively. Four studies scored 0 points. While 7 studies demonstrated capacity/resource, 8 demonstrated impact. None of the studies demonstrated interoperability in their digital systems. Conclusions Patients and staff alike are willing to engage in RTF delivered using digital technology, thereby disrupting previous paper-based feedback. However, a lack of emphasis on digital maturity may lead to ineffective RTF, thwarting improvement efforts. Therefore, given the potential benefits of RTF, health care services should ensure that their digital systems deliver across the digital maturity continuum.
Collapse
Affiliation(s)
- Mustafa Khanbhai
- Centre for Health Policy, Imperial College London, London, United Kingdom
| | - Kelsey Flott
- Centre for Health Policy, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Centre for Health Policy, Imperial College London, London, United Kingdom
| | - Erik Mayer
- Centre for Health Policy, Imperial College London, London, United Kingdom
| |
Collapse
|
33
|
Lalani M, Baines R, Bryce M, Marshall M, Mead S, Barasi S, Archer J, Regan de Bere S. Patient and public involvement in medical performance processes: A systematic review. Health Expect 2018; 22:149-161. [PMID: 30548359 PMCID: PMC6433319 DOI: 10.1111/hex.12852] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/15/2018] [Accepted: 11/07/2018] [Indexed: 12/26/2022] Open
Abstract
Background Patient and public involvement (PPI) continues to develop as a central policy agenda in health care. The patient voice is seen as relevant, informative and can drive service improvement. However, critical exploration of PPI's role within monitoring and informing medical performance processes remains limited. Objective To explore and evaluate the contribution of PPI in medical performance processes to understand its extent, purpose and process. Search strategy The electronic databases PubMed, PsycINFO and Google Scholar were systematically searched for studies published between 2004 and 2018. Inclusion criteria Studies involving doctors and patients and all forms of patient input (eg, patient feedback) associated with medical performance were included. Data extraction and synthesis Using an inductive approach to analysis and synthesis, a coding framework was developed which was structured around three key themes: issues that shape PPI in medical performance processes; mechanisms for PPI; and the potential impacts of PPI on medical performance processes. Main results From 4772 studies, 48 articles (from 10 countries) met the inclusion criteria. Findings suggest that the extent of PPI in medical performance processes globally is highly variable and is primarily achieved through providing patient feedback or complaints. The emerging evidence suggests that PPI can encourage improvements in the quality of patient care, enable professional development and promote professionalism. Discussion and conclusions Developing more innovative methods of PPI beyond patient feedback and complaints may help revolutionize the practice of PPI into a collaborative partnership, facilitating the development of proactive relationships between the medical profession, patients and the public.
Collapse
Affiliation(s)
- Mirza Lalani
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rebecca Baines
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sol Mead
- General Medical Council, Registration and Revalidation Directorate, London, UK.,NHS England London and Southeast Regions, Regional Medical Directorate, London, UK
| | - Stephen Barasi
- General Medical Council, Registration and Revalidation Directorate (Wales), Wales, UK
| | - Julian Archer
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Samantha Regan de Bere
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| |
Collapse
|
34
|
Hanson KT, Zalewski NL, Hocker SE, Caselli RJ, Habermann EB, Thiels CA. At the Intersection of Patient Experience Data, Outcomes Research, and Practice: Analysis of HCAHPS Scores in Neurology Patients. Mayo Clin Proc Innov Qual Outcomes 2018; 2:137-147. [PMID: 30225443 PMCID: PMC6124338 DOI: 10.1016/j.mayocpiqo.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To assess variation in patient-reported experience in inpatient neurology patients. Patients and Methods We retrospectively identified 1045 patients 18 years and older admitted to a neurology service and discharged from January 1, 2013, through September 30, 2016, who completed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Multivariable logistic regression evaluated the associations of patient factors with HCAHPS measures. Key driver analysis identified associations between HCAHPS measures and the Global score (combination of 0-10 hospital rating and likelihood to recommend). Multivariable logistic regression compared HCAHPS scores between neurology patients and those admitted to a neurosurgery (n=2190) or internal medicine (n=3401) service during the same period. Results Among patients admitted to a neurology service, overall (summary) scores did not vary significantly by diagnosis after adjustment for age, education, and overall health, but patients with neurologic diagnoses other than stroke, epilepsy, and neurodegenerative disease were more likely to report lower Pain Management scores compared with patients with cancer. Key driver analysis showed Care Transition scores as drivers of the Global score. After adjustment, general internal medicine service patients were more likely to report low Summary scores and neurosurgery service patients were significantly less likely to report low Summary scores compared with neurology service patients. Conclusion Efforts to improve how neurology patients experience their care should be aimed at targeting patients' perceptions of pain management, and improving care transitions is an important first-priority target for improvement. This analysis may help other institutions improve hospital rating, value-based payments, and patient-centered outcomes.
Collapse
Affiliation(s)
- Kristine T Hanson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | | | | | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Cornelius A Thiels
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Department of Surgery, Mayo Clinic, Rochester, MN
| |
Collapse
|
35
|
Wang H, Kline JA, Jackson BE, Robinson RD, Sullivan M, Holmes M, Watson KA, Cowden CD, Phillips JL, Schrader CD, Leuck J, Zenarosa NR. The role of patient perception of crowding in the determination of real-time patient satisfaction at Emergency Department. Int J Qual Health Care 2017; 29:722-727. [DOI: 10.1093/intqhc/mzx097] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/04/2017] [Indexed: 11/12/2022] Open
|
36
|
Davidson KW, Shaffer JA, Ye S, Falzon L, Emeruwa IO, Sundquist K, Inneh IA, Mascitelli SL, Manzano WM, Vawdrey DK, Ting HH. Interventions to improve hospital patient satisfaction with healthcare providers and systems: a systematic review. BMJ Qual Saf 2017; 26:596-606. [PMID: 27488124 PMCID: PMC5290224 DOI: 10.1136/bmjqs-2015-004758] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 07/07/2016] [Accepted: 07/14/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many hospital systems seek to improve patient satisfaction as assessed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. A systematic review of the current experimental evidence could inform these efforts and does not yet exist. METHODS We conducted a systematic review of the literature by searching electronic databases, including MEDLINE and EMBASE, the six databases of the Cochrane Library and grey literature databases. We included studies involving hospital patients with interventions targeting at least 1 of the 11 HCAHPS domains, and that met our quality filter score on the 27-item Downs and Black coding scale. We calculated post hoc power when appropriate. RESULTS A total of 59 studies met inclusion criteria, out of these 44 did not meet the quality filter of 50% (average quality rating 27.8%±10.9%). Of the 15 studies that met the quality filter (average quality rating 67.3%±10.7%), 8 targeted the Communication with Doctors HCAHPS domain, 6 targeted Overall Hospital Rating, 5 targeted Communication with Nurses, 5 targeted Pain Management, 5 targeted Communication about Medicines, 5 targeted Recommend the Hospital, 3 targeted Quietness of the Hospital Environment, 3 targeted Cleanliness of the Hospital Environment and 3 targeted Discharge Information. Significant HCAHPS improvements were reported by eight interventions, but their generalisability may be limited by narrowly focused patient populations, heterogeneity of approach and other methodological concerns. CONCLUSIONS Although there are a few studies that show some improvement in HCAHPS score through various interventions, we conclude that more rigorous research is needed to identify effective and generalisable interventions to improve patient satisfaction.
Collapse
Affiliation(s)
- Karina W. Davidson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
- Value Institute, New York-Presbyterian Hospital, New York, NY
| | - Jonathan A. Shaffer
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
- Department of Psychology, University of Colorado Denver, Denver, CO
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
| | - Iheanacho O. Emeruwa
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
| | - Kevin Sundquist
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
| | - Ifeoma A. Inneh
- Value Institute, New York-Presbyterian Hospital, New York, NY
| | | | | | | | - Henry H. Ting
- Value Institute, New York-Presbyterian Hospital, New York, NY
| |
Collapse
|
37
|
Siddiqui Z, Qayyum R, Bertram A, Durkin N, Kebede S, Ponor L, Oduyebo I, Allen L, Brotman DJ. Does Provider Self-Reporting of Etiquette Behaviors Improve Patient Experience? A Randomized Controlled Trial. J Hosp Med 2017; 12:402-406. [PMID: 28574528 DOI: 10.12788/jhm.2744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a glaring lack of published evidence-based strategies to improve the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience scores on the physician domain. Strategies that have been used are resource intensive and difficult to sustain. OBJECTIVE We hypothesized that prompting providers to assess their own etiquette-based practices every 2 weeks over the course of 1 year would improve patient experience on the physician domain. DESIGN Randomized controlled trial. SETTING 4 acute care hospitals. PARTICIPANTS Hospitalists. INTERVENTION Hospitalists were randomized to the study or the control arm. The study arm was prompted every 2 weeks for 12 months to report how frequently they engaged in 7 best-practice bedside etiquette behaviors. Control arm participants received similarly worded questions on quality improvement behaviors. MEASUREMENT Provider experience scores were calculated from the physician HCAHPS and Press Ganey survey provider items. RESULTS Physicians reported high rates of etiquette-based behavior at baseline, and this changed modestly over the study period. Self-reported etiquette behaviors were not associated with experience scores. The difference in difference analysis of the baseline and postintervention physician experience scores between the intervention arm and the control arm was not statistically significant (P = 0.71). CONCLUSION In this 12-month study, biweekly reflection and reporting of best-practice bedside etiquette behaviors did not result in significant improvement on physician domain experience scores. It is likely that hospitalists' self-assessment of their bedside etiquette may not reflect patient perception of these behaviors. Furthermore, hospitalists may be resistant to improvement in this area since they rate themselves highly at baseline. Journal of Hospital Medicine 2017;12:402-406.
Collapse
Affiliation(s)
- Zishan Siddiqui
- Hospitalist Program, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rehan Qayyum
- Department of Internal Medicine, University of Tennessee College of Medicine at Chattanooga, Chattanooga, Tennessee
| | - Amanda Bertram
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nowella Durkin
- Hospitalist Program, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sosena Kebede
- Hospitalist Program, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Lucia Ponor
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Ibironke Oduyebo
- Division of Gastrointestinal Diseases, Mayo Clinic, Rochester, Minnesota
| | - Lisa Allen
- Service Excellence Department, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Daniel J Brotman
- Hospitalist Program, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
38
|
Horton DJ, Yarbrough PM, Wanner N, Murphy RD, Kukhareva PV, Kawamoto K. Improving Physician Communication With Patients as Measured by HCAHPS Using a Standardized Communication Model. Am J Med Qual 2017; 32:617-624. [PMID: 28693347 DOI: 10.1177/1062860616689592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physicians often fail to communicate well with patients. The objective of this retrospective controlled interrupted time series study was to evaluate the impact of a standardized communication intervention to improve physician communication. All patients ages 18 years or older (N = 7739 visits) admitted to University of Utah Health Care in Salt Lake City, Utah, from July 1, 2012, to June 31, 2014, were included. Obstetrics, rehabilitation, and psychiatric patients were excluded. The primary outcome was the percentage of patients who answered "Always" to all HCAHPS questions regarding physician-patient communication. Among the intervention group, the primary outcome increased from 56% to 63% ( P = .014, N = 1021) while remaining stable for the control group (65% to 66%, P = .6, N = 6718). The downward trend reversed after the intervention (-0.6% to +1.7% per month, P < .001). Standardized communication was associated with improvement in physician communication HCAHPS scores.
Collapse
Affiliation(s)
| | - Peter M Yarbrough
- 1 University of Utah, Salt Lake City, UT.,2 George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, UT
| | | | | | | | | |
Collapse
|
39
|
|
40
|
Moura LMVR, Carneiro TS, Thorn EL, Seitz MP, Hsu J, Cole AJ, Vickrey BG, Hoch DB. Patient perceptions of physician-documented quality care in epilepsy. Epilepsy Behav 2016; 62:90-6. [PMID: 27450312 DOI: 10.1016/j.yebeh.2016.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to compare physician encounter documentation with patient perceptions of quality of epilepsy care and examine the association between quality and patient assessment of provider communication. METHODS We identified 505 adult patients with epilepsy aged 18years or older over a 3-year period in two large academic medical centers. We abstracted individual, clinical, and care measures from 2723 electronic clinical notes written by physicians. We then randomly selected 245 patients for a phone interview. We compared patient perceptions of care with the documented care for several established epilepsy quality measures. We also explored the association of patient's perception of provider communication with provider documentation of key encounter interventions. RESULTS There were 88 patients (36%) who completed the interviews. Fifty-seven (24%) refused to participate, and 100 (40%) could not be contacted. Participants and nonparticipants were comparable in their demographic and clinical characteristics; however, participants were more often seen by epilepsy specialists than nonparticipants (75% vs. 61.9%, p<0.01). Quality scores based on patient perceptions differed from those determined by assessing the documentation in the medical record for several quality measures, e.g., documentation of side effects of antiseizure therapy (p=0.05), safety counseling (p<0.01), and counseling for women of childbearing potential with epilepsy (McNemar's p=0.03; intraclass correlation coefficient, ICC=0.07). There was a significant, positive association between patient-reported counseling during the encounter (e.g., personalized safety counseling) and patient-reported scores of provider communication (p=0.05). CONCLUSIONS The association between the patient's recollection of counseling during the visit and his/her positive perception of the provider's communication skills highlights the importance of spending time counseling patients about their epilepsy and not just determining if seizures are controlled.
Collapse
Affiliation(s)
- Lidia M V R Moura
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - Thiago S Carneiro
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - Emily L Thorn
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - Michael P Seitz
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - John Hsu
- Massachusetts General Hospital, Department of Medicine, Mongan Institute, Boston, United States; Department of Health Care Policy, Harvard Medical School, Boston, United States.
| | - Andrew J Cole
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| | - Barbara G Vickrey
- Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, United States.
| | - Daniel B Hoch
- Massachusetts General Hospital, Department of Neurology, Boston, United States.
| |
Collapse
|