Measuring Patients' Experience of Rehabilitation Services Across the Care Continuum. Part I: A Systematic Review of the Literature

Identification of interventions to improve patient experienced quality of care in transitions between healthcare settings: a scoping review

BACKGROUND

Transitions in healthcare settings can be a challenge for patients and they express a need for guidance and support to cope with these transitions. The aim of this scoping review was to investigate if interventions can improve patients' experiences when transitioning between healthcare settings.

METHODS

This review was conducted following the Johanna Briggs Institute's methods and reported according to the PRISMA-ScR Checklist. Included articles were published and peer-reviewed, and reported qualitative and quantitative findings on patient experiences with interventions when transitioning between healthcare settings. The search was conducted in May 2024 in Medline Ovid, Embase Ovid, and Cinahl.

RESULTS

Twenty-three studies were included. Factors extracted from the studies were: author(s), year of publication, country of origin, study design, theoretical methods, population description, intervention, phenomena of interest(s), and key findings. There has been an increase in published studies on the subject in the last few years, and most of the included studies originated from Western countries. Most studies were quantitative, primarily RCTs, and the theoretical methods were thus mainly statistical analysis. The study populations were found to be heterogeneous. The interventions were categorized: care coordinator, program, integrated care, online communication platform, coaching, discharge care plan, and miscellaneous interventions.

CONCLUSIONS

Overall, interventions were found to improve the patient experience. Centralization of healthcare has increased the number of transitions, and patients express that the coordination of healthcare transitions can be improved. This review's findings should be used alongside other research on interventions' effect on factors like hospital readmissions and mortality to determine the optimal intervention to implement.

User Satisfaction with Primary Health Care Rehabilitation Services in a South African Metropolitan District

Rehabilitation services are critical to improve health outcomes, particularly at community level within primary healthcare settings. As groups with an interest in the health system, rehabilitation service users' and caregivers' involvement in various aspects of health system strengthening is important for healthcare planning and evaluation. This study aimed to explore rehabilitation service users' perceptions of the rehabilitation services and their effect on their functioning in the Johannesburg Metropolitan District. A qualitative study was conducted using purposive sampling of participants attending rehabilitation at nine provincially funded clinics. Semi-structured interviews were conducted, and data were analysed using reflexive thematic analysis. The findings revealed the theme of happy with rehabilitation services and five associated categories, namely (1) service provider actions, (2) service organisation, (3) service user actions, (4) service access, and (5) service outcomes. The participants expressed overall satisfaction with their experiences of rehabilitation services, highlighting the importance of effective communication, patient-centred care, strong therapeutic relationships, and active patient engagement to achieve positive outcomes. This study provides the evidence for maintaining and extending rehabilitation at the PHC level in support of the health policy changes proposed for South Africa.

Content validity of patient-reported measures evaluating experiences of the quality of transitions in healthcare settings-a scoping review

No reviews so far have been conducted to define the constructs of patient-experienced quality in healthcare transitions or to identify existing generic measures of patients' experience of the quality within healthcare transitions. Our aim was to identify domains relevant for people experiencing healthcare transitions when evaluating the quality of care they have received, map the comprehensiveness of existing patient-reported experience measures (PREM), and evaluate the PREMs' content validity. The method was guided by the Joanna Briggs Institutes' guidance for scoping reviews. The search was performed on 07 December 2021 and updated 27 May 2024, in the electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO). The search identified 20,422 publications, and 190 studies were included for review. We identified 30 PREMs assessing at least one aspect of adults' experience of transitions in healthcare. Summarising the content, we consider a model with two domains, organisational and human-relational, likely to be adequate. However, a more comprehensive analysis and adequate definition of the construct is needed. None of the PREMs were considered content valid.

Psychometric properties of the client-centred rehabilitation questionnaire-is derived from a large and varied group of rehabilitation users

PURPOSE

The purpose of this study was to inspect and establish the factor structure of the Icelandic Client-Centred Rehabilitation Questionnaire [CCRQ-is] and investigate the service experiences of a large and varied sample of rehabilitation users.

MATERIALS AND METHODS

Altogether 499 rehabilitation users completed the questionnaire. Confirmatory and exploratory factor analysis was conducted for analysis of items. Mann-Whitney's U and Kruskal-Wallis test was used to compare subscale responses based on participants' characteristics.

RESULTS

Four factors explained 53,2% of the variance: Respect and attentiveness, Interaction with significant others, Responsiveness to needs and preferences and Education and enablement. Subscales showed internal consistency from 0.72-0.91 and 0.92 for the whole instrument. The subscale Respect and attentiveness represented user centred rehabilitation the most and Interaction with significant others the least. Significant differences in relation to health conditions and age were obtained on all four subscales and differences by gender on one subscale.

CONCLUSIONS

Our results suggest the CCRQ-is is a reliable tool that can be used with rehabilitation users with a broad range of characteristics within the Icelandic context. The extent to which the intersection of age, gender and health issues influence users' perception of services needs to be further scrutinized.

Quality Measure Concepts for Inpatient Rehabilitation That Are Best Understood From the Patient's Perspective

PURPOSE

The aim of this study was to identify inpatient rehabilitation quality-of-care concepts that are best understood from the patient perspective.

DESIGN

We conducted 12 focus groups with 95 former patients, caregivers, and rehabilitation clinicians and asked them to describe high-quality inpatient rehabilitation care.

METHODS

We independently reviewed the focus group transcripts and then used an iterative process to identify the quality measure concepts identified by participants.

RESULTS

Based on participants' comments, we identified 18 quality measure concepts: respect and dignity, clinician communication with patient, clinician communication with family, organizational culture, clinician engagement with patient, clinician engagement with family, rehabilitation goals, staff expertise, responsiveness, patient safety, physical environment, care coordination, discharge planning, patient and family education, peer support, symptom management (pain, anxiety, fatigue, sadness), sleep, and functioning.

CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING

Rehabilitation nurses should be aware of the quality-of-care issues that are important to patients and their caregivers.

CONCLUSION

Important patient-reported domains of quality of care include interpersonal relationships, patient and family engagement, care planning and delivery, access to support, and quality of life.

Measuring shared decision-making and collaborative goal setting in community rehabilitation: a focused ethnography using cross-sectional surveys in Canada

OBJECTIVE

To describe and measure the shared decision-making (SDM) experience, including goal-setting experiences, from the perspective of patients and providers in diverse community-rehabilitation settings.

DESIGN

Prospective, longitudinal surveys.

SETTING

13 primary level-of-care community-rehabilitation sites in diverse areas varying in geography, patient population and provider discipline341 adult, English-speaking patient-participants, and 66 provider-participants.

MEASURES

Alberta Shared decision-maKing Measurement Instrument (dyadic tool measuring SDM), WatLX (outpatient rehabilitation experience) and demographic questionnaire. Survey packages distributed at two timepoints (T0=recruitment; T1=3 months later).

RESULTS

We found that among 341 patient-provider dyads, 26.4% agreed that the appointment at recruitment involved high-quality SDM. Patient perceptions of goal-setting suggested that 19.6% of patients did not set a goal for their care, and only 11.4% set goals in functional language that tied directly to an activity/role/responsibility that was meaningful to their life. Better SDM was clinically associated with higher total family income (p=0.045).

CONCLUSIONS

These findings provide evidence for the importance of SDM and goal setting in community rehabilitation. Among patients, lower ratings of SDM corresponded with less recognition of their preferences. Actionable strategies include supporting financially vulnerable patients in realising SDM through training of providers to make extra space for such patients to share their preferences and better preparing patients to articulate their preferences. We recommend more research into strategies that advance highly functional goal setting with patients, and that lessen survey ceiling effects.

Experiences of shared decision-making in community rehabilitation: a focused ethnography

BACKGROUND

Shared decision-making (SDM) can advance patient satisfaction, understanding, goal fulfilment, and patient-reported outcomes. We lack clarity on whether this physician-focused literature applies to community rehabilitation, and on the integration of SDM policies in healthcare settings. We aimed to understand patient and provider perceptions of shared decision-making (SDM) in community rehabilitation, particularly the barriers and facilitators to SDM.

METHODS

We used a focused ethnography involving 14 community rehabilitation sites across Alberta, including rural, regional-urban and metropolitan-urban sites. We conducted semi-structured interviews that asked participants about their positive and negative communication experiences (n = 23 patients; n = 26 providers).

RESULTS

We found SDM experiences fluctuated between extremes: Getting Patient Buy-In and Aligning Expectations. The former is provider-driven, prescriptive and less flexible; the latter is collaborative, inquisitive and empowering. In Aligning Expectations, patients and providers express humility and openness, communicate in the language of ask and listen, and view education as empowering. Patients and providers described barriers and facilitators to SDM in community rehabilitation. Facilitators included geography influencing context and connections; consistent, patient-specific messaging; patient lifestyle, capacity and perceived outlook; provider confidence, experience and perceived independence; provider training; and perceptions of more time (and control over time) for appointments. SDM barriers included lack of privacy; waitlists and financial barriers to access; provider approach; how choices are framed; and, patient's perceived assertiveness, lack of capacity, and level of deference.

CONCLUSIONS

We have found both excellent experiences and areas for improvement for applying SDM in community rehabilitation. We proffer recommendations to advance high-quality SDM in community rehabilitation based on promoting facilitators and overcoming barriers. This research will support the spread, scale and evaluation of a new Model of Care in rehabilitation by the provincial health system, which aimed to promote patient-centred care.

[Design and validation of SAHERA questionnaire to assess patient satisfaction in a Rehabilitation Service]

The development of a questionnaire that measures user satisfaction in the area of Rehabilitation is essential in order to measure the success achieved and to be able to introduce actions to improve health care.

OBJECTIVE

To design and validate a questionnaire to assess the satisfaction of the care received in a Rehabilitation Department.

MATERIAL AND METHODS

A cross-sectional study was carried out in the Rehabilitation Department of the Complejo Asistencial Universitario de Salamanca (CAUSA). A questionnaire was designed and prepared by experts using the Delphi technique. For the face validity, a pilot study was used using focal groups (doctors, nursing staff, physiotherapists, occupational therapists, and patients). An evaluation was made of the reliability (intraclass correlation coefficient) and internal consistency (Cronbach alpha). In a second stage, it was completed by 207 patients. The questionnaire consisted of 24 items that evaluated 4 dimensions: care/relationship, information/treatment, infrastructure, and general evaluation.

RESULTS

A Cronbach alpha and intraclass correlation of greater than 0.8 was obtained in the first stage using a pilot test on 40 patients with a mean age of 58 years (SD ±16). The scale showed a good internal consistency in its final version (Cronbach alpha of 0.82) and an adequate stability (intraclass correlation of 0.8).

CONCLUSIONS

The data obtained in the study showed that the designed questionnaire had a reliability of validity. And for this reason, it would be a valid and reliable tool for measuring the satisfaction of the care received by patients in Rehabilitation Departments.

Integrating a gait analysis test in hospital rehabilitation: A service design approach

BACKGROUND

Gait analysis with motion capture (MoCap) during rehabilitation can provide objective information to facilitate treatment decision making. However, designing a test to be integrated into healthcare services requires considering multiple design factors. The difficulty of integrating a 'micro-service' (gait test) within a 'macro-service' (healthcare service) has received little attention in the gait analysis literature. It is a challenge that goes beyond the gait analysis case study because service design methods commonly focus on the entire service design (macro-level).

OBJECTIVE

This study aims to extract design considerations and generate guidelines to integrate MoCap technology for gait analysis in the hospital rehabilitation setting. Specifically, the aim is to design a gait test to assess the response of the applied treatments through pre- and post-measurement sessions.

METHODS

We focused on patients with spasticity who received botulinum toxin treatment. A qualitative research design was used to investigate the integration of a gait analysis system based on inertial measurement units in a rehabilitation service at a reference hospital. The methodological approach was based on contrasted methodologies from the service design field, which materialise through observation techniques (during system use), semi-structured interviews, and workshops with healthcare professionals (13 patients, 10 'proxies', and 6 doctors).

RESULTS

The analysis resulted in six themes: (1) patients' understanding, (2) guiding the gait tests, (3) which professionals guide the gait tests, (4) gait test reports, (5) requesting gait tests (doctors and test guide communication), and the (6) conceptual design of the service with the gait test.

CONCLUSIONS

The extracted design considerations and guidelines increase the applicability and usefulness of the gait analysis technology, improving the link between technologists and healthcare professionals. The proposed methodological approach can also be useful for service design teams that deal with the integration of one service into another.

Determinants of satisfaction with motor rehabilitation in people with cerebral palsy: A national survey in France (ESPaCe)

BACKGROUND

User satisfaction is a key indicator of healthcare quality.

OBJECTIVE

We aimed to identify factors associated with satisfaction with motor rehabilitation (MR) in children and adults with cerebral palsy at a national level, using determinants related to patient characteristics, healthcare organisation and practice features.

METHODS

This study was part of ESPaCe, a national survey aimed at documenting the views of individuals with cerebral palsy and their families regarding MR services via a questionnaire, developed by a multidisciplinary group. The ESPaCe questionnaire included the Client Satisfaction Questionnaire (CSQ-8), whose total score was the primary outcome of this study. Survey participation was promoted nation-wide. The questionnaire could be completed by the person with cerebral palsy or their main carer. Analysis included the description of determinants across CSQ-8 quartiles and generalised linear modelling of the CSQ-8 score.

RESULTS

From June 2016 to June 2017, 1010 eligible participants (354 children, 145 adolescents and 511 adults) responded to the questionnaire, and 750 completed the CSQ-8. Univariate analysis suggested that multiple factors affected satisfaction with MR. On multivariate sequential adjustment, the factors that decreased satisfaction (all P<0.001) were being an adolescent, Gross Motor Function Classification System levels IV/V, frequent pain, receiving physiotherapy in private practice and poor access to a physiotherapist with specific CP training. Factors that increased satisfaction (all P<0.001) were presence of an MR coordinator, exchanges between healthcare professionals, provision of information regarding MR organisation, and goal setting and effective pain management by the physiotherapist. Organisation and practice features improved the predictive ability of patient characteristics (R²=0.40).

CONCLUSION

This study suggests that measures to improve the quality of healthcare for individuals with cerebral palsy should focus on improving pain management by the physiotherapist, establishing a therapeutic alliance, and greater provision of CP-specific practice education for healthcare professionals.

Prioritization of rehabilitation Domains for establishing spinal cord injury high performance indicators using a modification of the Hanlon method: SCI-High Project

Objectives: To prioritize Domains of SCI Rehabilitation Care (SCI-Care) based on clinical importance and feasibility to inform the development of indicators of quality SCI-Care for adults with SCI/D in Canada. Methods: A 17-member external advisory committee, comprised of key stakeholders, ranked 15/37 Domains of rehabilitation previously flagged by the E-scan project team for gaps between knowledge generation and clinical implementation. Priority scores (D) were calculated using the Hanlon formula: D=[A+(2×B)]×C , where A is prevalence, B is seriousness, and C is the effectiveness of available interventions. A modified "EAARS" (Economic, Acceptability, Accessibility, Resources, and Simplicity) criterion was used to rank feasibility on a scale of 0-4 (4 is high). The product of these two scores determined the initial Domain ranking. Following the consensus process, further changes were made to the Domain rankings. Results: Despite a low feasibility score, Sexual Health was ranked as high priority; and, the Community Participation and Employment Domains were merged. The 11 final prioritized Domains in alphabetic order were: Cardiometabolic Health; Community Participation and Employment; Emotional Well-Being; Reaching, Grasping, and Manipulation; Self-Management; Sexual Health; Tissue Integrity; Urinary Tract Infection; Urohealth; Walking, and Wheeled Mobility. Conclusions: The modified Hanlon method was used to facilitate prioritization of 11 of 37 Domains to advance the quality of SCI-care by 2020. In future, the Spinal Cord Injury Rehabilitation Care High Performance Indicators (SCI-High) Project Team will develop structure, process and outcome indicators for each prioritized Domain.

What Is Being Used and Who Is Using It: Barriers to the Adoption of Smartphone Patient Experience Surveys

BACKGROUND

Smartphones are positioned to transform the way health care services gather patient experience data through advanced mobile survey apps which we refer to as smart surveys. In comparison with traditional methods of survey data capture, smartphone sensing survey apps have the capacity to elicit multidimensional, in situ user experience data in real time with unprecedented detail, responsiveness, and accuracy.

OBJECTIVE

This study aimed to explore the context and circumstances under which patients are willing to use their smartphones to share data on their service experiences.

METHODS

We conducted in-person, semistructured interviews (N=24) with smartphone owners to capture their experiences, perceptions, and attitudes toward smart surveys.

RESULTS

Analysis examining perceived risk revealed a few barriers to use; however, major potential barriers to adoption were the identity of recipients, reliability of the communication channel, and potential for loss of agency. The results demonstrate that the classical dimensions of perceived risk raised minimal concerns for the use of smartphones to collect patient service experience feedback. However, trust in the doctor-patient relationship, the reliability of the communication channel, the altruistic motivation to contribute to health service quality for others, and the risk of losing information agency were identified as determinants in the patients' adoption of smart surveys.

CONCLUSIONS

On the basis of these findings, we provide recommendations for the design of smart surveys in practice and suggest a need for privacy design tools for voluntary, health-related technologies.