Patient centredness and quality improvement efforts in hospitals: rationale, measurement, implementation

Quality of life, functioning and participation of children and adolescents with visual impairment: A scoping review

BACKGROUND

Vision has a key role in children's neuromotor, cognitive and social development. Children with visual impairment attain developmental milestones at later stages and are at higher risk of developing psychological disorders and social withdrawn.

AIMS

We performed a scoping review to summarize the mostly used instruments assessing the impact of visual impairment on quality of life, functioning and participation of children and adolescents. In addition, the main findings of the included studies are discussed.

METHODS AND PROCEDURES

We searched for papers assessing quality of life, functioning and participation of children and adolescents with visual impairment from 0 to 18 years old conducted between 2000 and 2023.

OUTCOMES AND RESULTS

In total, 69 studies met the inclusion criteria and were included in the review. Child self-report, caregivers-proxy and self-report questionnaires as well as interviews were used. The results showed that quality of life, functioning and participation are significantly reduced in children and adolescents with visual impairment, and that the impact depends on different factors (e.g., severity of the impairment, age).

CONCLUSIONS AND IMPLICATIONS

Considering the significant impact of visual impairment on quality of life, functioning and participation on this population, it is fundamental to develop integrated and multi-dimensional assessment programs that evaluate the impact of visual impairment on those dimensions considering different contexts of life (e.g., family, school, leisure time). WHAT THIS PAPER ADDS?: The present review aims to give an overview of what is known about the impact of visual impairment on quality of life, functioning and participation of children and adolescents. We assumed a biopsychosocial perspective which, in line with the definition of health by the International Classification of Functioning, Disability and Health (WHO, 2001), considered how body functions and structures, functioning, participation and environmental factors dynamically interact to define the health, or the disease, status of a person at a certain moment of life. We reported the most used instruments for the assessment of quality of life, participation, and functioning, with a specific interest on Patient-Reported Outcome Measures and self-report measures. By reporting the different instruments used, we gave a broad overview about the available tools that can be used in clinical as well as in research field to assess quality of life, functioning and participation in this population. Additionally, the review of the existing literature allowed us to demonstrate that those dimensions are negatively impacted by visual impairment and thus they should be considered in the assessment programs. Specifically, there is the need to provide more integrated assessment programs that investigate the impact of visual impairment on children and adolescents' social and emotional wellbeing, everyday functioning and social relationship, considering their subjective experience together with the one of caregivers, teachers, health care professionals, and other relevant adults involved in their life. Additionally, it is essential to plan and implement multidimensional assessment programs that consider how all areas of life are differently impacted by visual impairment.

Psychosocial factors contributing to value creation in value-based healthcare: a scoping review

Background

Healthcare systems constantly evolve to improve care quality and resource utilization. One way is implementing Value-Based Healthcare (VBHC) an economic approach. This scoping review aims to identify and describe the literature on VBHC, particularly its psychosocial aspects, to uncover research gaps.

Method

The review followed the PRISMA guidelines for Scoping Reviews. We took the following 14 steps: (a) defining the research question; (b) identifying relevant studies; (c) selecting studies; (d) 15 mapping data; (e) collecting, synthesizing and reporting results. A detailed Boolean search was conducted from January 2021 to August 31, 2021, across APA PsycINFO and PubMed databases using keywords such as "Value-Based Healthcare" and "psychosocial perspective." Initially, three reviewers screened 70 e-records independently, assessing titles, abstracts, and full-text against the inclusion criteria. Discrepancies regarding the evaluation of the articles were resolved through consensus sessions between the reviewers.

Results

The final review included 14 relevant e-records in English from peer-reviewed sources, focusing on quantitative and qualitative research. From the analysis, four areas emerged: (1) Value chains in Healthcare; (2) Styles, activities, and practices of value co-creation in Healthcare; (3) Value co-creation in the encounter process; (4) Value co-creation in preventive health services.

Conclusion

The scoping review findings suggest several potential key aspects, including the interdependence between patients and healthcare organizations, organizational culture in healthcare, and the role of patient-centered approaches that focus on relationships, communication, and social support in healthcare. This can be achieved through patient engagement, patient-centered care and communication, health literacy, psychosocial support services, comprehensive psychosocial assessments, care coordination, and continuity of care. Integrating psychosocial elements in VHBC enhances quality and optimizes resource use. Findings highlight the need to develop practical guidance on how to implement a culture of value in care that takes into account the psychosocial aspects that have emerged, but not fully addressed. The pandemic teaches that the workforce poorly receives sudden and unsystematic changes. This review could provide an initial basis for the redesign of value in healthcare and a paradigm shift that has already begun with patient-centered medicine and patient engagement.

Development, validation and feasibility of a Patient Satisfaction Questionnaire for evaluating the quality performance of a diagnostic small fibre neuropathy service: A qualitative study

INTRODUCTION AND AIM

Small fibre neuropathy (SFN) is a peripheral neuropathy, leading to neuropathic pain and autonomic dysfunction. An evidence-based standardized patient diagnostic SFN service has been implemented in the Netherlands for improving patient-centred SFN care. However, the quality of care of this diagnostic SFN service has never been assessed from a patient perspective. The aim of this study was to develop and validate an SFN-Patient Satisfaction Questionnaire (SFN-PSQ) to measure the quality performance of a standardized diagnostic SFN service.

METHODS

A descriptive qualitative study to create the SFN-PSQ was performed using the (COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. For item generation and content development, domains and/or items from validated PSQs were selected. The content development and content validity were performed using a Delphi method with SFN expert caregivers with different backgrounds. By using the three-step-test method in individual cognitive interviews, the content validity by patients was finalized.

RESULTS

In one online Delphi panel round, the content of the first concept of the SFN-PSQ was validated, which resulted in the second concept of the SFN-PSQ. From July 2019 till March 2020, nine patients consented to participate in the individual cognitive interviews. The most significant changes of the new questionnaire were adding domains and items concerning the waiting list, the diagnostic services and consultation by the hospital psychiatrist. Also, a differentiation was made for both an inpatient and outpatient diagnostic SFN service. Furthermore, the clarity and intelligibility of the domains/items were improved, resulting in an increased comprehension of the SFN-PSQ. Ultimately, the new developed SFN-PSQ consisted of 10 domains and 51 items, suitable for measuring patient satisfaction of the neurological analysis in patients with SFN.

CONCLUSION

Through item generation, expert opinions and interviews with patients, the SFN-PSQ was developed and validated, and feasibility was confirmed. The structure of the questionnaire, based on the logistic and diagnostic SFN pathway, could be used as a model in other hospitals to improve the quality, continuity and access of SFN care and other chronic diseases taking into account potential cross-cultural differences.

PATIENT OR PUBLIC CONTRIBUTION

Caregivers were involved in the item generation and content development of the questionnaire. Patients were directly involved in testing the content validity and feasibility of the SFN-PSQ.

CLINICAL TRIAL REGISTRATION

Not applicable.

Leveraging Patients' Creative Ideas for Innovation in Health Care

Policy Points Patients' creative ideas may inform learning and innovation that improve patient-centered care. Routinely collected patient experience surveys provide an opportunity to invite patients to share their creative ideas for improvement. We develop and assess a methodological strategy that validates question wording designed to elicit creative ideas from patients. Health care organizations should consider how to report and use these data in health care delivery and quality improvement, and policymakers should consider promoting the use of narrative feedback to better understand and respond to patients' experiences.

CONTEXT

Learning health systems (LHSs) have been promoted for a decade to achieve high-quality, patient-centered health care. Innovation driven by knowledge generated through day-to-day health care delivery, including patient insights, is critical to LHSs. However, the pace of translating patient insights into innovation is slow and effectiveness inadequate. This study aims to evaluate a method for systematically eliciting patients' creative ideas, examine the value of such ideas as a source of insight, and examine patients' creative ideas regarding how their experiences could be improved within the context of their own health systems.

METHODS

The first stage of the study developed a survey and tested strategies for elicitation of patients' creative ideas with 600 patients from New York State. The second stage deployed the survey with the most generative open-ended question sequence within a health care system and involved analysis of 1,892 patients' responses, including 2,948 creative ideas.

FINDINGS

Actionable, creative feedback was fostered by incorporating a request for transformative feedback into a sequence of narrative elicitation questions. Patients generate more actionable and creative ideas when explicitly invited to share such ideas, especially patients with negative health care experiences, those from minority racial/ethnic backgrounds, and those with chronic illness. The most frequently elicited creative ideas focused on solving challenges, proposing interventions, amplifying exceptional practices, and conveying hopes for the future.

CONCLUSIONS

A valid and reliable method for eliciting creative ideas from patients can be deployed as part of routine patient experience surveys that include closed-ended survey items and open-ended narrative items in which patients share their experiences in their own words. The elicited creative ideas are promising for patient engagement and innovation efforts. This study highlights the benefits of engaging patients for quality improvement, offers a rigorously tested method for cultivating innovation using patient-generated knowledge, and outlines how creative ideas can enable organizational learning and innovation.

Navigating Nutritional Strategies: A Comprehensive Review of Early and Delayed Enteral Feeding in Acute Pancreatitis

This review critically examines enteral feeding strategies in managing acute pancreatitis, focusing on the contrasting early and delayed initiation approaches. Acute pancreatitis, marked by pancreatic inflammation, poses complex challenges, and nutritional interventions are pivotal in patient outcomes. Early enteral feeding, initiated within 24-48 hours, is associated with positive outcomes such as shortened hospital stays and reduced complications. However, controversies persist, with studies questioning its universal benefits. Conversely, delayed enteral feeding, employing a cautious approach, gains prominence in high-risk and severe cases. The identification of high-risk patients becomes paramount in decision-making. Practical recommendations for clinicians advocate an individualized approach, considering the severity of pancreatitis and regular monitoring. As the landscape of acute pancreatitis management evolves, staying abreast of emerging guidelines is essential. This review aims to provide a comprehensive understanding of critical findings, offering practical insights to guide clinicians in navigating the complexities of enteral feeding decisions in acute pancreatitis.

The first steps in the development of a cancer-specific patient-reported experience measure item bank (PREM-item bank): towards dynamic evaluation of experiences

OBJECTIVE

Since the implementation of value-based healthcare, there has been a growing emphasis on utilizing patient-reported experience measures (PREMs) to enhance the quality of care. However, the current PREMs are primarily generic and static, whereas healthcare is constantly evolving and encompasses a wide variety of aspects that impact care quality. To continuously improve care requires a dynamic PREM. The aim of this study was to propose an item bank for the establishment of a dynamic and care-specific patient-reported evaluation.

METHODS

In co-creation with patients, a mixed methods study was conducted involving: (1) an explorative review of the literature, (2) a focus group analysis with (ex-)patients, (3) qualitative analyses to formulate themes, and (4) a quantitative selection of items by patients and experts through prioritization.

RESULTS

Eight existing PREMs were evaluated. After removing duplicates, 141 items were identified. Through qualitative analyses of the focus group in which the patient journey was discussed, eight themes were formulated: "Organization of healthcare," "Competence of healthcare professionals," "Communication," "Information & services," "Patient empowerment," "Continuity & informal care," "Environment," and "Technology." Seven patients and eleven professionals were asked to prioritize what they considered the most important items. From this, an item bank with 76 items was proposed.

CONCLUSION

In collaboration with patients and healthcare professionals, we have proposed a PREM-item bank to evaluate the experiences of patients' receiving cancer care in an outpatient clinic. This item bank is the first step to dynamically assess the quality of cancer care provided in an outpatient setting.

Elements of person-centred diagnostic imaging care in low-and middle-income countries: A systematic review

INTRODUCTION

Diagnostic imaging professionals are trained to deliver safe and high-quality person-centred radiographic diagnostic imaging care. The term person-centred care has been described as a confused concept without a unified definition. This systematic review identified the elements that have been used to measure person-centred care in diagnostic imaging in low- and middle-income countries (LMICs).

METHODS

A systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Embase, MEDLINE and Cochrane library were searched. Bias was assessed using the Critical Appraisal Skill Programme and Mixed Method Appraisal Tool. A narrative synthesis guided by the Picker Principles of person-centred care was undertaken.

RESULTS

Of the 4482 articles identified, 26 articles were included. The studies were from 12 LMICs. Synthesis of the literature generated six themes, namely access to high quality and safe diagnostic imaging care, effective communication and shared diagnostic imaging decision making, suitable diagnostic imaging environment for physical comfort, respectful and compassionate diagnostic radiographers, effective coordination of diagnostic imaging care process, and family and friends' involvement in diagnostic imaging care.

CONCLUSION

Medical imaging facilities in most LMICs continue to struggle with issues of access, safety, quality, and responsiveness to the needs of patients. The need for innovative person-centred diagnostic imaging care interventions in LMICs has become urgent.

IMPLICATIONS FOR PRACTICE

If diagnostic imaging services in LMICs are to move beyond the current models of limited person-centred access to care, a greater focus on systems thinking is required. It is imperative to involve all stakeholders, not only patients and radiographers, but also policymakers whose works impact on equitable access to diagnostic imaging services.

Quality and Safety Practices Among Academic Obstetrics and Gynecology Departments

The objective was to quantify resources devoted to quality and patient safety initiatives, to document the development and use of key performance indicator reports regarding patient outcomes and patient feedback, and to assess the culture of safety within academic obstetrics and gynecology departments. Chairs of academic obstetrics and gynecology departments were asked to complete a quality and safety assessment survey. Surveys were distributed to 138 departments, yielding 52 completed responses (37.7%). Five percent of departments reported including a patient representative on a quality committee. Most committee leaders (60.5%) and members (67.4%) received no compensation. Formal training was required in 28.8% of responding departments. Most departments monitored key performance metrics for inpatient outcomes (95.9%). Leaders scored their departments' culture of safety highly. Most departments provided no protected time to faculty devoted to quality efforts, generation of key performance indicators for inpatient activities was prevalent and integrating patient and community input remain unrealized opportunities.

Mothers' involvement in providing care for their hospitalised sick newborns in Kenya: a focused ethnographic account

INTRODUCTION

There is growing evidence that parental participation in the care of small and sick newborns benefits both babies and parents. While studies have investigated the roles that mothers play in newborn units in high income contexts (HIC), there is little exploration of how contextual factors interplay to influence the ways in which mothers participate in the care of their small and sick newborn babies in very resource constrained settings such as those found in many countries in sub-Saharan Africa.

METHODS

Ethnographic methods (observations, informal conversations and formal interviews) were used to collect data during 627 h of fieldwork between March 2017 and August 2018 in the neonatal units of one government and one faith-based hospital in Kenya. Data were analysed using a modified grounded theory approach.

RESULTS

There were marked differences between the hospitals in the participation by mothers in the care of their sick newborn babies. The timing and types of caring task that the mothers undertook were shaped by the structural, economic and social context of the hospitals. In the resource constrained government funded hospital, the immediate informal and unplanned delegation of care to mothers was routine. In the faith-based hospital mothers were initially separated from their babies and introduced to bathing and diaper change tasks slowly under the close supervision of nurses. In both hospitals appropriate breast-feeding support was lacking, and the needs of the mothers were largely ignored.

CONCLUSION

In highly resource constrained hospitals with low nurse to baby ratios, mothers are required to provide primary and some specialised care to their sick newborns with little information or support on how undertake the necessary tasks. In better resourced hospital settings, most caring tasks are initially performed by nurses leaving mothers feeling powerless and worried about their capacity to care for their babies after discharge. Interventions need to focus on how to better equip hospitals and nurses to support mothers in caring for their sick newborns, promoting family centred care.

Patient involvement in quality improvement: a survey comparing naturalistic and reflective approaches

BACKGROUND

This study investigates reflective and naturalistic approaches to patient involvement in quality improvement. The reflective approach, using, for example, interviews, provides insights into patient needs and demands to support an established improvement agenda. The naturalistic approach, for example, observations, is used to discover practical problems and opportunities that professionals are currently unaware of.

METHODS

We assessed the use of naturalistic and reflective approaches in quality improvement to see whether they differed in their impact on patient needs, financial improvements and improved patient flows. Four possible combinations were used as a starting point: restrictive (low reflective-low naturalistic), in situ (low reflective-high naturalistic), retrospective (high reflective-low naturalistic) and blended (high reflective-high naturalistic). Data were collected through an online cross-sectional survey using a web-based survey tool. The original sample was based on a list of 472 participants enrolled in courses on improvement science in three Swedish regions. The response rate was 34%. Descriptives and ANOVA (Analysis of Variance) in SPSS V.23 were used for the statistical analysis.

RESULTS

The sample consisted of 16 projects characterised as restrictive, 61 as retrospective and 63 as blended. No projects were characterised as in situ. There was a significant effect of patient involvement approaches on patient flows and patient needs at the p<0.05 level (patient flows, (F(2, 128)=5.198, p=0.007) and patient needs (F(2, 127)=13.228, p=0.000)). No significant effect was found for financial results.

CONCLUSIONS

Moving beyond restrictive patient involvement is important to meet new patient needs and improve patient flows. This can be done either by increasing the use of a reflective approach or by increasing the use of both reflective and naturalistic approaches. A blended approach with high levels of both is likely to produce better results in addressing new patient needs and improving patient flows.

A systematic review of health communication strategies in Sub-Saharan Africa-2015-2022

Background: Health communication strategies have become critical in managing public health issues across sub-Saharan Africa. In the literature, health communication strategies have been well documented. The studies are often narrow, focusing on individual countries or specific health issues. No research documented and consolidated the health communication strategies across sub-Saharan Africa. This review attempts to catalogue prevalent health communication strategies, how the various countries have implemented these strategies and the barriers to effective health communication practices in Africa. Methods: We systematically reviewed existing literature on health communication strategies in sub-Saharan Africa to answer formulated questions. A Google search was performed in October 2022 with the keywords 'health communication', 'strategies', 'promotion,' 'education,' and 'engagement,' The data reported in this article included evidence published between 2013 and 2023. Selected documents were content analyzed, and significant sections were mapped against specific strategies/themes. These subsets of data were used to present the results and analysis. Results:The review indicates that different health communication strategies have been deployed across Africa. In some countries, specific strategies are used to tackle specific health issues, while a combination of strategies is used in others. In some countries, the strategies are unclear, and implementation is improvised, sometimes misapplied, or truncated by bureaucratic red tape and incompetence. The prevalent strategies are mainly those prescribed from outside with little input from the beneficiaries. Conclusion: The review suggests that using a holistic or multi-pronged health communication approach that is context-specific and participatory could attract more uptakes of health messages.

"It's like asking for a necktie when you don't have underwear": Discourses on patient rights in southern Karnataka, India

BACKGROUND

Ensuring patient rights is an extension of applying human rights principles to health care. A critical examination of how the notion of patient rights is perceived and enacted by various actors through critical discourse analysis (CDA) can help understand the impediments to its realization in practice.

METHODS

We studied the discourses and discursive practices on patient rights in subnational policies and in ten health facilities in southern Karnataka, India. We conducted interviews (78), focus group discussions (3) with care-seeking individuals, care-providers, health care administrators and public health officials. We also conducted participant observation in selected health facilities and examined subnational policy documents of Karnataka pertaining to patient rights. We analyzed the qualitative data for major and minor themes.

RESULTS

Patient rights discourses were not based upon human rights notions. In the context of neoliberalism, they were predominantly embedded within the logic of quality of care, economic, and consumerist perspectives. Relatively powerful actors such as care-providers and health facility administrators used a panoply of discursive strategies such as emphasizing alternate discourses and controlling discursive resources to suppress the promotion of patient rights among care-seeking individuals in health facilities. As a result, the capacity of care-seeking individuals to know and claim patient rights was restricted. With neoliberal health policies promoting austerity measures on public health care system and weak implementation of health care regulations, patient rights discourses remained subdued in health facilities in Karnataka, India.

CONCLUSIONS

The empirical findings on the local expression of patient rights in the discourses allowed for theoretical insights on the translation of conceptual understandings of patient rights to practice in the everyday lives of health system actors and care-seeking individuals. The CDA approach was helpful to identify the problematic aspects of discourses and discursive practices on patient rights where health facility administrators and care-providers wielded power to oppress care-seeking individuals. From the practical point of view, the study demonstrated the limitations of care-seeking individuals in the discursive realms to assert their agency as practitioners of (patient) rights in health facilities.

"You're Socially Distant and Trying Not to Be Emotionally Distant." Physicians' Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study

To: 1) characterize how COVID-19-related policies influence patient-clinician communication and relationships in the ICU, with attention to race and ethnicity as factors and 2) identify interventions that may facilitate patient-clinician communication.

DESIGN

We conducted a qualitative study between September 2020 and February 2021 that explored facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships. We used thematic analysis to develop findings describing patient-communication and therapeutic relationships within the ICU early in the COVID-19 pandemic.

SETTING

We purposively selected hospital dyads from regions in the United States that experienced early and/or large surges of patients hospitalized with COVID-19.

SUBJECTS

We recruited a national sample of ICU physicians from Veteran Affairs (VA) Health Care Systems and their associated academic affiliate hospitals.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Twenty-four intensivists from seven VA hospitals and six academic-affiliate hospitals participated. Intensivists noted the disproportionate impact of the pandemic on among people holding minoritized racial and ethnic identities, describing how language barriers and restrictive visitation policies exacerbated institutional mistrust and compromised physicians' ability to develop therapeutic relationships. We also identified several perceived influences on patient-clinician communication and the establishment of therapeutic relationships. Barriers included physicians' fear of becoming infected with COVID-19 and use of personal protective equipment, which created obstacles to effective physical and verbal interactions. Facilitators included the presence of on-site interpreters, use of web-based technology to interact with family members outside the ICU, and designation of a care team member or specialist service to provide routine updates to families.

CONCLUSIONS

The COVID-19 pandemic has threatened patient-clinician communication and the development of therapeutic relationships in the ICU, particularly among people holding minoritized racial and ethnic identities and their families. We identified several facilitators to improve patient-clinician communication as perceived by intensivists that may help improve trust and foster therapeutic alliances.

Patient and healthcare provider perceptions on using patient-reported experience measures (PREMs) in routine clinical care: a systematic review of qualitative studies

BACKGROUND

Patient-reported experience measures (PREMs) assess quality-of-care from patients' perspectives. PREMs can be used to enhance patient-centered care and facilitate patient engagement in care. With increasing quality improvement studies in clinical practice, the use of PREMs has surged. As a result, knowledge about stakeholder experiences of using PREMs to assess quality of care across diverse clinical settings is needed to inform PREM implementation efforts. To address this, this review examines the qualitative literature on patient and healthcare provider experiences of using PREMs in clinical practice.

METHODS

Medline, Embase and PsycInfo were systematically searched from inception to May 2021. Additional searching of reference lists for all included articles and relevant review articles were performed. Retrieved articles were screened for eligibility by one reviewer and 25% cross-checked by a second reviewer across all stages of the review. Full texts meeting eligibility criteria were appraised against the COREQ checklist for quality assessment and thematic analysis was used to analyze textual data extracted from the results.

RESULTS

Electronic searches identified 2683 records, of which 20 studies met eligibility criteria. Extracted data were synthesized into six themes: facilitators to PREM implementation; barriers to PREM implementation; healthcare providers' perspectives towards using PREMs; patients' perspectives towards using PREMs; advantages of using PREMs in clinical practice; limitations and practical considerations to reduce resistance of PREM usage. The primary factors facilitating and impeding the use of PREMs include organizational-, staff- and patient-related factors.

CONCLUSION

Results can be used to guide the usage and implementation of PREMs in clinical settings by addressing the identified barriers and building on the perceived benefits to encourage adoption of PREMs. Results around facilitators to PREM implementation and practical considerations could also promote appropriate use of PREMs by healthcare providers, helping to improve practice and the quality of care based on patient feedback.

Reducing Postoperative Opioid-prescribing Following Posterior Lumbar Fusion Does Not Significantly Change Patient Satisfaction

STUDY DESIGN

Retrospective comparative; LOE-3.

OBJECTIVE

The purpose of this study was to investigate what effect, if any, an institutional opioid reduction prescribing policy following one- or two-level lumbar fusion has on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results.

SUMMARY OF BACKGROUND DATA

Previous research has demonstrated that high levels of opioid-prescribing may be related, in part, to a desire to produce superior patient satisfaction.

METHODS

A retrospective review of prospectively collected data was conducted on patients who underwent one- or two-level lumbar fusions L3-S1 between October 2014 and October 2019 at a single institution. Patients with complete survey information were included in the analysis. Patients with a history of trauma, fracture, spinal deformity, fusions more than two levels, or prior lumbar fusion surgery L3-S1 were excluded. Cohorts were based on date of surgery relative to implementation of an institutional opioid reduction policy, which commenced in October 1, 2018. To better compare groups, opioid prescriptions were converted into milligram morphine equivalents (MME).

RESULTS

A total of 330 patients met inclusion criteria: 259 pre-protocol, 71 post-protocol. There were 256 one-level fusions and 74 two-level fusions included. There were few statistically significant differences between groups with respect to patient demographics (P > 0.05) with the exception of number of patients who saw the pain management service, which increased from 36.7% (95) pre-protocol to 59.2% (42) post-protocol; P < 0.001. Estimated blood loss (EBL) decreased from 533 ± 571 mL to 346 ± 328 mL (P = 0.003). Percentage of patients who underwent concomitant laminectomy decreased from 71.8% to 49.3% (P < 0.001). Average opioids prescribed on discharge in the pre-protocol period was 534 ± 425 MME, compared to after initiation of the protocol, that is 320 ± 174 MME (P < 0.001). There was no statistically significant difference with respect to satisfaction with pain control, 4.49 ± 0.85 pre-protocol versus 4.51 ± 0.82 post-protocol (P = 0.986).

CONCLUSION

A reduction in opioids prescribed at discharge after one- or two-level lumbar fusion is not associated with any statistically significant change in patient satisfaction with pain management, as measured by the HCAHPS survey.Level of Evidence: 3.

Person-Centered Gerontological Nursing: An Overview Across Care Settings

Person-centered care (PCC) is the gold standard in care delivery for all people, including older adults. Key players, such as the National Academies of Sciences, Engineering, and Medicine, the Institute for Healthcare Improvement, and the Centers for Medicare & Medicaid, have highlighted PCC as a means to better meet people's needs and improve their quality of care. Nurses are often a person's primary point of contact throughout their care trajectory, thus essential in planning, coordinating, and delivering PCC. However, limited literature focuses on the application and evaluation of nursing-related PCC for older adults. The current article aims to provide a nursing-focused conceptual review of PCC for older adults across care settings. This review describes PCC from a gerontological nursing perspective and presents setting-specific approaches and person-centered nursing practice outcomes. [Journal of Gerontological Nursing, 47(2), 7-12.].

Parent Experience of Communication about Children's Surgery: A Qualitative Analysis

Parent experience is a core component of the quality of pediatric care and an increasingly common focus of quality improvement initiatives. However, the parent experience of communication in the pediatric surgical setting remains unexplored.

Methods

We conducted semi-structured interviews with 20 parents of children undergoing surgery. Interviews were analyzed using directed qualitative content analysis.

Results

Content analysis revealed 3 overarching themes. The theme of "provider-parent communication" included interpersonal behaviors and communication-originating skills of the surgeon. Parents valued surgeons incorporating multimodal information-sharing techniques, recognizing children's psychological needs, providing reassurance, engaging in teamwork, and including parents. The theme of "parental emotional experiences" included domains of parent worry, intimidation, offense, self-doubt, mistrust, and strength surrounding their child's surgery. Parents felt simultaneously responsible for their child's welfare and for understanding medical information. The theme of "process improvement" included preparation for surgery, efficiency, managing delays, anesthesia induction, emergence from anesthesia, privacy, and preparation for recovery.

Conclusions

Themes identified through these parental narratives and proposed solutions inform quality improvement efforts related to surgeon communication strategies and facilitate family-centered surgical care for children. Parents often provided solutions after they described concerns, which attests to the utility of parent perspectives.

A telephone assessment and advice service within an ED physiotherapy clinic: a single-site quality improvement cohort study

BACKGROUND

In response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability.

METHODS

This was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, XMercy University Hospital, Cork, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study.

RESULTS

Those that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3-8 days) compared to those that opted for usual care (median 35 days; 19-39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction.

CONCLUSION

A telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.

The Effect of a Multifaceted Family Participation Program in an Adult Cardiovascular Surgery ICU

OBJECTIVES

To develop and implement a patient- and family-centered care program for patients in a cardiovascular surgery ICU.

DESIGN

Prospective, pre- and postintervention evaluations were conducted.

SETTING

The cardiovascular surgery ICU was located in a tertiary hospital.

PARTICIPANTS

Participants included 56 family members of patients in cardiovascular surgery ICU between May and July 2019.

INTERVENTIONS

Providing personalized treatment plans for patients by: 1) providing an ICU diary, 2) communicating with the medical staff, 3) providing personal care using ICU visitation kit, and 4) guiding bedside range of motion exercises. The experimental group received a guided ICU diary and education program from a nurse, including the application of a family participation visitation program. Family members were provided with customized information from the ICU diary and communicated with the medical staff for approximately 10 minutes. Family members were instructed on how to perform personal care using an "ICU visitation kit" during visitation hours when permitted to participate in bedside activities for approximately 10-minute intervals.

MEASUREMENTS AND MAIN RESULTS

Scores for satisfaction with the provided care and information increased significantly for the experimental group compared with the control group (t = 8.62; p < 0.001). Anxiety levels decreased significantly after intervention in both groups (t = -7.05; p < 0.001 and t = -12.94; p < 0.001) with a significant association observed between group and time point (F = 20.50; p < 0.001). However, no significant change was observed in satisfaction with decision-making following intervention in either group, and no significant association was noted between groups and time points for this variable (F = 0.24; p = 0.626).

CONCLUSIONS

This set of implemented family participation processes significantly improved satisfaction and reduced anxiety in family members of critically ill patients.

Do you need to pay for quality care? Associations between bribes and out-of-pocket expenditures on quality of care during childbirth in India

While it is mandated that reproductive and child health services be provided for free at public facilities in India, qualitative evidence suggests it is common for facilities to request bribes and other informal payments for medicines, medical tests or equipment. This article examines the prevalence of bribe requests, total out-of-pocket expenditures (OOPEs) and associations between bribe requests and total OOPEs on the experience of quality of care and maternal complications during childbirth. Women who delivered in public facilities in Uttar Pradesh, India were administered a survey on sociodemographic characteristics, bribe requests, total OOPEs, types of health checks received and experience of maternal complications. Data were analysed using descriptive, bivariate and multivariate statistics. Among the 2018 women who completed the survey, 43% were asked to pay a bribe and 73% incurred OOPEs. Bribe requests were associated with lower odds of receiving all health checks upon arrival to the facility (aOR = 0.49; 95% CI: 0.24-0.98) and during labour and delivery (aOR = 0.44; 95% CI: 0.25-0.76), lower odds of receiving most or all health checks after delivery (aOR = 0.44; 95% CI: 0.31-0.62) and higher odds of experiencing maternal complications (aOR = 1.45; 95% CI: 1.13-1.87). Although it is mandated that maternity care be provided for free in public facilities in India, these findings suggest that OOPEs are high, and bribes/tips contribute significantly. Interventions centred on improving person-centred care (particularly guidelines around bribes), health system conditions and women's expectations of care are needed.

Effect of an intervention on the congruence of nurses' and patients' perceptions of patient-centred care: A pre-test post-test study

AIMS AND OBJECTIVES

To evaluate measurement invariance of the Individualized Care Scale (ICS) across patients and nurses, and assess the degree of congruence in nurses' and patients' perceptions on patient-centredness and the impact of an intervention there on.

METHODS

A pre-post intervention study design with an expert by experience intervention was conducted in 2016 to 2017. Nurses (n = 138) and patients (n = 199) of two hospital departments in Belgium were surveyed. Patient-centredness was measured using the ICS (ICS-Nurse and ICS-Patient). Measurement invariance was evaluated by conducting multiple-group confirmatory factor analysis. Unpaired t tests and difference in difference analysis were used to evaluate the degree of congruence in nurses' and patients' perceptions on patient-centredness and assess pre-post changes in nurses' and patients' scores, respectively. SQUIRE guidelines were followed to report the study.

RESULTS

There was no evidence of measurement non-invariance. Nurses perceived the individuality of care more positively than patients both before and after the implementation of the intervention. Pre-post changes in nurses' and patients' scores were not statistically significant.

CONCLUSION

There is a significant gap between the perceptions of nurses and patients regarding the support and provision of individual care: nurses consider provided care as more individualized than patients do. To orient nurses' perspectives more towards their patients' perspective, multicomponent interventions are needed. Researchers and hospital managers may use the ICS to evaluate interventions that have the ability to close the gap in nurses' and patients' perceptions of patient-centredness. Embedding experts by experience in the professionals' team has the potential to foster patient-centredness but needs to focus on patients and nurses equally.

Towards a multilevel governance framework on the implementation of patient rights in health facilities: a protocol for a systematic scoping review

INTRODUCTION

Patient rights are "those rights that are attributed to a person seeking healthcare". Patient rights have implications for quality of healthcare and acts as a key accountability tool. It can galvanise structural improvements in the health system and reinforces ethical healthcare. States are duty bound to respect, protect and promote patient rights. The rhetoric on patient rights is burgeoning across the globe. With changing modes of governance arrangements, a number of state and non-state actors and institutions at various levels play a role in the design and implementation of (patient rights) policies. However, there is limited understanding on the multilevel institutional mechanisms for patient rights implementation in health facilities. We attempt to fill this gap by analysing the available scholarship on patient rights through a critical interpretive synthesis approach in a systematic scoping review.

METHODS

The review question is 'how do the multilevel actors, institutional structures, processes interact and influence the patient rights implementation in healthcare facilities? How do they work at what level and in which contexts?" Three databases PubMed, LexisNexis and Web of Science will be systematically searched until 30 th April 2020, for empirical and non-empirical literature in English from both lower middle-income countries and high-income countries. Targeted search will be performed in grey literature and through citation and reference tracking of key records. Using the critical interpretive synthesis approach, a multilevel governance framework on the implementation of patient rights in health facilities which is grounded in the data will be developed.

ETHICS AND DISSEMINATION

The review uses published literature hence ethics approval is not required. The findings of the review will be published in a peer-reviewed journal.

REGISTRATION NUMBER

PROSPERO 2020 CRD42020176939.

What do we know about patient-provider interactions in sub-Saharan Africa? a scoping review

Introduction

patient-centred care has become a rallying call for improving quality and access to care in countries where health system responsiveness and satisfaction with health services remain low. Understanding patient-provider interactions is important to guide implementation of an effective patient-centred care approach in sub-Saharan Africa. This review aims to overcome this knowledge gap by synthesizing the evidence on patient-provider interactions in sub-Saharan Africa.

Methods

we conducted a scoping review using Arksey and O´Malley´s framework. We searched in eight databases and the grey literature. We conducted a thematic analysis using an inductive approach to assess the studies.

Results

of the 80 references identified through database searching, nine met the inclusion criteria. Poor communication and several types of mistreatment (service denial, oppressive language, harsh words and rough examination) characterize patient-provider interactions in sub-Saharan Africa. Nevertheless, some health providers offer support to patients who cannot afford their medical expenses, cost of transportation, food or other necessities. Maintaining confidentiality depends on the context of care. Some patients blamed health providers for consulting with the door open or carrying out concomitant activities in the consultation room. However, in the context of HIV care provision, nurses emphasized the importance of keeping their patients´ HIV status confidential.

Conclusion

this review advocates for more implementation studies on patient-provider interactions in sub-Saharan Africa so as to inform policies and practices for patient-centred health systems. Decision-makers should prioritize training, mentorship and regular supportive supervision of health providers to provide patient-centred care. Patients should be empowered in care processes.

Exploring integrated supply chain performance in healthcare: a service provider perspective

Purpose

The paper identifies the antecedents and consequences of integrated supply chain performance (ISCP) in healthcare systems.

Design/methodology/approach

Based on a review of the literature constructs of supply chain flexibility (SCF), employee relationships (ERs), organizational orientation (OO) and knowledge exchange (KE) were identified as antecedents of ISCP, and patient centricity (PC) emerged as its consequence. This structural relationship was tested using partial least square structural equation modeling (PLS-SEM).

Findings

ERs, SCF, OO and KE positively impacted the performance of an integrated healthcare supply chain. Furthermore, enhanced ISCP in operational processes of the hospital positively influenced patient centeredness and care quality.

Research limitations/implications

Paper contributes by identifying antecedents and consequences of ISCP. Future researchers may explore the inter-relationships among the antecedents of ISCP.

Practical implications

Insights from this study will help practitioners in enhancing hospital operations by integrating processes along the healthcare service supply chain and developing a patient-centric approach.

Social implications

This paper highlights how PC may be achieved by focusing on a facilitative internal environment. This understanding may help in designing processes that deliver health as a social good in an effective manner.

Originality/value

The empirical evidence from this study can help hospitals integrate their functions, thus, enabling them to deliver quality care.

Patient-centered care in Israeli IVF units: divergent perceptions of patients and providers

Background

Patient-centered care is particularly important for patients undergoing fertility treatment because of their emotional involvement and their constant contact with providers. To the best of our knowledge, to date, there have been no rigorous studies of the discrepancies between the patients’ perceptions of the care they received and the providers’ perceptions of the care that they provided, in specific dimensions and elements of patient-centered care.

Objective

To compare provider and patient perceptions of the extent to which care in Israeli IVF units is patient-centered.

Methods

A previously validated survey instrument was used to assess the patient and provider perceptions of ten dimensions of patient-centered care: accessibility of providers, provision of information and of explanations, communication skills of providers, patient involvement in the treatment, respect for patient values and needs, continuity and transition in treatment, professional competence, care organization, physical comfort, and emotional support. The patient survey and the provider survey were conducted in 2016–2017; both surveys were carried out in 8 of 25 hospital-based IVF units in Israel. Seventy-six providers and 524 patients (response rate 79%) participated in the surveys.

Findings

The perceptions of patients and providers were similar regarding seven of the ten dimensions of patient-centered care, although there were some differences in patient vs. provider scores by unit. There were three dimensions with substantial provider-patient score differences: Moderate-sized gaps were found relative to the provision of information and explanations (1.96 vs. 2.38, on a 0–3 scale) and respect for patient values and needs (1.92 vs. 2.47). A large gap was observed relative to emotional support (0.96 vs. 2.54).

Conclusions

Providers appear to underestimate the needs of fertility treatment patients for information, respect, and emotional support. The observed differences between what patients feel about their care and what providers assume they provide, especially regarding emotional support, indicates a need for ongoing, specific feedback to providers as to the patient-centeredness of the care they provide. The particularly large patient – provider gap relative to the provision of emotional support highlights the importance of increasing the attention paid to the psychological impact of fertility treatment and of giving patients an opportunity to consult a counselor who is familiar with problems associated with fertility treatments.

Policy recommendations

Efforts to improve the patient-centeredness in FT should begin by establishing a national ongoing feedback mechanism, involving all 25 IVF units operating in Israel working in collaboration with the Ministry of Health. The findings from this joint effort should be shared with the public. In addition, we recommended appointing one professional in each IVF unit to be in charge of promoting improvements in the patient-centered care for that unit. Assigning a mental health professional (psychologist or social worker) to each and every IVF unit is also of crucial importance.

Patients' satisfaction with quality of care in general hospitals in Ebonyi State, Nigeria, using SERVQUAL theory

BACKGROUND

Patient satisfaction is an essential parameter in the assessment of quality of care and healthcare facility performance.

OBJECTIVE

To investigate patients' satisfaction with quality of care in general hospitals in Ebonyi State, South East, Nigeria, using the SERVQUAL.

METHODS

A cross-sectional descriptive study design was employed on a sample of 400 patients using a 27-item structured open-ended patients' satisfaction questionnaire with a multi-stage cluster sampling technique. Patients included in the study were those who must have come for an outpatient clinic within the period, be 18 years and above, and those who gave consent to participate. Of 400 questionnaires administered, 396 (99%) were retrieved. SPSS version 20 was used for data analysis. Descriptive statistics, such as frequencies, percentages, mean score (x), and standard deviation, were employed for interpretation.

RESULTS

Out of 396 patients, 156 (39.4%) were male and 240 (60.6%) were females. Most patients were 18-39 years (233 (58.8%)), had secondary education (139 (35.1%)), married (221 (55.8%)), earned <18,000 (170(42.9%)), and were traders (136 (34.3%)). Patients were satisfied with tangibility (2.57 ± 0.99) and reliability (2.84 ± 0.95) and very satisfied with responsiveness (3.06 ± 0.63), assurance (3.07 ± 0.63), and empathy (3.12 ± 0.57).

CONCLUSIONS

Patients were satisfied with the quality of care. However, satisfaction was highest with empathy and lowest with tangibility. Thus, managers should focus their quality improvement efforts on areas of the neat appearance of health workers, waiting facilities for attendants and patients, and hygienic conditions at the hospital. Also, biannual assessment of patients' satisfaction should be done and the results generated use judiciously to provide a platform for health sector reform.

What Do Patients Want? A Qualitative Analysis of Patient, Provider, and Administrative Perceptions and Expectations About Patients' Hospital Stays

Patient experience is increasingly recognized as a measure of health care quality and patient-centered care and is currently measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS survey may miss key factors important to patients, and in particular, to underserved patient populations. We performed a qualitative study utilizing semi-structured interviews with 45 hospitalized English- and Spanish-speaking patients and 6 focus groups with physicians, nurses, and administrators at a large, urban safety-net hospital. Four main themes were important to patients: (1) the hospital environment including cleanliness and how hospital policies and procedures impact patients’ perceived autonomy, (2) whole-person care, (3) communication with and between care teams and utilizing words that patients can understand, and (4) responsiveness and attentiveness to needs. We found that several key themes that were important to patients are not fully addressed in the HCAHPS survey and there is a disconnect between what patients and care teams believe patients want and what hospital policies drive in the care environment.

Exploring value-dense environment in the healthcare service delivery

Purpose

The purpose of this paper is to explore the antecedents and consequences of a value-dense environment in healthcare service delivery.

Design/methodology/approach

A structural model was developed based on a literature review. Circulation of a 31-indicator questionnaire among service receivers in the healthcare system across India generated 279 valid responses. The research model was assessed using a cross-sectional research design, and the data were analyzed by partial least squares-structural equation modeling.

Findings

Integrated supply chain performance (ISCP), internal service quality (ISQ) and coordinated care are antecedents of a value-dense environment, which drives patient-centricity. The leagile supply chain strategy strengthens the relationship between ISCP and coordinated care. Employee trust and commitment acts as a moderator between coordinated care and ISQ.

Research limitations/implications

By adopting the perspective of service receivers, this paper highlights the influence of value-density on patient-centricity in healthcare organizations. Future research should include healthcare professionals’ perceptions of value-dense environment creation.

Practical implications

The study provides suggestions to practitioners for designing patient-centric healthcare services by leveraging ISCP, coordinated care and ISQ in the value-creation process. Recognizing the relationships among these constructs can aid the timely formulation of corrective actions and future policies.

Social implications

This study underscores patient-centric care as a basis for effectively delivering healthcare as a social good.

Originality/value

This paper contributes to the body of knowledge by identifying and empirically validating the relationships between patient-centricity and value co-creation.

How can we achieve person-centred care for people living with HIV/AIDS? A qualitative interview study with healthcare professionals and patients in Ghana

Although person-centred care (PCC) has been identified as a means to achieve the 90-90-90 targets, limited research has considered PCC in low- or middle-income settings. We aimed to explore what constitutes PCC from the perspectives of PLWHA and healthcare professionals (HCP) in Ghana. We conducted 39 semi-structured qualitative interviews with PLWHA and HCP in two community clinics in Ghana, West Africa. Interviews were analysed deductively using thematic analysis, and sampling continued until thematic saturation was achieved. Twenty-four PLWHA (median age 42.5, 50% female) and 15 HCP (median age 34, 53% female) were interviewed. Three interconnected themes emerged across PLWHA and HCP: (1) care structures not built around the person, (2) priority outcomes and components of PCC and (3) re-engineering HIV care to be more person-centred. A conceptual model showing the overlap between PLWHA and HCP's perspectives of PCC and a framework to inform PCC delivery have been developed from these findings. Our data revealed that PLWHA want PCC to improve care outcomes, well-being and quality of life. Further testing of this model is required to inform PCC delivery for PLWHA in low- and middle-income countries.

PEN-13: A New Generic 13-Item Questionnaire for Measuring Patient Enablement (German Version)

Background: The purpose of our study was to develop and psychometrically test a German-language survey instrument that measures patient enablement generically and in greater detail than previous instruments. Methods: A multidisciplinary team developed 13 items to capture individual aspects of patient enablement (PEN-13). A pre-test with 26 subjects was followed by a random sample survey of N = 1168 subjects. An exploratory factor analysis was conducted in a random split-half sample of the data to explore PEN-13's factor structure; a confirmatory factor analysis was conducted in the validation sample. The internal consistency of the factors was evaluated using Cronbach's alpha, PEN-13's construct validity was checked by means of additional hypothesis testing. Results: The two factors self-management and patient-practitioner interaction, detected in the exploratory analysis, were confirmed with a few modifications in the confirmatory factor analysis, with the comparative fit index (CFI) amounting to 0.903. The Cronbach's alpha values of those two factors amounted to α = 0.90 and α = 0.82, respectively. The correlations of the PEN-13 score with the 'general self-efficacy' and 'health literacy' (HLS-EU-Q16) scores further confirmed its construct validity; the respective correlation coefficients amounted to 0.57 and 0.60. Conclusion: The German version of the survey instrument Patient Enablement Scale-13 items (PEN-13) shows acceptable psychometric properties. Practical implications: PEN-13 seems particularly suitable for health services research purposes. We recommend checking the results in another sample as well as evaluating its responsiveness to enablement-enhancing interventions.

Improving Patient Experience in Hospital Settings: Assessing the Role of Toolkits and Action Research Through a Process Evaluation of a Complex Intervention

This article presents a process evaluation of the implementation and refinement of a patient experience toolkit (PET) by action researchers in six hospital wards in the English National Health Service (NHS). An initial assumption that health care professionals (HCPs) would use PET to improve patient experience proved unrealistic due to staff and service pressures. However, the action researchers' facilitation of PET and their support during the implementation of quality improvement efforts filled in for HCPs' lack of time. The findings suggest that the PET can be a successful guide for skilled facilitators working with HCPs, although excessive staff pressures should be avoided. Toolkits designed for implementation by HCPs should, therefore, be used sparingly; a more appropriate target audience may be facilitators. Furthermore, while the potential of action research is confirmed by this evaluation, HCPs' time to engage in service improvement is found to moderate the success of this increasingly prominent methodology.

Building patient capacity to participate in care during hospitalisation: a scoping review

OBJECTIVES

To map the existing literature and describe interventions aimed at building the capacity of patients to participate in care during hospitalisation by: (1) describing and categorising the aspects of care targeted by these interventions and (2) identifying the behaviour change techniques (BCTs) used in these interventions. A patient representative participated in all aspects of this project.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, Embase and CINAHL (Inception -2017).

STUDY SELECTION

Studies reporting primary research studies on building the capacity of hospitalised adult patients to participate in care which described or included one or more structured or systematic interventions and described the outcomes for at least the key stakeholder group were included.

DATA EXTRACTION

Title and abstract screening and full text screening were conducted by pairs of trained reviewers. One reviewer extracted data, which were verified by a second reviewer. Interventions were classified according to seven aspects of care relevant to hospital settings. BCTs identified in the articles were assigned through consensus of three reviewers.

RESULTS

Database searches yielded a total 9899 articles, resulting in 87 articles that met the inclusion criteria. Interventions directed at building patient capacity to participate in care while hospitalised were categorised as those related to improving: patient safety (20.9%); care coordination (5.7%); effective treatment (5.7%) and/or patient-centred care using: bedside nursing handovers (5.7%); communication (29.1%); care planning (14%) or the care environment (19.8%). The majority of studies reported one or more positive outcomes from the defined intervention. Adding new elements (objects) to the environment and restructuring the social and/or physical environment were the most frequently identified BCTs.

CONCLUSIONS

The majority of studies to build capacity for participation in care report one or more positive outcomes, although a more comprehensive analysis is warranted.

Independent and Web-Based Advice for Infertile Patients Using Fertility Consult: Pilot Study

Background

Patient-centered care—that is, care tailored to personal wishes and needs of patients—has become increasingly important. It is especially relevant in health care areas where patients suffer from a high burden of disease, such as fertility care. At present, both diagnosis and treatment for infertile couples is provided at a single hospital. As a consequence, patients are not likely to receive optimal, independent advice regarding their fertility problems. Internet-based, independent advice could be feasible for large groups of patients because it is not limited by travel distance and overhead costs.

Objective

The aim of this study was to explore the experiences of both patients and professionals with an online platform using video consultations for patients with infertility seeking independent advice for their fertility problem.

Methods

This pilot study evaluated an online platform, Fertility Consult, where patients with infertility can get independent advice by a gynecologist through a video consultation, thus eliminating the need of meeting the doctor physically. Semistructured interviews were performed with 2 gynecologists and the chairman of the Dutch patients association. This information was used for a patients’ questionnaire about their first experiences with Fertility Consult, including questions about the level of patient-centeredness and shared decision making, using the Patient-Centered Questionnaire-Infertility (PCQ-Infertility) and the CollaboRATE questionnaire, respectively.

Results

Of the first 27 patients enrolled at Fertility Consult, 22 responded (82%). Most patients (82%) visited Fertility Consult for a second opinion, seeking more personal attention and independent advice. The mean level of patient-centeredness on the PCQ-Infertility questionnaire was 2.78 (SD 0.58) on a scale of 0 to 3. For the CollaboRATE questionnaire (scale 0-9), patients provided a median score of 8.0 (range 7-9) on all 3 questions about shared decision making.

Conclusions

Patients were satisfied with independent, well-prepared, Web-based advice; health care professionals felt they were able to provide patients with proper advice in a manner befitting patients’ needs, without any loss of quality. Future studies should focus more on the separation of advice and treatment and on Web-based consultations compared with face-to-face consultations to ascertain the possibility of increased patient involvement in the process to improve the level of patient-centered care.

Implementation of patient-centred care: which organisational determinants matter from decision maker's perspective? Results from a qualitative interview study across various health and social care organisations

OBJECTIVES

Health and social care systems, organisations and providers are under pressure to organise care around patients' needs with constrained resources. To implement patient-centred care (PCC) successfully, barriers must be addressed. Up to now, there has been a lack of comprehensive investigations on possible determinants of PCC across various health and social care organisations (HSCOs). Our qualitative study examines determinants of PCC implementation from decision makers' perspectives across diverse HSCOs.

DESIGN

Qualitative study of n=24 participants in n=20 semistructured face-to-face interviews conducted from August 2017 to May 2018.

SETTING AND PARTICIPANTS

Decision makers were recruited from multiple HSCOs in the region of the city of Cologne, Germany, based on a maximum variation sampling strategy varying by HSCOs types.

OUTCOMES

The qualitative interviews were analysed using an inductive and deductive approach according to qualitative content analysis. The Consolidated Framework for Implementation Research was used to conceptualise determinants of PCC.

RESULTS

Decision makers identified similar determinants facilitating or obstructing the implementation of PCC in their organisational contexts. Several determinants at the HSCO's inner setting and the individual level (eg, communication among staff and well-being of employees) were identified as crucial to overcome constrained financial, human and material resources in order to deliver PCC.

CONCLUSIONS

The results can help to foster the implementation of PCC in various HSCOs contexts. We identified possible starting points for initiating the tailoring of interventions and implementation strategies and the redesign of HSCOs towards more patient-centredness.

Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes

In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.

Patient satisfaction and treatment outcomes of primary care practice in Ghana

BACKGROUND

General evidence suggests a strong association between patient satisfaction and treatment outcomes, but data specific to the general Ghanaian population is lacking.

PURPOSE

To use nationally representative data to examine the effects of primary care practices on patient satisfaction and how satisfaction influences treatment outcomes.

METHODS

The study utilized WAVE 1 data from a nationally representative survey (n = 2,967) of patients who received outpatient medical care in Ghana. The data were collected by the World Health Organization between 2007 and 2010 and were analyzed using Kruskal Wallis test, binomial logistic regression, and correlations. Predictors for patients' experiences were waiting time, respectfulness, clear communication, privacy, decision-making, choice, and cleanliness.

RESULTS

Overall, the patients reported positive experiences with all aspects of their primary care services. Thirty-three percent were very satisfied and 57% were satisfied with their last outpatient visit. Adjusted for sociodemographic and other variables, patient satisfaction with primary care was predominantly determined through privacy, decision-making, communication, and respectfulness. The model explained 54.6% (Nagelkerke R 2) of the variance in satisfaction and correctly classified 85.2% of cases. Patient satisfaction and treatment outcomes were significantly related, r(2959) = .54, p < .001.

CONCLUSION

In a nationally representative sample, quality of patient experiences was associated with high satisfaction, which in turn was positively associated with improved treatment outcomes.

FUNDING

None.

How is patient involvement measured in patient centeredness scales for health professionals? A systematic review of their measurement properties and content

BACKGROUND

Patient centeredness is an important component of patient care and healthcare quality. Several scales exist to measure patient centeredness, and previous literature provides a critical appraisal of their measurement properties. However, limited knowledge exists regarding the content of the various scales in terms of what type of patient centeredness they represent and how they can be used for quality improvement. The aim of this study was to explore the measurement properties of patient centeredness scales and their content with a special focus on patient involvement, and assess whether and how they can be used for quality improvement.

METHODS

A systematic review of patient centeredness scales was conducted in Medline, CINAHL, Embase, and SCOPUS in April and May 2017. Inclusion criteria were limited to articles written in English published from 2005 to 2017. Eligible studies were critically appraised in terms of internal consistency and reliability, as well as their content, structural, and cross-cultural validity. Type of studies included were scale-development articles and validation studies of relevant scales, with healthcare personnel as respondents. We used directed content analysis to categorize the scales and items according to Tritter's conceptual framework for patient and public involvement.

RESULTS

Eleven scales reported in 22 articles were included. Most scales represented individual, indirect, and reactive patient involvement. Most scales included items that did not reflect patient centeredness directly, but rather organizational preconditions for patient centered practices. None of the scales included items explicitly reflecting the use of patient experiences of quality improvement.

CONCLUSIONS

There is a lack of patient centeredness scales focusing on direct and proactive involvement of patients in quality improvement. It would be useful to develop such instruments to further study the role of patient involvement in quality improvement in healthcare. Furthermore, they could be used as important tools in quality improvement interventions.

Determinants of patient satisfaction in outpatient musculoskeletal physiotherapy: a systematic, qualitative meta-summary, and meta-synthesis

Purpose: To identify and synthesise patient-identified factors that influence satisfaction with outpatient musculoskeletal physiotherapy (O-MSK).Methods: A systematic, qualitative meta-summary and meta-synthesis was conducted by accessing six electronic databases: CINAHL, Embase, MEDLINE, Scopus, Web of Science, and Wiley Online Library, from inception to March 2017. Additional studies were identified by using a "berry-picking" method. Search limits were: primary studies; English language; and involving human subjects. Qualitative peer-reviewed articles describing patient satisfaction in O-MSK were eligible for inclusion. Two reviewers critically appraised eligible studies independently using the critical appraisal of skills programme tool for qualitative studies. Extracted verbatim data of included studies were synthesised using the meta-summary and meta-synthesis by using a purpose-designed form.Results: Eleven studies were included in the article. Factors influencing patient satisfaction were grouped into six broad themes: 1) clinical outcomes; 2) physiotherapist features; 3) patient features; 4) physiotherapist-patient relationship; 5) treatment features, and 6) healthcare setting features.Conclusions: These findings suggest that patient satisfaction in O-MSK is a multidimensional construct influenced by individual patient/provider, clinical, and contextual factors. Future reviews should include a synthesis of findings from both qualitative and quantitative studies to establish a fully comprehensive understanding of this complex health phenomenon.Implications for rehabilitationPatient satisfaction in outpatient musculoskeletal physiotherapy is affected by different factors, thus reflecting a multidimensional construct;Single determinants are not sufficient to affect patient satisfaction;Patient satisfaction is influenced individual patient/provider, clinical outcomes, and contextual factors;Further studies should be designed to investigate the relationships among these factors.

The patient-centered medical home: a reality for HIV care in Nigeria

Objective

HIV care delivery in resource-limited settings (RLS) may serve as a paradigm for chronic disease care, but comprehensive measurement frameworks are lacking. Our objective was to adapt the patient-centered medical home (PCMH) framework for use in RLS, and evaluate the performance of HIV treatment programs within this framework.

Design and setting

Cross-sectional survey administered within the AIDS Prevention Initiative in Nigeria (APIN) network.

Participants

Medical directors at APIN clinics.

Main outcome measures

We adapted the 2011 US National Committee on Quality Assurance's PCMH standard to develop a survey measuring five domains of HIV care: (i) enhancing access and continuity, (ii) identifying and managing patient populations, (iii) planning and managing care, (iv) promoting self-care and support and (v) measuring and improving performance.

Results

Thirty-three of 36 clinics completed the survey. Most were public (73%) and urban/semi-urban (64%); 52% had >500 patients in care. On a 0-100 scale, clinics scored highest in self-care and support, 91% (63-100%); managing patient populations, 80% (72-81%) and improving performance, 72% (44-78%). Clinics scored lowest with the most variability in planning/managing care, 65% (22-89%), and access and continuity, 61% (33-80%). Average score across all domains was 72% (58-81%).

Conclusions

Our findings suggest that the modified PCMH tool is feasible, and likely has sufficient performance variation to discriminate among clinics. Consistent with extant literature, clinics showed greatest room for improvement on access and continuity, supporting the tool's face validity. The modified PCMH tool may provide a powerful framework for evaluating chronic HIV care in RLS.

Three Sides to Every Story: Preparing Patient and Family Storytellers, Facilitators, and Audiences

BACKGROUND

There is a growing recognition that patient engagement is necessary for the cultivation of patient- and family-centered care (PFCC) in the hospital setting. Acting on the emerging understanding that hearing stories from our patients gives valuable insight about our ability to provide compassionate PFCC, we developed an educational patient experience curriculum at our acute care teaching hospital.

OBJECTIVES

To understand the benefits and consequences of patient storytelling and to explore the impact of our curriculum on participants.

METHODS

The curriculum was codesigned with patients to illustrate the value and meaning of PFCC to health professional audiences. We surveyed audience members at nursing orientation events and interviewed the patient storytellers who shared their stories.

RESULTS

Participants indicated that patient stories could serve as lessons or reminders about the dimensions of PFCC and could inspire changes to practice. Storytellers reported an immensely rewarding experience and highlighted the value of educating and connecting with participants. However, they reported that the experience could also pose emotional challenges.

CONCLUSION

Careful and considerate facilitation of storytelling sessions is crucial to the delivery of a curriculum that is beneficial to both patients and participants. Our storytelling framework offers a novel approach to engaging patients in education, and it contributes to our existing understanding of how patient engagement efforts resonate within organizations.

How to practice person-centred care: A conceptual framework

BACKGROUND

Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation.

METHODS

Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health-care improvement was used to classify PCC domains into the categories of "Structure," "Process" and "Outcome" for health-care quality improvement.

DISCUSSION

The framework emphasizes the structural domain, which relates to the health-care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co-designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient-Reported Outcomes.

CONCLUSION

This conceptual framework provides a step-wise roadmap to guide health-care systems and organizations in the provision PCC across various health-care sectors.

Patient empowerment: Its implementation and systems within hospitals in England and Greece

Introduction

International health policies recognise patient empowerment, resulting in diverse empowerment models and systems. Research on organisational systems for implementing patient empowerment between countries or from organisational stakeholders’ perspective, however, is limited. Aims and methodology: This paper explores and compares organisational systems and structures for patient empowerment implementation in six acute public hospitals in England and Greece (three in each country), their cross-case and cross-national similarities and differences. It uses a comparative, qualitative, explanatory embedded case study design. Semi-structured interviews with a representative sample of stakeholders (n = 33) and documentary sources (n = 79) were analysed with framework.

Results

Two main patient empowerment themes were identified: (1) organisational leadership, systems, structures; (2) operational structures, services, mechanisms and activities. Generic organisational systems and structures for patient empowerment varied across-cases, but with common organisation of empowerment roles in England and common leadership in Greece. Operational structures, services and mechanisms supporting empowerment varied across-cases and cross-nationally, but with similarities in the main services.

Conclusion

Implementation of patient empowerment was weaker in Greece than in England, attributable to differing approaches to strategic and operational leadership, limited development of strategies and influential organisational structures. Overall, patient empowerment is well-embedded in organisations with a highly visible patient empowerment profile; commitment to policies and strategy implementation at different levels; strategic and operational leadership investing in dedicated roles with clear authority for patient empowerment, influential empowerment structures and mechanisms.

System-Wide and Group-Specific Health Service Improvements: Cross-Sectional Survey of Outpatient Improvement Preferences and Associations with Demographic Characteristics

Efficient patient-centred quality improvement requires an understanding of the system-wide areas of dissatisfaction along with evidence to identify the programs which can be strategically targeted according to specific patient characteristics and preferences. This cross-sectional study reports the proportion of chronic disease outpatients selecting 23 patient-centred improvement initiatives. Using univariate tests and multivariable logistic regressions, this multi-site study also identifies initiatives differentially selected by outpatients according to clinical and demographic characteristics. A total of 475 outpatients participated (49% response). Commonly selected initiatives included: reducing wait-times (22.3%); convenient appointment scheduling (16.0%); and receiving up-to-date treatment information (16.0%). Within univariate tests, preferences for information and service accessibility initiatives were not significantly associated with specific subgroups. However, seven initiatives were preferred according to age, gender, diagnosis status, and chronic disease type within multivariate models. For example, neurology outpatients were more likely to select assistance to manage psychological symptoms when compared to oncology outpatients (OR: 2.89). Study findings suggest that system-wide programs to enhance information provision are strategic approaches to improve experiences across patient characteristics. Furthermore, a few initiatives can be targeted to specific groups and emphasized the importance of detailed scoping analyses and tailored implementation plans when designing patient-centred quality improvement programs.

Prescription Opioid Use and Satisfaction With Care Among Adults With Musculoskeletal Conditions

PURPOSE

In the current payment paradigm, reimbursement is partially based on patient satisfaction scores. We sought to understand the relationship between prescription opioid use and satisfaction with care among adults who have musculoskeletal conditions.

METHODS

We performed a cross-sectional study using nationally representative data from the 2008-2014 Medical Expenditure Panel Survey. We assessed whether prescription opioid use is associated with satisfaction with care among US adults who had musculoskeletal conditions. Specifically, using 5 key domains of satisfaction with care, we examined the association between opioid use (overall and according to the number of prescriptions received) and high satisfaction, defined as being in the top quartile of overall satisfaction ratings.

RESULTS

Among 19,566 adults with musculoskeletal conditions, we identified 2,564 (13.1%) who were opioid users, defined as receiving 1 or more prescriptions in 2 six-month time periods. In analyses adjusted for sociodemographic characteristics and health status, compared with nonusers, opioid users were more likely to report high satisfaction with care (odds ratio = 1.32; 95% CI, 1.18-1.49). According to the level of use, a stronger association was noted with moderate opioid use (odds ratio = 1.55) and heavy opioid use (odds ratio = 1.43) (P <.001 for trend).

CONCLUSIONS

Among patients with musculoskeletal conditions, those using prescription opioids are more likely to be highly satisfied with their care. Considering that emerging reimbursement models include patient satisfaction, future work is warranted to better understand this relationship.