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O’Malley R, Lydon S, Faherty A, O’Connor P. Identifying Factors that Support the Delivery of Exceptional Care in General Practice and Development of the IDEAL Framework: A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1232-1248. [PMID: 37694934 PMCID: PMC10626987 DOI: 10.1177/10497323231197387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The positive deviance approach seeks to identify and learn from those that perform exceptionally well. Positive deviance as an approach to quality improvement is gaining traction in general practice. This study aimed to explore and compare stakeholders' perceptions of the factors that support the delivery of exceptional care in general practice and to refine a previously developed theoretical framework of factors associated with positively deviant care in general practice: the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework. Semi-structured interviews were conducted with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers in Irish general practice. Subsequently, a directed content analysis approach was employed to deductively analyse interview data using the IDEAL framework, and newly emerging factors were inductively analysed and abstracted into the framework. Several distinct strategies (e.g. patient activation and team collaboration), structures (e.g. facilities and staffing), and contextual factors (e.g. communication and rapport, and culture) were found to support the delivery of exceptional care, and differences in perceptions, values, and expectations emerged between patients and practice staff. Interview data largely supported the pre-determined factors posited by the IDEAL framework, and new factors were abstracted into the framework (e.g. facilities and infrastructure). Stakeholder engagement regarding the factors supporting exceptional care in general practice supported and extended the IDEAL framework, contributing to a more comprehensive understanding of how exceptional care is delivered in general practice. The refined framework will support researchers, policymakers, and teams looking to support, measure, and achieve exceptionally good patient care in general practice.
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Affiliation(s)
- Roisin O’Malley
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, Clinical Science Institute, University of Galway, Galway, Ireland
| | - Aileen Faherty
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Paul O’Connor
- Discipline of General Practice, University of Galway, Galway, Ireland
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Wang W, Zhang J, Lu J, Wei X. Patient views of the good doctor in primary care: a qualitative study in six provinces in China. Glob Health Res Policy 2023; 8:24. [PMID: 37434267 DOI: 10.1186/s41256-023-00309-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND China has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms, but these initiatives have not adequately met patient needs and expectations. In order to guide further reform efforts to better meet patient expectations, this study generates a profile of the good doctor in primary care from the patient perspective. METHODS Semi-structured interviews were conducted in six provinces (Shandong, Zhejiang, Henan, Shaanxi, Shanxi, Heilongjiang) in China. A total of 58 interviewees completed the recorded interviews. Tape-based analysis was used to produce narrative summaries. Trained research assistants listened to the recordings of the interviews and summarized them by 30-s segments. Thematic analysis was performed on narrative summaries to identify thematic families. RESULTS Five domains and 18 attributes were generated from the analysis of the interview data. The domains of the good doctor in primary care from the patient perspective were: strong Clinical Competency (mentioned by 97% of participants) and Professionalism & Humanism (mentioned by 93% of participants) during service delivery, followed by Service Provision and Information Communication (mentioned by 74% and 62% of participants, respectively). Moreover, Chinese patients expect that primary care doctors have high educational attainment and a good personality (mentioned by 41% of participants). CONCLUSIONS This five-domain profile of the good doctor in primary care constitutes a foundation for further primary care workforce capacity building. Further primary care reform efforts should reflect the patient views and expectations, especially in the family physician competency framework and primary care performance assessment system development. Meanwhile, frontline primary care organizations also need to create supportive environments to assist competent doctors practice in primary care, especially through facilitating the learning of primary care doctors and improving their well-being.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Servetkienė V, Puronaitė R, Mockevičienė B, Ažukaitis K, Jankauskienė D. Determinants of Patient-Perceived Primary Healthcare Quality in Lithuania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4720. [PMID: 36981628 PMCID: PMC10048695 DOI: 10.3390/ijerph20064720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Patient-centered care is considered to be one of the essential pillars of a modern healthcare system. Thus, quality assessment based on patients' perceptions, views and experiences in their journey through the healthcare system is recognized as one of the key principles for quality improvement initiatives. Measuring patient satisfaction can be confounded by expectations and prior experiences, which can be at least partly overcome by evaluating patient-perceived healthcare quality (PPHQ). Understanding the principal constituents of PPHQ may aid healthcare professionals and decision makers in the healthcare management process and help in creating instruments to meaningfully measure patient feedback. Herein, we aimed to analyze the primary determinants of PPHQ and their interactions, with a focus on patient experiences and healthcare accessibility, using the example of Lithuanian primary healthcare. For this purpose, we conducted a cross-sectional representative telephone survey that included a total of 1033 respondents (48% male) who had encountered primary healthcare during last 3 years. Survey questions consisted of sociodemographic characteristics, patient perceptions of healthcare service provision, patient experiences, self-reported health status and overall PPHQ ranked with a 5-point Likert scale as the primary outcome. The classification-regression tree (CRT) technique was used to analyze the relationship between different explanatory variables and PPHQ, as well as their relative importance and interactions. The majority of respondents (89%) evaluated PPHQ as acceptable or good. CRT analysis identified staff behavior, organizational accessibility and financial accessibility as the most important factors affecting PPHQ. Importantly, the latter factors surpassed the effect of other known PPHQ determinants, such as sociodemographic characteristics or health status. Further analysis has revealed that the relative importance of staff behavior, including understanding, attention and empathy, increased when more problems with organizational accessibility were encountered. In conclusion, our study suggests that PPHQ in primary healthcare may primarily be determined by organizational and financial accessibility and staff behavior, which may also act as an important mediating factor.
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Affiliation(s)
- Vaida Servetkienė
- Health Research Laboratory, Mykolas Romeris University, 08303 Vilnius, Lithuania
| | - Roma Puronaitė
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Birutė Mockevičienė
- Health Research Laboratory, Mykolas Romeris University, 08303 Vilnius, Lithuania
| | - Karolis Ažukaitis
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
- Clinic of Pediatrics, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
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Hannawa AF, Wu AW, Kolyada A, Potemkina A, Donaldson LJ. The aspects of healthcare quality that are important to health professionals and patients: A qualitative study. PATIENT EDUCATION AND COUNSELING 2022; 105:1561-1570. [PMID: 34711447 DOI: 10.1016/j.pec.2021.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Existing quality of care frameworks insufficiently integrate the perspectives of physicians, nurses and patients. We collected narrative accounts from these three groups to explore if their perspectives might add new content to these existing definitions. METHODS Ninety-seven descriptions of "good" and "poor" care episodes were collected from a convenience sample of physicians, nurses and outpatients at eight regional hospitals. Two coders classified the narrative contents into themes related to structures, processes and outcomes of care. RESULTS The physicians, nurses and patients raised the following "quality of care" aspects: Successful communication among staff, with patients and care companions; staff motivation; frequency of knowledge errors; prioritization of patient-preferred outcomes; institutional emphasis on building "quality cultures"; and organizational implementation of fluid system procedures. CONCLUSION Respondents primarily referred to care processes in their descriptions of "quality of care." "Hippocratic pride" (in response to care successes) and "Rapid reactivity" (in response to (near) failures) emerged as two new outcome indicators of high-quality care. PRACTICE IMPLICATIONS This study provides a first qualitative fundament for understanding the components of "quality of care" from a triangulated frontline perspective. Future research needs to validate our findings with quantitative data to explore their usefulness for completing existing quality frameworks.
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Affiliation(s)
- Annegret F Hannawa
- Center for the Advancement of Healthcare Quality & Patient Safety (CAHQS), Faculty of Communication, Culture & Society, Università della Svizzera italiana (USI), Via G. Buffi 13, 6900 Lugano, Switzerland.
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 653, Baltimore, MD 21205, USA.
| | - Anastasia Kolyada
- Center for the Advancement of Healthcare Quality & Patient Safety (CAHQS), Faculty of Communication, Culture & Society, Università della Svizzera italiana (USI), Via G. Buffi 13, 6900 Lugano, Switzerland.
| | - Anastasia Potemkina
- Center for the Advancement of Healthcare Quality & Patient Safety (CAHQS), Faculty of Communication, Culture & Society, Università della Svizzera italiana (USI), Via G. Buffi 13, 6900 Lugano, Switzerland.
| | - Liam J Donaldson
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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Improved Inpatient Care through Greater Patient-Doctor Contact under the Hospitalist Management Approach: A Real-Time Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115718. [PMID: 34073471 PMCID: PMC8198090 DOI: 10.3390/ijerph18115718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
Objective: To examine the difference between hospitalist and non-hospitalist frequency of patient–doctor contact, duration of contact, cumulative contact time, and the amount of time taken by the doctor to resolve an issue in response to a medical call. Research Design and Measures: Data from 18 facilities and 36 wards (18 hospitalist wards and 18 non-hospitalist wards) were collected. The patient–doctor contact slip and medical call response slips were given to each inpatient ward to record. A total of 28,926 contacts occurred with 2990 patients, and a total of 8435 medical call responses occurred with 3329 patients. Multivariate logistic regression analyses and regression analyses were used for statistical analyses. Results: The average frequency of patient–doctor contact during a hospital stay was 10.0 times per patient for hospitalist patients. Using regression analyses, hospitalist patients had more contact with the attending physician (β = 5.6, standard error (SE) = 0.28, p < 0.0001). Based on cumulative contact time, hospitalists spent significantly more time with the patient (β = 32.29, SE = 1.54, p < 0.0001). After a medical call to resolve the issue, doctors who took longer than 10 min were 4.14 times (95% CI 3.15–5.44) and those who took longer than 30 min were 4.96 times (95% CI 2.75–8.95) more likely to be non-hospitalists than hospitalists. Conclusion: This study found that hospitalists devoted more time to having frequent encounters with patients. Therefore, inpatient care by a hospitalist who manages inpatient care from admission to discharge could improve the care quality.
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Bernasconi A, Crabbé F, Raab M, Rossi R. Can the use of digital algorithms improve quality care? An example from Afghanistan. PLoS One 2018; 13:e0207233. [PMID: 30475833 PMCID: PMC6261034 DOI: 10.1371/journal.pone.0207233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/27/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Quality of care is a difficult parameter to measure. With the introduction of digital algorithms based on the Integrated Management of Childhood Illness (IMCI), we are interested to understand if the adherence to the guidelines improved for a better quality of care for children under 5 years old. METHODS More than one year after the introduction of digital algorithms, we carried out two cross sectional studies to assess the improvements in comparison with the situation prior to the implementation of the project, in two Basic Health Centres in Kabul province. One survey was carried out inside the consultation room and was based on the direct observation of 181 consultations of children aged 2 months to 5 years old, using a checklist completed by a senior physicians. The second survey queried 181 caretakers of children outside the health facility for their opinion about the consultation carried out through the tablet and prescriptions and medications given. RESULTS We measured the quality of care as adherence to the IMCI's guidelines. The study evaluated the quality of the physical examination and the therapies prescribed with a special attention to antibiotic prescription. We noticed a dramatic improvement (p<0.05) of several indicators following the introduction of digital algorithms. The baseline physical examination was appropriate only for 23.8% [IC% 19.9-28.1] of the patients, 34.5% [IC% 30.0-39.2] received a correct treatment and 86.1% [IC% 82.4-89.2] received at least one antibiotic. With the introduction of digital algorithms, these indicators statistically improved respectively to 84.0% [IC% 77.9-88.6], >85% and less than 30%. CONCLUSIONS Our findings suggest that digital algorithms improve quality of care by applying the guidelines more effectively. Our experience should encourage to test this tool in different settings and to scale up its use at province/state level.
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Affiliation(s)
- Andrea Bernasconi
- Swiss TPH, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - François Crabbé
- Swiss TPH, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin Raab
- Swiss TPH, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rodolfo Rossi
- PHC programs, International Committee of the Red Cross, Genève, Switzerland
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Stokes PJ, Levine R, Flessa KW. Choosing the Geoscience Major: Important Factors, Race/Ethnicity, and Gender. ACTA ACUST UNITED AC 2018. [DOI: 10.5408/14-038.1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Philip J. Stokes
- Department of Geosciences, University of Arizona, Tucson, Arizona 85721, USA
| | - Roger Levine
- Consultant, 168 Iris Street, Redwood City, California 94062, USA
| | - Karl W. Flessa
- Department of Geosciences, University of Arizona, Tucson, Arizona 85721, USA
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Berkowitz RL, Phillip N, Berry L, Yen IH. Patient Experiences in a Linguistically Diverse Safety Net Primary Care Setting: Qualitative Study. J Particip Med 2018; 10:e4. [PMID: 33052110 PMCID: PMC7434056 DOI: 10.2196/jopm.9229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 09/30/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The patient-centered medical home model intends to improve patient experience and primary care quality. Within an urban safety net setting in Northern California, United States, these desired outcomes are complicated by both the diversity of the patient community and the care continuity implications of a residency program. OBJECTIVE The objective of our study was to understand the patient experience beyond standardized satisfaction measures. METHODS We conducted a qualitative study, interviewing 19 patients from the clinic (English-, Spanish-, or Mien-speaking patients). RESULTS Some themes, such as the desire to feel confident in their doctor, emerged across language groups, pointing to institutional challenges. Other themes, such as distrust in care being provided, were tied distinctly to speaking a language different from one's provider. Still other themes, such as a sense of powerlessness, were related to cultural differences and to speaking a language (Mien) not spoken by staff. CONCLUSIONS Findings illuminate the need to understand cultural behaviors and interactional styles in a diverse patient population to create a high-quality medical home.
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Affiliation(s)
- Rachel L Berkowitz
- DrPH Program, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Nimeka Phillip
- Residency Program, Mountain Area Health Education Center, Hendersonville, NC, United States
| | - Lyn Berry
- Division of Primary Care, Department of Medicine, Alameda Health System, Oakland, CA, United States
| | - Irene H Yen
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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Abbott P. Patient-centred health care for people with chronic skin conditions. Br J Dermatol 2017; 177:329-330. [PMID: 28833008 DOI: 10.1111/bjd.15709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- P Abbott
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
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Wong MS, Showell NN, Bleich SN, Gudzune KA, Chan KS. The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity. PATIENT EDUCATION AND COUNSELING 2017; 100:1588-1597. [PMID: 28318844 PMCID: PMC5478425 DOI: 10.1016/j.pec.2017.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association. METHODS We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity. RESULTS Parents of obese children were more likely to report that their child's healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p<0.001) and spending enough time (p=0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively. CONCLUSION Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian. PRACTICE IMPLICATIONS Healthcare providers should ensure effective communication with obese parents of obese children.
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Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA.
| | - Nakiya N Showell
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sara N Bleich
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Kimberly A Gudzune
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kitty S Chan
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA
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Shrank WH. Primary Care Practice Transformation and the Rise of Consumerism. J Gen Intern Med 2017; 32:387-391. [PMID: 28243874 PMCID: PMC5377888 DOI: 10.1007/s11606-016-3946-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/27/2016] [Accepted: 11/21/2016] [Indexed: 11/14/2022]
Abstract
Americans are increasingly demanding the same level of service in healthcare that they receive in other services and products that they buy. This rise in consumerism poses challenges for primary care physicians as they attempt to transform their practices to succeed in a value-based reimbursement landscape, where they are rewarded for managing costs and improving the health of populations. In this paper, three examples of consumer-riven trends are described: retail healthcare, direct and concierge care, and home-based diagnostics and care. For each, the intersection of consumer-driven care and the goals of value-based primary care are explored. If the correct payment and connectivity enablers are in place, some examples of consumer-driven care are well-positioned to support primary care physicians in their mission to deliver high-quality, efficient care for the populations they serve. However, concerns about access and equity make other trends less consistent with that mission.
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Affiliation(s)
- William H Shrank
- UPMC Health Plan, U.S. Steel Tower, 55th Floor, 600 Grant Street, Pittsburgh, PA, 15219, USA.
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Wong MS, Gudzune KA, Bleich SN. Provider communication quality: influence of patients' weight and race. PATIENT EDUCATION AND COUNSELING 2015; 98:492-8. [PMID: 25617907 PMCID: PMC4379992 DOI: 10.1016/j.pec.2014.12.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/25/2014] [Accepted: 12/21/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To examine the relationship between patient weight and provider communication quality and determine whether patient race/ethnicity modifies this association. METHODS We conducted a cross-sectional analysis with 2009-2010 medical expenditures panel survey-household component (N=25,971). Our dependent variables were patient report of providers explaining well, listening, showing respect, and spending time. Our independent variables were patient weight status and patient weight-race/ethnicity groups. Using survey weights, we performed multivariate logistic regression to examine the adjusted association between patient weight and patient-provider communication measures, and whether patient race/ethnicity modifies this relationship. RESULTS Compared to healthy weight whites, obese blacks were less likely to report that their providers explained things well (OR 0.78; p=0.02) or spent enough time with them (OR 0.81; p=0.04), and overweight blacks were also less likely to report that providers spent enough time with them (OR 0.78; p=0.02). Healthy weight Hispanics were also less likely to report adequate provider explanations (OR 0.74; p=0.04). CONCLUSION Our study provides preliminary evidence that overweight/obese black and healthy weight Hispanic patients experience disparities in provider communication quality. PRACTICE IMPLICATION Curricula on weight bias and cultural competency might improve communication between providers and their overweight/obese black and healthy weight Hispanic patients.
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Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA.
| | - Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sara N Bleich
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA
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Almeida RSD, Bourliataux-Lajoinie S, Martins M. Satisfaction measurement instruments for healthcare service users: a systematic review. CAD SAUDE PUBLICA 2015; 31:11-25. [DOI: 10.1590/0102-311x00027014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 10/20/2014] [Indexed: 11/22/2022] Open
Abstract
Patient satisfaction surveys can be an interesting way to improve quality and discuss the concept of patient-centered care. This study aimed to conduct a systematic review of the validated patient satisfaction measurement instruments applied in healthcare. The systematic review searched the MEDLINE/PubMed, LILACS, SciELO, Scopus and Web of Knowledge. The search strategy used the terms: "Patient Satisfaction" AND "Patient centered care" AND "Healthcare survey OR Satisfaction questionnaire" AND "Psychometric properties". 37 studies were included and almost all studies showed that satisfaction is a multidimensional construct. In these studies, 34 different instruments were used and most surveys contained the dimension patient-healthcare professional interactions, physical environment and management process. The COSMIN score for methodological quality showed that most of them scored a good or fair average. We can conclude that there is not a gold standard instrument for patient satisfaction assessment but some dimensions are essential for this construct.
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Wiig S, Aase K, von Plessen C, Burnett S, Nunes F, Weggelaar AM, Anderson-Gare B, Calltorp J, Fulop N. Talking about quality: exploring how 'quality' is conceptualized in European hospitals and healthcare systems. BMC Health Serv Res 2014; 14:478. [PMID: 25303933 PMCID: PMC4283075 DOI: 10.1186/1472-6963-14-478] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 09/29/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.
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Affiliation(s)
- Siri Wiig
- />Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway
| | - Karina Aase
- />Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway
| | - Christian von Plessen
- />Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway
- />Department of Pulmonary and Infectious Diseases, North Zealand Hospital, Dyrehavevej, 29-3400 Hilleroed, Denmark
| | - Susan Burnett
- />Imperial College, London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK
| | - Francisco Nunes
- />ISCTE, Lisboa, Instituto Superior de Ciências do Trabalho e da Empresa (ISCTE), Av.ª das Forças Armadas, Lisbon, 1649-026 Portugal
| | - Anne Marie Weggelaar
- />Department of Health Policy and Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Boel Anderson-Gare
- />Jönköping Academy for improvement of Health and Welfare, Jönköping University, Box 1026, 551 11 Jönköping, Sweden
| | - Johan Calltorp
- />Jönköping Academy for improvement of Health and Welfare, Jönköping University, Box 1026, 551 11 Jönköping, Sweden
| | - Naomi Fulop
- />Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - For QUASER-team
- />Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway
- />Department of Pulmonary and Infectious Diseases, North Zealand Hospital, Dyrehavevej, 29-3400 Hilleroed, Denmark
- />Imperial College, London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK
- />ISCTE, Lisboa, Instituto Superior de Ciências do Trabalho e da Empresa (ISCTE), Av.ª das Forças Armadas, Lisbon, 1649-026 Portugal
- />Department of Health Policy and Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
- />Jönköping Academy for improvement of Health and Welfare, Jönköping University, Box 1026, 551 11 Jönköping, Sweden
- />Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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15
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Mohammed K, Nolan MB, Rajjo T, Shah ND, Prokop LJ, Varkey P, Murad MH. Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective. Am J Med Qual 2014; 31:12-21. [PMID: 25082873 DOI: 10.1177/1062860614545124] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes.
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Affiliation(s)
| | | | - Tamim Rajjo
- Mercy Family Medicine Residency Program, Toledo, OH
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