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.

Feedback reports to the general practitioner (GP) on the patients' experiences: are GPs interested, and is this interest associated with GP factors and patient experience scores?

BACKGROUND

Patient experience feedback is key in patient centred health systems, but empirical evidence of general practitioner (GP) interest in it is sparse. We aimed to: (i) quantitatively estimate the level of GP interest for feedback reports on patient experience; (ii) explore determinants of such interest; and (iii) examine potential association between a priori interest and patient experience.

METHODS

The patient experience survey included maximum 300 randomly selected patients for each of 50 randomly selected GPs (response rate 41.4%, n = 5,623). GPs were sent a postal letter offering feedback reports and were grouped according to their replies: (i) interested in the report; (ii) not interested. Associations between interest and GP variables were assessed with Chi-square tests and multivariate logistic regression, while associations between interest and scores for 5 patient experiences scales were assessed with multilevel regression models.

RESULTS

About half (n = 21; 45.7%) of the GPs showed interest in the report by asking to receive the report. The only GP variable associated with a priori interest was being a specialist in general practice (58.6% vs. 23.5% for those without) (P = 0.021). Interest was significantly associated with the practice patient experience scale (4.1 higher score compared with those not interested, P = 0.048). Interest in the report had small and nonsignificant associations with the remaining patient experience scales.

CONCLUSIONS

Almost half of the GPs, and almost 3 in 5 of specialists in general practice, were interested in receiving a GP-specific feedback report on patient experiences. Interest in the report was generally not related to patient experience scores.

The Impact of Clinical Experience in Advanced Practice Nursing Education-A Cross-Sectional Study of Norwegian Advanced Practice Nurses' Perspectives

BACKGROUND

An Advanced Practice Nurse (APN) is a specialized nurse who has acquired context specific knowledge, complex decision-making skills, and clinical competencies. Previously in Norway, APN education programs had a prerequisite of a minimum of two years of clinical nursing experience. Recently, the government decided to abandon this prerequisite.

OBJECTIVES

The objectives of this study were to assess APN's and APN students' (1) perspectives on the impact of clinical nursing experience on various aspects of nursing practice, (2) perspectives on the association between APN students' previous clinical experience and the ability to achieve the learning outcomes in the education program, and (3) attitudes towards clinical nursing practice as a prerequisite before entry to APN education programs.

DESIGN

An observational, cross-sectional design.

METHODS

APN and APN students were invited to respond to a researcher-developed questionnaire. A snowballing sampling method was used. The questionnaire included 24 questions scored on a five-point Likert scale, and two questions with text responses. Quantitative data were analyzed using descriptive statistics, and text responses with thematic analysis.

RESULTS

In total, 1767 APNs (92.9%) and APN students (7.1%) responded. Between 93.6 and 98.2% of the respondents (n = 1767) agreed that clinical nursing experience leads to experience with communication, collaboration, basic procedures, medical equipment and documentation, and to the development of situation awareness, increased awareness on own role in teams, the ability to provide person-centered nursing, an independent nursing identity, and feeling of security. Over 90% of the respondents agreed that students' previous clinical experience was associated with the ability to achieve the learning outcomes in the APN program. In addition, 93.7% of the respondents agreed that clinical nursing experience should be a prerequisite before entry to APN programs. Advantages of clinical experience were reported as 'Professional identity', 'Intuitive grasp', 'Integration of technical skills', and 'See the whole picture'. Disadvantages were reported as 'Prejudice and bad habits', 'The importance of relevant experience', and 'Recruitment issues'.

CONCLUSION

This study adds insights into the impact of clinical nursing experience as a prerequisite to APN education programs. The results indicate that clinical nursing experience is an essential contributor to the development of nursing competence and a nursing identity. This study was not registered.

Quality improvements of healthcare trajectories by learning from aggregated patient-reported outcomes: a mixed-methods systematic literature review

Background

In healthcare, analysing patient-reported outcome measures (PROMs) on an aggregated level can improve and regulate healthcare for specific patient populations (meso level). This mixed-methods systematic review aimed to summarize and describe the effectiveness of quality improvement methods based on aggregated PROMs. Additionally, it aimed to describe barriers, facilitators and lessons learned when using these quality improvement methods.

Methods

A mixed-methods systematic review was conducted. Embase, MEDLINE, CINAHL and the Cochrane Library were searched for studies that described, implemented or evaluated a quality improvement method based on aggregated PROMs in the curative hospital setting. Quality assessment was conducted via the Mixed Methods Appraisal Tool. Quantitative data were synthesized into a narrative summary of the characteristics and findings. For the qualitative analysis, a thematic synthesis was conducted.

Results

From 2360 unique search records, 13 quantitative and three qualitative studies were included. Four quality improvement methods were identified: benchmarking, plan-do-study-act cycle, dashboards and internal statistical analysis. Five studies reported on the effectiveness of the use of aggregated PROMs, of which four identified no effect and one a positive effect. The qualitative analysis identified the following themes for facilitators and barriers: (1) conceptual (i.e. stakeholders, subjectivity of PROMs, aligning PROMs with clinical data, PROMs versus patient-reported experience measures [PREMs]); (2a) methodological—data collection (i.e. choice, timing, response rate and focus); (2b) methodological—data processing (i.e. representativeness, responsibility, case-mix control, interpretation); (3) practical (i.e. resources).

Conclusion

The results showed little to no effect of quality improvement methods based on aggregated PROMs, but more empirical research is needed to investigate different quality improvement methods. A shared stakeholder vision, selection of PROMs, timing of measurement and feedback, information on interpretation of data, reduction of missing data, and resources for data collection and feedback infrastructure are important to consider when implementing and evaluating quality improvement methods in future research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00893-4.

What is already known on this topic

The aggregated patient-reported outcome measures (PROMs) can be used for analytical and organizational aspects of improving and regulating healthcare, but there is little empirical evidence regarding the effectiveness of aggregated PROMS.

What this study adds

This study adds a detailed overview of the types of quality improvement methods and recommendations for implementation in practice.

How this study might affect research, practice or policy

Researchers and policy-makers should consider the barriers, facilitators and lessons learned for future implementation and evaluation of quality improvement methods, as presented in this manuscript, to further advance this field.

Reliability and validity of the Psychiatric Inpatient Patient Experience Questionnaire - Continuous Electronic Measurement (PIPEQ-CEM)

Background

The increasing emphasis on patient-centred care has accelerated the demand for high-quality assessment instruments, but the development and application of measures of the quality of care provided for mental health have lagged behind other areas of medicine. The main objective of this study was to determine the psychometric properties of the Psychiatric Inpatient Patient Experience Questionnaire – Continuous Electronic Measurement (PIPEQ-CEM), which consists of large-scale measurements from a Norwegian population. The change from cross-sectional surveys to continuous measurements necessitated further validation of the instrument. The secondary objective was to develop a short version of the PIPEQ-CEM.

Methods

The data included responses from the first year of continuous measurement, and included adult inpatients (age ≥ 18 years) who received specialized mental healthcare from 191 different sections in Norway (n = 3,249). Missing data, ceiling effects, factor structure and internal consistency levels were assessed. The short scale was developed by exploring missing items, ceiling effects, results from exploratory factor analysis (EFA) and item performance from item response theory (IRT) analyses.

Results

Psychometric testing supported previous results and illustrated that the PIPEQ-CEM comprises three empirically based scales with good internal consistency, reliability and validity, and covers structure and facilities, patient-centred interactions, and outcomes. A seven-item short form was developed, which provides an efficient approach for brief yet comprehensive measurements that can be applied in the future.

Conclusion

The PIPEQ-CEM can be recommended for use in future national surveys that assess patient experience with inpatient psychiatric care in Norway and in other countries with similar healthcare systems. The short form can be applied where respondent burden and cognitive load are crucial issues.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08307-5.

Validation and Adjustment of the Patient Experience Questionnaire (PEQ): A Regional Hospital Study in Norway

This paper assesses the psychometric qualities of the Patient Experience Questionnaire (PEQ), thereby validating a patient-oriented measurement model in a hospital environment, and modifies the model based on empirical results. This study employed survey data gathered by the Norwegian Institute of Public Health from adult inpatients at somatic hospitals in the Health South-East RHF in Norway. The survey engaged 4603 patients out of 8381 from five main hospitals in the region. The study found that an eight-factor model of the PEQ generally showed good fitness to the data, but assessment of discriminant validity showed that this was not the optimal factor solution among four of the eight dimensions. After comparing models, the study proposed a model with a second-order factor for four of the factors: “nurse services”, “doctor services”, “information”, and “organization”, collectively named “treatment services”. The proposed model demonstrated good validity and reliability results. The results present theoretical and practical implications. The study recommends that inferential analyses on the PEQ should be done with the second-order factor. Furthermore, a revision of the PEQ is recommended subject to more confirmatory studies with larger samples in different regions. The study indicates a second-order factor structure for assessing and understanding patient experiences—a finding which has both theoretical and managerial implications.

Experience of Patients with Diabetes and Other Cardiovascular Risk Factors with Health Professionals and Healthcare in Spain

We aimed to evaluate the experience of patients with type 2 diabetes (T2DM) with healthcare received in Spain. This was a retrospective, observational study in patients with T2DM cared for in primary healthcare (PHC) centers. A cross-sectional analysis of the patients' experience data was performed using the Instrument for the Evaluation of the Experience of Chronic Patients (IEXPAC). A total of 475 patients with T2DM were recruited from 36 PHC centers, of which 248 (52.2%) completed the IEXPAC questionnaire. The IEXPAC total mean score (range 0-10) was 7 points, with an average "new relational model" score of 2.5 points. The mean continuity of care score after hospital discharge was 6.2 points. The results showed that 8% of the patients always or almost always used the internet to check their medical history, appointments or other data from their healthcare service, and 15% responded that healthcare professionals always or almost always informed them of forums or other reliable internet sites to obtain information about their illness. The study results show that there is a wide margin for improvement in the experience of patients with T2DM with healthcare in Spain, especially regarding the information patients receive or can obtain.

Social marketing interventions for the prevention and control of neglected tropical diseases: A systematic review

BACKGROUND

Social marketing is an approach to behavior change that contributes to disease prevention and control. This study aimed to understand how social marketing interventions have addressed neglected tropical diseases (NTDs). It examined the characteristics, breadth of coverage, and outcomes of social marketing interventions focused on the prevention and control of these diseases.

METHODOLOGY/PRINCIPAL FINDINGS

Studies published in any language between January 1971 and April 2017, targeting at least one of the 17 NTDs prioritized in the World Health Organization (WHO) NTD Roadmap were considered. Included studies had interventions that applied both, at least one core social marketing concept, "social behavioral influence", and one social marketing technique, "integrated intervention mix", described in the Hierarchical Model of Social Marketing. This review is registered with PROSPERO CRD42017063858. Twenty interventions, addressing eight NTDs, met the inclusion criteria. They focused on behaviors related to four of the five WHO public health strategies for NTDs. Most interventions incorporated the concepts "relationship building" and "public / people orientation focus", and the technique "insight-driven segmentation". All the interventions reported changing behavioral determinants such as knowledge, 19 reported behavior change, and four influenced health outcomes.

CONCLUSION/SIGNIFICANCE

Evidence from this study shows that social marketing has been successfully used to address behaviors related to most of the five public health strategic interventions for NTDs recommended by the WHO. It is suggested that social marketing interventions for the prevention and control of NTDs be grounded on an understanding of the audience and adapted to the contexts intervened. Building stakeholder relationships as early as possible, and involving the publics could help in reaching NTD outcomes. Elements of the intervention mix should be integrated and mutually supportive. Incorporating health education and capacity building, as well as being culturally appropriate, is also relevant. It is recommended that ongoing discussions to formulate the targets and milestones of the new global Roadmap for NTDs integrate social marketing as an approach to overcome these diseases.

The Adolescent Patient Experiences of Diabetes Care Questionnaire (APEQ-DC): Reliability and Validity in a Study Based on Data from the Norwegian Childhood Diabetes Registry

Purpose

Patient-reported experiences are a key source of information on quality in health care. Most patient experience surveys only include adults’ assessments including parent or proxy surveys in child health care settings. The aim of this study was to determine the psychometric properties of the Adolescent Patient Experiences of Diabetes Care Questionnaire, a new instrument developed to measure adolescent experiences of paediatric diabetes care at hospital outpatient departments in Norway.

Patients and Methods

The questionnaire was developed based on a literature review, qualitative interviews with adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The pilot study involved adolescents aged 12–17 years with type 1 diabetes, sampled from the four largest paediatric outpatient departments in Norway. We assessed the levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity.

Results

The pilot study included responses from 335 (54%) patients. Low proportions of missing or “not applicable” responses were found for 17 of the 19 items, and 14 of these 19 items were below the ceiling-effect criterion. Five indicators were identified: consultation, information on food and physical activity/exercise, nurse contact, doctor contact and outcome. All except one indicator met the criterion of 0.7 for Cronbach’s alpha. Each of the single items had a stronger correlation with its hypothesized indicator than with any of the other indicators. The construct validity of the instrument was supported by 38 out of 45 significant associations.

Conclusion

The content validity of the instrument was secured by a rigorous development process. Psychometric testing produced good evidence for data quality, internal consistency and construct validity. Further research is needed to assess the usefulness of the Adolescent Patient Experiences of Diabetes Care Questionnaire as a basis for quality indicators.

Patient experiences: a systematic review of quality improvement interventions in a hospital setting

Purpose: In the era of value-based healthcare, one strives for the most optimal outcomes and experiences from the perspective of the patient. So, patient experiences have become a key quality indicator for healthcare. While these are supposed to drive quality improvement (QI), their use and effectiveness for this purpose has been questioned. The aim of this systematic review was to provide insight into QI interventions used in a hospital setting and their effects on improving patient experiences, and possible barriers and promoters for QI work. Methods: Prisma guidelines were used to design this review. International academic literature was searched in Embase, Medline OvidSP, Web of Science, Cochrane Central, PubMed Publisher, Scopus, PsycInfo, and Google Scholar. In total, 3,289 studies were retrieved and independently screened by the first two authors for eligibility and methodological quality. Data was extracted on the study purpose, setting, design, targeted patient experience domains, QI strategies, results of QI, barriers, and promotors for QI. Results: Twenty-one pre-post intervention studies were included for review. The methodological quality of the included studies was assessed using a Critical Appraisal Skills Program (CASP) Tool. QI strategies used were staff education, patient education, audit and feedback, clinician reminders, organizational change, and policy change. Twenty studies reported improvement in patient experience, 14 studies of the 21 included studies reported statistical significance. Most studies (n=17) reported data-related barriers (eg, questionnaire quality), professional, and/or organizational barriers (eg, skepticism among staff), and 14 studies mentioned specific promoters (eg, engaging staff and patients) for QI. Conclusions: Several patient experience domains are targeted for QI using diverse strategies and methodological approaches. Most studies reported at least one improvement and also barriers and promoters that may influence QI work. Future research should address these barriers and promoters in order to enhance methodological quality and improve patient experiences.

Measuring clients' experiences with antenatal care before or after childbirth: it matters

Background

When clients’ experiences with maternity care are measured for quality improvement, surveys are administered once, usually six weeks or more after childbirth. Most surveys conveniently cover pregnancy, childbirth and postnatal care all in one. However, the validity of measuring the experiences during pregnancy (antenatal experiences) after childbirth is unknown. We explored the relation between the measurement of antenatal experiences late in pregnancy but prior to childbirth (‘test’ or gold standard) and its retrospective measurement after childbirth (retrospective test). Additionally, we explored the role of modifying determinants that explained the gap between these two measurements.

Methods and Findings

Client’s experiences were measured by the ReproQuestionnaire that consists of an antenatal and postnatal version, and covers the eight WHO Responsiveness domains. 462 clients responded to the antenatal and postnatal questionnaire, and additionally filled out the repeated survey on antenatal experiences after childbirth. First, we determined the association between the test and retrospective test using three scoring models: mean score, equal or above the median score and having a negative experience. The association was moderate for having any negative experience (absolute agreement = 68%), for the median (absolute agreement = 69%) and for the mean score (ICC = 0.59). Multiple linear and logistic regression analysis for all three scoring models revealed systematic modifiers. The gap between antenatal and postnatal measurement was (partly) associated with clients’ experiences during childbirth and postnatal care and by professional discontinuity during childbirth but unrelated to the perceived health outcome.

Conclusions

The antenatal experiences should be measured before and not after childbirth, as the association between the antenatal experiences measured before and after childbirth is moderate.

Health care quality from the patients' perspective: a comparative study between an old and a new, high-tech hospital

Purpose

Previous studies show that the hospital environment and the behavior of health care personnel may predict patients’ perceptions of care quality. The aim of the study was to explore changes in perceived care quality from the patients’ perspective (QPP) when hospital services are relocated from an old to a new high-tech hospital and to describe what is important for patients in the high-tech hospital.

Patients and methods

A comparative cross-sectional design was used. The questionnaire QPP, which is based on a theoretical model of the quality of care comprising four quality dimensions, was used. Data were collected in 2015 (old hospital) and 2016 (new hospital), with 253 and 324 respondents, respectively, by consecutive sampling. Comparative statistics was used to test differences between patients’ care quality perceptions (perceived reality [PR] and subjective importance [SI]) (P≤0.05).

Results

The patients rated PR of all four quality dimensions (the care organization’s physical-technical conditions and sociocultural approach and the caregivers’ medical-technical competence and identity-oriented approach) higher in the new hospital. However, only the two quality dimensions concerning the care organization were rated significantly more highly. On an item level, five of the 27 items scored significantly higher on patients’ SI than on patients’ PR of the care in the new hospital, indicating a quality deficiency from the patients’ perspective. This comprised receiving effective pain relief, receiving examination and treatment within an acceptable waiting time, receiving useful information on self-care, receiving useful information on which doctors were responsible for their medical care, and having a comfortable bed.

Conclusion

The increase in care QPP was associated with improved environmental conditions, and no significant improvement in care quality was associated with the health care personnel. The results indicate that being in a high-tech environment does not improve patients’ perceptions of care quality provided by health care personnel. The results gave valuable information for quality improvement in clinical practice, based on the patients’ perspective.

Parent experiences of diabetes care questionnaire (PEQ-DC): reliability and validity following a national survey in Norway

BACKGROUND

Patient experiences are acknowledged as an important aspect of health care quality but no validated instruments have been identified for the measurement of either parent or patient experiences with outpatient paediatric diabetes care. The aim of the current study was to assess the psychometric properties of a new instrument developed to measure parent experiences of paediatric diabetes care at hospital outpatient departments in Norway.

METHODS

The development of the questionnaire was based on a literature review of existing questionnaires, qualitative interviews with both parents and children/adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The national pilot study included parents of 2606 children/adolescents aged 0-17 years with Type 1 Diabetes registered in The Norwegian Childhood Diabetes Registry, a nationwide, population-based registry. Levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity were assessed.

RESULTS

A total of 2606 patients were included in the survey, but 80 were excluded due to incorrect addresses. 1399 (55%) parents responded to the questionnaire. Low levels of missing or "not applicable" responses were found for 31 of the 35 items (< 10%), and 27 of 35 items were below the ceiling-effect criterion. Psychometric testing and theoretical considerations identified six scales: Consultation (six items), organisation (five items), equipment (three items), nurse contact (four items), doctor contact (four items) and outcome (five items). All six scales met the 0.7 criterion for Cronbach's alpha (range: 0.71-0.90). As expected, each item had a higher correlation with its hypothesised scale than with any of the other five scales. The construct validity of the Parent Experiences of Diabetes Care Questionnaire (PEQ-DC) was supported by 17 out of 18 associations with variables expected to be related to parent experiences.

CONCLUSION

The psychometric testing of the PEQ-DC showed good evidence for data quality, internal consistency and construct validity. The instrument includes important aspects of diabetes care at paediatric outpatient departments from the perspective of the parent. The content validity of the PEQ-DC was secured by a rigorous development process, and the instrument was tested following a national survey in Norway, securing generalisability across Norway.

A randomized comparison of three data collection models for the measurement of parent experiences with diabetes outpatient care

BACKGROUND

The objective of this study was to compare three data collection methods for the measurement of parent experiences with hospital outpatient care for child and adolescent diabetes, based on a randomised national trial in Norway involving both pen-and-paper and electronic response options.

METHODS

The sample frame was patients registered in the Norwegian Childhood Diabetes Registry. Parents of patients were randomised into the following groups (n = 2606): group A, who were posted questionnaires with only a pen-and-paper response option (n = 859); group B, who were posted questionnaires with both an electronic and a pen-and-paper response option (n = 886); and group C, who were posted questionnaires with only an electronic response option (n = 861). The three groups were compared on response rate, background variables about respondents, main study results and survey costs. Statistical analysis included logistic regression to test group differences in response probabilities and multilevel linear regression to test differences in parent experiences.

RESULTS

The response rate was 61.8% for group A, 62.4% for group B and 41.6% for group C. The probability of answering was significantly higher for group A (OR = 2.3, p < 0.001) and B (OR = 2.3, p < 0.001) compared to group C. Respondent age, gender, education, living with the child and the degree of participation in consultations did not differ significantly between the three groups. Group differences in parent-reported experiences were small, varying from 1.0 (equipment and doctor contact) to 2.4 (outcome), on a scale from 0 to 100. Only one of 18 group differences was significant: the mixed group had significantly higher score than the electronic group on the organization scale (p < 0.05). The total cost of the electronic model was less than half the cost of the other models, and cost per response was 5.1 euros for the electronic model compared to 8.2 euros for group A and 7.6 euros for group B.

CONCLUSIONS

The models with pen-and paper questionnaire included had more than 20% higher response rate than the model with an electronic-only response option. Background variables and parent-reported experiences were similar between the three groups, and the electronic model was the more cost-effective model.

Secondary analysis of hospital patient experience scores across England's National Health Service - How much has improved since 2005?

OBJECTIVE

To examine trends in patient experience and consistency between hospital trusts and settings.

METHODS

Observational study of publicly available patient experience surveys of three hospital settings (inpatients (IP), accident and emergency (A&E) and outpatients (OP)) of 130 acute NHS hospital trusts in England between 2004/05 and 2014/15.

RESULTS

Overall patient experience has been good, showing modest improvements over time across the three hospital settings. Individual questions with the biggest improvement across all three settings are cleanliness (IP: +7.1, A&E: +6.5, OP: +4.7) and information about danger signals (IP: +3.8, A&E: +3.9, OP: +4.0). Trust performance has been consistent over time: 71.5% of trusts ranked in the same cluster for more than five years. There is some consistency across settings, especially between outpatients and inpatients. The lowest-scoring questions, regarding information at discharge, are the same in all years and all settings.

CONCLUSIONS

The greatest improvement across all three settings has been for cleanliness, which has seen national policies and targets. Information about danger signals and medication side-effects showed least consistency across settings and scores have remained low over time, despite information about danger signals showing a big increase in score. Patient experience of aspects of access and waiting have declined, as has experience of discharge delay, likely reflecting known increases in pressure on England's NHS.

The Norwegian patient experiences with GP questionnaire (PEQ-GP): reliability and construct validity following a national survey

OBJECTIVES

The aim of this study was to test the reliability and validity of a new questionnaire for measuring patient experiences with general practitioners (PEQ-GP) following a national survey.

SETTING

Postal survey among patients on any of 500 GPs patient lists in Norway. GPs were stratified by practice size and geographical criteria.

PARTICIPANTS

4964 patients who had at least one consultation with their regular GP in the foregoing 12 months were included in the study. The patients were randomly selected after the selection of GPs. 2377 patients (49%) responded to the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

The items were assessed for missing data and ceiling effects. Factor structure was assessed using exploratory factor analyses. Reliability was tested with item-total correlation, Cronbach's alpha and test-retest correlations. Item discriminant validity was tested by correlating items with all scales. Construct validity was assessed through associations of scale scores with health status, the patients' general satisfaction with the services, whether the patient had been incorrectly treated by the GP and whether the patient would recommend the GP to others.

RESULTS

Item missing varied from 1.0% to 3.1%, while ceiling effects varied from 16.1% to 45.9%. The factor analyses identified three factors. Reliability statistics for scales based on these three factors, and two theoretically derived scales, showed item-total correlations ranging from 0.63 to 0.85 and Cronbach's alpha values from 0.77 to 0.93. Test-retest correlation for the five scales varied from 0.72 to 0.88. All scales had the expected association with other variables.

CONCLUSIONS

The PEQ-GP has good evidence for data quality, internal consistency and construct validity. The PEQ-GP is recommended for use in local, regional and national surveys in Norway, but further studies are needed to assess the instrument's ability to detect differences over time and between different GPs.

Pay-for-performance reduces healthcare spending and improves quality of care: Analysis of target and non-target obstetrics and gynecology surgeries

Objective

In Korea, the Value Incentive Program (VIP) was first applied to selected clinical conditions in 2007 to evaluate the performance of medical institutes. We examined whether the condition-specific performance of the VIP resulted in measurable improvement in quality of care and in reduced medical costs.

Design

Population-based retrospective observational study.

Setting

We used two data set including the results of quality assessment and hospitalization data from National Health Claim data from 2011 to 2014.

Participants

Participants who were admitted to the hospital for obstetrics and gynecology were included. A total of 535 289 hospitalizations were included in our analysis.

Methods

We used a generalized estimating equation (GEE) model to identify associations between the quality assessment and length of stay (LOS). A GEE model based on a gamma distribution was used to evaluate medical cost. The Poisson regression analysis was used to evaluate readmission.

Main Outcome Measures

The outcome variables included LOS, medical costs and readmission within 30 days.

Results

Higher condition-specific performance by VIP participants was associated with shorter LOSs, decreases in medical cost, and lower within 30-day readmission rates for target and non-target surgeries. LOS and readmission within 30 days were different by change in quality assessment at each medical institute.

Conclusions

Our findings contribute to the body of evidence used by policy-makers for expansion and development of the VIP. The study revealed the positive effects of quality assessment on quality of care. To reduce the between-institute quality gap, alternative strategies are needed for medical institutes that had low performance.

Understanding and Using Patient Experience Feedback to Improve Health Care Quality: Systematic Review and Framework Development

Patient experience data is increasingly collected worldwide; however, questions persist regarding how it is used to improve health care quality. Synthesizing information from the existing literature, we have developed an empirically based framework to help organizations and managers understand what to do with patient experience feedback to improve health care quality at the organizational level. We identified six post-data collection/analysis activities, which were categorized into three main themes: 1) make sense of the data, 2) communicate and explain the data, and 3) plan for improvement. Our framework suggests that simply executing a survey will not improve performance. It is necessary that leaders understand the data, disseminate findings to all stakeholders, help staff understand the data, and then create a platform where all key stakeholders can be involved in discussing the results to generate improvement plans.

What is the effectiveness of obesity related interventions at retail grocery stores and supermarkets? -a systematic review

Background

The Prevalence of obesity and overweight has been increasing in many countries. Many factors have been identified as contributing to obesity including the food environment, especially the access, availability and affordability of healthy foods in grocery stores and supermarkets. Several interventions have been carried out in retail grocery/supermarket settings as part of an effort to understand and influence consumption of healthful foods. The review’s key outcome variable is sale/purchase of healthy foods as a result of the interventions. This systematic review sheds light on the effectiveness of food store interventions intended to promote the consumption of healthy foods and the methodological quality of studies reporting them.

Methods

Systematic literature search spanning from 2003 to 2015 (inclusive both years), and confined to papers in the English language was conducted. Studies fulfilling search criteria were identified and critically appraised. Studies included in this review report health interventions at physical food stores including supermarkets and corner stores, and with outcome variable of adopting healthier food purchasing/consumption behavior. The methodological quality of all included articles has been determined using a validated 16-item quality assessment tool (QATSDD).

Results

The literature search identified 1580 publications, of which 42 met the inclusion criteria. Most interventions used a combination of information (e.g. awareness raising through food labeling, promotions, campaigns, etc.) and increasing availability of healthy foods such as fruits and vegetables. Few used price interventions. The average quality score for all papers is 65.0%, or an overall medium methodological quality. Apart from few studies, most studies reported that store interventions were effective in promoting purchase of healthy foods.

Conclusion

Given the diverse study settings and despite the challenges of methodological quality for some papers, we find efficacy of in-store healthy food interventions in terms of increased purchase of healthy foods. Researchers need to take risk of bias and methodological quality into account when designing future studies that should guide policy makers. Interventions which combine price, information and easy access to and availability of healthy foods with interactive and engaging nutrition information, if carefully designed can help customers of food stores to buy and consume more healthy foods.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3985-x) contains supplementary material, which is available to authorized users.

Guidance on how to achieve comprehensible patient information leaflets in four steps

Comprehensible information leaflets can improve a patient's knowledge. However, in clinical studies leaflets are often introduced without meticulously verifying their comprehensibility. In an attempt to provide a feasible guidance on how to design comprehensible leaflets we complied and evaluated an easy-to-use development procedure. In January 2015, a literature search was performed to identify evidence for readily available quality assurance strategies as a starting point for a standardized strategy to develop and validate written patient information. The suggested development strategy is a consecutive four-step procedure that comprised already validated distinct quality assessments: (i) an initial requirement analysis specifying the needs and constraints of the target population and evidence-based preparation of the leaflets, (ii) a readability assessment, (iii) the Suitability Assessment of Materials instrument and (iv) iterative consumer test in the target population. The consecutive combination of pertinent and previously validated quality assessments provides an easy-to-use guidance on how to create comprehensibly written patient information, particularly for small-scale research projects with time and money constraints.

Applicability of the ReproQ client experiences questionnaire for quality improvement in maternity care

Background. The ReproQuestionnaire (ReproQ) measures the client's experience with maternity care, following the WHO responsiveness model. In 2015, the ReproQ was appointed as national client experience questionnaire and will be added to the national list of indicators in maternity care. For using the ReproQ in quality improvement, the questionnaire should be able to identify best and worst practices. To achieve this, ReproQ should be reliable and able to identify relevant differences. Methods and Findings. We sent questionnaires to 17,867 women six weeks after labor (response 32%). Additionally, we invited 915 women for the retest (response 29%). Next we determined the test-retest reliability, the Minimally Important Difference (MID) and six known group comparisons, using two scorings methods: the percentage women with at least one negative experience and the mean score. The reliability for the percentage negative experience and mean score was both 'good' (Absolute agreement = 79%; intraclass correlation coefficient = 0.78). The MID was 11% for the percentage negative and 0.15 for the mean score. Application of the MIDs revealed relevant differences in women's experience with regard to professional continuity, setting continuity and having travel time. Conclusions. The measurement characteristics of the ReproQ support its use in quality improvement cycle. Test-retest reliability was good, and the observed minimal important difference allows for discrimination of good and poor performers, also at the level of specific features of performance.

Participating physician preferences regarding a pay-for-performance incentive design: a discrete choice experiment

OBJECTIVE

To determine whether the magnitude of incentives or other design attributes should be prioritized and the most important attributes, according to physicians, of the diabetes P4P (pay-for-performance) program design.

DESIGN

We implemented a discrete choice experiment (DCE) to elicit the P4P incentive design-related preferences of physicians.

PARTICIPANTS

All of the physicians (n = 248) who participated in the diabetes P4P program located in the supervisory area of the northern regional branch of the Bureau of National Health Insurance in 2009 were included. The response rate was ∼ 60%.

RESULTS

Our research found that the bonus type of incentive was the most important attribute, followed by the incentive structure and the investment magnitude.

CONCLUSIONS

Physicians may feel that good P4P designs are more important than the magnitude of the investment by the insurer. The two most important P4P designs include providing the bonus type of incentive and using pay-for-excellence plus pay-for-improvement.

PIPEQ-OS--an instrument for on-site measurements of the experiences of inpatients at psychiatric institutions

BACKGROUND

The Psychiatric Inpatient Patient Experience Questionnaire (PIPEQ) was developed for post-discharge measurements of experiences, but the low response rates associated with post-discharge surveys restrict their usefulness. A new questionnaire was developed based on the PIPEQ for on-site measurements of patient experiences: the PIPEQ-OS. The aim of this study was to psychometrically test the PIPEQ-OS using data from a nationally representative survey conducted in Norway in 2014.

METHODS

Data were collected using a nationally representative patient-experience survey; 25% of the institutions in each of the 4 health regions in Norway were randomly selected, yielding a total of 26 institutions. The PIPEQ-OS questionnaire was completed by patients on-site on an agreed day in week 37 of 2014. Item missing and ceiling effects were assessed, and factor analysis was used to assess the structure of the items included in the PIPEQ-OS. The scales were tested for internal consistency reliability, test-retest reliability and construct validity.

RESULTS

The initial sample comprised 857 patients. Of these, 60 were excluded for ethical reasons and 57 were excluded because they were absent on the day of the survey. Of the remaining 740 patients, 552 (74.6% of the included population) returned the questionnaire. Low levels of missing or "not applicable" responses were found for 18 of the 21 items (<20%), and 20 of 21 items were below the ceiling-effect criterion. Psychometric testing identified three scales: structure and facilities (six items), patient-centred interaction (six items) and outcomes (five items). All scales met the criterion of 0.7 for Cronbach's alpha (range: 0.79-0.91) and test-retest reliability (range: 0.83-0.84). The construct validity of the scales was supported by 14 of 15 significant associations with variables known to be related to psychiatric inpatient experiences.

CONCLUSIONS

The PIPEQ-OS comprises three scales with satisfactory internal consistency reliability and construct validity. This instrument can be used for on-site assessments of psychiatric inpatient patient experiences, but further research is needed to evaluate its usefulness as basis for external quality indicators.

How to routinely collect data on patient-reported outcome and experience measures in renal registries in Europe: an expert consensus meeting

Despite the potential for patient-reported outcome measures (PROMs) and experience measures (PREMs) to enhance understanding of patient experiences and outcomes they have not, to date, been widely incorporated into renal registry datasets. This report summarizes the main points learned from an ERA-EDTA QUEST-funded consensus meeting on how to routinely collect PROMs and PREMs in renal registries in Europe. In preparation for the meeting, we surveyed all European renal registries to establish current or planned efforts to collect PROMs/PREMs. A systematic review of the literature was performed. Publications reporting barriers and/or facilitators to PROMs/PREMs collection by registries were identified and a narrative synthesis undertaken. A group of renal registry representatives, PROMs/PREMs experts and patient representatives then met to (i) share any experience renal registries in Europe have in this area; (ii) establish how patient-reported data might be collected by understanding how registries currently collect routine data and how patient-reported data is collected in other settings; (iii) harmonize the future collection of patient-reported data by renal registries in Europe by agreeing upon preferred instruments and (iv) to identify the barriers to routine collection of patient-reported data in renal registries in Europe. In total, 23 of the 45 European renal registries responded to the survey. Two reported experience in collecting PROMs and three stated that they were actively exploring ways to do so. The systematic review identified 157 potentially relevant articles of which 9 met the inclusion criteria and were analysed for barriers and facilitators to routine PROM/PREM collection. Thirteen themes were identified and mapped to a three-stage framework around establishing the need, setting up and maintaining the routine collection of PROMs/PREMs. At the consensus meeting some PROMs instruments were agreed for routine renal registry collection (the generic SF-12, the disease-specific KDQOL™-36 and EQ-5D-5L to be able to derive quality-adjusted life years), but further work was felt to be needed before recommending PREMs. Routinely collecting PROMs and PREMs in renal registries is important if we are to better understand what matters to patients but it is likely to be challenging; close international collaboration will be beneficial.

The relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan

OBJECTIVE

The purpose of this study was to explore the relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan.

DESIGN

Cross-sectional study from 2007 Taiwan Longitudinal Study on Ageing (TLSA) survey.

SETTING

Community-based study.

PARTICIPANTS

A total of 4249 middle-aged and elderly subjects were recruited.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Outpatient visits within 1 month, and hospitalization, emergency visits as well as to shop in pharmacy stores within 1 year, respectively.

RESULTS

Adjusting for important confounding variables, the middle-aged and elderly with National Health Insurance (NHI) and commercial insurance compared with those with NHI alone tended to have outpatient visits. The middle-aged and elderly with longer time to access healthcare facilities were less likely to shop in pharmacy stores compared with those with <30 min. The middle-aged and elderly who perceived inconvenient to access health care tended to shop in pharmacy stores compared with those with perceived convenience.

CONCLUSIONS

Our study of Taiwan's experience could provide a valuable lesson for countries that are planning to launch universal health insurance system, locate budgets in health care and transportation. The middle-aged and elderly who were facing more challenges in accessing health care, no matter in perceived accessibility or real time to access health care, had less outpatient visits and more drug stores shopping. Strategic policies are needed to improve accessibility in increasing patients' perception on access and escalating convenience of transportation system for improving accessibility.

A short generic patient experience questionnaire: howRwe development and validation

Background

Patient experience is a key quality outcome for modern health services, but most existing survey methods are long and setting-specific. We identified the need for a short generic questionnaire for tracking patient experience.

Methods

We describe the development and validation of the howRwe questionnaire. This has two items relating to clinical care (treat you kindly; listen and explain) and two items relating to the organisation of care (see you promptly; well organised) as perceived by patients. Each item has four responses (excellent, good, fair and poor). The questionnaire was trialled in 828 patients in an orthopaedic pre-operative assessment clinic (PAC).

Results

The howRwe questionnaire is shorter (29 words) and more readable (Flesch-Kincaid grade score 2.2) than other questionnaires with broadly similar objectives. Psychometric properties in this sample are good with Cronbach’s α=0.82. Following a change to the appointments system in the clinic, howRwe showed improvement in promptness and organisation, but not in kindness and communication, showing that it can distinguish between the clinical and organisational aspects of patient experience.

Conclusions

howRwe meets the criteria for a short generic patient experience questionnaire that is suitable for frequent use. In the validation study of PAC patients, it showed good psychometric properties and concurrent, construct and discriminant validity.