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Karkowski KA, Ibrahim S, Thorley K, Rodriguez CJ, Kong L, Crosby DL, Lansigan F. Utilization of an Outpatient Integrated Infusion Suite to Decrease Length of Stay, Increase Revenue, and Improve Patient Experience for Elective Chemotherapy Admissions. JCO Oncol Pract 2022; 18:e1484-e1493. [PMID: 35700420 PMCID: PMC10476723 DOI: 10.1200/op.21.00914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/09/2022] [Accepted: 05/10/2022] [Indexed: 09/06/2023] Open
Abstract
PURPOSE Reduction of chemotherapy start times (CST) and length of stay (LOS) for elective chemotherapy admissions is a priority. The aim of this project was to improve efficiency of patient care while simultaneously increasing revenue by reducing LOS and transitioning high-cost chemotherapy to the outpatient setting. METHODS A multidisciplinary quality improvement team proposed building a new outpatient infusion suite in close proximity to the inpatient unit. This suite was then integrated into the flow of elective inpatient chemotherapy admissions and discharges for etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R). Quality measures such as CST, LOS, and revenue were used to evaluate the new infusion suite. RESULTS In the pilot phase of the study, the average CST improved by approximately 1 hour 45 minutes (P = .0218). The mean LOS was reduced from 4.3 to 4.1 midnights (P = .0214). In terms of hours, LOS was reduced from 105.8 to 95.5 hours (P < .0001). A mean quarterly revenue of $309,410 US dollars was noted during the pilot that had not been previously billed. These improvements were sustained throughout the control phase. CONCLUSION Delays in CST and prolonged LOS lead to patient dissatisfaction and increased cost to the health care system. Focus groups and patient feedback are important when designing and implementing new workflows. The creation of an outpatient integrated infusion suite allows medical centers to meet patients' expectations of reducing number of visits while also reducing LOS and capturing new revenue. Adherence to scheduling guidelines further reduces the CST for elective chemotherapy administration.
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Corsini RR, Costa A, Fichera S, Pluchino A. A configurable computer simulation model for reducing patient waiting time in oncology departments. Health Syst (Basingstoke) 2022; 12:208-222. [PMID: 37234470 PMCID: PMC10208172 DOI: 10.1080/20476965.2022.2030655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/21/2021] [Indexed: 10/19/2022] Open
Abstract
Nowadays, the increase in patient demand and the decline in resources are lengthening patient waiting times in many chemotherapy oncology departments. Therefore, enhancing healthcare services is necessary to reduce patient complaints. Reducing the patient waiting times in the oncology departments represents one of the main goals of healthcare managers. Simulation models are considered an effective tool for identifying potential ways to improve patient flow in oncology departments. This paper presents a new agent-based simulation model designed to be configurable and adaptable to the needs of oncology departments which have to interact with an external pharmacy. When external pharmacies are utilised, a courier service is needed to deliver the individual therapies from the pharmacy to the oncology department. An oncology department located in southern Italy was studied through the simulation model and different scenarios were compared with the aim of selecting the department configuration capable of reducing the patient waiting times.
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Affiliation(s)
| | - Antonio Costa
- Dicar Department, University of Catania, CataniaItaly
| | | | - Alessandro Pluchino
- Department of Physics and Astronomy ”E-majorana”, University of Catania, CataniaItaly
- Sezione Infn of Catania, Department of Physics and Astronomy ”E-majorana”, University of Catania, Catania, Italy
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Shukla R, Gagan S, Padhi S, Patro K, Shukla S, Arora D, Singh T, Kundu C, Bhattacharya PS, Krishna V, Madhur P. Daily waiting time management for modern radiation oncology department in Indian perspective. J Cancer Res Ther 2022; 18:1796-1800. [DOI: 10.4103/jcrt.jcrt_1481_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hashemi-Sadraei N, Sasankan S, Crozier N, Tawfik B, Kittson R, Abernathy J, Lauer R, Dayao Z. Improving Outpatient Infusion Clinic Wait Times at a Comprehensive Cancer Center. JCO Oncol Pract 2021; 17:e1935-e1942. [PMID: 34138653 DOI: 10.1200/op.21.00118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many factors contribute to long wait times for patients on the day of their chemotherapy infusion appointments. Longer wait time leads to nonoptimal care, increased costs, and decreased patient satisfaction. We conducted a quality improvement project to reduce the infusion wait times at a Comprehensive Cancer Center. METHODS A multidisciplinary working group of physicians, infusion center nurses, pharmacists, information technology analysts, the Chief Medical Officer, and patient advocates formed a working group. Wait times were analyzed, and the contributing factors to long wait time were identified. Plan-Do-Study-Act cycles were implemented and included labeling patients ready to treat earlier, loading premedications into the medication dispensing system, increasing the number of pharmacy staff, and improving communication using a secure messaging system. The outcome measure was time from patient appointment to initiation of first drug at the infusion center. The secondary outcome measure was patient wait time satisfaction on the basis of Press Ganey score. RESULTS Postintervention, the mean time from appointment to initiation of first drug decreased 17.6 minutes (P < .001; 95% CI, 16.3 to 18.9), from 58.1 minutes to 40.5 minutes (43.5% decrease). Patient wait time satisfaction score increased 8.9 points (P < .001; 95% CI, 6.0 to 11.82), from 76.2 to 85.1 (11.7% increase). CONCLUSION Exploring real-time data and using a classic quality improvement methodology allowed a Comprehensive Cancer Center to identify deficiencies and prevent delays in chemotherapy initiation. This significantly improved patient wait time and patient satisfaction.
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Affiliation(s)
- Neda Hashemi-Sadraei
- Division of Hematology and Oncology, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Shenthol Sasankan
- Division of Hematology and Oncology, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Nick Crozier
- Division of Hematology and Oncology, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Bernard Tawfik
- Division of Hematology and Oncology, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Ronald Kittson
- Division of Hematology and Oncology, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Janet Abernathy
- Division of Hematology and Oncology, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Richard Lauer
- Division of Hematology and Oncology, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Zoneddy Dayao
- Division of Hematology and Oncology, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
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Comparison of Patient-Reported Experience of Patients Receiving Radiotherapy Measured by Two Validated Surveys. ACTA ACUST UNITED AC 2021; 28:2180-2189. [PMID: 34204701 PMCID: PMC8293109 DOI: 10.3390/curroncol28030202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
Patient-reported experience is associated with improved patient safety and clinical outcomes. Quality improvement programs rely on validated patient-reported experience measures (PREMs) to design projects. This descriptive study compares the experience of cancer patients treated with radiation as recorded through the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) or as recorded through Your Voice Matters (YVM) between February and August 2019. Six questions were compared (“overall experience with care”, “discussion of worries”, “involvement in decisions”, “trusting providers with confidential information”, “providing family with information”, and “knowing who to contact”). Positive experience scores were calculated by cohort and by tumor groups. Multivariable logistic regression models evaluated factors associated with positive experience. Two cohorts (220 and 200 patients) met the eligibility criteria for the AOPSS and YVM, respectively. Positive experience was reported similarly between the two PREMs for “overall experience with care”, “discussion of worries”, and “trusting providers with confidential information” with a score difference of 1–4% at the cohort level. Positive experience score difference ranged from 5% to 44% across questions at the tumor group level. Different experience gaps were identified with the two measures, mainly at the tumor group level. Programs interested in using these PREMS might consider this when designing projects.
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Factors contributing to satisfaction with care in cancer outpatients. Support Care Cancer 2021; 29:4575-4586. [PMID: 33483788 DOI: 10.1007/s00520-020-05978-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate satisfaction with care (SC) in cancer patients treated at a Spanish day hospital, to identify determinants of SC, and to assess the association between SC and quality of life (QL). METHODS Cross-sectional study in which 119 patients undergoing outpatient chemotherapy completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Cancer Outpatient Satisfaction with Care questionnaire for chemotherapy (OUT-PATSAT35 CT), and an item on loyalty. Bivariate correlations between each subscale of the OUT-PATSAT35 CT and overall satisfaction, and between the subscales of OUT-PATSAT35 CT and QLQ-C30, were calculated. Multiple linear regression models were used to analyze determinants of patients' SC. RESULTS Mean age was 62.5 years (SD 11.7), and 54.6% of the sample were female. Mean scores for SC were > 75 out of 100 on all OUT-PATSAT35 CT subscales, except environment. Overall satisfaction was higher than satisfaction in any subscale, and all patients would choose the same day hospital again. Correlation with overall satisfaction was moderate but statistically significant for all subscales. Patients treated for tumor recurrence and those undergoing palliative treatment manifested significantly lower overall satisfaction. Correlation between the EORTC QLQ-C30 and the OUT-PATSAT35 CT was not statistically significant, although patients with better health status reported higher satisfaction in several subscales. CONCLUSION Patient-reported SC and loyalty towards the day hospital were high. Disease evolution and aim of treatment were determinants of overall satisfaction. The correlation between SC and QL was unclear. Some areas for improving care were noted.
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Washington C, Benvengo S, Lynch K. Addressing Service Recovery Practice With Radiation Oncology Frontline Managers: A Project Brief. J Patient Exp 2020; 7:915-919. [PMID: 33457520 PMCID: PMC7786715 DOI: 10.1177/2374373520967797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The relationship between patient satisfaction, care compliance, and treatment outcomes suggests patients who report dissatisfaction perceive receipt of suboptimal care. Patient satisfaction plays a role in defining quality of care, affecting institutional reimbursement and reputation capital. Using an explanatory sequential mixed methodology approach, this study explored frontline management's role in effective service recovery, actively addressing instances of patient dissatisfaction to improve the overall patient experience. A survey of frontline managers, document and artifact reviews, and probing interviews identify the importance of consistent performance measurement, feedback, and frequent leadership training on the relevance and importance of service recovery.
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Affiliation(s)
| | | | - Kathleen Lynch
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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8
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Lamba N, Niemierko A, Martinez R, Leland P, Shih HA. The Interaction of Waiting Time and Patient Experience during Radiation Therapy: A Survey of Patients from a Tertiary Cancer Center. J Med Imaging Radiat Sci 2020; 51:40-46. [DOI: 10.1016/j.jmir.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022]
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Galeas JN, Packer S, Browne R, Sakalian S, Binder AF. Decreasing Time to Initiation of Chemotherapy for Patients Electively Admitted to a Hematologic Malignancy Service. J Oncol Pract 2019; 15:e906-e915. [PMID: 31393808 DOI: 10.1200/jop.19.00120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Delays in initiating elective inpatient chemotherapy can decrease patient satisfaction and increase length of stay. At our institution, we observed that 86% of patients who were admitted for elective chemotherapy experienced a delay-more than 6 hours-with a median time to chemotherapy of 18.9 hours. We developed a process improvement initiative to improve time to chemotherapy for elective chemotherapy admissions. METHODS Our outcome measure was the time from admission to chemotherapy administration in patients who were admitted for elective chemotherapy. Process measures were identified and monitored. We collected baseline data and used performance improvement tools to identify key drivers. We focused on these key drivers to develop multiple plan-do-study-act cycles to improve our outcome measure. Once we started an intervention, we collected data every 2 weeks to assess our intervention. RESULTS At the time of interim analysis, we observed a median decrease in time to chemotherapy administration from 18.9 hours to 8.85 hours (P = .005). Median time to laboratory results resulted decreased from 3.17 hours to 0.00 hours. There was no change in time from signing chemotherapy to nurse releasing the chemotherapy. We noted that more providers were signing the chemotherapy before patient admission. CONCLUSION By implementing new admission workflows, optimizing our use of the electronic medical record to communicate among providers, and improving preadmission planning we were able to reduce our median time to chemotherapy for elective admissions by 53.2%. Improvement is still needed to meet our goals and to ensure the sustainability of these ongoing efforts.
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Affiliation(s)
| | | | | | | | - Adam F Binder
- Thomas Jefferson University Hospital, Philadelphia, PA
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10
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Dos Santos M, Lequesne J, Dugué AE, Grellard JM, Ory C, Jaffré S, Lavergne K, Lelaidier A, Laroche L, Divanon F, Delcambre C, Galais MP, Clarisse B, Faveyrial A. Optimisation of chemotherapy prescription and preparation in an ambulatory unit: Validation of the OPTIMA program. Eur J Cancer Care (Engl) 2019; 28:e13015. [PMID: 30790365 DOI: 10.1111/ecc.13015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We implemented the two-step OPTIMA program to anticipate chemotherapy prescription which aims to assess the discrepancy rate between anticipated and real prescription and its impact on waiting time and quality of care. METHODS This prospective study included cancer patients receiving any intravenous chemotherapy. The OPTIMA program consists in a nurse phone call and a blood sample two days before the planned treatment. Collected information and biological results were used by a physician to issue a non-effective (step 1) or effective (step 2) anticipated prescription the day before the consultation. The real prescription was given as usual by another physician on the day of the consultation. Waiting time was collected, and patients' satisfaction with care was assessed with the OUT-PATSAT35 questionnaire. RESULTS Respectively, 540 and 979 consultations (283 and 294 patients) were analysed in both steps. The discrepancy rate was 8.7% (step 1). In routine practice, the OPTIMA program (step 2) reduced patients' waiting time (median time 55 vs. 95 min, p < 0.001). A high general care satisfaction score was observed in both steps (80.7% and 80.2%). CONCLUSIONS This anticipation program demonstrated the accuracy of chemotherapy prescription, whatever the regimen and cancer site, and its impact on waiting time optimisation.
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Affiliation(s)
- Mélanie Dos Santos
- Clinical Research Unit, Centre François Baclesse, Caen, France.,Department of Medicine, Hospital University, Caen, France
| | | | | | | | - Céline Ory
- Ambulatory Department, Centre François Baclesse, Caen, France
| | | | - Kelly Lavergne
- Clinical Research Unit, Centre François Baclesse, Caen, France
| | - Anaïs Lelaidier
- Northwest Data Center (CTD-CNO), Centre François Baclesse, Caen, France
| | - Lucie Laroche
- Northwest Data Center (CTD-CNO), Centre François Baclesse, Caen, France
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Djambazov SN, Giammanco MD, Gitto L. Factors That Predict Overall Patient Satisfaction With Oncology Hospital Care in Bulgaria. Value Health Reg Issues 2019; 19:26-33. [PMID: 30641294 DOI: 10.1016/j.vhri.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/07/2018] [Accepted: 11/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The relevance of studies focusing on patient satisfaction becomes imperative for patients with cancer, who often face major changes in their lifestyles. Their perceived uncertainty in illness and their personal experiences with the services received are crucial factors for a qualitatively adequate assistance. OBJECTIVES To assess the determinants of patient satisfaction, using a sample of 306 Bulgarian oncology outpatients. METHODS The hypotheses tested concern the extent to which patient satisfaction depends on the uncertainty in illness; the patients' assessment of technical and interpersonal skills of nurses and medical staff; the information provision; and some organizational aspects. Patients were asked to answer a questionnaire composed of internationally validated scales assessing the determinants of patient satisfaction (measured through the European Organization for Research and Treatment of Cancer), uncertainty in illness (assessed through the Mishel Uncertainty in Illness Scale), and patients' health status (assessed through the EuroQol 5-dimensional questionnaire and the visual analogue scale). An ordered logit model was run, using the level of overall patient satisfaction as a dependent variable. RESULTS This is one of the first studies carried out in Bulgaria for oncology patient satisfaction of subjective factors related to the frailty of the oncology patient status such as age, self-assessed health-related quality of life, and uncertainty in illness. Nevertheless, other determinants, reflecting the quality of the care provided, also have an impact on patient satisfaction, namely, the assessment of the nonmedical personnel, the perception of medical technical skills, and the access to a medical center. CONCLUSIONS Results stress the relevance of reducing uncertainty in illness in patients with cancer by implementing a satisfactory patient-physician relationship in the management of the disease.
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Affiliation(s)
| | | | - Lara Gitto
- CEIS Sanità EEHTA, University of Rome "Tor Vergata", Rome, Italy
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Randhawa S, Viqar A, Strother J, Prabhu AV, Xia F, Heron D, Beriwal S. How Do Patients Rate Their Radiation Oncologists in the Modern Era: An Analysis of Vitals.com. Cureus 2018; 10:e3312. [PMID: 30473945 PMCID: PMC6248776 DOI: 10.7759/cureus.3312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The popularity of online physician rating websites has risen substantially. These third-party sites have the potential to significantly influence patients’ perception of their healthcare providers. The purpose of this study was to evaluate online ratings of U.S. radiation oncologists (ROs) on Vitals.com, one of the most popular physician rating websites, and the variables that most significantly affect patients’ overall rating (OR) of their ROs. Methods The Centers for Medicare and Medicaid Physician Comparable Downloadable File was analyzed to obtain data on all self-identified ROs in the U.S. and Puerto Rico. Patient Review Satisfaction Scores (PRSS) that ranged from one (poor) to five (excellent) for the following variables were recorded: OR, accurate diagnosis, spending appropriate time with patients, ease of appointment, courteous staff, bedside manner, follow-up after visit, promptness, and wait time. Associations among these factors were assessed. Results Of 4,443 self-identifying Medicare-accepting ROs, 1,797 (40.4%) ROs who had at least one OR rating and at least one written comment were included in this study. The ROs’ mean OR was 4.34 ± 0.2 (median 4; 30% received a score of 5; 78% received a score greater than 4). OR was found to have a strong correlation with accuracy of diagnosis (r = 0.69), bedside manner (r = 0.71), and spends appropriate time with patients (r = 0.69). With the exception of the number of ratings (p = 0.07), physicians with over 10 years of experience showed statistically significant differences in how much better they scored in each of the variables compared to those with less than 10 years of experience (p < 0.01 for each characteristic). Significant differences in OR were also observed between ROs whose wait times exceeded 20 minutes compared to those with wait times less than 10 minutes (p < 0.01) for all internal and external metrics except for the number of ratings (p = 0.42) and number of reviews (p = 0.88) Conclusion Patients are providing high ratings for their ROs on Vitals.com and are more frequently recommending them to friends and family. Given the rise in popularity of third-party physician rating sites, it is important for ROs to understand the various factors that may influence their online ratings.
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Affiliation(s)
- Simrath Randhawa
- Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, USA
| | - Asim Viqar
- Medicine, Perelman School of Medicine, University of Pennsylvania, Pittsburgh, USA
| | - Julia Strother
- Medicine, Frank H. Netter Md School of Medicine at Quinnipiac University, North Haven, USA
| | - Arpan V Prabhu
- Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Fen Xia
- Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Dwight Heron
- Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Sushil Beriwal
- Radiation Oncology, University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, USA
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Yi X, Leung EKY, Mika D, Wolsky RJ, Van Slambrouck C, Leanse J, Nabhan C, Yeo KTJ. Reengineering Critical Laboratory Testing for Timely Chemotherapeutic Management. J Appl Lab Med 2018; 3:240-249. [PMID: 33636941 DOI: 10.1373/jalm.2017.025973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/02/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Delivery of cytotoxic therapy is a complex multifaceted process that involves harmonized collaboration between all systems involved. Optimizing laboratory turnaround time (TAT) ensures timely delivery of chemotherapy, which potentially translates into improved patient outcomes and satisfaction. In this study, we aimed to reduce the laboratory TAT for key laboratory tests to optimize the timely administration of chemotherapy. METHODS TAT data for complete blood count (CBC) and comprehensive metabolic panel (CMP) included specimen collection to receipt (Col-Rcv), specimen receipt to result release (Rcv-Res), and the overall TAT from specimen collection to result release (Col-Res). Work flows were reconfigured to transport CBC specimens directly to the hematology laboratory after collection and to treat all CMP samples from chemotherapy clinics as urgent [i.e., shortest turnaround time (STAT)]. From the CMP, total bilirubin and creatinine-the 2 key analytes for liver and renal toxicity assessment before chemotherapy drug administration-were analyzed on ABL 800 whole blood analyzers to further improve the laboratory TAT. RESULTS CBC showed a significant reduction in the median (Col-Res) TAT to 16 min (P < 0.0001). For CMP, by processing all specimens as STAT samples, the median (Col-Res) TAT was reduced from 74 min to 54 min (P < 0.0001), and it was further reduced to 9 min (P < 0.0001) for total bilirubin and creatinine. CONCLUSION Careful work flow analysis and reengineering of preanalytical and analytical process for key laboratory tests significantly reduced median overall TAT to <20 min, which helped facilitate more timely delivery of chemotherapy, without necessitating the construction of a satellite laboratory.
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Affiliation(s)
- Xin Yi
- Department of Pathology, The University of Chicago, Chicago, IL
| | | | - Diane Mika
- Department of Pathology, The University of Chicago, Chicago, IL
| | | | | | - Julie Leanse
- Department of Pathology, The University of Chicago, Chicago, IL
| | - Chadi Nabhan
- Department of Medicine, The University of Chicago, Chicago, IL
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Smith CF, Tompson AC, Jones N, Brewin J, Spencer EA, Bankhead CR, Hobbs FR, Nicholson BD. Direct access cancer testing in primary care: a systematic review of use and clinical outcomes. Br J Gen Pract 2018; 68:e594-e603. [PMID: 30104328 PMCID: PMC6104856 DOI: 10.3399/bjgp18x698561] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/04/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Direct access (DA) testing allows GPs to refer patients for investigation without consulting a specialist. The aim is to reduce waiting time for investigations and unnecessary appointments, enabling treatment to begin without delay. AIM To establish the proportion of patients diagnosed with cancer and other diseases through DA testing, time to diagnosis, and suitability of DA investigations. DESIGN AND SETTING Systematic review assessing the effectiveness of GP DA testing in adults. METHOD MEDLINE, Embase, and the Cochrane Library were searched. Where possible, study data were pooled and analysed quantitatively. Where this was not possible, the data are presented narratively. RESULTS The authors identified 60 papers that met pre-specified inclusion criteria. Most studies were carried out in the UK and were judged to be of poor quality. The authors found no significant difference in the pooled cancer conversion rate between GP DA referrals and patients who first consulted a specialist for any test, except gastroscopy. There were also no significant differences in the proportions of patients receiving any non-cancer diagnosis. Referrals for testing were deemed appropriate in 66.4% of those coming from GPs, and in 80.9% of those from consultants; this difference was not significant. The time from referral to testing was significantly shorter for patients referred for DA tests. Patient and GP satisfaction with DA testing was consistently high. CONCLUSION GP DA testing performs as well as, and on some measures better than, consultant triaged testing on measures of disease detection, appropriateness of referrals, interval from referral to testing, and patient and GP satisfaction.
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Affiliation(s)
| | - Alice C Tompson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Nicholas Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Josh Brewin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Elizabeth A Spencer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Clare R Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
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15
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Aziz A, Samoon Z, Khurshid M, Feroz A, Ayoub N, Awan S, Beg M. Clinical audit to assess delays in chemotherapy administration at daycare oncology center at a tertiary care hospital in Karachi, Pakistan. Indian J Cancer 2018; 55:111-114. [PMID: 30147105 DOI: 10.4103/ijc.ijc_493_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim There were delays reported by patients in chemotherapy administration in daycare oncology. Therefore, we decided to audit all processes which are involved in chemotherapy administration. The objective was to improve our service by decreasing the time between admission and initiation of chemotherapy and identify the reasons for delays. Materials and Methods The audit was conducted in three parts. In Review I, audit tool was developed and information documented of 109 patients receiving chemotherapy at daycare center from April 14 to May 13, 2015. Five processes were assessed out of which delay in initial assessment by the nurse was the only factor identified leading to delay in chemotherapy. Review II was done from March 1 to 31, 2016 of 208 patients after increasing the number of nurses and Review III from June 7 to August 25, 2016 of 287 patients by dividing the initial assessment process at two different areas to decrease delay in initial assessment. Results Seventy-two percent of patients had their initial assessment done within 15 min of arrival in daycare in the first audit. In the second part of audit this percentage decreased to 55%, and finally, in the third part of the audit, percentage was improved and increased to 75% after separating initial assessment process into two areas (P < 0.001, Kruskal-Wallis test). Conclusion After separating initial assessment process into two different areas, delays in chemotherapy administration were reduced.
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Affiliation(s)
- Arifa Aziz
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Zarka Samoon
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Khurshid
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Afsheen Feroz
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Nadia Ayoub
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Safia Awan
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Madhia Beg
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
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Mengistu B, Ray D, Lockett P, Dorsey V, Phipps RA, Subramanian H, Atkins JT, El Osta B, Falchook GS, Karp DD. Innovative Strategies for Decreasing Blood Collection Wait Times for Patients in Early-Phase Cancer Clinical Trials. J Oncol Pract 2016; 12:e784-91. [PMID: 27328793 DOI: 10.1200/jop.2015.007674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Long wait times are a primary source of dissatisfaction among patients enrolled in early-phase clinical trials. We hypothesized that an automated patient check-in system with readily available display for increasing awareness of waiting intervals would improve patient flow and use of our rooms, with decreased turnover time and increased throughput. METHODS We recorded in-room wait times for patients seen in our clinic and observed the logistics involved in the blood collection process to delineate causes for delays. We then implemented a three-step strategy to alleviate the causes of these delays: (1) changing the collection of materials and the review of faxed orders, (2) improving our LabTracker automated database system that included wait time calculators and real-time information regarding patient status, and (3) streamlining lower complexity appointments. RESULTS After our intervention, we observed a 19% decrease in mean wait times and a 30% decrease in wait times among patients waiting the longest (95th percentile). We also observed an increase in staff productivity during this process. Modifications in LabTracker provided the biggest reduction in mean wait times (17%). CONCLUSION We observed a significant decrease in mean wait times after implementing our intervention. This decrease led to increased staff productivity and cost savings. Once wait times became a measurable metric, we were able to identify causes for delays and improve our operations, which can be performed in any patient care facility.
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Affiliation(s)
- Bayabel Mengistu
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Dina Ray
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Passion Lockett
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Vivian Dorsey
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Ron A Phipps
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Harihara Subramanian
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Johnique T Atkins
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Badi El Osta
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Gerald S Falchook
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
| | - Daniel D Karp
- The University of Texas MD Anderson Cancer Center, Houston, TX; Medical College of Georgia, Augusta, GA; and Sarah Cannon Research Institute at HealthONE, Denver, CO
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Foglino S, Bravi F, Carretta E, Fantini MP, Dobrow MJ, Brown AD. The relationship between integrated care and cancer patient experience: A scoping review of the evidence. Health Policy 2016; 120:55-63. [DOI: 10.1016/j.healthpol.2015.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/18/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022]
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Gjolaj LN, Campos GG, Olier-Pino AI, Fernandez GL. Delivering Patient Value by Using Process Improvement Tools to Decrease Patient Wait Time in an Outpatient Oncology Infusion Unit. J Oncol Pract 2015; 12:e95-e100. [PMID: 26420892 DOI: 10.1200/jop.2015.006155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study aimed to streamline workflow from arrival to premedication by decreasing patient wait time to increase value in a high-volume academic outpatient oncology infusion unit. The streamlining process involved identifying and prioritizing patients for treatment by driving out waste in patient flow. METHODS The plan-do-check-act (PDCA) method and Lean Methodology were used in completing a project to streamline a defined subset of patient experiences within an outpatient oncology infusion unit in an academic comprehensive cancer center. Wait time for patients whose labs were completed before treatment day and within normal limits and whose orders were signed the day before treatment was collected manually for a period of 5 months and tracked via value stream and control charts. RESULTS Postimplementation, patients experienced a decrease of 17 minutes in mean patient arrival to premedication start time (preimplementation 77 minutes, postimplementation 60 minutes). Additionally, a value stream analysis demonstrated that in the new process, patient touch points were decreased by two, and value-added time was increased by 17%. CONCLUSION By using the systematic PDCA tool, the team was able to identify opportunities to reduce waste in the system and streamline patient care. The results demonstrated a significant improvement in reducing patient wait time from arrival to premedication start time and increasing percentage of total value added during a patient's treatment cycle.
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Affiliation(s)
- Lauren N Gjolaj
- University of Miami Health System; and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Gloria G Campos
- University of Miami Health System; and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Angela I Olier-Pino
- University of Miami Health System; and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Gustavo L Fernandez
- University of Miami Health System; and Sylvester Comprehensive Cancer Center, Miami, FL
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Petersen GS, Knudsen JL, Vinter MM. Cancer patients' preferences of care within hospitals: a systematic literature review. Int J Qual Health Care 2015; 27:384-95. [PMID: 26265160 DOI: 10.1093/intqhc/mzv059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Knowledge about cancer patients' preferences in health care is important because it enables care to be patient centered. However, the literature does not provide an overview. The aim of this study was to identify the dimensions of hospital-based cancer care that patients evaluate the most important using Patient-rated importance as a method. DATA SOURCE PubMed was searched in 2013/2014. STUDY SELECTION Studies were identified, if they were in accordance with specific search terms and focused on hospital-based cancer care. Totally, 11 studies were found. DATA EXTRACTION The 11 studies comprised a total of 598 items. Of these, 592 items were categorized into 19 care dimensions. The highest rated quartile of items was identified as care elements patients evaluated to be the most important. Identification of the most important dimensions was done by calculating the percentages of items within each dimension that were within the highest quartile. RESULTS OF DATA SYNTHESIS The 11 studies varied a lot in regard to aim and patient characteristics. The three most important dimensions were as follows: Rapid diagnosis and treatment; High professional standard; and Information about treatment and side(effects)/consequences. Within four dimensions, Psychosocial support, Physical facilities, Waiting time and Transparency in care, no items were within the highest quartile. CONCLUSION Patient-rated importance was a useful method in identifying the care patients preferred. Due to a limited number of studies and great diversity within studies evaluated, interpretation of results should be cautious. However, it seems that cancer patients treated in hospitals with a curative intent find treatment-related information, professional standard and short delay of diagnosis and treatment most important.
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Affiliation(s)
| | - Janne Lehmann Knudsen
- Danish Cancer Society, Documentation & Quality, Strandboulevarden 49, Copenhagen DK-2100, Denmark
| | - Mette Marianne Vinter
- Danish Cancer Society, Documentation & Quality, Strandboulevarden 49, Copenhagen DK-2100, Denmark
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Liew HP, Gardner S. Determinants of patient satisfaction with outpatient care in Indonesia: A conjoint analysis approach. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2014.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hamel LM, Chapman R, Eggly S, Penner LA, Tkatch R, Vichich J, Albrecht TL. Measuring the use of examination room time in oncology clinics: a novel approach to assessing clinic efficiency and patient flow. J Oncol Pract 2014; 10:e385-9. [PMID: 25248723 PMCID: PMC4223711 DOI: 10.1200/jop.2013.001359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The use of time in outpatient cancer clinics is a marker of quality and efficiency. Inefficiencies such as excessive patient wait times can have deleterious effects on clinic flow, functioning, and patient satisfaction. We propose a novel method of objectively measuring patient time in cancer clinic examination rooms and evaluating its impact on overall system efficiency. METHODS We video-recorded patient visits (N = 55) taken from a larger study to determine patient occupancy and flow in and out of examination rooms in a busy urban clinic in a National Cancer Institute-designated comprehensive cancer center. Coders observed video recordings and assessed patient occupancy time, patient wait time, and physician-patient interaction time. Patient occupancy time was compared with scheduled occupancy time to determine discrepancy in occupancy time. Descriptive and correlational analyses were conducted. RESULTS Mean patient occupancy time was 94.8 minutes (SD = 36.6), mean wait time was 34.9 minutes (SD = 28.8), and mean patient-physician interaction time was 29.0 minutes (SD = 13.5). Mean discrepancy in occupancy time was 40.3 minutes (range, 0.75 to 146.5 minutes). We found no correlation between scheduled occupancy time and patient occupancy time, patient-physician interaction time, and patient wait time, or between discrepancy in occupancy time and patient-physician interaction time. CONCLUSION The method is useful for assessing clinic efficiency and patient flow. There was no relationship between scheduled and actual time patients spend in exam rooms. Such data can be used in the design of interventions that reduce patient wait times, increase efficient use of resources, and improve scheduling patterns.
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Affiliation(s)
- Lauren M Hamel
- Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI
| | - Robert Chapman
- Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI
| | - Susan Eggly
- Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI
| | - Louis A Penner
- Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI
| | - Rifky Tkatch
- Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI
| | - Jennifer Vichich
- Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI
| | - Terrance L Albrecht
- Wayne State University-Barbara Ann Karmanos Cancer Institute; and Josephine Ford Cancer Institute-Henry Ford Health System, Detroit, MI
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Aragon SJ, Richardson LJ, Lawrence W, Gesell SB. Nurses' Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units. Nurs Res Pract 2013; 2013:563282. [PMID: 24027634 PMCID: PMC3762141 DOI: 10.1155/2013/563282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/23/2013] [Indexed: 11/18/2022] Open
Abstract
Objective. This study examined to what degree patient-centeredness-measured as an underlying ability of obstetrical nurses-influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units.
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Affiliation(s)
- Stephen J. Aragon
- Winston-Salem State University, School of Business and Economics, Department of Management and Marketing, Healthcare Administration Program, Winston-Salem, NC 27110, USA
| | - Liana J. Richardson
- University of North Carolina at Chapel Hill, Department of Sociology and Carolina Population Center, 155 Hamilton Hall, CB No.3210, Chapel Hill, NC 27599, USA
| | - Wanda Lawrence
- Winston-Salem State University, School of Health Sciences, Division of Nursing, Winston-Salem, NC 27110, USA
| | - Sabina B. Gesell
- Wake Forest School of Medicine, Public Health Sciences, Department of Social Sciences and Health Policy, and Maya Angelou Center for Health Equity, Winston-Salem, NC 27157, USA
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What do consumers see as important in the continuity of their care? Support Care Cancer 2013; 21:2637-42. [DOI: 10.1007/s00520-013-1889-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 06/24/2013] [Indexed: 11/26/2022]
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Patients' and professionals' evaluations of quality of care in oncology outpatient clinics. Support Care Cancer 2013; 21:2983-90. [PMID: 23760457 DOI: 10.1007/s00520-013-1872-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study is to compare patients' and professionals' evaluations of the quality of care in oncology outpatient clinics. METHODS The data were drawn from a 2011 survey of 1,379 patients and 155 professionals conducted in 15 % of oncology outpatient clinics in Quebec, Canada. Respondents completed self-administered questionnaires that addressed the aspects of timeliness (TIM), patient-centred care (PCC), communication (COM), quality of the physical environment (QPE), and continuity (CONT). Patients' and professionals' mean scores (maximum = 4) for each aspect were compared using mixed model analysis. RESULTS Patients' and professionals' perceptions of quality of care were largely positive, with mean scores for all items of 3.66 and 3.37, respectively. However, for the majority of aspects of quality, the professionals' scores were lower than those of patients. The aspects rated most positively by both groups were PCC, COM and CONT. Timeliness was the least positively evaluated, with mean scores of 3.34 for patients and 3.16 for professionals. CONCLUSIONS In many respects, cancer patients and professionals share relatively common views about the most and least positive aspects of the quality of care, although professionals tend to be more critical. Aspects evaluated less favourably by both groups and those on which opinions differ are good candidates for improvements. Some ideas for solutions are proposed. Positive patient feedback is especially important in cancer care, where attraction and retention of professionals is a key concern.
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Evaluation of Patient Satisfaction: Radiation Therapy Services for Chinese Patients at the British Columbia Cancer Agency – Vancouver Centre. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013. [DOI: 10.1017/s1460396912000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground: Patient satisfaction surveys conducted in English exclude respondents who are not proficient in the English language. This makes it difficult to assess whether health care services provided are culturally appropriate. This study aims to evaluate the level of satisfaction for Chinese speaking patients who received radiation treatments at the British Columbia Cancer Agency, Vancouver Centre in Canada.Patients and Methods: Chinese patients were given a translated patient satisfaction survey on a voluntary basis to complete at the end of treatment. Contingency table analysis using the Pearson chi-square test or Fisher’s exact test was performed at 5% significance level for all analyses. Logistic regression analysis was conducted to investigate whether complete satisfaction with an aspect of care influenced overall satisfaction with services provided by the RT team.Results: The level of satisfaction in Chinese speaking patients was lower compared to English speaking patients. The results from the Chinese survey also identified the importance of treatment patients with courtesy and providing them with a pleasant wait area.Conclusions: Despite a language barrier, Chinese speaking patients still contributed to improvement initiatives at the Vancouver Centre. Efforts to ensure a culturally appropriate environment and provision of services include recruitment of staff members who reflect the cultural diversity of the community serviced, use of interpreter services or bilingual health providers for clients, use of linguistically appropriately education materials, and health care settings that is pleasant and respects the cultural diversity of the population serviced. This assessment provided a better understanding of whether services at the Vancouver Centre were culture appropriate.
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Cuadrado-Cenzual MÁ, García-Saenz JÁ, López Palacios S, de Pedro Moro JA, Díaz-Rubio E. [New strategies to improve accessibility to laboratory tests in cancer patients]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2013; 28:217-23. [PMID: 23298729 DOI: 10.1016/j.cali.2012.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 11/15/2012] [Accepted: 11/16/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop models to improve accessibility of performing laboratory tests on chronic oncology patients, as well as a more flexible choice of sample collection in both primary and specialized care. MATERIAL AND METHODS Circuit analysis of cancer patients. Patient survey to study access to laboratory tests. High Resolution Consultation Development Model (MCAR) and Patient Access Analytical Model (MAAP). RESULTS The percentage of cancer patients on treatment has increased by 8.76% in the past two years. There was a 32% increased in the use of the MAAP model in the two years of its implementation, and has been the choice of 74% due to greater accessibility, with 8% of the patients having used both models to suit their needs. CONCLUSIONS The implementation of optimized and preferred care systems has shown that both models improve accessibility and flexibility of the diagnostic testing laboratory in the patients studied.
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Kenyon CC, Kavanagh PL, Fiechtner LG, Textor TE, Wang CJ. Setting the agenda for quality improvement in pediatric sickle cell disease. J Natl Med Assoc 2012; 104:337-41. [PMID: 23092048 DOI: 10.1016/s0027-9684(15)30174-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite recent scientific advances, children with sickle cell disease (SCD) continue to experience high mortality and significant morbidity, in part due to variations in the care provided. We sought to identify and compare drivers for quality improvement among clinical staff and parents of children with SCD. METHODS We interviewed clinical staff across care settings in an urban teaching hospital to elicit their perspectives on improving care for children with SCD. Concurrently, we invited parents of children with SCD to participate in focus groups to identify their needs. Findings are reported according to Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS We conducted 29 interviews with clinical staff and 4 focus groups with parents. Both groups identified the need for effective communication of relevant patient information across disciplines as a key area for improvement. Clinical staff cited standardization of care delivery as a top priority through increased accessibility of pertinent clinical information, enhanced pain assessment and management, and improved availability of clinical decision-making tools. Parents listed the need for increased community awareness about SCD, including school and day care staff, enhanced parental education and peer support, and self-management skills for their children as opportunities to improve pediatric SCD care. CONCLUSIONS Identifying drivers for quality improvement is a critical first step in transforming the care provided to children with SCD. Using a systematic approach that includes eliciting the perspectives of both clinicians and parents may significantly enhance the development of a patient-centered quality improvement agenda.
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Affiliation(s)
- Chén C Kenyon
- Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, USA
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Kallen MA, Terrell JA, Lewis-Patterson P, Hwang JP. Improving wait time for chemotherapy in an outpatient clinic at a comprehensive cancer center. J Oncol Pract 2012; 8:e1-7. [PMID: 22548015 DOI: 10.1200/jop.2011.000281] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 01/28/2023] Open
Abstract
PURPOSE We conducted our study at the Ambulatory Treatment Center (ATC) of the MD Anderson Cancer Center, a network of six outpatient treatment units for patients receiving infusion therapies. Excessive patient wait time for chemotherapy was a primary source of ATC patient dissatisfaction. ATC employees expressed frustration, because often, patients arrived physically on time but were not treatment ready. Additionally, ATC staff emphasized challenges associated with obtaining finalized treatment orders for prescheduled appointments (ie, placeholder appointments without associated physician treatment orders). We aimed to decrease mean patient wait time from check-in to treatment in one ATC unit by 25%. METHODS We studied appointment cycle time in the ATC Green Unit, stratifying appointments by type (ie, prescheduled [no finalized treatment orders] and scheduled [finalized treatment orders]). We obtained mean wait times at baseline (control) and again after our intervention period. We conducted interviews and observations in ATC Green, from which we developed a three-part plan to reduce wait time: increase process efficiency within ATC Green, enhance communications with MD Anderson clinics and centers, and incorporate information technology applications. RESULTS After our intervention, we observed a 15% decrease in wait time for patients with prescheduled appointments and a 29% decrease for those with scheduled appointments. Overall, there was a 26.8% reduction in mean patient wait time relative to baseline (control). CONCLUSION We observed a significantly decreased mean patient wait time after implementing our intervention. This decrease may improve patient satisfaction, relieve employee frustration with appointment scheduling, and create opportunities for increasing institutional revenue.
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Paul C, Carey M, Anderson A, Mackenzie L, Sanson-Fisher R, Courtney R, Clinton-McHarg T. Cancer patients' concerns regarding access to cancer care: perceived impact of waiting times along the diagnosis and treatment journey. Eur J Cancer Care (Engl) 2012; 21:321-9. [PMID: 22111696 PMCID: PMC3410528 DOI: 10.1111/j.1365-2354.2011.01311.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2011] [Indexed: 01/07/2023]
Abstract
Waiting times can raise significant concern for cancer patients. This study examined cancer patients' concern levels at each phase of waiting. Demographic, disease and psychosocial characteristics associated with concern at each phase were also assessed. 146 consenting outpatients (n= 146) were recruited from two hospitals in Sydney, Australia. Each completed a touch-screen computer survey, asking them to recall concern experienced regarding waiting times at each treatment phase. Approximately half (52%) reported experiencing concern during at least one treatment phase, while 8.9% reported experiencing concern at every phase. Higher proportions of patients reported concern about waiting times from: deciding to have radiotherapy to commencement of radiotherapy (31%); the first specialist appointment to receiving a cancer diagnosis (28%); and deciding to have chemotherapy to commencement of chemotherapy (28%). Patient groups more likely to report concern were those of lower socio-economic status, born outside Australia, or of younger age. Although a small proportion of patients reported very high levels of concern regarding waiting times, the experience of some concern was prevalent. Opportunities for reducing this concern are discussed. Vulnerable groups, such as younger and socio-economically disadvantaged patients, should be the focus of efforts to reduce waiting times and patient concern levels.
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Affiliation(s)
- C Paul
- The University of Newcastle, Health Behaviour Research Group and Priority Research Centre for Health Behaviour, Hunter Medical Research Institute Callaghan, NSW 2308, Australia. )
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Colosia AD, Peltz G, Pohl G, Liu E, Copley-Merriman K, Khan S, Kaye JA. A review and characterization of the various perceptions of quality cancer care. Cancer 2011; 117:884-96. [PMID: 20939015 PMCID: PMC3073118 DOI: 10.1002/cncr.25644] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 08/12/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND It is important to maintain high-quality cancer care while reducing spending. This requires an understanding of how stakeholders define "quality." The objective of this literature review was to understand the perceptions patients, physicians, and managed care professionals have about quality cancer care, especially chemotherapy. METHODS A computerized literature search was conducted for articles concerning quality cancer care in patients who received chemotherapy. Among >1100 identified sources, 25 presented interviews/survey results from stakeholders. RESULTS Patients defined quality cancer care as being treated well by providers, having multiple treatment options, and being part of the decision-making process. Waiting to see providers, having problems with referrals, going to different locations for treatment, experiencing billing inaccuracies, and navigating managed care reimbursement negatively affected patients' quality-of-care perceptions. Providers perceived quality cancer care as making decisions based on the risks-benefits of specific chemotherapy regimens and patients' health status rather than costs. Providers objected to spending substantial time interacting with payers instead of delivering care to patients. Payers must control the costs of cancer care but do not want an adversarial relationship with providers and patients. Payers' methods of managing cancer more efficiently involved working with providers to develop assessment and decision-assist tools. CONCLUSIONS Delivering quality cancer care is increasingly difficult because of the shortage of oncologists and rising costs of chemotherapy agents, radiation therapy, and imaging tests. The definition of quality cancer care differed among stakeholders, and healthcare reform must reflect these various needs to maintain and improve quality while controlling costs.
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Affiliation(s)
- Ann D Colosia
- Market Access and Outcomes Strategy, RTI Health Solutions, Research Triangle Park, North Carolina.
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Couillerot-Peyrondet AL, Midy F, Bruneau C. [Perception of health care quality by patients with chronic conditions]. Rev Epidemiol Sante Publique 2011; 59:23-31. [PMID: 21251780 DOI: 10.1016/j.respe.2010.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 09/02/2010] [Accepted: 09/09/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patient opinion is becoming ever more important when considering healthcare quality and the reforms required to improve healthcare quality. The main aim of this study was to explore factors determining perceived healthcare quality among patients with chronic diseases. METHODS Data are drawn from the survey carried out in 2008 by the Commonwealth Fund, in partnership with the French Superior Health Authority (Haute Autorité de santé). The prospective telephone survey targeted adults in eight countries who had serious health problems (chronic or severe disease, declared poor state of health, hospital admission or major surgery). Of the 1202 French respondents, 851 had at least one diagnosed chronic disease. A multinomial logistic model was used to identify the relationship between perceived healthcare quality and patients' recent experience with the healthcare system. RESULTS People with chronic disease in general perceived that healthcare quality was excellent (45%) or good (44%). Only 11% of respondents judged it to be average or poor. There was a hint of "could do better", for example when considering podology and ophthalmology follow-up in diabetes or the management of multiple medications. The explanatory model revealed a positive correlation between excellent perceived healthcare quality and a strong doctor-patient relationship, taking into account both the length of this relationship and the ability of the doctor to involve the patient at all stages of decision-making concerning therapeutic management. There was no major link between the perceived quality of care and objective care quality, the quality of procedures, the cost of care to the patient or how frequently patients access the healthcare system. CONCLUSION The quality of the relationship between the patient and his/her doctor is a determining factor in the patient's judgement of the quality of healthcare he/she receives.
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Affiliation(s)
- A-L Couillerot-Peyrondet
- Haute Autorité de santé, 2, avenue du Stade-de-France, 93218 Saint-Denis La Plaine cedex, France
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Abstract
A patient satisfaction survey was conducted with ambulatory cancer patients to identify areas that they consider priorities for change. Wait times and telephone contact with healthcare providers were the 2 areas of lowest satisfaction. Despite previous interventions to improve wait times, it is consistently the lowest ranked item for patient satisfaction. A subset of patients who were followed by a nurse navigator was more satisfied with wait times than those who were not followed by a nurse navigator.
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Investigating Patient Wait Times for Daily Outpatient Radiotherapy Appointments (A Single-Centre Study). J Med Imaging Radiat Sci 2010; 41:145-151. [DOI: 10.1016/j.jmir.2010.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 06/01/2010] [Accepted: 06/10/2010] [Indexed: 11/19/2022]
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Wessels H, de Graeff A, Wynia K, de Heus M, Kruitwagen CLJJ, Teunissen SCCM, Voest EE. Are health care professionals able to judge cancer patients' health care preferences correctly? A cross-sectional study. BMC Health Serv Res 2010; 10:198. [PMID: 20615226 PMCID: PMC2911431 DOI: 10.1186/1472-6963-10-198] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 07/08/2010] [Indexed: 11/29/2022] Open
Abstract
Background Health care for cancer patients is primarily shaped by health care professionals. This raises the question to what extent health care professionals are aware of patients' preferences, needs and values. The aim of this study was to explore to what extent there is concordance between patients' preferences in cancer care and patients' preferences as estimated by health care professionals. We also examined whether there were gender differences between health care professionals with regard to the degree in which they can estimate patients' preferences correctly. Methods To obtain unbiased insight into the specific preferences of cancer patients, we developed the 'Cancer patients' health care preferences' questionnaire'. With this questionnaire we assessed a large sample of cancer patients (n = 386). Next, we asked health care professionals (medical oncologists, nurses and policymakers, n = 60) to fill out this questionnaire and to indicate preferences they thought cancer patients would have. Mean scores between groups were compared using Mann-Whitney tests. Effect sizes (ESs) were calculated for statistically significant differences. Results We found significant differences (ESs 0.31 to 0.90) between patients and professionals for eight out of twenty-one scales and two out of eight single items. Patients valued care aspects related to expertise and attitude of health care providers and accessibility of services as more important than the professionals thought they would do. Health care professionals overestimated the value that patients set on particularly organisational and environmental aspects. We found significant gender-related differences between the professionals (ESs 0.69 to 1.39 ) for eight out of twenty-one scales and two out of eight single items. When there were significant differences between male and female healthcare professionals in their estimation of patients health care preferences, female health care professionals invariably had higher scores. Generally, female health care professionals did not estimate patients' preferences and needs better than their male colleagues. Conclusions Health care professionals are reasonably well able to make a correct estimation of patients preferences, but they should be aware of their own bias and use additional resources to gain a better understanding of patients' specific preferences for each patient is different and ultimately the care needs and preferences will also be unique to the person.
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Affiliation(s)
- Hester Wessels
- 1Department of Corporate Communications, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
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Wessels H, de Graeff A, Wynia K, de Heus M, Kruitwagen CLJJ, Woltjer GTGJ, Teunissen SCCM, Voest EE. Gender-related needs and preferences in cancer care indicate the need for an individualized approach to cancer patients. Oncologist 2010; 15:648-55. [PMID: 20507890 DOI: 10.1634/theoncologist.2009-0337] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM Improving quality of care for cancer patients requires insight into their specific wishes, needs, and preferences concerning cancer care. The aim of this study was to explore the impact of gender on cancer patients' needs and preferences. PATIENTS AND METHODS Data were obtained from 386 questionnaires assessing cancer patients' preferences for health care. Multivariate regression analyses were performed with data obtained from medical oncology patients treated in seven Dutch hospitals, using the scales of the questionnaire as dependent variables. RESULTS Patients rated safety, expertise, performance, and attitude of physicians and nurses highest on their list of preferences. There were significant differences between male and female patients concerning preferences in health care in 15 of the 21 scales and in two of the eight single items. Without exception, women found the care aspects mentioned in these scales and items more important than men. Multivariate regression analysis showed that, of all the patient- and disease-related factors, gender was the most important independent predictor of patient preferences. CONCLUSION Gender impacts cancer patients' needs and preferences and should be taken into account for optimal cancer care. Cancer care might be tailored toward gender, for example, with regard to the means and extent of communication, manner and extent of support, counseling and rehabilitation, consultation length, and physician assignment. The results of this study may guide health care professionals and organizations to develop a gender-specific health care approach to further improve cancer patient-centered care.
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Affiliation(s)
- Hester Wessels
- Department of Medical Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
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Bounthavong M, Christopher MLD, Mendes MAS, Foster EB, Johns ST, Lim L, Rubin LM, Patel JJ, Stewart AG. Measuring patient satisfaction in the Pharmacy Specialty Immunization Clinic: a pharmacist‐run immunization clinic at the Veterans Affairs San Diego Healthcare System. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.18.02.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Mark Bounthavong
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | | | | | | | - Scott T. Johns
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lesley Lim
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lisa M. Rubin
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jignesh J. Patel
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Lis CG, Rodeghier M, Gupta D. Distribution and determinants of patient satisfaction in oncology: A review of the literature. Patient Prefer Adherence 2009; 3:287-304. [PMID: 19936172 PMCID: PMC2778427 DOI: 10.2147/ppa.s6351] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Indexed: 12/03/2022] Open
Abstract
Cancer is one of the leading causes of morbidity and mortality in the United States. It places considerable mental, physical, and emotional stress on patients and requires them to make major adjustments in many key areas of their lives. As a consequence, the demands on health care providers to satisfy the complex care needs of cancer patients increase manifold. Of late, patient satisfaction has been recognized as one of the key indicators of health care quality and is now being used by health care institutions for monitoring health care improvement programs, gaining accreditation, and marketing strategies. The patient satisfaction information is also being used to compare and benchmark hospitals, identify best-performance institutions, and discover areas in need of improvement. However, the existing literature on patient satisfaction with the quality of cancer care they receive is inconsistent and heterogeneous because of differences in study designs, questionnaires, study populations, and sample sizes. The aim of this review was therefore to systematically evaluate the available information on the distribution and determinants of patient satisfaction in oncology.
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Affiliation(s)
- Christopher G Lis
- Correspondence: Christopher G Lis, Cancer Treatment Centers of America, 2610 Sheridan Road, Zion, IL 60099, USA, Tel +1 847 746 4328, Fax +1 847 746 4329, Email
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Lis CG, Rodeghier M, Grutsch JF, Gupta D. Distribution and determinants of patient satisfaction in oncology with a focus on health related quality of life. BMC Health Serv Res 2009; 9:190. [PMID: 19845942 PMCID: PMC2770467 DOI: 10.1186/1472-6963-9-190] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 10/21/2009] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cancer patients usually undergo extensive and debilitating treatments, which make quality of life (QoL) and patient satisfaction important health care assessment measures. However, very few studies have evaluated the relationship between QoL and patient satisfaction in oncology. We investigated the clinical, demographic and QoL factors associated with patient satisfaction in a large heterogeneous sample of cancer patients. METHODS A cohort of 538 cancer patients treated at Cancer Treatment Centers of America (CTCA) was assessed. A patient satisfaction questionnaire developed in-house by CTCA was used. It covered the following dimensions of patient satisfaction: hospital operations and services, physicians and staff, and patient endorsements for themselves and others. QoL was assessed using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30). The clinical, demographic and QoL factors were evaluated for predictive significance using univariate and multivariate logistic regression. RESULTS The mean age of our patient population was 54.1 years (SD = 10.5, range 17-86), with a slight preponderance of females (57.2%). Breast cancer (n = 124) and lung cancer (n = 101) were the most frequent cancer types. 481 (89.4%) patients were "very satisfied" with their overall experience. Age and several QoL function and symptom scales were predictive of overall patient satisfaction upon univariate analysis. In the multivariate modeling, only those with a score above the median on the fatigue measure (i.e. worse fatigue) had reduced odds of 0.28 of being very satisfied (p = 0.03). CONCLUSION Patient fatigue, as reported by the QoL fatigue scale, was an independent significant predictor of overall patient satisfaction. This finding argues for special attention and programs for cancer patients who report higher levels of fatigue given that fatigue is the most frequently reported symptom in cancer patients.
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Affiliation(s)
- Christopher G Lis
- Cancer Treatment Centers of America(CTCA) at Midwestern Regional Medical Center, 2610 Sheridan Road, Zion, IL, 60099, USA
| | - Mark Rodeghier
- Cancer Treatment Centers of America(CTCA) at Midwestern Regional Medical Center, 2610 Sheridan Road, Zion, IL, 60099, USA
| | - James F Grutsch
- Cancer Treatment Centers of America(CTCA) at Midwestern Regional Medical Center, 2610 Sheridan Road, Zion, IL, 60099, USA
| | - Digant Gupta
- Cancer Treatment Centers of America(CTCA) at Midwestern Regional Medical Center, 2610 Sheridan Road, Zion, IL, 60099, USA
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Bergenmar M, Nylén U, Lidbrink E, Bergh J, Brandberg Y. Improvements in patient satisfaction at an outpatient clinic for patients with breast cancer. Acta Oncol 2009; 45:550-8. [PMID: 16864168 DOI: 10.1080/02841860500511239] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study prospectively investigated changes in patient satisfaction at an outpatient clinic for patients with breast cancer. Consecutive patients were asked to anonymously complete a questionnaire after their medical examination. The questionnaire consisted of 12 multiple-choice items concerning waiting time, interpersonal skills of physician and nurse, continuity of care, length of medical visit, communication and expectations. Finally, patients were asked for suggestions for improvements at the clinic in an open-ended question. The first measurement was conducted in 2000/2001 and the last in 2004, and between the two points of assessments efforts to develop care were introduced. Statistically significant improvements were found in eight of the 12 items: waiting time, length of medical visit, information, expectations and continuity of care. In conclusion, the questionnaire captured positive changes in patient satisfaction between the two measurements. Further changes for the better were still requested concerning continuity of care despite reported improvement.
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Affiliation(s)
- Mia Bergenmar
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
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Wessels H, de Graeff A, Wynia K, Sixma HJ, de Heus M, Schipper M, Woltjer GTGJ, Teunissen SCCM, Voest EE. Medical oncology patients' preferences with regard to health care: development of a patient-driven questionnaire. Ann Oncol 2009; 20:1708-13. [PMID: 19497943 DOI: 10.1093/annonc/mdp044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To improve quality of care for cancer patients, it is important to have an insight on the patient's view on health care and on their specific wishes, needs and preferences, without restriction and without influence of researchers and health care providers. The aim of this study was to develop a questionnaire assessing medical oncology patients' preferences for health care based on their own input. PATIENTS AND METHODS Items were generated using 10 focus group interviews with 51 cancer patients. A preliminary questionnaire was handed out to 681 patients of seven Dutch departments of medical oncology. Explorative factor analysis was carried out on the 386 returned questionnaires (response 57%). RESULTS Focus group interviews resulted in a preliminary questionnaire containing 136 items. Explorative factor analysis resulted in a definitive questionnaire containing 123 items (21 scales and eight single items). Patients rated expertise, safety, performance and attitude of physicians and nurses as the most important issues in cancer care. CONCLUSION This questionnaire may be used to assess preferences of cancer patients and to come to a tailored approach of health care that meets patients' wishes and needs.
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Affiliation(s)
- H Wessels
- Department of Medical Oncology, University Medical Centre Utrecht, Heidelberglaan, Utrecht
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Brédart A, Dolbeault S, Savignoni A, Simard S, Gomme S, Asselain B, Copel L. Pilot evaluation of a French interdisciplinary supportive care department. Support Care Cancer 2009; 17:1507-16. [PMID: 19343371 DOI: 10.1007/s00520-009-0617-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 03/15/2009] [Indexed: 12/30/2022]
Abstract
PURPOSE OF THE STUDY This pilot study was designed to evaluate the impact of management by the Interdisciplinary Supportive Care Department for Cancer Patients (Département Interdisciplinaire de Soins de Support pour le Patient en Oncologie-DISSPO) at the Institut Curie in Paris, France on patient quality of life and satisfaction with care. MATERIALS AND METHODS Patients hospitalised for cancer treatment and referred to DISSPO during their hospitalisation were invited to complete the European Organization for Research and Treatment of Cancer core quality of life (EORTC QLQ-C30) and patient satisfaction (EORTC IN-PATSAT32) questionnaires during the week following their initial management by DISSPO (T0) and 2 months later (T1). These patients were compared with control patients matched for age, gender, ward and period of hospitalisation in terms of quality of life and satisfaction with care. MAIN RESULTS One hundred fourteen (77%) DISSPO patients at T0 and 72 (48%) patients at T1 and 102 (89%) control patients at T0 and 66 (57%) at T1 returned their completed questionnaires. Baseline characteristics of DISSPO patients and control patients were significantly different in terms of duration of the current hospitalisation, interval between the date of diagnosis of the cancer and inclusion in the study (both longer for DISSPO patients) and Karnofsky performance status (lower for DISSPO patients). For the 43 pairs of patients who completed the questionnaires at the two time points, significant independent positive effects of management by DISSPO and age (less than or equal to 60 years) were demonstrated for patient satisfaction in relation to the availability of the nursing and paramedical team. In particular, patients over the age of 60 not managed by DISSPO presented a significant reduction of patient satisfaction scores over the 2 months compared to age-matched patients managed by DISSPO. CONCLUSIONS Management of cancer patients by an interdisciplinary supportive care department appears to have a positive impact on patient satisfaction in relation to availability of the nursing and paramedical team. These results need to be confirmed in a larger study.
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Affiliation(s)
- Anne Brédart
- Psycho-Oncology Unit, Institut Curie, 26 rue d'Ulm, 75.246, Paris Cedex 05, France.
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Abstract
Patient satisfaction is an important component in the evaluation of health services provided to patients. This study evaluates the results of a patient satisfaction survey collected over five years in a radiation therapy department. The analysis identifies that satisfaction has improved in almost all areas, but there is room for improvement in others. The key findings are the importance of treating patients with courtesy and respect and the relatively lower levels of satisfaction noted for patients treated with palliative intent, an area of concern given these patients' greater needs. We provide aggregate results, identify factors that influence overall satisfaction and demonstrate how the survey results have led to quality improvement initiatives, which in turn have resulted in improved levels of satisfaction for patients.
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Affiliation(s)
- John French
- Operations, Radiation Therapy and Surgical Oncology Program, British Columbia Cancer Agency, Vancouver Centre
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Groff SL, Carlson LE, Tsang K, Potter BJ. Cancer patients' satisfaction with care in traditional and innovative ambulatory oncology clinics. J Nurs Care Qual 2008; 23:251-7. [PMID: 18562868 DOI: 10.1097/01.ncq.0000324590.99460.f6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the effects of environmental changes, such as rearranging the seating area, playing soft music, and displaying scenes of nature, on aspects of patient satisfaction, ranging from satisfaction with the physical environment and wait times to continuity of care, confidentiality, and trust in providers. Patients receiving care in a new, innovative cancer center had significantly higher satisfaction scores on the physical environment and wait time subscales than the patients receiving care in an older, traditional center. However, the 2 centers did not differ on any of the other satisfaction subscales. Implications of these findings are discussed.
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Affiliation(s)
- Shannon L Groff
- Department of Psychology, University of Calgary, Alberta, Canada.
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Patient satisfaction in outpatient cancer care: a prospective survey using The PASQOC questionnaire. Support Care Cancer 2008; 16:947-54. [PMID: 18204867 DOI: 10.1007/s00520-007-0362-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 10/31/2007] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVES To examine how outpatient cancer patients assess their cancer care in private oncology practices and day hospitals, and to identify the extent to which staff meet the expectations of their patients. SETTING Private practices (n = 41) and day hospitals (n = 8) in Germany, including 16 "repeater" practices who had already participated in the 2002 Patient Satisfaction and Quality in Oncological Care (PASQOC) survey. PARTICIPANTS n = 4,615 patients with cancer. Diagnoses: 25% breast cancer, 21% colorectal cancer, 12% haematologic malignancies, 11% lymphomas; mean age 63.5 years; 57% female; n = 1,639 patients from repeater practices. MEASUREMENTS The 2004 PASQOC questionnaire contained 63 problem-oriented items which covered 15 different dimensions of care. Practice staff invited their patients to participate and surveys were mailed to all sampled patients. For statistical analysis, the problem frequency (PF) was calculated for each item. RESULTS Of 5,600 patients who received the questionnaire, 4,615 replied (response rate: 82%). The best results were obtained for the dimensions "further support in daily life" (3% PF), "nurses" (5% PF), and "physician-patient-relationship" (8% PF). Potential for improvement was most pronounced for "handling of side effects" (39% PF), "partnership and shared decision making" (30% PF), "side effects" (30% PF) and "communication with other patients" (26% PF). Considerable differences in PFs between practices were observed. Mean results from the 16 repeater practices revealed only few changes compared to the 2002 PASQOC survey, although some practices had greatly improved their performance. CONCLUSIONS The PASQOC questionnaire identified strengths and weaknesses of outpatient care for cancer patients. By providing a comparison with other practices, PASQOC can help staff of individual practices to improve their performance.
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Abstract
The health care system has undergone major changes in the last decade. With greater acuity and complexity of illness, the adoption of innovative technologies and the shortage of health care personnel, the coordination and integration of health care services has become increasingly demanding for administrators. Growing dissatisfaction and concerns about safety issues are being expressed by the users of care who need to navigate through an increasingly complex system and by health care personnel who feel less efficient within the organization. Nursing administrators have a responsibility to address these issues but there is little scientific evidence to guide their actions. There are also few comprehensive models highlighting the main components of nursing administration - models that could guide nursing administration research. This paper presents a conceptual framework for nursing administration and research that links patient health care needs, nursing resources and the nursing care processes to the context of the health care system, and the social, political and cultural environments of care. A selected review of the oncology and cancer care literature is presented to demonstrate how this framework can organize existing knowledge about these concepts in the context of cancer care.
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Affiliation(s)
- Alain D Biron
- School of Nursing, McGill University, Montreal, Québec, Canada.
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Sandoval GA, Brown AD, Sullivan T, Green E. Factors that influence cancer patients' overall perceptions of the quality of care. Int J Qual Health Care 2006; 18:266-74. [PMID: 16809400 DOI: 10.1093/intqhc/mzl014] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study outlines predictors of cancer patients' overall perceptions of the quality of care. DESIGN AND SETTING Our sample included 2790 patients who received cancer care services during 2004 in 15 comprehensive cancer programmes across Ontario, Canada. Patients were classified into three groups: those receiving both chemotherapy and radiotherapy (n = 752), those receiving only chemotherapy (n = 1044), and those receiving only radiotherapy (n = 994). An ordinal logistic regression model for each patient group was performed to determine which variables most affected the probabilities of the patients' overall evaluations of the quality of care. Potential control variables were patients' age, sex, type of cancer, self-assessed health, and who completed the survey. RESULTS Among seven common predictors of the overall quality perception across the three models, four should be of particular interest because patients perceived them as relatively problematic aspects of care. These are 'was informed about follow-up care after completing treatment', 'knew next step in care', 'knew who to go to with questions', and 'providers were aware of test results'. These predictors explained between 25 and 34% of the variance (depending on the model) of the overall perception of quality. The explanatory power of these predictors did not change across sex and age group. 'Self-assessed health' was the only control variable that remained in all three models. CONCLUSIONS From a practical perspective, improvement efforts are best focused on factors that are strong predictors as well as on those for which there is a low score. Thus, on the basis of this study, practitioners' improvement efforts might be constructively focused on the four predictors mentioned above.
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Affiliation(s)
- Guillermo A Sandoval
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Sandoval GA, Levinton C, Blackstien-Hirsch P, Brown AD. Selecting predictors of cancer patients' overall perceptions of the quality of care received. Ann Oncol 2006; 17:151-6. [PMID: 16236755 DOI: 10.1093/annonc/mdj020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The goal of this study was to identify aspects of care (predictors) that can most easily be modified to produce an improvement in the score of patients' overall evaluations of the quality of care received. PATIENTS AND METHODS Our sample consisted of 2247 cancer patients hospitalized in Ontario acute care hospitals in 1999/2000. We sought predictors of patients' overall perceptions of the quality of care by applying a methodology that minimizes the improvement of the predictors while gaining a desired increase in the score of the dependent variable. This approach tends to ignore items that rate relatively high and focuses on those for which hospitals can more easily modify the score. Two main subgroups were analyzed in this study: patients with malignant and benign neoplasms. RESULTS 'Skills of nursing staff', 'courtesy of nursing staff', 'courtesy of people who drew blood' and 'cleanliness of hospital in general' were consistently selected by our approach in both cancer groups. CONCLUSIONS This study identifies an efficient approach to improving the score of patients' overall perceptions of the quality of care received. By focusing on these aspects of care, hospitals may be able to improve the allocation of scarce resources when planning patient satisfaction improvement initiatives.
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Affiliation(s)
- G A Sandoval
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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