Medical practices' sensitivity to patients' needs. Opportunities and practices for improvement

Delivering bad or difficult news. An innovative simulation-based education approach to prepare interdisciplinary fellowships

BACKGROUND

There is limited data on the effectiveness of training interventions to improve the delivery of bad news.

METHODS

This preliminary research included pre-post assessments and an open-ended survey to evaluate the effectiveness and perceived value of training on delivering bad news for 26 first- and second-year fellows from five adult and pediatric fellowship programs.

RESULTS

There was a significant increase in faculty assessment scores (34.5 vs. 41.0, respectively, Z = -3.661, p < 0.001) and Standardized Patient (SP) assessment scores (37.5 vs .44.5, respectively, Z = -2.244, p = 0.025). Fellows valued having a standard framework to aid in the delivery of bad news; receiving targeted feedback and having the opportunity to apply their skills in a subsequent case.

CONCLUSIONS

A one-hour, four-phase lesson plan that includes an individualized training approach and simulation do-overs can be effective and valuable for preparing fellows to deliver bad news.

Patient and Provider Attitudes, Beliefs, and Biases That Contribute to a Marginalized Process of Care and Outcomes in Chronic Musculoskeletal Pain. A Systematic Review. Part I: Clinical Care

OBJECTIVE

Chronic musculoskeletal pain (CMP) outcomes are affected by numerous variables including the clinical conversation. When good therapeutic/working alliances are formed, congruent clinical conversations can lead to improved CMP outcomes. Identifying patient/provider attitudes, beliefs, and biases in CMP that can influence the clinical conversation, and thus clinical management decisions, is foundationally important.

DESIGN

The aims of this systematic review were to 1) summarize the evidence of the attitudes and beliefs of patients and healthcare providers (HCPs) involved in the clinical conversation of CMP; 2) examine if/how these perceptions impacted the process of care.

METHODS

A systematic search of CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used PRISMA guidelines. Included studies: vulnerable adult populations with chronic pain. Study bias was examined using the Downs and Black tool.

RESULTS

Seven retrospective studies were included. HCPs demonstrated negative implicit biases toward minorities and women when making pharmaceutical management decisions. HCPs demonstrated negative implicit biases toward lower educated women when making referrals to multidisciplinary care. Unmet patient expectations resulted in higher drop-out rates at multidisciplinary pain management programs. Patients' trust was influenced by healthcare setting and patients often had limited options secondary to health insurance type/status.

CONCLUSION

These findings suggest that patients with CMP may experience a marginalized process of care due to HCPs' negative implicit biases, unmet patient expectations, and healthcare setting. Results suggest several factors may contribute to inequitable care and the recalcitrant nature of CMP, particularly in vulnerable populations with limited healthcare choices.

Use of standardised patients in optometry training

Clinical relevance: The ability to articulate clinical findings to patients through effective communication is a key skill in all health-care professions.Background: Unannounced standardised patients (SPs) are successful in measuring quality of clinical care provided by qualified optometrists but have not been used in optometry training. Final-year undergraduate optometry students examine members of the public during primary care clinics observed by visiting clinical tutors (VCTs) who provide individualised feedback, highlighting areas for improvement. This pilot study investigates whether unannounced SPs can be used as an additional resource providing enhanced feedback on communication skills in undergraduate optometry education.Methods: Two SPs received intensive training on reporting on students eye examinations and communication skills through completion of pre-designed checklists for each patient encounter. Each SP presented 16 times as an unannounced patient for routine eye examinations. SPs' comments on communication skills of 32 students during 32 examinations was compared to feedback from 10 VCTs. SPs' performance was monitored to ensure consistency. Evaluation of differences in quality and quantity of feedback provided by SPs and VCTs was performed using thematic analysis and chi-squared tests. Student feedback on the use of SPs was obtained on completion of the study.Results: Qualitative thematic analysis revealed six overarching themes emerging from 64 sets of feedback. SPs gave significantly more feedback, both positive comments and comments with recommendations, than VCTs for the (a) total number of comments for each theme (p = 0.0000) and (b) detail and depth of these comments. Students reported that SPs commented on aspects of communication (e.g., establishing rapport and body language) not noted by VCTs.Conclusions: Unannounced SPs can provide enhanced feedback on communication skills to final-year undergraduate optometry students. Students greatly valued VCTs feedback; however, they felt SPs commented on elements of communication not noted by VCTs.

Development and pilot test of ComCare - a questionnaire for quick assessment of communicative and social competences in medical students after interviews with simulated patients

Background: Physicians' communicative and social competences are highly relevant for doctor-patient relationships. Simulation-based learning is frequently used to provide students with learning experiences resembling realistic medical situations. This study aims to assess communication and interpersonal skills in medical students after simulated consultations with a newly designed short questionnaire. Methods: In 2019, 103 final year students participated in a simulated consultation hour seeing four simulated patients. Communicative and social competences were assessed by a questionnaire including items for communication (Com) and interpersonal (Care) skills. The questionnaire was used by the simulated patients (ComCareP) after each consultation and as self-assessment by the students (ComCareD) after the fourth consultation. An explorative factor analysis was performed and the results of ComCareP and ComCareD were compared with respect to students' sex and advancement in their final year. Results: All ComCareP items loaded on one factor, which explained 50.7% of the variance. The participants self-assessed their communication and interpersonal skills significantly better than the simulated patients. No significant differences were found for students' sexes or advancement in their final year except for the item "responding to patients' needs satisfactorily" which was significantly lower in students at the end of their final year. Patients' general "satisfaction with the consultation" was higher while physicians' general "satisfaction with the consultation" was lower than their total ComCare mean score. The general satisfaction with the consultation showed a significant positive correlation with both ComCares' total mean scores. Conclusion: The ComCare measures communication and interpersonal skills as one factor. It can be used directly after consultations and shows significant positive correlation with the general satisfaction with a consultation. Since simulated patients' satisfaction with the consultation was higher than their ComCare score, other factors than communication and interpersonal skills could play a role for patient satisfaction with a conversation and need to be further investigated.

Defining patient communication needs during hospitalization to improve patient experience and health literacy

Background

In order to play an active role in their health care, patients need information and motivation. Current delivery systems limit patients’ involvement because they do not routinely provide them with enough details of their own clinical results, conditions and other important clinical data. The purpose of this study was to identify, from the perspective of patients, which topics matter the most, who should be communicating them, and when and how should they be provided.

Methods

We conducted a qualitative, phenomenological study analysing the content of subjective experiences, feelings and behaviours. We organized two focus groups with 13 participants and 15 in-depth interviews. Transcripts of the focus groups and interviews were checked for accuracy and then entered into Atlas ti™ v7.5.13 qualitative software. Two independent researchers performed a qualitative inductive content analysis to classify the data in two levels: themes and categories.

Results

The qualitative analysis provided 377 units of meaning synthesized into 22 categories and six themes: hospitalization procedure, Health Literacy relating to the patient’s condition, information content, satisfaction, professional-patient relationship, and patient proactivity. Patients described which information they wished for, when they needed it, and who would provide it, usually related to actions such as admission, discharge or diagnostic tests. Oral information was more difficult to comprehend than the written kind, as patients can check written information several times if needed. Nurses were the most available professionals, and patients found easier to relate to them and ask them questions. Moreover, patients identified physicians as those professionals responsible for providing clinical information.

Conclusions

Our results showed that patients suffered from poor Health Literacy regarding their personal condition, as they were unable to describe the symptoms, the type of tests being performed or their results, and some of them also had difficulties in naming the specific disease or comorbidities they had. During the hospitalization process, patients were in good shape to come with doubts and actively asked for more information. Healthcare organizations and professionals were offered the chance to ensure the correct communication and comprehension to their patients.

Preferred Medium of Receiving Diagnostic News Depending on Patients' Perception of Their Health Status (Healthy or Sick)

BACKGROUND

The study aims to gain insight into people's preferred medium of receiving diagnostic news depending on their perception of their health status (either sick or healthy).

METHODS

Comprehensive research was carried out on two main groups of past and prospective patients, Polish respondents (N=72) and International respondents (N= 214), using a CAWI (Computer-Assisted Web Interview) technique. Respondents were asked in an online questionnaire about the past history of illness, whether they would like to receive their diagnostic news and preferred medium of receiving diagnostic news whether they perceive they are sick or healthy.

RESULTS

Amongst the international group, majority of respondents (143 resp. - 73.71%) would generally like to receive their diagnostic news and 156 resp. (80.83%) would prefer to receive their bad diagnostic news (BDN) from medical specialist doctors as opposed to other technological and non-technological means. Meanwhile, in the polish group, 65 resp. (90.28%) would like to generally receive their diagnostic news and 66 resp. (91.67%) would prefer to receive their BDN from medical specialist doctors as opposed to other proposed means of obtaining BDN.

CONCLUSION

The result of this study indicates that medical doctors, especially specialists, are still a preferred medium of receiving diagnostic news. However, a certain proportion of respondents will be open to technological medium in receiving their diagnostic news.

The Challenges of Multisource Feedback: Feasibility and Acceptability of Gathering Patient Feedback for Pediatric Residents

OBJECTIVE

The Accreditation Council for Graduate Medical Education calls for residency programs to incorporate multisource feedback, which may include patient feedback, into resident competency assessments. Program directors face numerous challenges in gathering this feedback. This study assesses the feasibility and acceptability of patient feedback collection in the inpatient and outpatient setting at 3 institutions.

METHODS

Patient feedback was collected using a modified version of the Communication Assessment Tool (CAT). Trained research assistants administered the CAT to eligible patients and families in pediatric ward, intensive care, and outpatient settings from July to October 2015. Completion rates and reasons for non-completion were recorded. Patient satisfaction with the CAT was assessed on a 5-point Likert scale.

RESULTS

The CAT was completed by 860/1413 (61%) patients. Completion rates in the pediatric ward and intensive care settings were 45% and 38%, respectively, compared to 91% in the outpatient setting. In inpatient settings, survey non-completion was typically due to participant unavailability; this was rarely a reason in the outpatient setting. A total of 93.4% of patients were satisfied or very satisfied with using the CAT. It was found that 6.36 hours of research assistant time would be required to gather a valid quantity of patient feedback for a single resident in the outpatient setting, compared to 10.14 hours in the inpatient setting.

CONCLUSIONS

Although collecting feedback using our standardized protocol is acceptable to patients, obtaining sufficient feedback requires overcoming several barriers and a sizable time commitment. Feedback collection in the outpatient setting may be higher yield than in the inpatient setting due to greater patient/family availability. Future work should focus on innovative methods to gather patient feedback in the inpatient setting to provide program directors with a holistic view of their residents' communication skills.

Measuring Quality of Care in Community Mental Health: Validation of Concordant Clinician and Client Quality-of-Care Scales

Measuring quality of care can transform care, but few tools exist to measure quality from the client's perspective. The aim of this study was to create concordant clinician and client self-report quality-of-care scales in a sample of community mental health clinicians (n = 189) and clients (n = 469). The client scale had three distinct factors (Person-Centered Care, Negative Staff Interactions, and Inattentive Care), while the clinician scale had two: Person-Centered Care and Discordant Care. Both versions demonstrated adequate internal consistency and validity with measures related to satisfaction and the therapeutic relationship. These measures are promising, brief quality assessment tools.

Delivering bad news: patient's perspective and opinions

PURPOSE

The aim of our research was to gain knowledge about patients' opinions, experiences, and preferences with regard to the way the news is being delivered to them.

MATERIALS AND METHODS

Detailed research was carried out on a group of 314 patients using the CAWI (Computer-Assisted Web Interview) technique. Adult responders who had earlier received bad news were questioned about their opinion about the way the doctor acted while delivering bad news and how he did it.

RESULTS

Patients, who define the following aspects of their visit as negative/lacking: 1) doctor's behavior in the moment of delivering bad news, 2) amount of time devoted to the visit, 3) lack of doctor's attention, 4) usage of medical terminology, 5) doctor's honesty, 6) emotional and cognitive support from the doctor, more often tend to change the doctor in charge of their therapy or decide to cease the medical treatment.

CONCLUSION

Doctors' behavior and the way they deliver news to patients are key elements that strongly influence patients' future therapy. It makes an impact on patient's decision whether to continue or cease the treatment. In the first case, it also leads the patient to choose to continue the treatment under the guidance of the same specialist or to find another one. The data that we acquired and that we will discuss below will form the basis for editing a communication protocol concerning delivering bad news. It is necessary to create such a protocol in order to improve the quality of communication with patients, especially as regards delivering bad news to them.

Satisfaction with cancer care among underserved racial-ethnic minorities and lower-income patients receiving patient navigation

BACKGROUND

Patient navigation is a barrier-focused program of care coordination designed to achieve timely and high-quality cancer-related care for medically underserved racial-ethnic minorities and the poor. However, to the authors' knowledge, few studies to date have examined the relationship between satisfaction with navigators and cancer-related care.

METHODS

The authors included data from 1345 patients with abnormal cancer screening tests or a definitive cancer diagnosis who participated in the Patient Navigation Research Program to test the efficacy of patient navigation. Participants completed demographic questionnaires and measures of patient satisfaction with cancer-related care (PSCC) and patient satisfaction with interpersonal relationship with navigator (PSN-I). The authors obtained descriptive statistics to characterize the sample and conducted regression analyses to assess the degree of association between PSN-I and PSCC, controlling for demographic and clinical factors. Analyses of variance were conducted to examine group differences controlling for statistically significant covariates.

RESULTS

Statistically significant relationships were found between the PSCC and PSN-I for patients with abnormal cancer screening tests (1040 patients; correlation coefficient (r), 0.4 [P<.001]) and those with a definitive cancer diagnosis (305 patients; correlation coefficient, 0.4 [P<.001]). The regression analysis indicated that having an abnormal colorectal cancer screening test in the abnormal screening test group and increased age and minority race-ethnicity status in the cancer diagnosis group were associated with a higher satisfaction with cancer care (P<.01).

CONCLUSIONS

Satisfaction with navigators appears to be significantly associated with satisfaction with cancer-related care. Information regarding the patient-navigator relationship should be integrated into patient navigation programs to maximize the likelihood of reducing caner disparities and mortality for medically underserved racial-ethnic minorities and the poor.

Assessment of interpersonal communication skills among sari health centers' staff

Background and aim:

Ability to communicate correctly has been one of the life's basic social skills and its significance in human life is to some extent that some of the experts attribute the human growth foundation owners of the leading personal injuries and progress to human relationship. Purpose of this study was to evaluate the interpersonal communication skills among the health care centers staff.

Methods:

This study was a descriptive–cross sectional study was done among 85 staff in 12 metropolitan and 9 urban health centers in 2013. According to Kerejsi and Morgan's table, 70 employees were determined as samples. Seventy questionnaires were distributed at the mentioned centers and 60 measurable health questionnaires were examined. Demographic data and measure of communication skills: is a 36-items consisting of seven domains: (general Communication, speaking, listening, interpretation and clarification, asking, feedback, and reward and punishment), obtained data were analyzed by inferential statistical tests (Mann-Whitney U, Kruskal-Wallis and correlation coefficient).

Results:

Most respondents 38 (63.3%) were women, 57 (95%) married and 17 (28.1 %) age means of 43-47 years. In the study status of the communication skills status of employees employed in health centres, Sari, “Punish and encourage skills” with mean and total standard deviation of 4.11±37.0 assigned the highest score and “feedback” skill with mean and total standard deviation of 3.68±045 assigned the less score.

Conclusion:

Findings showed that public relation skill, listening, reward and punishment in good scope and other skills were in the average scope. No need for training skills of empowerment of staff and their mental health. These results could be used for developing similar instruments in other health workers.

Improving the economic and humanistic outcomes for diabetic patients: making a case for employer-sponsored medication therapy management

Background

The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees.

Methods

Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman’s test was used to determine changes in outcomes due to the nonparametric nature of the data.

Results

The mean number of visits to a physician’s office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed.

Conclusion

Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program.

Patient experience in the pediatric otolaryngology clinic: does the teaching setting influence parent satisfaction?

OBJECTIVES

Patient experience scores are now recognized as a chief indicator of healthcare quality. This report compares outpatient pediatric otolaryngology patient satisfaction in the teaching and non-teaching settings.

STUDY DESIGN

Cross-sectional, multi-site, patient-level analysis of satisfaction surveys (Press Ganey™ Medical Practice©) completed by parents of pediatric otolaryngology patients in FY2010.

METHODS

Surveys were stratified by teaching/non-teaching affiliation. The survey has 29 Likert-scaled questions which comprise an overall score and subscores in 6 domains: access, visit, nursing, provider, personal issues, and assessment. The item likelihood-to-recommend was measured to indicate practice loyalty. Mean scores were compared by Kruskal-Wallis rank test. Multivariate logistic regression was performed to evaluate the association of teaching status with receipt of highest scores (HI-SCORES).

RESULTS

4704 pediatric surveys were analyzed, with 1984 (42%) from the teaching setting. For the teaching setting, mean scores were lower overall (88.1 vs. 89.0; p<0.001) and in domains of access (includes scheduling ease, promptness in returning calls; 86.7 vs. 89.4; p<0.001) and personal issues (includes office hour convenience, sensitivity to needs; 87.0 vs. 88.5; p<0.001). Differences in access scores were largest for young children (0-<6 years; 86.0 vs. 89.5; p<0.001). Children in the teaching setting were less likely to have HI-SCORES overall (OR 0.78; 95%CI 0.65-0.95; p=0.011) and for access (OR 0.8; 95%CI 0.67-0.95; p=0.012); probability of HI-SCORES was similar for the two settings for all other domains.

CONCLUSIONS

Parents of pediatric otolaryngology patients evaluated in the teaching setting report lower satisfaction related to access, but similar scores for care providers and practice loyalty. Academic otolaryngology practices might focus on access issues to improve the overall care experience for children and families.

Patient experience in outpatient pediatric otolaryngology

OBJECTIVES/HYPOTHESIS

Patient experience scores are emerging as a key measure of healthcare quality. This report evaluated differences in outpatient otolaryngology patient satisfaction scores by age.

STUDY DESIGN

Patient-level analysis of Press Ganey Medical Practice surveys completed by otolaryngology patients or parents in 2010.

METHODS

Surveys were grouped by child (<18 years old) or adult age. Children were evaluated in three subgroups (0-5 years, 6-12 years, and 13-17 years). The survey contains 29 items, which comprise six service domains of access, visit, nursing, provider, personal issues, and assessment. Comparison of mean scores was performed using the Kruskal-Wallis rank test for nonparametric data. Multivariate logistic regression analysis was performed to evaluate association of age with receipt of highest scores (HI-SCORES) in each domain.

RESULTS

Of 44,010 surveys analyzed, 5,996 (13.6%) were pediatric. The majority of children were <6 years (n = 3,141; 52.4%). Mean scores were lower for children overall (88.4 children vs. 90.2 adults) and in domains of access, visit, nursing, issues, and assessment (P < .005, all comparisons); scores were equal for care provider. Mean scores were lowest for children 0 to 5 years across all domains (overall means: 88.0, 0-5; 88.4, 6-12; 89.4, 13-17; 90.2 >18; P = .0001) and increased with age. Multivariate analysis showed that children were less likely than adults to give HI-SCORES overall (odds ratio, 0.81, 95% confidence interval, 0.76-0.86; P < .001) and in all domains (P = .0001) except for provider.

CONCLUSIONS

Compared to adults, satisfaction is lower in all service domains except care provider for pediatric otolaryngology patients, and is lowest for younger children. Otolaryngologists should consider the unique needs of the child and family to improve overall patient experience.

Patient satisfaction in otolaryngology: Can academic institutions compete?

OBJECTIVES

Public reporting and transparency of patient experience is an emerging national healthcare priority. The objectives of this report are to describe patient satisfaction scores in ambulatory otolaryngology and examine the association of teaching status across multiple service domains.

STUDY DESIGN

Cross-sectional patient-level analysis of Press Ganey outpatient medical practice surveys completed by otolaryngology patients in fiscal year 2010.

METHODS

The survey contains 29 Likert-scaled items that comprise an overall score and scores in six service domains: access, visit, nursing, care provider, personal issues, and assessment. The item "likelihood-to-recommend practice" was measured as an indicator of patient loyalty. Surveys were grouped according to teaching or nonteaching setting. Mean scores were compared by Kruskal-Wallis rank test for nonparametric data with Bonferroni's correction for multiple comparisons. A dichotomous variable (ALL-5s) was created to measure percentages of surveys with highest scores in each domain. Multivariate logistic regression adjusting for sex, age, geographical region, urban-rural status, and first visit was performed to evaluate the association of teaching status with ALL-5s in each domain. Pearson correlation (r) was used to evaluate correlation of individual survey items to the "likelihood-to-recommend practice" question.

RESULTS

A total of 36,089 surveys were included, of which 16,057 (44%) were from a teaching setting. The mean age of respondents was 54.1 years (range, 0-90 years), and 52.7% were female. Patients seen in the teaching setting had lower mean scores overall and in domains of access, visit, and personal issues (P = .004) but had higher mean scores for likelihood-to-recommend practice (P = .007). No differences were identified between groups in domains of nursing, care provider, and assessment. Multivariate analysis of association of teaching setting with ALL-5s demonstrated that patients in a teaching setting were more likely to have the highest scores (ALL-5s) in the domain of nursing (OR, 1.09; 95% confidence interval [CI], 1.03-1.16; P = .002) and for the loyalty question of "likelihood-to-recommend practice" (OR, 1.12; 95% CI, 1.05-1.19; P = .001), and less likely to have highest scores for the overall survey (OR, 0.88; 95% CI, 0.83-0.93; P < .001) and domains of access (OR, 0.89; 95% CI, 0.84-0.94;P < .001) and visit (OR, 0.89; 95% CI, 0.85-0.94; P < .001). No association was identified between teaching status and domains of care provider, personal issues, and assessment. Survey items correlated with likelihood-to-recommend practice were similar between groups. Items most closely correlated with loyalty were all within the care provider domain consisting of "likelihood-to-recommend care provider" (r = 0.839), "confidence in care provider" (r = 0.785), and "concern care provider showed" (r = 0.733; P < .001). Items least closely correlated were within the visit domain related to waiting room comfort (r = 0.467), registration speed (r = 0.447), and wait time (r = 0.432; P < .001).

CONCLUSIONS

Otolaryngology patients evaluated in the teaching setting report lower patient satisfaction overall, primarily related to access to care and visit-specific processes; however, they are more likely to display loyalty and recommend their practice and care provider. The teaching setting does not influence care provider satisfaction scores. Because practice loyalty is most closely correlated to provider-specific behaviors, otolaryngologists may consider enhancement of provider-patient communication to improve patient satisfaction regardless of the practice setting. Academic otolaryngology practices should consider focusing on access systems and process improvement to enhance the overall patient experience.

Success with men's educational group appointments (MEGA): subjective improvements in patient education

Men have a higher age-adjusted death rate from many of the leading causes of death, compared with women. Avoidance of health care and unhealthy behavior contribute to premature death among men. The Lahey Clinic recently initiated a program, the Men's Educational Group Appointment (MEGA), which capitalizes on the potential benefits of group dynamics in an effort to educate men about preventative health. We hypothesized that putting men into a group setting for the educational portion of the visit would improve information exchange and patient learning. During 12 months, 261 men between the ages of 22 and 67 were evaluated. A survey designed to address both patient satisfaction and patients' perceptions regarding how much they learned was administered to all patients following the MEGA session. We identified high patient satisfaction with the MEGA model. This study illustrates the potential utility of the group model for improving patient education regarding health maintenance among men.

State Nursing Shortages and Patient Satisfaction

This study of 827,430 patients, 733 hospitals, and 25 states compares state performance in patient satisfaction with the supply of registered nurses. A significant, positive relationship exists between a state's supply of registered nurses and patients' evaluations of their care experiences. Hospitals in states with nursing shortages may be challenged by national comparisons of patient satisfaction and should take these results into account when devising their quality improvement strategy.

Construct validation of a physician satisfaction survey

Hospitals continuously look for ways to improve patient care and retain high-quality physicians. Previous research indicates that physicians' satisfaction with where they practice is a crucial part of addressing these issues. A reliable and valid method to assess physician satisfaction is needed in order to identify potential areas of discontent. The purpose of the present study was to develop and validate a self-administered medical staff satisfaction survey. The survey contains 13 Likert-type items divided into three reliable subscales: Quality of Patient Care (alpha = .84), Ease of Practice (alpha = .76), and Relationship with Leadership (alpha = .92). Results from both exploratory and confirmatory factor analyses supported the survey's structure and robustness across three independent samples.

Patient perceptions of quality in discharge instruction

The present study investigates patient perceptions of the quality of discharge instruction by assessing inpatients' ratings of care and service in the United States over the past 5 years (1997-2001) (n = 4,901,178). As expected, patients' ratings of "instructions given about how to care for yourself at home" showed a strong, consistent positive relationship with overall patient satisfaction from 1997 through 2001. Nevertheless, patient satisfaction with discharge instructions decreased significantly each year (p < 0.001). Patients gave lower ratings to the quality of discharge instruction than to the overall quality of their hospital stay which indicates a failure to match the quality delivered among other services within the hospital. Patient assessments of discharge instruction quality varied systematically among conditions. Patients with musculoskeletal diseases and disorders (MDC-8) rated discharge instruction considerably lower than all other patient groups. Patients' age, sex, self-described health status and length of stay did not predict patients' evaluations of discharge instructions. U.S. hospitals may not be meeting existing AMA and JCAHO standards for patient education and discharge.

Inpatients' ratings of care in 5 common clinical conditions

OBJECTIVE

Using the dimensions of patient-centered care defined by the Institute of Medicine, this study examined patient satisfaction within 5 clinical conditions.

METHOD

Items from the Press Ganey Inpatient Questionnaire were mapped onto the Institute of Medicine dimensions of patient-centered care. A standardized mail-out/mail-back methodology was used to collect data from random samples of patients within 5 days of discharge.

SAMPLE

Patients hospitalized for heart attack, heart failure, stroke, pneumonia, or childbirth were included in the study. The sample contained 10,000 patients at 210 hospitals.

RESULTS

Patients hospitalized for different clinical conditions expressed different levels of satisfaction. There may be different care needs, expectations, and evaluations of care based on these clinical conditions. However, it is probable that an all-encompassing patient-centered focus would improve care for all of these groups.

CONCLUSIONS

Quality improvement professionals should attend to 2 Institute of Medicine dimensions: (1) respect for patient's values, preferences, and expressed needs and (2) emotional support, relieving fear and anxiety. It is in these areas that improved performance will be associated with the greatest increases in patient satisfaction. Four specific issues were identified as quality improvement priorities, regardless of condition: response to complaints; sensitivity to the inconvenience of hospitalization; including patients in decision making; addressing emotional and spiritual needs.

Inpatient heart failure treatment from the patient's perspective

OBJECTIVE

The objective of this study was 2-fold: (1) to identify particular opportunities for improvement in patient-centered care of heart failure patients and (2) to suggest strategies for service quality improvement focusing on those areas.

SAMPLE

A national cross-sectional sample of survey data from diagnostic-related group 127 patients was collected between December 1, 2001, and November 30, 2003. Data were split into two 12-month samples to compare results over time. The 2002 sample included 5224 patients treated at 220 hospitals; the 2003 sample included 6531 patients treated at 269 hospitals.

METHOD

A standardized mail-out/mail-back methodology was used to collect data from random samples of patients within 5 days of discharge.

RESULTS

For both samples, the ranking of service issues was highly similar, with the same 4 areas emerging as the foremost priorities: patient involvement in decision making, staff response to concerns voiced during the hospital stay, staff sensitivity to the inconvenience of heart failure and hospitalization, and emotional/spiritual support. Improvement in these 4 service areas should be associated with the greatest increases in patient satisfaction and quality of care for heart failure patients.

CONCLUSIONS

Adequately addressing these patient needs should increase patient satisfaction and quality of care for heart failure patients.

Elderly inpatients' priorities for acute care service quality

This study examines elderly and advanced elderly inpatients' perceptions of acute care service quality, prioritises opportunities for quality improvement, and assesses variation in patients' satisfaction with care. Psychometrically-validated postal questionnaires were sent to random samplings of patients discharged from the US acute care facilities in 2002 (n = 2,057,164). Quality improvement priorities among non-elderly (< 65 years), elderly (65-74 years), and advanced elderly (> 74 years) were similar but substantial variation was found comparing single items between age groups. Elderly and advanced elderly patients rated the quality of meals and rooms significantly lower than the non-elderly, and the advanced elderly rated treatment decision making involvement significantly lower than the other two age groups. The data reveals specific, actionable areas for quality improvement and a non-linear relationship between age and satisfaction. Findings question assumptions regarding older patients' evaluations of care and indicate directions for quality improvement that account for their unique needs.

Empathy: towards a conceptual framework for health professionals

Effective provider-patient communication and the relationships that it supports are located at the centre of quality health-care delivery. The patient-centred approach is increasingly seen as an effective way to provide effective patient care, being more sensitive and responsive to the needs of the individual. Empathy has been identified as a core component of "patient-centredness" but definitions often lack conceptual clarity. This paper proposes to clarify the definition of empathy keeping the discussion true to Rogers' original definitions of the concept whilst integrating the work of other writers. A major thrust is the development of an innovative conceptual model of empathy which has the potential to both integrate previous research findings and provide a framework for future research and training. The model is based in social psychological conceptions of attitude.

Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease

Background

The objective of this study was to develop and psychometrically evaluate a general measure of patients' satisfaction with medication, the Treatment Satisfaction Questionnaire for Medication (TSQM).

Methods

The content and format of 55 initial questions were based on a formal conceptual framework, an extensive literature review, and the input from three patient focus groups. Patient interviews were used to select the most relevant questions for further evaluation (n = 31). The psychometric performance of items and resulting TSQM scales were examined using eight diverse patient groups (arthritis, asthma, major depression, type I diabetes, high cholesterol, hypertension, migraine, and psoriasis) recruited from a national longitudinal panel study of chronic illness (n = 567). Participants were then randomized to complete the test items using one of two alternate scaling methods (Visual Analogue vs. Likert-type).

Results

A factor analysis (principal component extraction with varimax rotation) of specific items revealed three factors (Eigenvalues > 1.7) explaining 75.6% of the total variance; namely Side effects (4 items, 28.4%, Cronbach's Alpha = .87), Effectiveness (3 items, 24.1%, Cronbach's Alpha = .85), and Convenience (3 items, 23.1%, Cronbach's Alpha = .87). A second factor analysis of more generally worded items yielded a Global Satisfaction scale (3 items, Eigenvalue = 2.3, 79.1%, Cronbach's Alpha = .85). The final four scales possessed good psychometric properties, with the Likert-type scaling method performing better than the VAS approach. Significant differences were found on the TSQM by the route of medication administration (oral, injectable, topical, inhalable), level of illness severity, and length of time on medication. Regression analyses using the TSQM scales accounted for 40–60% of variation in patients' ratings of their likelihood to persist with their current medication.

Conclusion

The TSQM is a psychometrically sound and valid measure of the major dimensions of patients' satisfaction with medication. Preliminary evidence suggests that the TSQM may also be a good predictor of patients' medication adherence across different types of medication and patient populations.