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Jeffs L, Kuluski K, Flintoft V, MacLaurin A, Asselbergs M, Zeng RL, Bruno F, Schonewille N, Baker GR. Reconceptualizing Patient Safety Beyond Harm: Insights From a Mixed-Methods Qualitative Inquiry. J Nurs Care Qual 2024; 39:226-231. [PMID: 38198670 DOI: 10.1097/ncq.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Although patients' and care partners' perspectives on patient safety can guide health care learning and improvements, this information remains underutilized. Efforts to leverage this valuable data require challenging the narrow focus of safety as the absence of harm. PURPOSE The purpose of this study was to gain a broader insight into how patients and care partners perceive and experience safety. METHODS We used a mixed-methods approach that included a literature review and interviews and focus groups with patients, care partners, and health care providers. An emergent coding schema was developed from triangulation of the 2 data sets. RESULTS Two core themes-feeling unsafe and feeling safe-emerged that collectively represent a broader view of safety. CONCLUSION Knowledge from patients and care partners about feeling unsafe and safe needs to inform efforts to mitigate harm and promote safety, well-being, and positive outcomes and experiences.
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Affiliation(s)
- Lianne Jeffs
- Author Affiliations: Science of Care Institute, and Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada (Dr Jeffs); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (Drs Jeffs, Kuluski, and Baker and Ms Flintoft); Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada (Dr Kuluski); Healthcare Excellence Canada, Ottawa, Ontario, Canada (Ms MacLaurin); Patients for Patient Safety Canada, Healthcare Excellence Canada, Ottawa, Ontario, Canada (Ms Asselbergs); and Sinai Health, Toronto, Ontario, Canada (Mss Zeng and Bruno and Mr Schonewille)
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Dukhanin V, Gamper MJ, Gleason KT, McDonald KM. Patient-reported outcome and experience domains for diagnostic excellence: a scoping review to inform future measure development. Qual Life Res 2024:10.1007/s11136-024-03709-w. [PMID: 38850395 DOI: 10.1007/s11136-024-03709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE "Diagnostic excellence," as a relatively new construct centered on the diagnostic process and its health-related outcomes, can be refined by patient reporting and its measurement. We aimed to explore the scope of patient-reported outcome (PRO) and patient-reported experience (PRE) domains that are diagnostically relevant, regardless of the future diagnosed condition, and to review the state of measurement of these patient-reported domains. METHODS We conducted an exploratory analysis to identify these domains by employing a scoping review supplemented with internal expert consultations, 24-member international expert convening, additional environmental scans, and the validation of the domains' diagnostic relevance via mapping these onto patient diagnostic journeys. We created a narrative bibliography of the domains illustrating them with existing measurement examples. RESULTS We identified 41 diagnostically relevant PRO and PRE domains. We classified 10 domains as PRO, 28 as PRE, and three as mixed PRO/PRE. Among these domains, 19 were captured in existing instruments, and 20 were captured only in qualitative studies. Two domains were conceptualized during this exploratory analysis with no examples identified of capturing these domains. For 27 domains, patients and care partners report on a specific encounter; for 14 domains, reporting relates to an entire diagnostic journey over time, which presents particular measurement opportunities and challenges. CONCLUSION The multitude of PRO and PRE domains, if measured rigorously, would allow the diagnostic excellence construct to evolve further and in a manner that is patient-centered, prospectively focused, and concentrates on effectiveness and efficiency of diagnostic care on patients' well-being.
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Affiliation(s)
- Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Suite 643, Baltimore, MD 21205, USA.
| | - Mary Jo Gamper
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Kelly T Gleason
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Kathryn M McDonald
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Serrano-Ripoll MJ, Fiol-deRoque MA, Valderas JM, Zamanillo-Campos R, Llobera J, de Labry Lima AO, Pastor-Moreno G, Ricci-Cabello I. Feasibility of the SINERGIAPS ("Sinergias entre profesionales y pacientes para una Atención Primaria Segura") intervention for improving patient safety in primary care. Fam Pract 2022; 39:843-851. [PMID: 35253839 DOI: 10.1093/fampra/cmac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM The primary aim was to examine the feasibility of intervention delivery and of trial procedures. Secondary aims were to study the intervention uptake; its acceptability and perceived utility; and its potential to improve safety culture and avoidable hospital admissions. METHODS We conducted a 3-month, single-arm feasibility study in 10 primary care (PC) centres in Spain. Centres received information regarding patients' experiences of safety (through the Patient Reported Experiences and Outcomes of Safety in Primary Care [PREOS-PC] questionnaire), and were instructed to plan safety improvements based on that feedback. We used a bespoke online tool to recruit PC professionals, collect patient feedback, and deliver it to the centres, and to collect outcome data (patient safety culture [Medical Office Survey on Patient Safety Culture, MOSPSC questionnaire]). We measured recruitment and follow-up rates and intervention uptake (based on the number of safety improvement plans registered). We conducted semistructured interviews with 9 professionals to explore the intervention acceptability and perceived utility. RESULTS Of 256 professionals invited, 120 (47%) agreed to participate, and 97 completed baseline and postintervention measures. Of 780 patients invited, 585 (75%) completed the PREOS-PC questionnaire. Five of 10 centres (50%) designed an improvement plan, providing 27 plans in total (range per centre, 1-14). The intervention was perceived as a novel strategy for improving safety, although the healthcare professionals identified several factors limiting its acceptability and utility: lack of feedback at the individual professional level; potentially unrepresentative sample of patients providing feedback; and number of educational materials deemed overwhelming. DISCUSSION It is feasible to deliver the proposed intervention so long as the identified limitations are addressed.
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Affiliation(s)
- Maria J Serrano-Ripoll
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain.,University of the Balearic Islands, Psychology Department, Palma, Illes Balears, Spain
| | - Maria A Fiol-deRoque
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain
| | - José M Valderas
- Yong Loo Lin School of Medicine, National University of Singapore and Department of Family Medicine, National University Health System, Singapore
| | - Rocío Zamanillo-Campos
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain
| | - Joan Llobera
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Primary Care Preventive and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - Antonio Olry de Labry Lima
- Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain.,Research Group in Health and Gender, Andalusian School of Public Health, Granada, Andalucía, Spain
| | - Guadalupe Pastor-Moreno
- Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain.,Research Group in Health and Gender, Andalusian School of Public Health, Granada, Andalucía, Spain
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Illes Balears, Spain.,Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Illes Balears, Spain.,Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain
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Liow Y, Young D, Stavdal A, Valderas JM. From Astana to Singapore: Primary Health Care is key to the long-term success of Singapore's health system. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:528-530. [PMID: 36189697 DOI: 10.47102/annals-acadmedsg.2022194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Yiyang Liow
- Department of Family Medicine, National University Health System, Singapore
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Fiol-deRoque MA, Serrano-Ripol MJ, Gens-Barberà M, Sánchez E, Mayer MA, Martín-Luján F, Valderas JM, Ricci-Cabello I. [Impact of the COVID-19 pandemic on patient-reported patient safety in Primary Care]. Aten Primaria 2021; 53 Suppl 1:102222. [PMID: 34961582 PMCID: PMC8708814 DOI: 10.1016/j.aprim.2021.102222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the impact of the changes introduced in response to the pandemic on patient-reported patient safety in Primary Care. DESIGN Prospective observational panel study (health center) based on two cross-sectional surveys. SETTING 29 Primary Health Care centers from three Spanish health regions (Mallorca, Catalunya Central and Camp de Tarragona). PARTICIPANTS Random sample of patients visiting their centers before (n=2199 patients) and during the pandemic (n=1955 patients) MAIN MEASUREMENTS: We used the PREOS-PC questionnaire, a validated instrument which assesses patient-reported patient safety in Primary Care. We compared mean scores of the "experiences of errors" and "harm" scales in both periods, and built multilevel regression analyzes to study the variations in patient and center characteristics associated with worse levels of safety. A qualitative (content) analysis of patients' experiences during the pandemic was also performed. RESULTS The "experiences of errors" and "harm" scales scores significantly worsened during the COVID-19 period (92.65 to 88.81 (Cohen's d=0.27); and 96.92 to 79.97 (d=0.70), respectively). Patient and center characteristics associated to worsened scores were: women, people with a lower educational level, worse health status, more years assigned to the center, and health region. CONCLUSIONS During the pandemic, a perceptible worsening in patient safety perceived by patients treated in Primary Care has been observed, which has differentially affected patients according to their sociodemographic characteristics or health center profiles.
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Affiliation(s)
- Maria A Fiol-deRoque
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España
| | - Maria J Serrano-Ripol
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Universidad de las Islas Baleares (UIB), Departamento de Psicología, Palma, Islas Baleares, España.
| | - Montserrat Gens-Barberà
- Unitat de Qualitat i Seguretat dels Pacients, Gerència Territorial Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Encarna Sánchez
- Unitat de Qualitat i Seguretat, Gerència Territorial Catalunya Central, Institut Català de la Salut, Departament de Salut, Barcelona, España
| | - Miguel A Mayer
- Research Programme on Biomedical Informatics (GRIB) del Instituto Hospital del Mar de Investigaciones Médicas y la Universitat Pompeu Fabra, Barcelona, España
| | - Francisco Martín-Luján
- Unitat de Suport a la Recerca de Tarragona, Institut de d'investigació en l'Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, Tarragona, España
| | - José M Valderas
- Health Services & Polic Research Group, Exeter Collaboration for Academic Primary Care, University of Exeter, National Institute for Health Research School for Primary Care Research
| | - Ignacio Ricci-Cabello
- Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Gerencia de Atención Primaria de Mallorca, Servicio de Salud de las Islas Baleares, Palma, Islas Baleares, España; Ciber de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Lewis M, Palmer VJ, Kotevski A, Densley K, O'Donnell ML, Johnson C, Wohlgezogen F, Gray K, Robins-Browne K, Burchill L. Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol. JMIR Res Protoc 2021; 10:e26168. [PMID: 33635823 PMCID: PMC7945974 DOI: 10.2196/26168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/10/2021] [Accepted: 02/25/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the importance of health care workers' mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. OBJECTIVE RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. METHODS The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. RESULTS The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. CONCLUSIONS The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26168.
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Affiliation(s)
- Matthew Lewis
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Victoria J Palmer
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Aneta Kotevski
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Konstancja Densley
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Meaghan L O'Donnell
- Phoenix Australia, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Caroline Johnson
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Franz Wohlgezogen
- Centre for Workplace Leadership, Faculty of Business and Economics, The University of Melbourne, Melbourne, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Kate Robins-Browne
- Integrated Mental Health Research Program, Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Luke Burchill
- Department of Medicine, The University of Melbourne, Parkville, Australia.,Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia
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