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Lion KC, Zhou C, Fishman P, Senturia K, Cole A, Sherr K, Opel DJ, Stout J, Hazim CE, Warren L, Rains BH, Lewis CC. A sequential, multiple assignment randomized trial comparing web-based education to mobile video interpreter access for improving provider interpreter use in primary care clinics: the mVOCAL hybrid type 3 study protocol. Implement Sci 2023; 18:8. [PMID: 36915138 PMCID: PMC10012737 DOI: 10.1186/s13012-023-01263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Individuals who use a language other than English for medical care are at risk for disparities related to healthcare safety, patient-centered care, and quality. Professional interpreter use decreases these disparities but remains underutilized, despite widespread access and legal mandates. In this study, we compare two discrete implementation strategies for improving interpreter use: (1) enhanced education targeting intrapersonal barriers to use delivered in a scalable format (interactive web-based educational modules) and (2) a strategy targeting system barriers to use in which mobile video interpreting is enabled on providers' own mobile devices. METHODS We will conduct a type 3 hybrid implementation-effectiveness study in 3-5 primary care organizations, using a sequential multiple assignment randomized trial (SMART) design. Our primary implementation outcome is interpreter use, calculated by matching clinic visits to interpreter invoices. Our secondary effectiveness outcome is patient comprehension, determined by comparing patient-reported to provider-documented visit diagnosis. Enrolled providers (n = 55) will be randomized to mobile video interpreting or educational modules, plus standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative strategy. After another 9 months, both strategies will be available to enrolled providers for 9 more months. Providers will complete 2 surveys (beginning and end) and 3 in-depth interviews (beginning, middle, and end) to understand barriers to interpreter use, based on the Theoretical Domains Framework. Patients who use a language other than English will be surveyed (n = 648) and interviewed (n = 75) following visits with enrolled providers to understand their experiences with communication. Visits will be video recorded (n = 100) to assess fidelity to assigned strategies. We will explore strategy mechanism activation to refine causal pathway models using a quantitative plus qualitative approach. We will also determine the incremental cost-effectiveness of each implementation strategy from a healthcare organization perspective, using administrative and provider survey data. DISCUSSION Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, the mechanisms by which they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities. TRIAL REGISTRATION NCT05591586.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA.
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA
| | - Paul Fishman
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Kirsten Senturia
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - James Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carmen E Hazim
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
| | - Louise Warren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Bonnie H Rains
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Cara C Lewis
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Key Patient Experience Drivers That Result in Exemplary Overall Provider Performance Ratings in the Ambulatory Environment: A Quantitative Study. J Ambul Care Manage 2022; 45:182-190. [PMID: 35612389 DOI: 10.1097/jac.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study highlights the key drivers that form particular patient impressions resulting in exemplary overall provider performance ratings across service lines in the ambulatory environment. Two national samples of CG-CAHPS data were analyzed. Results indicate variance of impact among all CG-CAHPS questions on "top-box" scores for overall rating of provider among specialties. Interestingly, the same 5 explanatory variables-provider listened carefully, provider spent enough time, provider showed respect, provider knew important information about medical history, and provider explained things clearly-had the greatest explanatory power across the primary and specialty care samples when analyzed via multiple logistic regression analysis.
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Amuta-Jimenez AO, Smith GPA, Brown KK. Patterns and Correlates of Cervical Cancer Prevention Among Black Immigrant and African American Women in the USA: the Role of Ethnicity and Culture. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:798-805. [PMID: 32990933 DOI: 10.1007/s13187-020-01884-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
Cervical cancer prevention disparities between Black and White women have been researched extensively, but less is known about disparities among Black subpopulations, despite increased risk, distinct cultures, and rapidly increasing numbers of Black immigrant women to the USA. A 74-item survey was used to conduct a cross-sectional descriptive study. Independent sample t tests, logistic multiple regressions, and chi-square tests were used to carry out all comparative analyses. The survey was administered via Psychdata from January 2020 to February 2020. The final sample included 450 eligible participants (African American women [AAW] = 335; Black immigrant women [BIW] from either West, Central, East Africa, or the Caribbean = 115). Compared to AAW, BIW demonstrated much lower knowledge of cervical cancer, AAW were more likely to visit a gynecologist, and to have had a well-woman exam every 3 years or less. A greater percentage of BIW reported not getting Pap smear test because they had no symptoms or because they feared bad results while AAW reported not receiving a Pap smear because it was not convenient, they did not trust any doctor/gynecologist, and lacked access to a gynecologist. Doctor and family advising had a much larger effect on cervical screening among BIW compared to AAW. This study provides evidence of crucial differences in CC knowledge, attitudes, and screening behaviors among BIW and AAW. Funding agencies, program planners and evaluators, and health policymakers are encouraged to require disaggregation of Black women in healthcare research to tease out specific ways interventions can be most effective.
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Affiliation(s)
- Ann Oyare Amuta-Jimenez
- School of Health Promotion and Kinesiology, Texas Woman's University, 304 Administration Drive, Denton, TX, 76204, USA.
| | - Gabrielle P A Smith
- Department of Psychology and Philosophy, Texas Woman's University, 304 Administration Drive, Denton, TX, 76204, USA
| | - Kyrah K Brown
- Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA
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A Closer Examination of the Patient Experience in the Ambulatory Space: A Retrospective Qualitative Comparison of Primary Care With Specialty Care Experiences. J Ambul Care Manage 2020; 43:89-97. [PMID: 31770188 DOI: 10.1097/jac.0000000000000310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This qualitative study explores key patient experience impressions responsible for driving quality. Differences between primary and specialty care patient perspectives were analyzed using a mixed-methods design in high-, median-, and low-quality performing practices. We found that primary care patients highly value provider listening, time spent with provider, and consistent and effective coordination of care. Specialty care patients were found to highly value provider clinical skill acumen/outcomes, being kept informed with timely updates and care instructions, and a stress- and pain-free experience. We conclude that differing patient types attach greater value to different elements of their health care experiences.
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Lee B, Hollenbeck-Pringle D, Goldman V, Biondi E, Alverson B. Are Caregivers Who Respond to the Child HCAHPS Survey Reflective of All Hospitalized Pediatric Patients? Hosp Pediatr 2019; 9:162-169. [PMID: 30709907 DOI: 10.1542/hpeds.2018-0139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The Child Hospital Consumer Assessment of Healthcare Providers and Systems (C-HCAHPS) survey was developed to measure satisfaction levels of pediatric inpatients' caregivers. Studies in adults have revealed that certain demographic groups (people of color or who are multiracial and people with public insurance) respond to surveys at decreased rates, contributing to nonresponse bias. Our primary goal was to determine if results from the C-HCAHPS survey accurately reflect the intended population or reveal evidence of nonresponse bias. Our secondary goal was to examine whether demographic or clinical factors were associated with increased satisfaction levels. METHODS This was a retrospective cohort study of responses (n = 421) to the C-HCAHPS survey of patients admitted to a tertiary-care pediatric hospital between March 2016 and March 2017. Respondent demographic information was compared with that of all hospital admissions over the same time frame. Satisfaction was defined as "top-box" scores for questions on overall rating and willingness to recommend the hospital. RESULTS Caregivers returning surveys were more likely to be white, non-Hispanic, and privately insured (P < .001). Caregivers with the shortest emergency department wait times were more likely to assign top-box scores for global rating (P = .025). We found no differences in satisfaction between race and/or ethnicity, length of stay, insurance payer, or total cost. CONCLUSIONS Caregivers who identified with underrepresented minority groups and those without private insurance were less likely to return surveys. Among the surveys received, short emergency department wait time and older age were the only factors measured that were associated with higher satisfaction. Efforts to increase patient satisfaction on the basis of satisfaction scores may exacerbate existing disparities in health care.
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Affiliation(s)
- Brian Lee
- Hasbro Children's Hospital, Providence, Rhode Island;
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | | | - Victoria Goldman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Eric Biondi
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Brian Alverson
- Hasbro Children's Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
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Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams. Med Care 2019; 56:610-618. [PMID: 29762272 DOI: 10.1097/mlr.0000000000000926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. OBJECTIVE To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). RESEARCH DESIGN We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. SUBJECTS Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). MEASURES Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. RESULTS In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). CONCLUSIONS VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.
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Loftus J, Allen EM, Call KT, Everson-Rose SA. Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans. J Rural Health 2018; 34 Suppl 1:s48-s55. [PMID: 28295584 PMCID: PMC6069955 DOI: 10.1111/jrh.12235] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 01/30/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota. METHODS This was a secondary analysis of a 2008 statewide, cross-sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities. RESULTS Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00-1.88). Provider- and system-level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34-2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03-2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01-2.85). These and additional provider-level barriers were also identified among urban enrollees. CONCLUSIONS Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural-urban residence.
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Affiliation(s)
- John Loftus
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Elizabeth M Allen
- Department of Public Health, St. Catherine University, St. Paul, Minnesota
| | - Kathleen Thiede Call
- School of Public Health, Division of Health Policy & Management, and SHADAC, University of Minnesota, Minneapolis, Minnesota
| | - Susan A Everson-Rose
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota
- Department of Medicine, and Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota
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Jones AL, Mor MK, Cashy JP, Gordon AJ, Haas GL, Schaefer JH, Hausmann LRM. Racial/Ethnic Differences in Primary Care Experiences in Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders. J Gen Intern Med 2016; 31:1435-1443. [PMID: 27325318 PMCID: PMC5130946 DOI: 10.1007/s11606-016-3776-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/12/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient-Centered Medical Homes (PCMH) may be effective in managing care for racial/ethnic minorities with mental health and/or substance use disorders (MHSUDs). How such patients experience care in PCMH settings is relatively unknown. OBJECTIVE We aimed to examine racial/ethnic differences in experiences with primary care in PCMH settings among Veterans with MHSUDs. DESIGN We used multinomial regression methods to estimate racial/ethnic differences in PCMH experiences reported on a 2013 national survey of Veterans Affairs patients. PARTICPANTS Veterans with past-year MHSUD diagnoses (n = 65,930; 67 % White, 20 % Black, 11 % Hispanic, 1 % American Indian/Alaska Native[AI/AN], and 1 % Asian/Pacific Island[A/PI]). MAIN MEASURES Positive and negative experiences from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) PCMH Survey. RESULTS Veterans with MHSUDs reported the lowest frequency of positive experiences with access (22 %) and the highest frequency of negative experiences with self-management support (30 %) and comprehensiveness (16 %). Racial/ethnic differences (as compared to Whites) were observed in all seven healthcare domains (p values < 0.05). With access, Blacks and Hispanics reported more negative (Risk Differences [RDs] = 2 .0;3.6) and fewer positive (RDs = -2 .3;-2.3) experiences, while AI/ANs reported more negative experiences (RD = 5.7). In communication, Blacks reported fewer negative experiences (RD = -1.3); AI/ANs reported more negative (RD = 3.6) experiences; and AI/ANs and APIs reported fewer positive (RD = -6.5, -6.7) experiences. With office staff, Hispanics reported fewer positive experiences (RDs = -3.0); AI/ANs and A/PIs reported more negative experiences (RDs = 3.4; 3.7). For comprehensiveness, Blacks reported more positive experiences (RD = 3.6), and Hispanics reported more negative experiences (RD = 2.7). Both Blacks and Hispanics reported more positive (RDs = 2.3; 4.2) and fewer negative (RDs = -1.8; -1.9) provider ratings, and more positive experiences with decision making (RDs = 2.4; 3.0). Blacks reported more positive (RD = 3.9) and fewer negative (RD = -5.1) experiences with self-management support. CONCLUSIONS In a national sample of Veterans with MHSUDs, potential deficiencies were observed in access, self-management support, and comprehensiveness. Racial/ethnic minorities reported worse experiences than Whites with access, comprehensiveness, communication, and office staff helpfulness/courtesy.
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Affiliation(s)
- Audrey L Jones
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA, 15240-1001, USA.
| | - Maria K Mor
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - John P Cashy
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam J Gordon
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gretchen L Haas
- VISN4 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James H Schaefer
- Department of Veterans Affairs Office of Analytics and Business Intelligence, Durham, NC, USA
| | - Leslie R M Hausmann
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Woollen J, Prey J, Wilcox L, Sackeim A, Restaino S, Raza ST, Bakken S, Feiner S, Hripcsak G, Vawdrey D. Patient Experiences Using an Inpatient Personal Health Record. Appl Clin Inform 2016; 7:446-60. [PMID: 27437053 PMCID: PMC4941852 DOI: 10.4338/aci-2015-10-ra-0130] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/15/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate patients' experience using an inpatient personal health record (PHR) on a tablet computer to increase engagement in their hospital care. METHODS We performed observations and conducted semi-structured interviews with 14 post-operative cardiac surgical patients and their family members who received an inpatient PHR. Themes were identified using an inductive coding scheme. RESULTS All participants responded favorably to having access to view their clinical information. A majority (85.7%) of participants used the application following an initial training session. Patients reported high satisfaction with being able to view their hospital medications and access educational materials related to their medical conditions. Patients reported a desire to view daily progress reports about their hospital stay and have access to educational information about their post-acute recovery. In addition, patients expressed a common desire to view their diagnoses, laboratory test results, radiology reports, and procedure notes in language that is patient-friendly. CONCLUSION Patients have unmet information needs in the hospital setting. Our findings suggest that for some inpatients and their family members, providing personalized health information through a tablet computer may improve satisfaction, decrease anxiety, increase understanding of their health conditions, and improve safety and quality of care.
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Affiliation(s)
- Janet Woollen
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Jennifer Prey
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Lauren Wilcox
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA
| | | | - Susan Restaino
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Syed T. Raza
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, NY
- School of Nursing, Columbia University, New York, NY
| | - Steven Feiner
- Department of Computer Science, Columbia University, New York, NY
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - David Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY
- NewYork-Presbyterian Hospital, New York, NY
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Demir MO, Basaran MA, Simonetti B. Determining factors affecting healthcare service satisfaction utilizing fuzzy rule-based systems. J Appl Stat 2016. [DOI: 10.1080/02664763.2016.1181727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lion KC, Brown JC, Ebel BE, Klein EJ, Strelitz B, Gutman CK, Hencz P, Fernandez J, Mangione-Smith R. Effect of Telephone vs Video Interpretation on Parent Comprehension, Communication, and Utilization in the Pediatric Emergency Department: A Randomized Clinical Trial. JAMA Pediatr 2015; 169:1117-25. [PMID: 26501862 PMCID: PMC5524209 DOI: 10.1001/jamapediatrics.2015.2630] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Consistent professional interpretation improves communication with patients who have limited English proficiency. Remote modalities (telephone and video) have the potential for wide dissemination. OBJECTIVE To test the effect of telephone vs. video interpretation on communication during pediatric emergency care. DESIGN, SETTING, AND PARTICIPANTS Randomized trial of telephone vs. video interpretation at a free-standing, university-affiliated pediatric emergency department (ED). A convenience sample of 290 Spanish-speaking parents of pediatric ED patients with limited English proficiency were approached from February 24 through August 16, 2014, of whom 249 (85.9%) enrolled; of these, 208 (83.5%) completed the follow-up survey (91 parents in the telephone arm and 117 in the video arm). Groups did not differ significantly by consent or survey completion rate, ED factors (eg, ED crowding), child factors (eg, triage level, medical complexity), or parent factors (eg, birth country, income). Investigators were blinded to the interpretation modality during outcome ascertainment. Intention-to-treat data were analyzed August 25 to October 20, 2014. INTERVENTIONS Telephone or video interpretation for the ED visit, randomized by day. MAIN OUTCOMES AND MEASURES Parents were surveyed 1 to 7 days after the ED visit to assess communication and interpretation quality, frequency of lapses in interpreter use, and ability to name the child's diagnosis. Two blinded reviewers compared parent-reported and medical record-abstracted diagnoses and classified parent-reported diagnoses as correct, incorrect, or vague. RESULTS Among 208 parents who completed the survey, those in the video arm were more likely to name the child's diagnosis correctly than those in the telephone arm (85 of 114 [74.6%] vs. 52 of 87 [59.8%]; P = .03) and less likely to report frequent lapses in interpreter use (2 of 117 [1.7%] vs. 7 of 91 [7.7%]; P = .04). No differences were found between the video and telephone arms in parent-reported quality of communication (101 of 116 [87.1%] vs. 74 of 89 [83.1%]; P = .43) or interpretation (58 of 116 [50.0%] vs. 42 of 89 [47.2%]; P = .69). Video interpretation was more costly (per-patient mean [SD] cost, $61 [$36] vs. $31 [$20]; P < .001). Parent-reported adherence to the assigned modality was higher for the video arm (106 of 114 [93.0%] vs .68 of 86 [79.1%]; P = .004). CONCLUSIONS AND RELEVANCE Families with limited English proficiency who received video interpretation were more likely to correctly name the child's diagnosis and had fewer lapses in interpreter use. Use of video interpretation shows promise for improving communication and patient care in this population. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01986179.
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Affiliation(s)
- K. Casey Lion
- Department of Pediatrics, University of Washington, Seattle, Washington,Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington,Seattle Children’s Hospital, Seattle, Washington
| | - Julie C. Brown
- Department of Pediatrics, University of Washington, Seattle, Washington,Seattle Children’s Hospital, Seattle, Washington,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Beth E. Ebel
- Department of Pediatrics, University of Washington, Seattle, Washington,Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington,Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington,Center for Diversity and Health Equity, Seattle Children’s Hospital, Seattle, Washington
| | - Eileen J. Klein
- Department of Pediatrics, University of Washington, Seattle, Washington,Seattle Children’s Hospital, Seattle, Washington,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Bonnie Strelitz
- Seattle Children’s Hospital, Seattle, Washington,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | | | - Patty Hencz
- Center for Diversity and Health Equity, Seattle Children’s Hospital, Seattle, Washington
| | - Juan Fernandez
- Center for Diversity and Health Equity, Seattle Children’s Hospital, Seattle, Washington
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington,Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington,Seattle Children’s Hospital, Seattle, Washington
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Mangione-Smith R, Zhou C, Robinson JD, Taylor JA, Elliott MN, Heritage J. Communication practices and antibiotic use for acute respiratory tract infections in children. Ann Fam Med 2015; 13:221-7. [PMID: 25964399 PMCID: PMC4427416 DOI: 10.1370/afm.1785] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE This study examined relationships between provider communication practices, antibiotic prescribing, and parent care ratings during pediatric visits for acute respiratory tract infection (ARTI). METHODS A cross-sectional study was conducted of 1,285 pediatric visits motivated by ARTI symptoms. Children were seen by 1 of 28 pediatric providers representing 10 practices in Seattle, Washington, between December 2007 and April 2009. Providers completed post-visit surveys reporting on children's presenting symptoms, physical examination findings, assigned diagnoses, and treatments prescribed. Parents completed post-visit surveys reporting on provider communication practices and care ratings for the visit. Multivariate analyses identified key predictors of prescribing antibiotics for ARTI and of parent visit ratings. RESULTS Suggesting actions parents could take to reduce their child's symptoms (providing positive treatment recommendations) was associated with decreased risk of antibiotic prescribing whether done alone or in combination with negative treatment recommendations (ruling out the need for antibiotics) [adjusted risk ratio (aRR) 0.48; 95% CI, 0.24-0.95; and aRR 0.15; 95% CI, 0.06-0.40, respectively]. Parents receiving combined positive and negative treatment recommendations were more likely to give the highest possible visit rating (aRR 1.16; 95% CI, 1.01-1.34). CONCLUSION Combined use of positive and negative treatment recommendations may reduce the risk of antibiotic prescribing for children with viral ARTIs and at the same time improve visit ratings. With the growing threat of antibiotic resistance at the community and individual level, these communication techniques may assist frontline providers in helping to address this pervasive public health problem.
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Affiliation(s)
- Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington Seattle Children's Research Institute, Seattle, Washington
| | - Chuan Zhou
- Department of Pediatrics, University of Washington, Seattle, Washington Seattle Children's Research Institute, Seattle, Washington
| | - Jeffrey D Robinson
- Department of Communication, Portland State University, Portland, Oregon
| | - James A Taylor
- Department of Pediatrics, University of Washington, Seattle, Washington
| | | | - John Heritage
- Department of Sociology, University of California, Los Angeles, Los Angeles, California
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Paternotte E, van Dulmen S, van der Lee N, Scherpbier AJJA, Scheele F. Factors influencing intercultural doctor-patient communication: a realist review. PATIENT EDUCATION AND COUNSELING 2015; 98:420-45. [PMID: 25535014 DOI: 10.1016/j.pec.2014.11.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/23/2014] [Accepted: 11/17/2014] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Due to migration, doctors see patients from different ethnic backgrounds. This causes challenges for the communication. To develop training programs for doctors in intercultural communication (ICC), it is important to know which barriers and facilitators determine the quality of ICC. This study aimed to provide an overview of the literature and to explore how ICC works. METHODS A systematic search was performed to find literature published before October 2012. The search terms used were cultural, communication, healthcare worker. A realist synthesis allowed us to use an explanatory focus to understand the interplay of communication. RESULTS In total, 145 articles met the inclusion criteria. We found ICC challenges due to language, cultural and social differences, and doctors' assumptions. The mechanisms were described as factors influencing the process of ICC and divided into objectives, core skills and specific skills. The results were synthesized in a framework for the development of training. CONCLUSION The quality of ICC is influenced by the context and by the mechanisms. These mechanisms translate into practical points for training, which seem to have similarities with patient-centered communication. PRACTICE IMPLICATIONS Training for improving ICC can be developed as an extension of the existing training for patient-centered communication.
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Affiliation(s)
- Emma Paternotte
- Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands.
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway.
| | - Nadine van der Lee
- Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands.
| | - Albert J J A Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Fedde Scheele
- Medical School of Sciences, Vu University Medical Center, Amsterdam, The Netherlands.
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Shek DTL, Ma CMS. Validation of a subjective outcome evaluation tool for participants in a positive youth development program in Hong Kong. J Pediatr Adolesc Gynecol 2014; 27 Suppl:S43-9. [PMID: 24792762 DOI: 10.1016/j.jpag.2014.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE Utilizing primary-factor and hierarchical confirmatory factor analyses, this study examined the factor structure of a subjective outcome evaluation tool for the program participants for the Project P.A.T.H.S. in Hong Kong. DESIGN AND PARTICIPANTS A subjective outcome evaluation scale was used to assess the views of program participants on the program, implementer, and program effectiveness of the Project P.A.T.H.S. A total of 28,431 Secondary 2 students responded to this measure after they had completed the program. RESULTS Consistent with the conceptual model, findings based on confirmatory factor analyses provided support for the primary factor model and the higher-order factor model containing 3 primary factors. By randomly splitting the total sample into 2 subsamples, support for different forms of factorial invariance was found. There was also support for the internal consistency of the total scale and the 3 subscales. CONCLUSION Confirmatory factor analyses provided support for the factorial validity of the subjective outcome evaluation instrument designed for program participants in the Project P.A.T.H.S. in Hong Kong.
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Affiliation(s)
- Daniel T L Shek
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, P.R. China; Centre for Innovative Programmes for Adolescents and Families, The Hong Kong Polytechnic University, Hong Kong, P.R. China; Department of Social Work, East China Normal University, Shanghai, P.R. China; Kiang Wu Nursing College of Macau, Macau, P.R. China.
| | - Cecilia M S Ma
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, P.R. China
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Quigley DD, Elliott MN, Farley DO, Burkhart Q, Skootsky SA, Hays RD. Specialties differ in which aspects of doctor communication predict overall physician ratings. J Gen Intern Med 2014; 29:447-54. [PMID: 24163151 PMCID: PMC3930786 DOI: 10.1007/s11606-013-2663-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 09/13/2013] [Accepted: 09/26/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Effective doctor communication is critical to positive doctor-patient relationships and predicts better health outcomes. Doctor communication is the strongest predictor of patient ratings of doctors, but the most important aspects of communication may vary by specialty. OBJECTIVE To determine the importance of five aspects of doctor communication to overall physician ratings by specialty. DESIGN For each of 28 specialties, we calculated partial correlations of five communication items with a 0-10 overall physician rating, controlling for patient demographics. PATIENTS Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS®) 12-month Survey data collected 2005-2009 from 58,251 adults at a 534-physician medical group. MAIN MEASURES CG-CAHPS includes a 0 ("Worst physician possible") to 10 ("Best physician possible") overall physician rating. Five doctor communication items assess how often the physician: explains things; listens carefully; gives easy-to-understand instructions; shows respect; and spends enough time. KEY RESULTS Physician showing respect was the most important aspect of communication for 23/28 specialties, with a mean partial correlation (0.27, ranging from 0.07 to 0.44 across specialties) that accounted for more than four times as much variance in the overall physician rating as any other communication item. Three of five communication items varied significantly across specialties in their associations with the overall rating (p < 0.05). CONCLUSIONS All patients valued respectful treatment; the importance of other aspects of communication varied significantly by specialty. Quality improvement efforts by all specialties should emphasize physicians showing respect to patients, and each specialty should also target other aspects of communication that matter most to their patients. The results have implications for improving provider quality improvement and incentive programs and the reporting of CAHPS data to patients. Specialists make important contributions to coordinated patient care, and thus customized approaches to measurement, reporting, and quality improvement efforts are important.
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Bayldon BW, Glusman M, Fortuna NM, Ariza AJ, Binns HJ. Exploring caregiver understanding of medications immediately after a pediatric primary care visit. PATIENT EDUCATION AND COUNSELING 2013; 91:255-260. [PMID: 23428512 DOI: 10.1016/j.pec.2012.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/12/2012] [Accepted: 12/29/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Assess accuracy of caregiver understanding of children's prescribed medications and examine factors associated with accurate recall. METHODS Cross-sectional, observational study of English- or Spanish-speaking caregivers of primary care patients aged 0-7 years. Child and visit characteristics and caregiver health literacy (short test of health literacy in adults) were assessed. Post-visit, caregivers completed questionnaires on medications prescribed. Caregiver and medical record agreement on medication name and administration (dose and frequency) were examined using chi square and logistic regression. RESULTS Analyses included 68 caregivers (28% low health literacy); 96% of children had public insurance. Caregivers indicated that the doctor provided clear medication information (100%) and they could follow instructions (98%). 101 medicines were prescribed; 6 were recalled by caregiver only. 71% of medications were accurately named; 37% of administration instructions were accurately recalled. Accurate naming was more often found for patients 3-7 years, without conditions requiring repeat visits, and new medications. Accurate administration responses were associated with having only 1 child at the visit. CONCLUSION Unperceived medication instruction understanding gaps exist at physician visits for caregivers of all literacy levels. Communication and care delivery practices need further evaluation. PRACTICE IMPLICATIONS Clinicians should be aware of the frequency of caregiver medication misunderstanding.
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Affiliation(s)
- Barbara W Bayldon
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago 60611-2605, USA.
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Abstract
BACKGROUND Prior studies have shown that racial/ethnic minorities have lower Consumer Assessments of Healthcare Providers and Systems (CAHPS) scores. Perceived discrimination may mediate the relationship between race/ethnicity and patient experiences with care. OBJECTIVE To examine the relationship between perceived discrimination based on race/ethnicity and Medicaid insurance and CAHPS reports and ratings of care. METHODS The study analyzed 2007 survey data from 1509 Florida Medicaid beneficiaries. CAHPS reports (getting needed care, timeliness of care, communication with doctor, and health plan customer service) and ratings (personal doctor, specialist care, overall health care, and health plan) of care were the primary outcome variables. Patient perceptions of discrimination based on their race/ethnicity and having Medicaid insurance were the primary independent variables. Regression analysis modeled the effect of perceptions of discrimination on CAHPS reports and ratings controlling for age, sex, education, self-rated health status, race/ethnicity, survey language, and fee-for-service enrollment. SEs were corrected for correlation within plans. RESULTS Medicaid beneficiaries reporting discrimination based on race/ethnicity had lower CAHPS scores, ranging from 15 points lower (on a 0-100 scale) for getting needed care to 6 points lower for specialist rating, compared with those who never experienced discrimination. Similar results were obtained for perceived discrimination based on Medicaid insurance. CONCLUSIONS Perceptions of discrimination based on race/ethnicity and Medicaid insurance are prevalent and are associated with substantially lower CAHPS reports and ratings of care. Practices must develop and implement strategies to reduce perceived discrimination among patients.
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Rodriguez HP, Crane PK. Examining multiple sources of differential item functioning on the Clinician & Group CAHPS® survey. Health Serv Res 2011; 46:1778-802. [PMID: 22092021 DOI: 10.1111/j.1475-6773.2011.01299.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate psychometric properties of a widely used patient experience survey. DATA SOURCES English-language responses to the Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS®) survey (n = 12,244) from a 2008 quality improvement initiative involving eight southern California medical groups. METHODS We used an iterative hybrid ordinal logistic regression/item response theory differential item functioning (DIF) algorithm to identify items with DIF related to patient sociodemographic characteristics, duration of the physician-patient relationship, number of physician visits, and self-rated physical and mental health. We accounted for all sources of DIF and determined its cumulative impact. PRINCIPAL FINDINGS The upper end of the CG-CAHPS® performance range is measured with low precision. With sensitive settings, some items were found to have DIF. However, overall DIF impact was negligible, as 0.14 percent of participants had salient DIF impact. Latinos who spoke predominantly English at home had the highest prevalence of salient DIF impact at 0.26 percent. CONCLUSIONS The CG-CAHPS® functions similarly across commercially insured respondents from diverse backgrounds. Consequently, previously documented racial and ethnic group differences likely reflect true differences rather than measurement bias. The impact of low precision at the upper end of the scale should be clarified.
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Affiliation(s)
- Hector P Rodriguez
- Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90095, USA.
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