Patient perceptions of the quality of health services

Design and validation of an instrument to evaluate Person-Centered care in health services

BACKGROUND

The concept of quality in health care has evolved, placing greater importance on the patient's needs, culture, and social context, as well as their participation in clinical decision-making, as highlighted by Mead and Bower's Person-Centered Care Model. The aim of the present study was to design and validate an instrument to assess the extent to which healthcare services provided by PEMEX (Petróleos Mexicanos) offer person-centered care according to user perceptions.

METHODS

The first phase comprised the development of 57 items based on the analysis of responses from an open-ended questionnaire administered to 30 users of Pemex healthcare services. This questionnaire was designed considering the four factors of the person-centered care model, however, the high correlation between the 4 factors (i.e., r ≥ .80) indicated an overfactoring effect and consequently an increase in the risk of overfitting. Therefore, an exhaustive analysis of the instrument was performed, starting with the review of the individual behavior of each item, and carrying out exploratory and confirmatory factor analysis. Using a sample of 330 individuals, an exploratory factor analysis was perfomed. Afterward, a confirmatory factorial analysis was carried out with 335 participants. Finally, a new confirmatory factorial analysis included 130 participants due to the refinements made in the previous phase. Internal consistency was assessed using Cronbach's α and McDonald's ω at every phase.

RESULTS

The exploratory factor analysis retained 35 items in a single factor that accounted for 49% of the variance with an internal consistency of Cronbach's α and McDonald's ω = 0.97. Because the factorial structure by confirmatory factorial analysis was unsatisfactory, the initial model was refined, leading to the retention of 11 items and a final model with adjustment index of χ2 = 127.53, χ2/gl = 2.89, RMSEA = 0.07, IC RMSEA 0.06 to 0.09, TLI = 0.95 and CFI = 0.96, with an internal consistency of Cronbach's α and McDonald's ω = 0.93. Due to the refinements, a new confirmatory factorial analysis was conducted with suitable goodness-of-fit criteria in most items (χ2 = 151.44, χ2/gl = 3.43, RMSEA = 0.13, IC RMSEA 0.11 to 0.16, TLI = 0.93 and CFI = 0.94), resulting in a Cronbach's α and McDonald's ω = 0.98.

CONCLUSIONS

The instrument exhibits suitable psychometric properties to be employed to measure the degree to which medical care is patient centered. This instrument represents a strategy for promoting an innovative healthcare model.

Maternal birthplace and experiences of perinatal healthcare in Belgium: Evidence from a cross-sectional survey

BACKGROUND

Patient experience is an important part of perinatal care quality. Migrant women in high-income countries often report more negative experiences than non-migrants, but evidence in Europe is patchy. In this study, we compared the experiences of two migrant populations with non-migrants, taking into account socioeconomic characteristics.

METHODS

We surveyed mothers born in Belgium, North-Africa, and Sub-Saharan Africa (n = 877) using an adapted version of the Migrant-Friendly Maternity Care Questionnaire. Two patient experience scores were created using multiple correspondence analyses: a) information and communication with healthcare professionals and overall satisfaction with pregnancy care, and b) patient-centred aspects and satisfaction with delivery care. Through descriptive analyses and multivariable logistic regressions we estimated the associations of maternal characteristics with each score.

RESULTS

Overall, positive experiences were reported in terms of communication (83 %) and patient-centred care (86 %). North African immigrants with low language proficiency had higher odds of negative communication experience (especially problems understanding information) (ORa: 2.30, 95 %CI 1.17-4.50), regardless of socioeconomic position. Among women with language barriers, 88 % were never offered a professional interpreter, relying on family members for translation. Patient-centred care was not associated with maternal birth region but was rated more negatively by older mothers, those with longer residence in Belgium, and higher majority-language proficiency.

CONCLUSION

In Belgium, perinatal care experiences were generally positive, although communication with immigrants was suboptimal. Language barriers, single motherhood, and unstable housing increased communication issues. Our findings underline the necessity to improve information-exchange with immigrants and socioeconomically vulnerable women.

Women and opioid use disorder treatment: A scoping review of experiences, use of patient-reported experience measures, and integration of person-centred care principles

BACKGROUND

Patient-reported experience measures (PREMs) are an important aspect of assessing and improving women's experiences of person-centred care during treatment for Opioid Use Disorder (OUD). This scoping review aimed to 1) examine the extent, type, and characteristics of evidence regarding women's OUD treatment experiences, and 2) describe the extent to which PREMs and person-centred care principles are incorporated within research methods.

METHODS

Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a scoping review to identify peer-reviewed articles on women's OUD treatment experiences. Data were extracted from 39 included studies and synthesised based on study design, method of assessment/analysis (including use of PREMs), key findings, and the integration of person-centred care principles.

RESULTS

Analysis of included studies revealed a predominance of qualitative research focused on women's experiences of pharmacological OUD treatment (methadone and/or buprenorphine) in Western countries. Women in these studies reported predominantly negative or mixed experiences of treatment. Few studies used validated PREMs and there was a lack of direct assessment or focus on recognised person-centred care principles. However, common categories of outcomes/findings identified in results across studies broadly aligned with person-centred care principles (e.g., fast access to reliable healthcare, effective treatment by trusted professionals), emphasising their applicability to women's experiences of treatment.

CONCLUSIONS

Although there has been an increased focus on women's experiences of treatment for OUD in recent years, results highlighted room for improvement regarding the systematic and comprehensive assessment of women's experiences across different contexts. Given the often negative or mixed experiences reported by women, an increased focus on assessing service provision through a person-centred care lens (including utilising PREMs) may allow for service improvements or adaptations targeted towards the needs and experiences of women.

A qualitative exploration of patients' perception regarding the comprehensive dental services availed at a primary health center

Introduction

Comprehensive oral care is a service centered around the patient, and individuals who need it the most often face limited access. Patient perception acts as a guide for enhancing quality, ensuring patients' future intent to utilize the services and facilitating recommendations to others. The present study aimed to assess the patients' perception of comprehensive dental services availed at a Primary Health Center (PHC).

Methods

This qualitative study was based on a phenomenological interpretive approach, and judgment sampling method was employed. A validated interview guide, developed from relevant literature was employed in the local language to conduct interviews among adults visiting the PHC, gathering their views regarding the services provided. The interviews were audio recorded on a digital voice recorder, and files were password protected. Content saturation guided the determination of the final number of participants interviewed. After translating and transcribing the interviews, thematic analysis and coding were performed using ATLAS. ti 23 for Windows.

Results

A total of 12 participants were included in the study, following data saturation. Among them, there were 8(66.7%) female and 4(33.3%) male participants. Ten overarching main themes were discerned through the assigned codes, including positive views, neutral views, negative views, previous dental clinics visited, previous experience with dental treatment, treatments sought at the center, referrals, source of information about the dental center, subsequent visits and suggestions for improvement.

Conclusions

The findings of this study revealed a positive patient perception of the comprehensive dental services offered at the PHC. Through insightful interviews, various strengths, and areas for improvement regarding the center and care provision were identified. These insights provide valuable suggestions that can be applied to elevate the utilization of dental services, ensuring continuous improvement in patient care.

Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach: Exploratory Cross-Sectional Study of Patients' Views on Quality of Care

PURPOSE

The purpose of this study was to evaluate patients' perception and quality of diabetic foot ulcer (DFU) care delivered by an interdisciplinary team approach (ITA).

DESIGN

Exploratory cross-sectional study.

SUBJECTS AND SETTING

Twenty patients with a healed plantar DFU were recruited from an interdisciplinary Wound Care clinic of a Canadian University affiliated hospital. Their mean age was 64 years (75% were males [n = 15]), 18 (90%) were living with type 2 diabetes, and 45% (n = 9) had osteomyelitis in the previous year of their enrollment in the study.

METHODS

The validated short form of the Quality From the Patient's Perspective questionnaire was used to evaluate quality of care dimensions (medical-technical competence of the caregivers; physical-technical conditions of the care organization; degree of identity-orientation in the attitudes and actions of the caregivers; and sociocultural atmosphere of the care organization).

RESULTS

Respondents reported experiencing a high level of quality care with an ITA. All indicators of patient-perceived reality of care delivered were superior or equal related to their subjective importance in all dimensions of quality care (with scores ranging from 3.85 to 4.00 on a 4-Point Likert scale). Patients' satisfaction regarding the ITA was high.

CONCLUSIONS

Study findings suggest that an ITA model provided high quality of care for treating DFUs for all quality dimensions judged important for patients.

Patients' and caregivers' perceptions of the quality of hospital-at-home service: A scoping review

AIM

This scoping review aims to provide an overview of patients and caregivers perceptions of hospital-at-home (HaH) services.

BACKGROUND

HaH services provide patients with hospital-level care at home and are central to integrated healthcare systems. Despite favourable data from individual studies in the literature, in-depth analysis from patient and caregivers perspectives is lacking. This understanding is essential for the dissemination and scaling of HaH services.

DESIGN

The scoping review was performed using the PRISMA-ScR checklist and PAGER framework for the findings report and research recommendations.

METHOD

Literature from PubMed, Web of Science, Ovid, CINAHL, Cochrane and Mednar databases were searched. Relevant studies published between 1st January 2005 and 31st December 2022 were identified. The conceptual model of the development of patient perceptions of quality was used for data extraction and tabulation.

RESULTS

The review included 24 articles. Expectation attributions were identified as needs, types of service, hospitalisation experiences, family care preferences, social-demographics and coping skills. From patient's and caregiver's perspectives, HaH was safe, effective and viewed positively. Perceived concerns/barriers and enablers/facilitators were associated with individual, caregiver and system factors, but demonstrated an overall satisfaction in the HaH service.

CONCLUSION

HaH provides an excellent service according to patients' and caregivers' perceptions. However, gaps in care were identified such as prioritising patient-centred care, along with improved multidisciplinary continuity of care and future studies should incorporate these into their research of HaH.

RELEVANCE TO CLINICAL PRACTICE

Patients' and caregivers' HaH needs should be embedded in the design, development and implementation of HaH services.

PATIENT AND PUBLIC CONTRIBUTION

Not applicable for the study design of this scoping review.

Citizens' perspectives on relocating care: a scoping review

BACKGROUND

Healthcare systems around the world are facing large challenges. There are increasing demands and costs while at the same time a diminishing health workforce. Without reform, healthcare systems are unsustainable. Relocating care, for example, from hospitals to sites closer to patients' homes, is expected to make a key contribution to keeping healthcare sustainable. Given the significant impact of this initiative on citizens, we conducted a scoping review to provide insight into the factors that influence citizens' attitudes towards relocating care.

METHOD

A scoping review was conducted. The search was performed in the following databases: Pubmed, Embase, Cinahl, and Scopus. Articles had to include relocating healthcare and citizens' perspectives on this topic and the articles had to be about a European country with a strong primary care system. After applying the inclusion and exclusion criteria, 70 articles remained.

RESULTS

Factors positively influencing citizens' attitudes towards relocating care included: convenience, familiarity, accessibility, patients having more control over their disease, and privacy. Factors influencing negative attitudes included: concerns about the quality of care, familiarity, the lack of physical examination, contact with others, convenience, and privacy. Furthermore, in general, most citizens preferred to relocate care in the studies we found, especially from the hospital to care provided at home.

CONCLUSION

Several factors influencing the attitude of citizens towards relocating care were found. These factors are very important when determining citizens' preferences for the location of their healthcare. The majority of studies in this review reported that citizens are in favour of relocating care. In general citizens' perspectives on relocating care are very often missing in articles. It was significant that very few studies on relocation from the hospital to the general practitioner were identified.

Quality of Care is Perceived to be High with Community-based Antiretroviral Therapy (ART) Services for Female Sex Workers in Tanzania: Qualitative Findings from a Pilot Implementation Science Study

This qualitative study reports on female sex workers' (FSWs) perceptions of the quality of antiretroviral therapy (ART) services they received as part of a community-based ART distribution intervention compared to services received by FSWs in the standard of care (SOC) arm. In-depth interviews were conducted with 24 participants to explore their perceptions of the quality of ART services. Data was analyzed using a quality-of-care framework that included but was not limited to, domains of accessibility, effective organization of care, package of services, and patient-centered care. Overall, FSWs in the intervention arm reported community-based ART services to be highly accessible, organized, and effective, and they highly valued the patient-centered care and high level of privacy. Community-based ART programs for FSWs can have high quality-of-care, which can have a positive effect on HIV treatment outcomes for FSWs.

Community-based management of acute malnutrition: Implementation quality, and staff and user satisfaction with services

Background

Malnutrition is a problem that affects many children and therefore is the focus of multiple interventions worldwide. One intervention is community-based management of acute malnutrition (CMAM).

Objective

This study assessed CMAM implementation quality in the Builsa North District of Ghana, and the satisfaction among both users and CMAM staff.

Design

The study used a convergent mixed-method design involving in-depth interviews with CMAM staff and users, document reviews, and observations of the CMAM implementation. The data were collected across eight health care facilities in eight sub-districts. The data were qualitatively and thematically analysed in Nvivo software.

Results

Several factors were found to adversely affect the quality of CMAM implementation. Significant factors included inadequate training of CMAM workers; religious belief systems; and a lack of implementation materials, such as ready-to-use therapeutic food (RUTF), CMAM registration forms/cards, and computers. These factors adversely affected programme quality, thus resulting in dissatisfaction among CMAM users and staff.

Conclusion

This study established that the CMAM programme in the Builsa North District of Ghana is hindered by a lack of primary resources and logistics necessary for successful programme implementation. Most health facilities in the district lack such resources and are not delivering the intended results.

Bidirectional referral system between National Taiwan University Hospital medical center and Zhongxiao Branch community hospital of Taipei City Hospital: focus on patient satisfaction

The policy of bidirectional referral between National Taiwan University Hospital and Taipei City Hospital has been launched due to the over-crowding of the emergency department at National Taiwan University Hospital. This research aims to evaluate patient satisfaction with the bidirectional referral. Sixty-six patients have been referred from the emergency department of National Taiwan University Hospital to Taipei City Hospital, Zhongxiao campus from April 2015 to December 2017. The selection criteria of the subjects for bidirectional referral include the management of patients classified as triage classification 2 or 3. Exclusion criteria are as follows: incomplete patient records and patients who chose hospice care. Sixty-six patients completed the questionnaires. Multivariate regression was used to evaluate the determinants of overall satisfaction scores of the bidirectional referral. The two overall satisfaction scores of patients were high (> 7). Three independent variables, (1) overall satisfaction scores of medical care at Taipei City Hospital, Zhongxiao campus, (2) waiting times for examination, treatment, and test, and (3) a positive question regarding quality improvement of delivered care for patients and family explained 69.3% adjusted variability of the overall satisfaction scores of bidirectional referrals. Therefore, the policy of bidirectional referrals and direct admission into the wards of Taipei City Hospital, Zhongxiao campus, from the emergency department of National Taiwan University Hospital met the criteria for patient satisfaction and public accountability.

Examining the factors associated with inpatients' perception of overtreatment in Korea: a cross-sectional study

BACKGROUND

Patients' perception of receiving overtreatment can cause distrust in medical services. Unlike outpatients, inpatients are highly likely to receive many medical services without fully understanding their medical situation. This information asymmetry could prompt inpatients to perceive treatment as excessive. This study tested the hypothesis that there are systematic patterns in inpatients' perceptions of overtreatment.

METHODS

We examined determinant factors of inpatients' perception of overtreatment in a cross-sectional design that used data from the 2017 Korean Health Panel (KHP), a nationally representative survey. For sensitivity analysis, the concept of overtreatment was analyzed by dividing it into a broad meaning (any overtreatment) and a narrow meaning (strict overtreatment). We performed chi-square for descriptive statistics, and multivariate logistic regression with sampling weights employing Andersen's behavioral model.

RESULTS

There were 1,742 inpatients from the KHP data set that were included in the analysis. Among them, 347 (19.9%) reported any overtreatment and 77 (4.42%) reported strict overtreatment. Furthermore, we found that the inpatient's perception of overtreatment was associated with gender, marital status, income level, chronic disease, subjective health status, health recovery, and general tertiary hospital.

CONCLUSION

Medical institutions should understand factors that contribute to inpatients' perception of overtreatment to mitigate patients' complaints due to information asymmetry. Moreover, based on the result of this study, government agencies, such as the Health Insurance Review and Assessment Service, should create policy-based controls and evaluate overtreatment behavior of the medical providers and intervene in the miscommunication between patients and providers.

Research on the service quality of emergency medical language services during major unexpected public health events

Introduction

Emergency Medical Language Services (EMLS) have played a crucial role in the COVID-19 pandemic. Research on the quality and its influencing factors of EMLS is necessary.

Methods

This study used the SERvice QUALity (SERVQUAL) model to determine factors affecting the quality of EMLS during the pandemic. An online questionnaire was completed by 206 participants who received the service in 2021-2022. Structural Equation Modeling (SEM) indicated that the service provider and service process significantly influenced the Service Results.

Results

In the service process, the evaluation of service content and responsiveness were highly correlated, and both factors significantly affected user satisfaction. In the service provider, tangibility and reliability were highly correlated. The key factors for user willingness to recommend the service were service content and tangibility.

Discussion

Based on the results of the data analysis, it can be inferred that EMLS should be improved and upgraded in terms of service organization, talent cultivation, and service channel expansion. To enhance service organization, an emergency medical language team should establish a close collaboration with local medical institutions and government departments, and an EMLS center should be established with the support of hospitals, government, or civil organizations.

Determinants of Patient-Perceived Primary Healthcare Quality in Lithuania

Patient-centered care is considered to be one of the essential pillars of a modern healthcare system. Thus, quality assessment based on patients' perceptions, views and experiences in their journey through the healthcare system is recognized as one of the key principles for quality improvement initiatives. Measuring patient satisfaction can be confounded by expectations and prior experiences, which can be at least partly overcome by evaluating patient-perceived healthcare quality (PPHQ). Understanding the principal constituents of PPHQ may aid healthcare professionals and decision makers in the healthcare management process and help in creating instruments to meaningfully measure patient feedback. Herein, we aimed to analyze the primary determinants of PPHQ and their interactions, with a focus on patient experiences and healthcare accessibility, using the example of Lithuanian primary healthcare. For this purpose, we conducted a cross-sectional representative telephone survey that included a total of 1033 respondents (48% male) who had encountered primary healthcare during last 3 years. Survey questions consisted of sociodemographic characteristics, patient perceptions of healthcare service provision, patient experiences, self-reported health status and overall PPHQ ranked with a 5-point Likert scale as the primary outcome. The classification-regression tree (CRT) technique was used to analyze the relationship between different explanatory variables and PPHQ, as well as their relative importance and interactions. The majority of respondents (89%) evaluated PPHQ as acceptable or good. CRT analysis identified staff behavior, organizational accessibility and financial accessibility as the most important factors affecting PPHQ. Importantly, the latter factors surpassed the effect of other known PPHQ determinants, such as sociodemographic characteristics or health status. Further analysis has revealed that the relative importance of staff behavior, including understanding, attention and empathy, increased when more problems with organizational accessibility were encountered. In conclusion, our study suggests that PPHQ in primary healthcare may primarily be determined by organizational and financial accessibility and staff behavior, which may also act as an important mediating factor.

Patients' experiences with an obstetric telephone triage system: A qualitative study

BACKGROUND

Telephone Triage Systems aim to provide a uniform and practical system for healthcare professionals in order to prioritize urgency of care. A disadvantage of telephone triage system could be that the conversations are experienced as less personal, as it uses a uniform procedure for every patient. Therefore, aside from the clinical relevance, patient expectations, experiences and satisfaction were studied.

OBJECTIVE

The purpose of this study is to explore patients' experiences with obstetric telephone triage.

METHODS

A descriptive, qualitative design to explore experiences after triage with Dutch Obstetric Telephone Triage System. Participants, recruited from two Dutch hospitals, were pregnant women who received triage by telephone. Semi-structured interviews were held. The following topics were discussed: expectations before triage, experiences with triage, waiting time, information and communication, approach of healthcare professional, and quality of treatment. Data were analyzed using open, axial and selective coding.

RESULTS

Overall, the participants experienced the telephone conversation as satisfactory. This was due to the perceived professionalism with high accessibility and perceived reassurance. The approach of the professional was experienced as friendly and empathetic. Participants suggested that triage services could be improved by looking specifically at information provision. Explaining in advance how the service works can be helpful to create more awareness and to align better with expectations.

CONCLUSION

Participants reported that they could tell their own story and most participants realized that the professional asked extra questions in order to quantify the seriousness of the complaints. The level of involvement in the next steps of their care episode experienced by respondents lead us to conclude that the professional intended patient-centered care.

PRACTICE IMPLICATIONS

Improving the provision of information during waiting times and about the accessibility of the service can increase the quality of obstetric triage care. Patient involvement is necessary to increase trust and to meet the needs of the patient.

A qualitative analysis of obstetric violence in rural Madagascar

In Madagascar, a country where maternal mortality remains high, the quality of obstetric care as perceived by users has been little explored. In this paper, we examine the perception of the quality of care in rural areas, by identifying women's experiences and expectations for basic and emergency obstetric care and how providers are meeting them. Data were collected in 2020, in three rural regions (Fenerive-Est, Manakara and Miandrivazo). 58 semi-structured interviews were conducted with women who had given birth in basic health centers or at home, and with other key informants including caregivers, birth attendants (known as matrones), grandmothers and community agents. 6 focus groups took place with mothers who had given birth at home and at a basic health centers and 6 observations took place during prenatal consultations. This article highlights the major dysfunctions perceived in the services offered and their influence on healthcare use. The women highlighted a lack of consideration of their expectations in obstetric care, with a defective caregiver/patient relationship, unforeseen costs and inadequate infrastructures incapable of guaranteeing intimacy. The women also complained of a lack of consideration of their fady (cultural prohibitions that can lead to misfortune) that surround pregnancy. These local practices conflict with the medical requirements of priority interventions in maternal care, and the respect of these practices by the women leads to reprimands and humiliation from caregivers. This obstetric violence, which emanates from the structure of society, gender relations and the biomedical practices governing pregnancy and childbirth in health facilities in Madagascar, constitutes an obstacle to the use of obstetric services. We hope that this description of the various dimensions of obstetric violence in Madagascar will make it possible to identify the structural obstacles limiting the capacity to provide quality care and to engender positive improvements in obstetric care in Madagascar.

Patient Satisfaction with Healthcare Services and the Techniques Used for its Assessment: A Systematic Literature Review and a Bibliometric Analysis

Patient satisfaction with healthcare provision services and the factors influencing it are be-coming the main focus of many scientific studies. Assuring the quality of the provided services is essential for the fulfillment of patients' expectations and needs. Thus, this systematic review seeks to find the determinants of patient satisfaction in a global setting. We perform an analysis to evaluate the collected literature and to fulfill the literature gap of bibliometric analysis within this theme. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. We conducted our database search in Scopus, Web of Science, and PubMed in June 2022. Studies from 2000-2021 that followed the inclusion and exclusion criteria and that were written in English were included in the sample. We ended up with 157 articles to review. A co-citation and bibliographic coupling analysis were employed to find the most relevant sources, authors, and documents. We divided the factors influencing patient satisfaction into criteria and explanatory variables. Medical care, communication with the patient, and patient's age are among the most critical factors for researchers. The bibliometric analysis revealed the countries, institutions, documents, authors, and sources most productive and significant in patient satisfaction.

Development of indicators for integrated antenatal care service provision: a feasibility study in Burkina Faso, Kenya, Malawi, Senegal and Sierra Leone

OBJECTIVES

While service integration has gained prominence as an objective of many global initiatives, there is no widely recognised single definition of integration nor a clear understanding of how programmes are integrated into health systems to achieve improved health outcomes. This study aims to review measurement approaches for integrated antenatal care (ANC) services, propose and operationalise indicators for measuring ANC service integration and inform an integrated ANC indicator recommendation for use in low-income and middle-income countries (LMICs).

DESIGN

Feasibility study.

SETTING

Burkina Faso, Kenya, Malawi, Senegal and Sierra Leone.

METHODS

Our six-step approach included: (1) conceptualise ANC service integration models; (2) conduct a targeted literature review on measurement of ANC service integration; (3) develop criteria for ANC service integration indicators; (4) propose indicators for ANC service integration; (5) use extant data to operationalise the indicators; and (6) synthesise information to make an integrated ANC indicator recommendation for use in LMICs.

RESULTS

Given the multidimensionality of integration, we outlined three models for conceptualising ANC service integration: integrated health systems, continuity of care and coordinated care. Looking across ANC service integration estimates, there were large differences between estimates for ANC service integration depending on the model used, and in some countries, the ANC integration indicator definition within a model. No one integrated ANC indicator was consistently the highest estimate for ANC service integration. However, continuity of care was consistently the lowest estimate for ANC service integration.

CONCLUSIONS

Integrated ANC services are foundational to ensuring universal health coverage. However, our findings demonstrate the complexities in monitoring indicators of ANC service quality using extant data in LMICs. Given the challenges, it is recommended that countries focus on monitoring measures of service quality. In addition, efforts should be made to improve data collection tools and routine health information systems to better capture measures of service integration.

Exploring stakeholder experiences of dietetic service and care delivery: A systematic qualitative review

BACKGROUND

There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This systematic review of the literature used qualitative synthesis to explore the perceptions and experiences of multiple stakeholders involved in the delivery of nutrition care and dietetic service.

METHODS

MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, ISI Web of Science, PsycINFO and ProQuest were systematically searched. Study characteristics and perceptions of stakeholders regarding nutrition care services were extracted. Qualitative synthesis was employed and thematic analysis conducted.

RESULTS

Five themes were identified from 44 studies related to stakeholders' perceptions of dietetic services. Studies included quantitative, qualitative and mixed methods involving patients, families, dietitians and other healthcare professionals. The themes were (1) patients desiring a personalised approach to nutrition care; (2) accessing dietetic service; (3) perceived impact of nutrition care on the patient; (4) relationships between stakeholders; and (5) beliefs about nutrition expertise. Two themes were specific to patients; these were the desire for individualised care and the impact of nutrition care. Within each theme perceptions varied with patients' views often contrasting with those of dietetic service providers.

CONCLUSIONS

Experiences of dietetic service do not always meet stakeholder expectations which impacts on patient engagement. Seeking stakeholder input is imperative to design dietetic services that engage patients in positive and supportive clinical partnerships.

Older Adults' Satisfaction with Telemedicine During the COVID-19 Pandemic: A Systematic Review

Aims: This systematic review aimed to evaluate the satisfaction of older adults with telemedicine during the COVID-19 pandemic, assess preferences to telemedicine or in-person visits, and identify factors of influence on the satisfaction with telemedicine. Methods: The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. A search through key electronic databases identified 228 citations. After duplicate record removal, and title and abstract screening, 43 articles were eligible for full-text review. Of these, 10 studies meeting the inclusion criteria of the review were finally included. Results: Older adults were satisfied with telemedicine during the COVID-19 pandemic. Patients were in favor of telemedicine compared to in-person visits, but the evidence support for this preference was limited. Factors influencing satisfaction were identified and categorized under four main categories: system-related factors, patient-related factors, socioeconomic factors, and factors related to the nature of the medical intervention. Conclusions: Older adults were satisfied with telemedicine during the COVID-19 pandemic. A positive trend of preference toward telemedicine was observed, but not well established due to the lack of an objective measure of assessment. Technical issues related to the telemedicine delivery system were the main challenges. The socioeconomic status and level of education of older adults can relatively influence the level of satisfaction with telemedicine. The experience of older adults with telemedicine is still evolving and advanced technologies specifically designed to address their needs must be explored to increase the telemedicine uptake among the older adult population during and beyond the COVID-19 pandemic.

Incorporation of the emotional indicators of the patient journey into healthcare organization management

BACKGROUND

In recent years, attempts have been made to incorporate patients' experiences into healthcare processes, to complement clinical indicators, with what are known as patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). While the research into PROMs is more developed, the application of PREMs faces some difficulties. The incorporation of emotional indicators into assessments of the experience is an area that remains to be explored.

OBJECTIVES

This study proposes a new technique to analyse the emotions experienced by patients during the care process, examines how these emotions influence their satisfaction and propose that if healthcare services focus more on patients' emotions, they can improve the effectiveness of the sector.

METHODS

The first, qualitative stage, gathered data from patients to design a patient journey (PJ). The PJ was then reproduced as a video. In a subsequent, quantitative stage, the video was shown to experimental participants, and their emotions were measured through facial expression analysis and a questionnaire.

RESULTS

A new technique to gather emotional data showed that the emotions patients experience do not affect their satisfaction with their clinical care or the physical aspects of the process. However, their emotions did affect their satisfaction with people and organizations.

CONCLUSIONS

The importance of the emotional component of patients' experiences was underlined. Therefore, healthcare organizations should take account of this dimension, as well as the cognitive, to increase patient satisfaction and improve their care processes. Understanding the impact of the emotions identified at the subconscious level can help improve the patient experience. A new methodology was applied that may help health professionals to collect emotional data about patients' experiences and to develop PREMs.

PATIENT/PUBLIC CONTRIBUTION

Patients were involved in all stages of this research. In the exploratory phase, some helped define the touchpoints of the PJ. The data from the subsequent experimental phase were collected from another group, and the emotions they experienced were identified through the analysis of their facial expressions. Based on the results of this study, a working group including patients has been established to work on improvements in the PJ.

PediHome: Development of a Family-Reported Measure of Pediatric Home Healthcare Quality

OBJECTIVE

No validated tools exist to measure pediatric home healthcare quality. The objective of this work was to develop a family-reported survey (PediHome) to measure the quality of home healthcare for children with medical complexity (CMC).

METHODS

A national multidisciplinary expert panel (N = 19) was convened to develop survey content domains. Panelist were joined by 3 additional experts to rank candidate survey items for importance and evaluate relevance and structure. Cognitive interviews were conducted with English-speaking (n = 12) and Spanish-speaking (n = 4) family caregivers of CMC to revise problematic items and clarify response options. A cross-sectional survey was then fielded (6/1/20-10/31/20) to parents whose children receive healthcare at 2 regional academic medical centers.

RESULTS

The final measure included N = 28 total items with 4 items quantifying access, 1 evaluating overall quality rating, and 21 items assessing provider tasks (11 home nursing only, 2 certified nursing assistant/home health aide only, and 1 dual). Out of 312 caregivers of CMC, 142 (46%) responded and one-half (n = 68, 48%) reported a child receiving home nursing. They received a weekly median of 58.4% (IQR ±31.2%) of approved nursing hours with 55% reporting a missed nursing shift within the last month. Median overall quality was 75-9 (0-10 scale) and median scores on specific quality items ranged from 31^-4 to 43^-4 (0-4 scale).

CONCLUSIONS

PediHome is a new content-valid family-reported measure of home healthcare quality for CMC that is useful for evaluating healthcare quality across several domains. Future work will involve assessing PediHome's construct and predictive validity.

Satisfaction with dental care services in Great Britain 1998-2019

Background

Satisfaction with dental services can provide valuable insights into aspects of quality including access as well as changes in this over time. In the UK publicly funded dental services are ostensibly delivered by private sector general dental practitioners for whom private patients represent an opportunity cost to the provision of care to public patients. This study examined changes in satisfaction as economic circumstances and policy changed in Britain between 1998 and 2019.

Methods

Data were taken from successive waves of the British Social Attitudes Survey a representative cross-sectional survey of the population between 1998 and 2019. Descriptive statistics and a series of logistic regression analyses were used to examine the relationships between satisfaction and a range of socio-demographic characteristics over time.

Results

37,328 usable responses were extracted from the survey spanning 21 years of data. Over the course of the survey approximately 71% of the sample was very satisfied, satisfied or neither satisfied nor dissatisfied with publicly funded dental services. Satisfaction fell at the outset of the study period but rose following the economic downturn from 2008 which coincided with increased use of publicly funded services. Differences were evident in satisfaction between older versus younger respondents, more affluent versus less affluent respondents and better educated versus less well-educated respondents. Satisfaction did not appear to change in response to policy changes.

Conclusion

Satisfaction is an important outcome of service provision. Policies aiming to improve satisfaction with publicly funded dental care in the UK must take account of the competing demands on dentists’ time from private patients. At times of economic expansion or when supply has been disrupted, these may be particularly acute and require specific interventions to improve access for those who depend on public services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02343-7.

Quality of the Healthcare Services During COVID-19 Pandemic in Selected European Countries

Background

There are several definitions of the quality of healthcare services. It may be defined as a level of value provided by any health care resource, as determined by some measurement. Scientists use a variety of quality measures to attempt to determine health care quality. They use special indicators or based on a patients' or healthcare professional's perception. This article aims to provide a short review of the available data on the quality of healthcare services in selected European countries during the COVID-19 pandemic.

Methodology

The research was done by the use of online databases such as PubMed, Google Scholar, and Science Direct. All the studies focused on the quality of healthcare services, yet the studies used different methods to measure this quality. In addition, the results of the authors' survey on the assessment of the quality of healthcare services before and during the COVID-19 pandemic were presented.

Results

Among twelve studies, four were from the United Kingdom and one each of Catalonia, Italy, Sweden, Poland, Netherlands, France, Germany, Belgium. Patients in the United Kingdom felt that the quality of services was good during the pandemic, whereas the quality declined in the other studies cited. The results of our research also revealed a decrease in the quality of healthcare services provided.

Conclusions

Nevertheless the development of telemedicine has had a positive impact on the quality of healthcare services. The COVID-19 pandemic has undoubtedly affected most European countries' quality of healthcare services.

A Patient-Centred Medical Home Care Model for Community-Dwelling Older Adults in Singapore: A Mixed-Method Study on Patient's Care Experience

Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore. We used a mixed-method design with a prospective single-group pre-post quantitative component and a concurrent qualitative component. Participants were administered the validated Consumer Assessment of Health Providers and Systems Clinician & Group Survey (CG-CAHPS) at baseline (N = 184) and 6-month (N = 166) post-enrolment. We conducted focus group discussions (FGDs) on a purposive sample of 24 participants. Both methods suggest better care experience in PCMH relative to usual care. There were improvements in the CG-CAHPS measures on patient–provider communication, care coordination, office staff interactions, support for patients in caring for their own health, and provider rating in PCMH relative to usual care. In the FGDs, participants reported benefits of consolidated appointments and positive experience in sustained patient–provider relationship, shared-decision making, and family/caregiver engagement in PCMH. Participants may not fully comprehend the concept of integrated care, hindering both the effective communication of the intended care model and perceived benefits such as the provision of multidisciplinary team-based care.

Hearing the patient voice: a qualitative interview study exploring the patient experience of a nurse-led initiative to integrate and enhance primary and secondary healthcare pathways

Objective

The Transitional Care Nursing Service was a 2-year proof-of-concept trial exploring local health system readiness for incorporating integrated, person-centred models of care into existing health service structures within a provincial New Zealand context. Improved patient experience remains a priority in international and local healthcare policy directives. This qualitative study aimed to investigate patient experience by exploring the effectiveness of this integrated care person-centred service from the patients’ perspective.

Methods

Qualitative, semistructured, face-to-face interviews with 12 patients purposively sampled to achieve maximum variation of patient characteristics within the trial cohort. Interviews were audio-recorded and transcribed verbatim before analysing the data using thematic analysis supported by a general inductive approach.

Results

Findings demonstrated that patient interactions with the transitional care nurse positively influenced patient experience, self-reported outcomes and quality of life following hospitalisation and during the transition period between hospital and home. Participants perceived the nurse to be highly skilled in displaying kindness, empathy, accessibility and responsiveness, and communication skills with participants and their families. They perceived that their interactions with this individual team member working from an integrated care paradigm had a positive impact on their overall experience of care and recovery.

Conclusion

This study supports the use of integrated care principles to deliver person-centred care. The findings emphasise the need to place kindness, compassion and respect at the heart of care delivered to patients, and suggest these core values are an essential factor in improving patient experience and thus the effectiveness of our healthcare systems.

Preferences for home care to enable home death among adult patients with cancer in late palliative phase - a grounded theory study

BACKGROUND

The wish to be cared for and to die at home is common among people with end-stage cancer in the western world. However, home deaths are declining in many countries. The aim of this study was to explore the preferences for home care over time to enable home death among adult patients with cancer in the late palliative phase.

METHODS

A qualitative method was applied according to grounded theory (Corbin & Strauss, 2008). Data was collected using individual interviews (n = 15) with nine adult patients. One to two follow up interviews were conducted with four patients. Sampling, data collection and constant comparative analysis were undertaken simultaneously.

RESULTS

The findings are presented as a conceptual model of patients' preferences for care to enable home death. The core category "Hope and trust to get the care I need to die at home" showed that the preference to die at home seemed stable over time and did not change with deterioration in health status and progression in illness. Five categories were related to the core category. The categories "being in the present", "be safe and in charge" and "be seen and acknowledged" describe the patients' preferences to live a meaningful life until death and be the same person as always. These preferences depended on the categories describing characteristics of healthcare personnel and the organisation of care: "reliable, compassionate and competent healthcare personnel" and "timely, predictive, continuous and adaptive organisation".

CONCLUSION

An important preference over time was to be here and now and to live as meaningful a life as possible until death. Moreover, the patients preferred to retain control over their lives, to be autonomous and to be seen as the person they had always been. To achieve this, person-centred care provided by healthcare personnel with competence, skills and enough/ample time were required. In addition, home care needed to be organised in a way that ensured continuity and predictability. Systematic implementation of a person-centred care model and the use of advanced home care plans with continued re-evaluation for patients' preferences of home care were proposed measures to enable home death.

From generalist to specialist: A qualitative study of the perceptions of infertility patients

Few studies explore in-depth accounts of women's and men's experiences with, and transitions between, obstetrician/gynaecologists (OB/GYNs) and reproductive endocrinologists during infertility diagnostic and treatment processes. This study examined this subject matter with data from qualitative, in-depth, semi-structured interviews. Between April 2007 and March 2008, the first author interviewed 20 women and eight men from a large midwestern metropolitan area in the USA who had used, or were in the process of using, any fertility treatment in the 5 years preceding the interview. Six couples and 16 individuals were interviewed, resulting in narratives of 22 distinct infertility journeys. The main complaints made by respondents about OB/GYNs were that they were insufficiently concerned with providing timely treatment and that they paid insufficient attention to male partners. Women felt that their concerns were taken more seriously by reproductive endocrinologists, but complained of insensitivity, depersonalization and misinformation, and were suspicious of a profit orientation.

Measuring the quality of care for older adults with multimorbidity: Results of the MULTIqual project

Background and Objectives

Providing health care for older adults with multimorbidity is often complex, challenging, and prone to fragmentation. Although clinical decision making should take into account treatment interactions, individual burden, and resources, current approaches to assessing quality of care mostly rely on indicators for single conditions. The aim of this project was to develop a set of generic quality indicators for the management of patients aged 65 and older with multimorbidity that can be used in both health care research and clinical practice.

Research Design and Methods

Based on the findings of a systematic literature review and eight focus groups with patients with multimorbidity and their family members, we developed candidate indicators. Identified aspects of quality were mapped to core domains of health care to obtain a guiding framework for quality-of-care assessment. Using nominal group technique, indicators were rated by a multidisciplinary expert panel (n = 23) following standardized criteria.

Results

We derived 47 candidate quality indicators from the literature and 4 additional indicators from the results of the focus groups. The expert panel selected a set of 25 indicators, which can be assigned to the levels of patient factors, patient–provider communication, and context and organizational structures of the conceptual framework.

Discussion and Implications

We developed a comprehensive indicator set for the management of multimorbidity that can help to highlight areas with potential for improving the quality of care and support application of multimorbidity guidelines. Furthermore, this study may serve as a blueprint for participatory designs in the development of quality indicators.

Quality Perceptions and Choice of Public Health Facilities: A Mediation Effect Analysis of Outpatient Experience in Rural China

PURPOSE

Outpatients have choices of providers in the hierarchical health service delivery system of China. Understanding how quality perceptions and outpatient experience affect the choice of health facility would help inform decisions about priorities for action aimed at guiding the use of primary care. This study examines how quality perceptions of outpatient service affect the facility level choice in rural China.

METHODS

Household surveys were conducted in 2011, 2012 and 2015 in Ningxia Hui Autonomous Region, China. We selected 968 respondents as the study sample, who had at least two outpatient visits to the public health facilities during each survey period. Prior quality perceptions of the outpatient service at the village clinics, township centers, and county hospitals were reported on an 8-item Quality Indicator questionnaire. Experienced quality perception from the first outpatient visit was also reported. The outcome of interest was outpatients' facility level choices. We used regression and mediation analysis to explore whether and how outpatient experience at a specific health facility would mediate the relationship between prior quality perceptions and the facility level choice.

RESULTS

Overall, the quality perception was positively and significantly associated with outpatients' staying at the same or lower levels of care (β=0.265, P=0.007). This effect was fully mediated by experienced quality perception (z=2.985, P=0.003). The indirect effect was significant for three particular dimensions, including quality perceptions of the environment (β=0.075, P=0.025), doctor-patient communication (β=0.065, P=0.022), and physician ability (β=0.062, P=0.021).

CONCLUSION

Outpatient quality perceptions-especially positive perceptions regarding environment, doctor-patient communication, and physician ability-could contribute to minimizing upward referral via improvement in outpatient experience. Policymakers and health care providers may need to therefore optimize outpatient experience as they push to develop a more locally responsive primary care system.

Patient-Reported Dental Safety Events: A South African Perspective

OBJECTIVES

In recent years, there has been an increase in research studies highlighting patients' experiences of adverse events (AEs) as well as the role of patients in promoting safety. The primary goal of the study was to assess the prevalence of dental AEs (DAEs) among dental patients in South Africa and its associated factors. The integration of the patient perspective into dental patient safety research will enhance our collective understanding of DAEs.

METHODS

We conducted a cross-sectional study of adult patients at a large dental academic institution in South Africa from May to June 2015, evaluating their previous experiences of DAEs at any dental clinic in South Africa. Descriptive statistics and bivariate and multivariate analyses were performed to identify the factors associated with an increased likelihood of experiencing a DAE.

RESULTS

A total of 440 questionnaires were returned during the 6-week study period (response rate = 97.8%). Overall, 45.5% of participants reported experiencing one or more DAEs. Two hundred participants reported a total of 717 DAEs giving us a lifetime prevalence of 1.6 DAEs per respondent. Our results suggest that respondents who were younger (18-24 y), from high-income families (>R150,000 or US $9200), dissatisfied with their last dental visit and oral health had an increased likelihood of reporting a previous experience of a DAE.

CONCLUSIONS

This study provides an insight into the nature of information that can be gleaned from dental patients regarding safety and helps lay the foundation for patient involvement in patient safety reporting.

Mobile Health Systems Affordability in India: Perspectives of Stakeholders

Purpose:

The purpose of this study were to identify stakeholder perspective for achieving affordable and cost-effective system outcomes and what describes success associated with mHealth systems in India. This study identifies stakeholder views on (a) fundamental conditions for initiating mobile health (mHealth) systems and (b) desirable outcomes regarding affordable and cost-effectiveness of successful mHealth systems.

Design/Methodology/Approach:

This qualitative study uses existing models of affordability and used an inductive approach to organise emerging codes as per a priori themes. Data were collected from direct observations and 17 in-depth interviews both online and offline involving stakeholder, namely healthcare professionals, technology entrepreneurs and software developers working on health information and mHealth systems.

Findings:

Findings illustrated people’s need and unwillingness, lack of application infrastructure, ecosystem development, governmental policies, and training and support as factors influencing successful mHealth systems in India.

Originality/Value:

Earlier studies were less adequate in explaining mHealth systems affordability and cost-effectiveness from the perspective of stakeholder. The current study attempts to provide fundamental conditions and desirable outcomes that are considered to be valuable for developing mHealth systems. This makes healthcare providers with information of what needs to be considered for developing mHealth systems.

Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

Background

Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered.

Methods

Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient.

Results

People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence.

Conclusion

People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care.

Trial registration

ISRCTN41083256. Registered on 30/03/2016.

Satisfaction with maternity care among recent migrants: an interview questionnaire-based study

OBJECTIVE

To examine factors associated with recently migrated women's satisfaction with maternity care in urban Oslo, Norway.

DESIGN

An interview-based cross-sectional study, using a modified version of Migrant Friendly Maternity Care Questionnaire.

SETTING

Face-to-face interview after birth in two maternity wards in urban Oslo, Norway, from January 2019 to February 2020.

PARTICIPANTS

International migrant women, ≤5 years length of residency in Norway, giving birth in urban Oslo, excluding women born in high-income countries.

PRIMARY OUTCOME

Dissatisfaction of care during pregnancy and birth, measured using a Likert scale, grouped into satisfied and dissatisfied, in relation to socio-demographic/clinical characteristics and healthcare experiences.

SECONDARY OUTCOME

Negative healthcare experiences and their association with reason for migration.

RESULTS

A total of 401 women answered the questionnaire (87.6% response rate). Overall satisfaction with maternal healthcare was high. However, having a Norwegian partner, higher education and high Norwegian language comprehension were associated with greater odds of being dissatisfied with care. One-third of all women did not understand the information provided by the healthcare personnel during maternity care. More women with refugee background felt treated differently because of factors such as religion, language and skin colour, than women who migrated due to family reunification.

CONCLUSIONS

Although the overall satisfaction was high, for certain healthcare experiences such as understanding information, we found more negative responses. The negative healthcare experiences and factors associated with satisfaction identified in this study have implications for health system planning, education of healthcare personnel and strategies for quality improvement.

Power and Efficacy of Maternal Voice in Neonatal Intensive Care Units: Implicit Bias and Family-Centered Care

INTRODUCTION

Implicit bias can lead medical professionals in Neonatal Intensive Care Units (NICUs) to disregard mothers who are Black and economically disadvantaged as they advocate for their infants' health. Disregard can weaken underlying communication principles within the Family-Centered Care (FCC) model of pediatric health in NICUs and increase maternal distress. This study is the first to address communication disregard by examining mothers' perceived power and efficacy of voice with NICU doctors and nurses. We hypothesized that mothers who are Black and economically disadvantaged would report lower efficacy of voice and higher levels of distress as compared to White mothers with higher income.

METHODS

During pre-assessment within a small clinical trial of a parenting intervention, 33 racially and economically diverse mothers, from three Midwest NICUs serving the urban poor, responded to a 14-item measure of maternal power and efficacy of voice and measures of somatization, depression, anxiety and eating/sleeping disorders. Nonparametric examinations assessed the relation of power and efficacy of voice to maternal race, income, and distress.

RESULTS

In contrast to White, higher-income mothers, Black, economically disadvantaged mothers reported lower perceived efficacy of voice with doctors (U = 74.5, d = 0.65) and nurses (U = 74.0; d = .0.66). These mothers with lower perceived efficacy with doctors and nurses, reported higher levels of somatization (U = 16.5, d = 1.14; U = 13.5, d = 1.38, respectively) and eating disorders (U = 14.0, d = 1.29; U = 12.0, d = 1.48, respectively).

DISCUSSION

Study results are discussed within the framework of implicit bias in FCC in the NICU, expanding our understanding of effective communication with economically stressed, Black mothers.

Quality of care for people with multimorbidity: a focus group study with patients and their relatives

BACKGROUND

Prevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients' perspective and match them to a literature-based set of QIs.

METHODS

We conducted eight focus groups with patients with multimorbidity and three focus groups with patients' relatives using a semistructured guide. Data were analysed using Kuckartz's qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI.

RESULTS

We created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants' accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups.

CONCLUSION

We show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity.

TRIAL REGISTRATION NUMBER

German clinical trials registry (DRKS00015718), Pre-Results.

Implementing care coordination in a large dental care organization in the United States by upskilling front office personnel

BACKGROUND

Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilot's success, a formal "dental care advocate" (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation.

METHODS

Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed.

RESULTS

With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients' questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed.

CONCLUSIONS

Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry.

Patient Factors and Perioperative Outcomes Affect Hospital Consumer Assessment of Healthcare Providers and Systems Survey Response Rates After Primary Total Hip Replacement

INTRODUCTION

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a federally mandated survey that assesses patient satisfaction after hospitalization. It has been noted that a minority of patients actually return the survey. Potential bias in who does and does not respond to the survey (nonresponse bias) after total hip arthroplasty (THA) may affect the survey results.

METHODS

All adult patients undergoing inpatient elective primary THA between February 2013 and May 2020 at a single institution were selected for retrospective analysis. After discharge, all had been mailed the HCAHPS survey, and the primary outcome for the current study was survey return. Patient characteristics and 30-day perioperative outcomes were assessed. Univariate and multivariate analyses were performed to determine correlations between the above variables and HCAHPS survey return status.

RESULTS

Of 3,310 THA patients analyzed, 1,049 (31.69%) returned the HCAHPS surveys. On multivariate regression analyses, patients who did not return the survey were more likely to have a higher American Society of Anesthesia score (score of three or higher, odds ratio [OR] = 2.27; P < 0.001), be more functionally dependent (OR = 2.69; P = 0.005), or be Black/African American (OR = 3.40; P < 0.001). Similarly, patients who did not return the survey were more likely to have had any adverse event (OR = 1.80; P = 0.012), major adverse event (OR = 2.88; P = 0.007), readmission (OR = 2.13; P < 0.001), be discharged to a place other than home (OR = 1.71; P < 0.001), or stay in the hospital for longer than 3 days (OR = 1.89; P < 0.001).

DISCUSSION

After THA, the HCAHPS survey response rate was only 31.69% and completion of the survey correlated with demographic and perioperative variables. These findings suggest that the HCAHPS survey results should be interpreted as a skewed sample of the true surgical patient population. Nonresponse bias is an important factor to consider when evaluating healthcare quality, patient satisfaction survey results, and their effects on federal hospital reimbursement rates.

Putting patients first: development of a patient advocate and general practitioner-informed model of patient-centred care

Background

Patients, providers and health care organisations benefit from an increased understanding and implementation of patient-centred care (PCC) by general practitioners (GPs). This study aimed to evaluate and advance a theoretical model of PCC developed in consultation with practising GPs and patient advocates.

Methods

Qualitative description in a social constructivist/interpretivist paradigm. Participants were purposively sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia. Participants engaged in focus group discussions where they expressed their perceptions, views and feelings of an existing PCC model. Data was analysed thematically using a constant-comparison approach.

Results

Three focus groups with 15 patient advocates and three focus groups with 12 GPs were conducted before thematic saturation was obtained. Three themes emerged: i) the model represents the ideal, ii) considering the system and collaborating in care and iii) optimising the general practice environment. The themes related to participants’ impression of the model and new components of PCC perceived to be experienced in the ‘real world’. The data was synthesised to produce an advanced model of PCC named, “Putting Patients First: A Map for PCC”.

Conclusions

Our revised PCC model represents an enhanced understanding of PCC in the ‘real world’ and can be used to inform patients, providers and health organisations striving for PCC. Qualitative testing advanced and supported the credibility of the model and expanded its application beyond the doctor-patient encounter. Future work could incorporate our map for PCC in tool/tool kits designed to support GPs and general practice with PCC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06273-y.

Implementation of the INTERGROWTH-21st gestational dating and fetal and newborn growth standards in Nairobi, Kenya: women's experiences with ultrasound and newborn assessment

Background

In order to make further gains in preventing newborn deaths, effective interventions are needed. Ultrasounds and newborn anthropometry are proven interventions to identify preterm birth complications, the leading cause of newborn deaths. The INTERGROWTH-21^st global gestational dating and fetal and newborn growth standards prescribe optimal growth in any population. Jacaranda Health in Kenya was the first low-resource health facility to implement the standards and evaluate their feasibility and acceptability.

Objective

To capture patients’ perceptions of ultrasound and newborn care before and during implementation of the INTERGROWTH-21^st standards.

Methods

The study was conducted over two years before and during the introduction of the INTERGROWTH-21^st standards. Fifty pregnant and/or newly delivered women were selected for in-depth interviews and focus group discussions using convenience and purposive sampling. Interviews were conducted by research assistants using semi-structured guides once in the pre-implementation phase and twice in the implementation phase. Interviews were transcribed, double-coded by two independent researchers and thematically analyzed together. Demographic information was obtained from hospital records.

Results

Patients reported being generally satisfied with ultrasound care when providers communicated effectively. Women reported a priority for ultrasound was that it allowed them to feel reassured. However, a clear need for better pre-screening information emerged consistently from patients. Women noted that factors facilitating their choosing to have an ultrasound included ensuring the well-being of the fetus and learning the sex. Barriers included wait times and financial constraints. Patients were generally satisfied with care using the newborn standards.

Conclusions

As the INTERGROWTH-21^st standards are implemented worldwide, understanding ways to facilitate implementation is critical. Increased and standardized communication about ultrasound should be provided before the procedure to increase satisfaction and uptake. Considering patient perspectives when integrating new standards or guidelines into routine clinical care will inform effective strategies in care provision, thus improving maternal and newborn health and survival.

Hospital Competition and Unplanned Readmission: Evidence from a Systematic Review

Competition has been widely introduced among hospitals in the hope of improving health-care quality. However, whether competition leads to higher-quality health care is a topic of considerable debate. We conducted a systematic review to assess the impact of hospital-market competition on unplanned readmission. We searched six electronic databases (PubMed, EmBase, Wiley Online Library, Web of Science, Scopus, and JSTOR) and reference lists of screened articles for relevant studies, and strictly followed methods proposed by the Cochrane Collaboration. Finally, nine observational studies with 2,241,767 patients were included. For the primary outcome, pooled results of three studies showed that it was uncertain whether or not hospital competition reduces readmission (β=0.02, P=0.06; very low certainty of evidence, as they were all observational studies with high heterogeneity). Inconsistent results were found in the remaining six studies, and they were assessed as very low–certainty evidence, downgraded for either inconsistency or indirectness or both. As for secondary outcomes, seven of the nine studies reported on the impact of competition on the risk of mortality, and two reported on length of stay (LOS). It was uncertain whether competition had an effect on mortality or LOS. The relevant studies were limited and of very low certainty, which means there is currently no reliable evidence showing that hospital competition reduces quality of health care in terms of readmission/mortality/LOS. There is a need for rigorous studies to assess the impact of hospital competition on the quality of health care.

Patient-centered communication: an extension of the HCAHPS survey

Purpose

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has been recognized as a “gold standard” set of “practical standardized measures” for assessing hospital service quality. Beginning with the HCAHPS, the purpose of this paper is to extend efforts to assess patient-centered communication (PCC) and the quality of healthcare and presents a scale for measuring patient perceptions and expectations of service quality in an emerging economy context.

Design/methodology/approach

A self-administered survey of patients in private hospitals (N = 171) was conducted to test the proposed framework. Exploratory and confirmatory factor analyses were used to establish the measurement model. Multiple regression analysis was used to explain the scale's predictive ability. ANOVA was used to analyze service quality gaps and rank patients' priorities.

Findings

Five components of PCC are identified. Among these, nurse affective communication has a significant positive effect on patient satisfaction. The gap analysis shows that patients have high expectations for doctors' affective communication, while they perceive a low level of service performance in the realm of nurse affective communication. The study highlights a new means of measuring “reliability” in healthcare. Important findings on patients' priorities are evaluated and discussed.

Practical implications

Healthcare organizations and practitioners can improve patient-centered care by stressing the dimensions of PCC, including clinicians' affective and instrumental communication.

Originality/value

The study expands the understanding of HCAHPS instruments in an emerging economy context and opens avenues for more widespread use of the measures. The research contributes to the literature on patient-centered care and healthcare service quality by proposing a scale for managing specific practices and interactions in healthcare.

Patient-centred care delivered by general practitioners: a qualitative investigation of the experiences and perceptions of patients and providers

BACKGROUND

Patient-centred care (PCC) is care that is respectful and responsive to the wishes of patients. The body of literature on PCC delivered by general practitioners (GPs) has increased steadily over time. There is an opportunity to advance the work on GP-delivered PCC through qualitative research involving both patients and providers.

AIM

To explore the perceptions and experiences of PCC by patient advocates and GPs.

DESIGN AND SETTING

Qualitative description in a social constructivist paradigm. Participants were sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia.

METHOD

Purposive sampling was used to recruit English-speaking adult participants who were either practising GPs or patient advocates. Focus group sessions explored participants' perceptions and experiences of PCC. Data were analysed thematically using a constant-comparative approach.

RESULTS

Three focus groups with 15 patient advocates and three focus groups with 12 practising GPs were conducted before thematic saturation was obtained. Five themes emerged: (1) understanding of PCC is varied and personal, (2) valuing humanistic care, (3) considering the system and collaborating in care, (4) optimising the general practice environment and (5) needing support for PCC that is embedded into training.

CONCLUSION

Patient advocates' and GPs' understanding of PCC are diverse, which can hinder strategies to implement and sustain PCC improvements. Future research should explore novel interventions that expose GPs to unique feedback from patients, assess the patient-centeredness of the environment and promote GP self-reflection on PCC.

Perception of integrative care in paediatric oncology-perspectives of parents and patients

PURPOSE

For some years now, a programme for the use of integrative care in paediatric oncology has been established in a German university hospital and offers patients and parents complementary treatment options. According to their medical condition and wishes. A variety of external applications such as medical wraps, warm oil compresses and rhythmic embrocations are offered. This article analyses how patients and parents perceived and experienced the integrative care program.

METHODS

In this qualitative study, data consists of field notes conducted through participant observation, informal conversations and interviews with parents (n = 25) during the implementation phase of the program. Data was analysed on basis of thematic analysis and organized with the analysis software MAXQDA.

RESULTS

Parents and families intuitively developed strategies for dealing with crisis situations such as childhood cancer. In addition, many of the families brought with them a wealth of experience in complementary medicine. Parents perceived the integrative care treatments as soothing, relaxing and pain-relieving for their child. Patients could relax and side effects of chemotherapy were alleviated. However, children, who undergoing chemotherapy were not always open for physical touch and thus sometimes also rejected the treatments sometimes.

CONCLUSION

The analysed integrative care programme is perceived as a strong patient and family-centred approach of support during the oncological paediatric treatment. From a salutogenetic viewpoint, this program aims to strengthen the dimension of manageability within the concept of sense of coherence. Parents are given supportive means to manage side effects and ease their child's suffering, through touch and attention that can be very beneficial.

Perceived quality of surgical care in association with patient-related factors and correlation to reported postoperative complications in Finland: a cross-sectional study

OBJECTIVE

To study if patient-related factors are associated with patient-evaluated quality of care in surgery. To examine if there is an association with postoperative complications and patient-evaluated low quality of care.

DESIGN

A correlation cross-sectional study, in addition, a phone call interview at 30 days postoperatively to examine complications.

SETTING

The data on patients admitted for non-cardiac general and orthopaedic surgery at a central hospital in Southwestern Finland were collected in two phases during an 8-month period.

PARTICIPANTS

436 consecutive consenting and eligible in-ward non-cardiac general surgery and orthopaedic surgery adult patients. Ambulatory, paediatric and memory disorder patients were excluded. 378 patients completed the questionnaire (Good Nursing Care Scale for Patients (GNCS-P)).

METHODS

Perceived quality of care was examined by the GNCS-P questionnaire. Patient-related factors were obtained from electronic patient records and questionnaire. A telephone interview related to postdischarge complications was conducted 30 days after discharge.

MAIN OUTCOME MEASURES

Patient evaluation of quality of care at discharge, its association with patient-related factors and patient-reported postdischarge complications.

RESULTS

The overall quality was evaluated high or very high by the patients. The lowest overall quality of care rate was assessed by surgical patients living alone (p=0.0088) and patients who evaluated their state of health moderate or poor (p=0.0047). Surgical patients reporting postoperative complications after discharge evaluated lower overall quality of care (p=0.0105) than patients with no complications.

CONCLUSION

Patient demographic factors do not seem to influence the perceptions of the quality of care. Instead, subjective state of health and living conditions (living alone) may have an influence on the patient experience of quality of care. The perceived quality of care in healthcare staff technical and communication skills may have an association with reported postoperative complications.

Measuring the Patient Experience of Mental Health Care: A Systematic and Critical Review of Patient-Reported Experience Measures

BACKGROUND

There is growing concern about measuring patient experience with mental health care. There are currently numerous patient-reported experience measures (PREMs) available for mental health care, but there is little guidance for selecting the most suitable instruments. The objective of this systematic review was to provide an overview of the psychometric properties and the content of available PREMs.

METHODS

A comprehensive review following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines was conducted using the MEDLINE database with no date restrictions. The content of PREMs was analyzed using an inductive qualitative approach, and the methodological quality was assessed according to Pesudovs quality criteria.

RESULTS

A total of 86 articles examining 75 PREMs and totaling 1932 items were included. Only four PREMs used statistical methods from item response theory (IRT). The 1932 items covered seven key mental health care domains: interpersonal relationships (22.6%), followed by respect and dignity (19.3%), access and care coordination (14.9%), drug therapy (14.1%), information (9.6%), psychological care (6.8%) and care environment (6.1%). Additionally, a few items focused on patient satisfaction (6.7%) rather than patient experience. No instrument covered the latent trait continuum of patient experience, as defined by the inductive qualitative approach, and the psychometric properties of the instruments were heterogeneous.

CONCLUSION

This work is a critical step in the creation of an item library to measure mental health care patient-reported experience that will be used in France to develop, validate, and standardize item banks and computerized adaptive testing (CAT) based on IRT. It will also provide internationally replicable measures that will allow direct comparisons of mental health care systems.

TRIAL REGISTRATION

NCT02491866.