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Chapman M, Milte R, Dawson S, Laver K. Patient-reported experience measures for people living with dementia: A scoping review. DEMENTIA 2024; 23:1354-1381. [PMID: 39118041 DOI: 10.1177/14713012241272823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
The prevalence of dementia is increasing globally, with an estimated 139 million people expected to be living with dementia by 2050. Across numerous countries, substandard care for people with dementia is evident, with quality improvement needed. Recently, a focus on patient-reported experience measures (PREMs) has been utilised in healthcare services as a method of evaluating the care experiences provided and determining areas of improvement. The literature is scarce regarding the feasibility and acceptability of implementing PREMs with people with moderate to advanced dementia. This scoping review aimed to identify PREMs that have been used with vulnerable populations including people with cognitive impairment, mental health concerns, and children, outline dimensions included, and determine adaptions made to the PREMs to improve acceptability of the instruments for vulnerable populations. A database search of Medline was conducted to identify 36 studies including 32 PREMs. The PREMs identified covered a range of dimensions, most frequently care effectiveness, care environment, and patient involvement. The most common adaption to the PREMs was simplification of wording and sentence structure. Several measures conflated patient outcomes and patient satisfaction with patient experience, limiting utility for improving patient experience specifically. While several PREMs have been used with people with dementia, challenges in their implementation and their applicability to specific settings limit their use more broadly. Evidently, there is a need for development of a PREM for people with moderate to advanced dementia that is applicable across healthcare settings and is appropriately adapted for varying cognitive and communicative barriers.
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Affiliation(s)
- Madison Chapman
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Suzanne Dawson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Kate Laver
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
- Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Australia
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Ma K, Rahimi A, Rajagopal M, Yaskina M, Goldman RD, Jones A, Erickson T, Poonai N, McGahern C, Weingarten L, Lerman B, Auclair MC, Wong H, Hartling L, Schreiner K, Scott S, Ali S. A national survey of children's experiences and needs when attending Canadian pediatric emergency departments. PLoS One 2024; 19:e0305562. [PMID: 38917134 PMCID: PMC11198794 DOI: 10.1371/journal.pone.0305562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition. METHODS 514 children, aged 7-17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018-2020. RESULTS Median child age was 12.0 years (IQR 9.0-14.0); 56.5% (290/513) were female. 78.8% (398/505) reported adequate privacy during healthcare conversations and 78.3% (395/504) during examination. 69.5% (348/501) understood their diagnosis, 89.4% (355/397) the rationale for performed tests, and 67.2% (338/503) their treatment plan. Children felt well taken care of by nurses (90.9%, 457/503) and doctors (90.8%, 444/489). Overall, 94.8% (475/501) of children were happy with their ED visit. Predictors of a child better understanding their diagnosis included doctors talking directly to them (OR 2.21 [1.15, 4.28]), having someone answer questions and worries (OR 2.51 [1.26, 5.01]), and older age (OR 1.08 [1.01, 1.16]). Direct communication with a doctor (OR 2.08 [1.09, 3.99]) was associated with children better understanding their treatment, while greater fear/ 'being scared' at baseline (OR 0.59 [0.39, 0.89]) or at discharge (OR 0.46 [0.22, 0.96]) had the opposite effect. INTERPRETATION While almost all children felt well taken care of and were happy with their visit, close to 1/3 did not understand their diagnosis or its management. Children's reported satisfaction in the ED should not be equated with understanding of their medical condition. Further, caution should be employed in using caregiver satisfaction as a proxy for children's satisfaction with their ED visit, as caregiver satisfaction is highly linked to having their own needs being met.
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Affiliation(s)
- Keon Ma
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Asa Rahimi
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Manasi Rajagopal
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Maryna Yaskina
- Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
| | - Ran D. Goldman
- Department of Pediatrics, University of British Columbia and BC Children’s Hospital Research Institute, Division of Emergency Medicine, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Vancouver, BC, Canada
| | - Ashley Jones
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Tannis Erickson
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Naveen Poonai
- Departments of Paediatrics, Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Candice McGahern
- Division of Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Laura Weingarten
- Division of Pediatric Emergency Medicine, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Bethany Lerman
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kurt Schreiner
- Pediatric Emergency: Advancing Knowledge (PEAK) Research Team, University of Alberta, Edmonton, AB, Canada
| | - Shannon Scott
- Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
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Vukovic AA, Krentz C, Gauthier A, Harun N, Porter SC. The Association of Emergency Severity Index Score and Patient and Family Experience in a Pediatric Emergency Department. J Patient Exp 2023; 10:23743735231179040. [PMID: 37469553 PMCID: PMC10353023 DOI: 10.1177/23743735231179040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
The study aim was to determine the relationship between a patient's Emergency Severity Index (ESI) score and their or their family's response to the key performance indicator (KPI) question on the post-visit patient and family experience (PFE) survey. Retrospective review of patients presenting to the Pediatric Emergency Department between July 1, 2021, and June 30, 2022, who completed the KPI question on an associated post-visit survey. We performed univariate analyses on all candidate variables; multivariable linear regression identified independent predictors of KPI on the PFE survey. A total of 8136 patients were included in the study. Although ESI score was significantly associated with PFE in univariate analysis, this association was lost in the multivariable model. Independent associations were appreciated with race/ethnicity, time to provider, length of stay, and procedure performance during the visit. Although ESI is not independently associated with PFE in this study, its interaction with factors such as time to provider, length of stay, and procedure performance may be important for emergency department providers creating interventions to impact experience during low acuity visits.
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Affiliation(s)
- Adam A Vukovic
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Callie Krentz
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abigail Gauthier
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephen C Porter
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Rochat J, Ehrler F, Siebert JN, Ricci A, Garretas Ruiz V, Lovis C. Usability Testing of a Patient-Centered Mobile Health App for Supporting and Guiding the Pediatric Emergency Department Patient Journey: Mixed Methods Study. JMIR Pediatr Parent 2022; 5:e25540. [PMID: 35289754 PMCID: PMC8965675 DOI: 10.2196/25540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/18/2021] [Accepted: 12/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patient experience in emergency departments (EDs) remains often suboptimal and can be a source of stress, particularly in pediatric settings. In an attempt to support patients and their families before, during, and after their visit to a pediatric ED, a mobile health (mHealth) app was developed by a multidisciplinary team based on patient-centered care principles. OBJECTIVE This study aims to evaluate the usability (effectiveness, efficiency, and satisfaction) of a new mHealth app, InfoKids, by potential end users through usability testing. METHODS The app was assessed through an in-laboratory, video-recorded evaluation in which participants had to execute 9 goal-oriented tasks, ranging from account creation to the reception of a diagnostic sheet at the end of the emergency care episode. Effectiveness was measured based on the task completion rate, efficiency on time on task, and user satisfaction according to answers to the System Usability Scale questionnaire. Think-aloud usability sessions were also transcribed and analyzed. Usability problems were rated for their severity and categorized according to ergonomic criteria. RESULTS A total of 17 parents participated in the study. The overall completion rate was 97.4% (149/153). Overall, they reported good effectiveness, with the task successfully completed in 88.2% (135/153) of cases (95% CI 83%-93%). Each task, with the exception of the first, created difficulties for some participants but did not prevent their completion by most participants. Users reported an overall good to excellent perceived usability of the app. However, ergonomic evaluation identified 14 usability problems occurring 81 time. Among these, 50% (7/14) were serious as their severity was rated as either major or catastrophic and indicated areas of improvements for the app. Following the suggested usability improvements by participants, mitigation measures were listed to further improve the app and avoid barriers to its adoption. CONCLUSIONS Usability of the InfoKids app was evaluated as good to excellent by users. Areas of improvement were identified, and mitigation measures were proposed to inform its development toward a universal app for all ED patients visiting a digitalized institution. Its contribution could also be useful in paving the way for further research on mobile apps aimed at supporting and accompanying patients in their care episodes, as research in this area is scarce.
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Affiliation(s)
- Jessica Rochat
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Ehrler
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Arnaud Ricci
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Victor Garretas Ruiz
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
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Heyming TW, Donaldson CD, Ehwerhemuepha L, Feaster W, Fortier MA, Kain ZN. Multivariable Analysis of Patient Satisfaction in the Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e544-e549. [PMID: 34348353 DOI: 10.1097/pec.0000000000002514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Published data on predictive factors associated with parent satisfaction from care in a pediatric emergency department (ED) visit are limited to be descriptive and obtained from small data sets. Accordingly, the purpose of this study was to determine both modifiable and nonmodifiable demographic and operational factors that influence parental satisfaction using a large and ethnically diverse site data set. METHODS Data consist of responses to the National Research Council (NRC) survey questionnaires and electronic medical records of 15,895 pediatric patients seen in a pediatric ED between the ages of 0 and 17 years discharged from May 2018 to September 2019. Bivariate, χ2, and multivariable logistic regression analyses were carried out using the NRC item on rating the ED between 0 and 10 as the primary outcome. Responses were coded using a top-box approach, a response of "9" or "10" represented satisfaction with the facility, and every other response was indicated as undesirable. Demographic data and NRC questionnaire were used as potential predictors. RESULTS Multivariable regression analysis found the following variables as independent predictors for positive parental rating of the ED: Hispanic race/ethnicity (odds ratio [OR], 1.285), primary language Spanish (OR, 2.399), and patients who had government-sponsored insurance (OR, 1.470). Those survey items with the largest effect size were timeliness of care (OR, 0.188) and managing discomfort (OR, 0.412). CONCLUSIONS Parental rating of an ED is associated with nonmodifiable variables such as ethnicity and modifiable variables such as timeliness of care and managing discomfort.
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Spezia N, Soncin M, Masella C, Agasisti T. Studying the Experience of Care Through Latent Class Analysis: An Application to Italian Neonatal Intensive Care Units. J Patient Exp 2022; 9:23743735221107231. [PMID: 35813241 PMCID: PMC9260577 DOI: 10.1177/23743735221107231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Though many data on the experience of care of patients and caregivers are collected, they are rarely used to improve the quality of health care delivery. One of the main causes is the widespread struggle in interpreting and enhancing these data, requiring the introduction of new techniques to extract intelligible, meaningful, and actionable information. This research explores the potentiality of the latent class analysis (LCA) statistical model in studying experience data. A cross-sectional survey was administered to 482 parents of infants hospitalized in several Italian neonatal intensive care units. Through a 3-step LCA, four subgroups of parents with specific experience profiles, sociodemographic characteristics, and levels of satisfaction were identified. These were composed of parents who reported (1) a positive experience (36%), (2) problematic communication with unit staff (30%), (3) limited access to the unit and poor participation in their baby's care (26%), and (4) a negative experience (8%). Through its explorative segmentation, LCA can provide valuable information to design quality improvement interventions tailored to the specific needs and concerns of each subgroup.
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Affiliation(s)
- Nicola Spezia
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Mara Soncin
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Cristina Masella
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Tommaso Agasisti
- Department of Management, Economics, and Industrial Engineering, Politecnico di Milano, Milan, Italy
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