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Collins-Fairclough A, Rideout K, Joshi P, Philips J, Lanier T, Chow S, Smith D, Hoens A, FitzGerald JM, Rauscher C, Strydom N, Carlsten C. Opportunities to improve asthma and COPD prevention and care: insights from the patient journey obtained through focus groups. BMJ Open Qual 2023; 12:e002403. [PMID: 38092427 PMCID: PMC11148695 DOI: 10.1136/bmjoq-2023-002403] [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] [Received: 05/03/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The healthcare experiences of patients hold valuable insights for improving the quality of services related to their well-being. We therefore invited and explored the perspectives of patients living with asthma and chronic obstructive pulmonary disease (COPD) on their interaction with the systems supporting health, in order to identify opportunities to improve services to prevent, treat and manage these conditions. METHODS Two virtual focus groups were held in August 2021, one for adult asthma and one for COPD, to learn of patients' experiences receiving care for these conditions in the Vancouver Coastal Health (VCH) region of British Columbia. Participants were recruited through online postings or their clinician. We discussed the care pathway for each condition and invited participants to share their experiences of the past 5 years, specifically their reflections on the process, including feelings, points of praise and frustration, and opportunities for improvement in this context. Composite patient journey maps were developed for each condition to reflect the experiences shared. Audio recordings of the focus groups were transcribed and used in qualitative data analysis. RESULTS Thematic analysis revealed the following as possible areas for improvement: low public awareness of asthma and COPD and associated risk factors, non-standardised diagnosis pathways that delay diagnosis, and inconsistency in delivering valued aspects of care such as supports for self-management, trust-inspiring acute care, empowering patient communication and timely access to care. CONCLUSION We successfully used focus groups to generate composite journey maps of the experiences of patients living with asthma (n=8) and COPD (n=9) to identify features that these patients consider important for improving the healthcare system for asthma and COPD in VCH. Health professionals, decision makers and patient advocates in VCH and beyond can consider these insights when evaluating, and planning changes to, current practices and policies in service delivery.
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Affiliation(s)
- Aneisha Collins-Fairclough
- Division of Respiratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Karen Rideout
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Center for Lung Health, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Phalgun Joshi
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Center for Lung Health, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Jeremiah Philips
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tony Lanier
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Santa Chow
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Dan Smith
- Legacy for Airway Health, Community Stakeholder Committee, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Alison Hoens
- Department of Physical Therapy, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Center for Lung Health, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Chris Rauscher
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Nardia Strydom
- Department of Family and Community Medicine, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
- Department of Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
| | - Christopher Carlsten
- Division of Respiratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Barbazza E, Allin S, Byrnes M, Foebel AD, Khan T, Sidhom P, Klazinga NS, Kringos DS. The current and potential uses of Electronic Medical Record (EMR) data for primary health care performance measurement in the Canadian context: a qualitative analysis. BMC Health Serv Res 2021; 21:820. [PMID: 34392832 PMCID: PMC8364440 DOI: 10.1186/s12913-021-06851-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Electronic Medical Records (EMRs) are a rich data source to measure and improve quality of care. As Canadian primary health care (PHC) EMRs mature, there is increasing potential use of EMR data for performance measurement. This study identifies and describes current uses of EMR data for performance measurement and considerations to further its potential in the Canadian context. METHODS We applied a qualitative case study design and descriptive assessment in three phases, consulting multiple data sources including scientific and grey literature, system leaders (n = 41), and clinician/researchers (n = 20). Phases included a multimethod approach to identify initiatives using EMR data for performance measurement across Canadian jurisdictions; in-depth review of current initiatives identified from a healthcare performance intelligence lens; and triangulation and thematic analysis across data sources to explore considerations for advancing performance measurement uses of EMR data in the Canadian context. RESULTS Six initiatives of EMR data use for performance measurement were identified: one multi-jurisdictional; five jurisdiction-specific in the provinces of British Columbia, Manitoba and Ontario. EMR data uses were predominately for micro-level PHC physician and team performance improvement, with some use for meso-level organization/network-wide improvement. Indicator sets varied in number, though shared emphasis on chronic disease management and prevention/screening and to a lesser extent medication management. Key considerations for governing, resourcing and implementing EMR data for performance measurement were identified. CONCLUSIONS The extent of EMR data use for performance measurement varies across Canada. To further its potential, pan-Canadian data and privacy standards, performance intelligence competencies and renewed core PHC indicators should be prioritized. Experiences across countries, coupled with increasing momentum for performance measurement using real-world data, should be leveraged to avoid unnecessarily slow progress in Canada and abroad.
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Affiliation(s)
- Erica Barbazza
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Sara Allin
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Mary Byrnes
- Canadian Institute for Health Information (CIHI), Toronto, Canada
| | - Andrea D Foebel
- Canadian Institute for Health Information (CIHI), Toronto, Canada
| | - Tanya Khan
- Canadian Institute for Health Information (CIHI), Toronto, Canada
| | - Patricia Sidhom
- Canadian Institute for Health Information (CIHI), Toronto, Canada
| | - Niek S Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Dionne S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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