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Hussien M. The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study. BMC Health Serv Res 2024; 24:614. [PMID: 38730420 PMCID: PMC11084123 DOI: 10.1186/s12913-024-11091-z] [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: 12/26/2023] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Patients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users' perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers. METHODS A community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval. RESULTS A typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0-10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091). CONCLUSIONS Service users' perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users' perceptions, with a special emphasis on improving health care providers' communication skills and removing facility-level access barriers.
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Affiliation(s)
- Mohammed Hussien
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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2
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Rudilla D, Alonso T, García E, Pérez P, Valenzuela C, Girón R, Zamora E, Soriano J, Landete P, Ancochea J. Psychometric Validation of the Patient-Reported Experience Measure (PREM) Questionnaire "HowRwe" in Patients With Respiratory Disease Receiving Home Respiratory Therapies. OPEN RESPIRATORY ARCHIVES 2024; 6:100304. [PMID: 38496265 PMCID: PMC10943053 DOI: 10.1016/j.opresp.2024.100304] [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] [Received: 12/27/2023] [Accepted: 01/28/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction The patient experience is defined as all the interactions that occur between patients and the healthcare system. The experience of patients with respiratory disease with home respiratory treatments (HRT) is not captured in currently available Patient-Reported Outcome Measures (PROM). We present the psychometric validation of the Patient-Reported Experience Measure (PREM) 'HowRwe' in Spanish and for respiratory patients with HRT. Methods After translation following ISPOR guidelines (International Society for Pharmacoeconomics and Outcomes Research), the questionnaire was administered to adult respiratory patients who were receiving treatment at Hospital Universitario de La Princesa. The administration was done in two stages with 6 months of difference between the pre- and post-test. Results We studied 228 respiratory patients, with a mean (SD) age of 64.1 (13.2) years, 52.2% were men, 68.0% were married or coupled, and 56.6% were retired. Reliability coefficients of the scale were adequate, with α = .921 and Ω = .929 for pre-test, and α = .940 and Ω = .958 for post. The confirmatory factor analysis tested for pre- and post-intervention, showed an excellent overall fit: χ2(2) = 49.380 (p < .001), CFI = .941 and SRMR = .072; and χ2(2) = 37.579 (p < .001), CFI = .982 and SRMR = .046, respectively. No statistically significant associations were observed for neither age, adherence nor quality of life, except between HowRwe post-test and quality of life pre-test (r = .14 [.01,.26]; p = .035). No significant differences were found in sociodemographic variables. No differences in pre-test or post-test were found in effect of HRT. 85.6% of patients found the content of HowRwe "Useful", and the preferred channel to respond it were paper, app and email. Conclusions The Spanish version of the 'HowRwe' questionnaire to measure the experience in respiratory patients with home respiratory treatments (HRT), has adequate psychometric properties and conceptual and semantic equivalence with the original English version.
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Affiliation(s)
- David Rudilla
- Air Liquide Healthcare, Spain
- Hospital Universitario de La Princesa, Spain
| | | | | | | | | | - Rosa Girón
- Hospital Universitario de La Princesa, Spain
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3
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Rioles N, March C, Muñoz CE, Ilkowitz J, Ohmer A, Wolf RM. Stakeholder Engagement in Type 1 Diabetes Research, Quality Improvement, and Clinical Care. Endocrinol Metab Clin North Am 2024; 53:165-182. [PMID: 38272594 DOI: 10.1016/j.ecl.2023.09.007] [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: 01/27/2024]
Abstract
The integration of stakeholder engagement (SE) in research, quality improvement (QI), and clinical care has gained significant traction. Type 1 diabetes is a chronic disease that requires complex daily management and care from a multidisciplinary team across the lifespan. Inclusion of key stakeholder voices, including patients, caregivers, health care providers and community advocates, in the research process and implementation of clinical care is critical to ensure representation of perspectives that match the values and goals of the patient population. This review describes the current framework for SE and its application to research, QI, and clinical care across the lifespan.
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Affiliation(s)
| | - Christine March
- Division of Pediatric Endocrinology and Diabetes, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Cynthia E Muñoz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeniece Ilkowitz
- Pediatric Diabetes Center, NYU Langone Health, New York, NY, USA
| | - Amy Ohmer
- International Children's Advisory Network, Atlanta, GA, USA
| | - Risa M Wolf
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Jayakumar P, Lopez PL, Mather R. Implementation of Patient-Reported Outcome Measures for Your Practice Needs. J Am Acad Orthop Surg 2023; 31:1067-1077. [PMID: 37561974 DOI: 10.5435/jaaos-d-23-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 08/12/2023] Open
Abstract
Patient-reported outcome (PRO) measures offer a unique opportunity to systematically incorporate patient perspectives of their health and wellbeing into treatment, view progress over time, and develop opportunities related to clinical decision support, shared decision making, and outcomes-driven payment and practice transformation. As healthcare institutions increasingly look toward adopting PRO measures in their practices, more information is needed regarding the practicalities of implementing a successful PRO program outside of the research setting. This article offers a stepwise approach to implementing a PRO program while overcoming barriers and leveraging facilitators that commonly exist in the realms of human contribution or team building, technological infrastructure, and process design. To routinely adopt and implement these instruments, we need a multifaceted approach to operationalizing patient-reported outcome measure (PROMs) for high-value outcomes-driven, patient-centered musculoskeletal care.
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Affiliation(s)
- Prakash Jayakumar
- From the University of Texas at Austin Dell Seton Medical Center: Dell Seton Medical Center at The University of Texas (Jayakumar, and Livingston Lopez), Duke University School of Medicine (Jayakumar, and Mather III), and Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX (Livingston Lopez)
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Benson T, Benson A. Routine measurement of patient experience. BMJ Open Qual 2023; 12:bmjoq-2022-002073. [PMID: 36707125 PMCID: PMC9884896 DOI: 10.1136/bmjoq-2022-002073] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023] Open
Abstract
Patient experience is a key pillar of healthcare quality. We describe a framework of three short generic measures covering Patient Experience, Result Satisfaction and Service Integration. The Result Satisfaction measure is described for the first time.These measures capture twelve aspects of patient experience covering the relationship between patients and clinicians (Patient Experience), the immediate results of the consultation or treatment as perceived by patients (Result Satisfaction) and collaboration between different healthcare services and silos (Service Integration). Each measure has four items.These measures are compared with three national measures: the Friends and Family Test and the General Practice Patient Survey used in England, and HCAHPS used in US hospitals. The expected benefits of national measures are not being achieved and we need to think again about how best to tailor health services to meet patients' expectations.The three measures described (Patient Experience, Result Satisfaction and Service Integration) are generic, short and have low reading ages. They share common forms and scoring schemes, which mean that they can be used individually or in combination at all levels of a healthcare provider.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Newbury, UK .,Institute of Health Informatics, UCL, London, UK
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Hussien M, Azage M, Bayou NB. Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a community-based, cross-sectional study. BMJ Open 2022; 12:e063098. [PMID: 36253038 PMCID: PMC9577901 DOI: 10.1136/bmjopen-2022-063098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine how clients perceived the quality of healthcare they received and identify associated factors both at the individual and facility levels. DESIGN A community-based, cross-sectional study. SETTING Two rural districts of northeast Ethiopia, Tehulederie and Kallu. PARTICIPANTS 1081 rural households who had ever been enrolled in community-based health insurance and visited a health centre at least once in the previous 12 months. Furthermore, 194 healthcare providers participated in the study to provide cluster-level data. OUTCOME MEASURES The outcome variable of interest was the perceived quality of care, which was measured using a 17-item scale. Respondents were asked to rate the degree to which they agreed on 5-point response items relating to their experiences with healthcare in the outpatient departments of nearby health centres. A multilevel linear regression analysis was used to identify predictors of perceived quality of care. RESULTS The mean perceived quality of care was 70.28 (SD=8.39). Five dimensions of perceived quality of care were extracted from the factor analysis, with the patient-provider communication dimension having the highest mean score (M=77.84, SD=10.12), and information provision having the lowest (M=64.67, SD=13.87). Wealth status, current insurance status, perceived health status, presence of chronic illness and time to a recent health centre visit were individual-level variables that showed a significant association with the outcome variable. At the cluster level, the work experience of healthcare providers, patient volume and an interaction term between patient volume and staff job satisfaction also showed a significant association. CONCLUSIONS Much work remains to improve the quality of care, especially on information provision and access to care quality dimensions. A range of individual-level and cluster-level characteristics influence the perceived quality of care. For a better quality of care, it is vital to optimise the patient-provider ratio and enhance staff job satisfaction.
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Affiliation(s)
- Mohammed Hussien
- Health Systems Management and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Muluken Azage
- Environmental Health, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
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Building from Patient Experiences to Deliver Patient-Focused Healthcare Systems in Collaboration with Patients: A Call to Action. Ther Innov Regul Sci 2022; 56:848-858. [PMID: 35854183 PMCID: PMC9356929 DOI: 10.1007/s43441-022-00432-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
Patients’ experiences of their diagnosis, condition, and treatment (including the impact on their lives), and their experiences surrounding expectations of care, are becoming increasingly important in shaping healthcare systems that meet the evolving needs and priorities of different patient communities over time; this is an ongoing goal of all healthcare stakeholders. Current approaches that capture patient experiences with data are fragmented, resulting in duplication of effort, numerous requests for information, and increased patient burden. Application of patient experience data to inform healthcare decisions is still emerging and there remains an opportunity to align diverse stakeholders on the value of these data to strengthen healthcare systems. Given the collective value of understanding patient experiences across multiple stakeholder groups, we propose a more aligned approach to the collection of patient experience data. This approach is built on the principle that the patients’ experiences are the starting point, and not just something to be considered at the end of the process. It must also be based on meaningful patient engagement, where patients are collaborators and decision makers at each step, thereby ensuring their needs and priorities are accurately reflected. The resulting data and evidence should be made available for all stakeholders, to inform their decision making and healthcare strategies in ways that meet patient priorities. We call for multi-stakeholder collaboration that will deliver healthcare systems and interventions that are better centered around and tailored to patient experiences, and that will help address patients’ unmet needs.
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Bull C, Teede H, Watson D, Callander EJ. Selecting and Implementing Patient-Reported Outcome and Experience Measures to Assess Health System Performance. JAMA HEALTH FORUM 2022; 3:e220326. [DOI: 10.1001/jamahealthforum.2022.0326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Claudia Bull
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
| | - Diane Watson
- Bureau of Health Information, New South Wales Health, St Leonards, New South Wales, Australia
| | - Emily J. Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
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Gilsenan R, Schwartz R, Gutmanis IA, Day AMB, Ryan DP, Brander RRA, Milne K, Molnar F. Collaborative Development of an Older Adult Experience Survey for Specialized Geriatric Services. Can Geriatr J 2021; 24:96-110. [PMID: 34079603 PMCID: PMC8137462 DOI: 10.5770/cgj.24.487] [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: 11/22/2022] Open
Abstract
Background While generic, site, and disease-specific patient experience surveys exist, such surveys have limited relevance to frail, medically complex older adults attending appointment-based specialized geriatric services (SGS). The study objective was to develop and evaluate a patient experience survey specific to this population. Methods Using established survey research methods, this study was conducted collaboratively with older adults (patients and family members/friends) at three Ontario sites offering SGS. The study was done in three phases: Phase One—literature review, evidence alignment, and operationalization of core survey items; Phase Two—cognitive interviews and refinement; and Phase Three—pilot testing, survey item analysis, and refinement. Results Based on an evidence-informed framework, the “Older Adult Experience Survey” includes 12 core items, two global rating items, two open-ended questions, and two demographic questions. The summed 12 core items demonstrated acceptable internal consistency (Cronbach’s alpha: 0.83), and the correlation between the summed score and a global question was 0.59, providing evidence of construct validity. The survey also demonstrated face and content validity. Conclusion This open access, collaboratively developed, psychometrically sound patient experience survey can be used to assess, then improve, the clinical experience and quality of care of older adults attending appointment-based SGS clinics/programs.
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Affiliation(s)
| | | | - Iris A Gutmanis
- Regional Geriatric Program of South West Ontario, Western University, London, ON
| | - Adam M B Day
- North East Specialized Geriatric Centre, Thunder Bay, ON
| | - David P Ryan
- Regional Geriatric Program of Toronto, University of Toronto, Toronto, ON
| | - Rosemary R A Brander
- Specialized Geriatric Services, South East Ontario, Queens University, Kingston, ON
| | - Kelly Milne
- Regional Geriatric Program of Eastern Ontario, Ottawa, ON
| | - Frank Molnar
- Regional Geriatric Program of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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10
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Benson T, Seers H, Webb N, McMahon P. Development of social contact and loneliness measures with validation in social prescribing. BMJ Open Qual 2021; 10:bmjoq-2020-001306. [PMID: 33990393 PMCID: PMC8127978 DOI: 10.1136/bmjoq-2020-001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
Aims This paper describes two patient-reported measures of social contact and loneliness, which are closely related concepts. The first measure (R-Outcomes Social Contact measure) was developed from scratch, based on customer needs and literature review. It covers emotional and social aspects using positive terms. The second measure (R-Outcomes Loneliness measure) is adapted from the GSS Loneliness Harmonised Standard. Both measures are patient-reported outcome measures, based on patients’ own perception of how they feel. Method This development started in 2016 in response to customers’ requests to measure social contact/loneliness for patients in social prescribing projects. Both measures are compared with three other loneliness measures (the GSS Loneliness Harmonised Standard, De Jong Gierveld and Campaign to End Loneliness). Both measures are short (36 and 21 words, respectively). Mean improvement is reported as a positive number on a 0–100 scale (where high is good). We tested the psychometric performance and construct validity of the R-Outcomes Social Contact measure using secondary analysis of anonymised data collected before and after social prescribing interventions in one part of Southern England. Results In the validation study, 728 responses, collected during 2019–2020, were analysed. 90% were over 70 years old and 62% women. Cronbach’s α=0.76, which suggests that it is appropriate to use a single summary score. Mean Social Contact scores before and after social prescribing intervention were 59.9 (before) and 66.7 (after, p<0.001). Exploratory factor analysis shows that measures for social contact, health status, health confidence, patient experience, personal well-being, medication adherence and social determinants of health are correlated but distinct factors. Construct validation shows that the results are consistent with nine hypotheses, based on the loneliness literature. Conclusion The R-Outcomes Social Contact measure has good psychometric and construct validation results in a population referred to social prescribing. It is complementary to other R-Outcomes measures.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Newbury, UK .,Institute of Health Informatics, University College London, London, UK
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Kelly B, Innes A, Holl M, Mould L, Powell S, Burns D, Doherty P, Whyte G, King J, Deniszczyc D. Scalable modEls of Community rehAbilitation for Individuals Recovering From COVID:19 reLated illnEss: A Longitudinal Service Evaluation Protocol-"SeaCole Cohort Evaluation". Front Public Health 2021; 9:628333. [PMID: 34055711 PMCID: PMC8155345 DOI: 10.3389/fpubh.2021.628333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: High levels of physical, cognitive, and psychosocial impairments are anticipated for those recovering from the COVID-19. In the UK, ~50% of survivors will require additional rehabilitation. Despite this, there is currently no evidence-based guideline available in England and Wales that addresses the identification, timing and nature of effective interventions to manage the morbidity associated following COVID-19. It is now timely to accelerate the development and evaluation of a rehabilitation service to support patients and healthcare services. Nuffield Health have responded by configuring a scalable rehabilitation pathway addressing the immediate requirements for those recovering from COVID-19 in the community. Methods and Analysis: This long-term evaluation will examine the effectiveness of a 12-week community rehabilitation programme for COVID-19 patients who have been discharged following in-patient treatment. Consisting of two distinct 6-week phases; Phase 1 is an entirely remote service, delivered via digital applications. Phase 2 sees the same patients transition into a gym-based setting for supervised group-based rehabilitation. Trained rehabilitation specialists will coach patients across areas such as goal setting, exercise prescription, symptom management and emotional well-being. Outcomes will be collected at 0, 6, and 12 weeks and at 6- and 12-months. Primary outcome measures will assess changes in health-related quality of life (HR-QOL) and COVID-19 symptoms using EuroQol Five Dimension Five Level Version (EQ-5D-5L) and Dyspnea-12, respectively. Secondary outcome measures of the Duke Activity Status Questionnaire (DASI), 30 s sit to stand test, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Experience Questionnaire (PEQ) and Quality Adjusted Life Years (QALY) will allow for the evaluation of outcomes, mediators and moderators of outcome, and cost-effectiveness of treatment. Discussion: This evaluation will investigate the immediate and long-term impact, as well as the cost effectiveness of a blended rehabilitation programme for COVID-19 survivors. This evaluation will provide a founding contribution to the literature, evaluating one of the first programmes of this type in the UK. The evaluation has international relevance, with the potential to show how a new model of service provision can support health services in the wake of COVID-19. Trial Registration: Current Trials ISRCTN ISRCTN14707226 Web: http://www.isrctn.com/ISRCTN14707226.
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Affiliation(s)
- Benjamin Kelly
- Quality and Assurance Directorate, Nuffield Health, Epsom, United Kingdom
- Department for Health, Psychology & Community, Manchester Metropolitan University, Manchester, United Kingdom
| | - Aidan Innes
- Quality and Assurance Directorate, Nuffield Health, Epsom, United Kingdom
- Department for Health, Psychology & Community, Manchester Metropolitan University, Manchester, United Kingdom
| | - Marc Holl
- Quality and Assurance Directorate, Nuffield Health, Epsom, United Kingdom
| | - Laura Mould
- Quality and Assurance Directorate, Nuffield Health, Epsom, United Kingdom
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Susan Powell
- Quality and Assurance Directorate, Nuffield Health, Epsom, United Kingdom
- Department for Health, Psychology & Community, Manchester Metropolitan University, Manchester, United Kingdom
| | - Danielle Burns
- Department for Health, Psychology & Community, Manchester Metropolitan University, Manchester, United Kingdom
| | - Patrick Doherty
- Department of Health Sciences, York University, York, United Kingdom
| | - Greg Whyte
- School of Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - James King
- National Centre for Sports and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Davina Deniszczyc
- Quality and Assurance Directorate, Nuffield Health, Epsom, United Kingdom
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Lamprell K, Fajardo Pulido D, Tran Y, Nic Giolla Easpaig B, Liauw W, Arnolda G, Braithwaite J. Personal Accounts of Young-Onset Colorectal Cancer Organized as Patient-Reported Data: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e25056. [PMID: 33635274 PMCID: PMC7954655 DOI: 10.2196/25056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young-onset colorectal cancer is a contemporary issue in need of substantial research input. The incidence of colorectal cancer in adults younger than 50 years is rising in contrast to the decreasing incidence of this cancer in older adults. People with young-onset colorectal cancer may be at that stage of life in which they are establishing their careers, building relationships with long-term partners, raising children, and assembling a financial base for the future. A qualitative study designed to facilitate triangulation with extant quantitative patient-reported data would contribute the first comprehensive resource for understanding how this distinct patient population experiences health services and the outcomes of care throughout the patient pathway. OBJECTIVE The aim of this study was to undertake a mixed-methods study of qualitative patient-reported data on young-onset colorectal cancer experiences and outcomes. METHODS This is a study of web-based unsolicited patient stories recounting experiences of health services and clinical outcomes related to young-onset colorectal cancer. Personal Recollections Organized as Data (PROD) is a novel methodology for understanding patients' health experiences in order to improve care. PROD pivots qualitative data collection and analysis around the validated domains and dimensions measured in patient-reported outcome and patient-reported experience questionnaires. PROD involves 4 processes: (1) classifying attributes of the contributing patients, their disease states, their routes to diagnosis, and the clinical features of their treatment and posttreatment; (2) coding texts into the patient-reported experience and patient-reported outcome domains and dimensions, defined a priori, according to phases of the patient pathway; (3) thematic analysis of content within and across each domain; and (4) quantitative text analysis of the narrative content. RESULTS Relevant patient stories have been identified, and permission has been obtained for use of the texts in primary research. The approval for this study was granted by the Macquarie University Human Research Ethics Committee in June 2020. The analytical framework was established in September 2020, and data collection commenced in October 2020. We will complete the analysis in March 2021 and we aim to publish the results in mid-2021. CONCLUSIONS The findings of this study will identify areas for improvement in the PROD methodology and inform the development of a large-scale study of young-onset colorectal cancer patient narratives. We believe that this will be the first qualitative study to identify and describe the patient pathway from symptom self-identification to help-seeking through to diagnosis, treatment, and to survivorship or palliation for people with young-onset colorectal cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25056.
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Affiliation(s)
- Klay Lamprell
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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13
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Kjærandsen KS, Brøndbo PH, Halvorsen MB. Determinants of caregiver satisfaction with child neurodevelopmental assessment in neuropaediatric clinics. BMC Health Serv Res 2021; 21:139. [PMID: 33579275 PMCID: PMC7881610 DOI: 10.1186/s12913-021-06153-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 02/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In addition to patient evaluations, caregiver evaluations and experiences are important indicators of the quality of health services. The aim of this study was to examine determinants of caregiver satisfaction with and perceived benefit of child neurodevelopmental assessment in neuropaediatric clinics. METHODS The study was conducted among caregivers of children and adolescents aged 4-18 years (N = 330) referred for neurodevelopmental assessment in two neuropaediatric clinics in the specialised health service in Northern Norway. The Generic Short Patient Experiences Questionnaire (GS-PEQ) for child psychiatric outpatient patients was distributed to caregivers immediately following the assessment, and two of its items were used as measurements of caregiver satisfaction with and perceived benefit of the assessment. RESULTS Caregiver satisfaction with the assessment was correlated with a better general level of function in the child, higher socioeconomic status, Norwegian mother tongue, referral from a specialist, and the respondent being a woman. Higher perceived benefit of the assessment was correlated with higher socioeconomic status, Norwegian mother tongue, and younger age of the child. Regression analysis revealed that caregivers' perception that the assessment was suited to their child's situation and that there was good cooperation with other public services (e.g., primary care and social/educational services) seemed more fundamental to caregiver satisfaction with neuropaediatric clinics' services than any background variable. Younger age of the child, in addition to caregivers' perception that the assessment was suited to their child and receiving sufficient information about the child's diagnosis/afflictions, were essential to the perceived benefit of the assessment. CONCLUSIONS Caregiver satisfaction with child neurodevelopmental assessment in neuropaediatric clinics partly depends on variables not related to the assessment experience per se. An assessment that was suited to the child, good cooperation with other public services such as primary health care and social/educational services, and giving sufficient information about the child's diagnosis are essential to an overall positive caregiver evaluation of neurodevelopmental assessments.
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Affiliation(s)
| | - Per Håkan Brøndbo
- RKBU Nord, Faculty of Health Sciences, UiT Arctic University of Norway, Tromsø, Norway
| | - Marianne Berg Halvorsen
- Department of Paediatric Rehabilitation, University Hospital of North Norway, Tromsø, Norway
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Koffman J, Yorganci E, Murtagh F, Yi D, Gao W, Barclay S, Pickles A, Higginson I, Johnson H, Wilson R, Bailey S, Ewart C, Evans C. The AMBER care bundle for hospital inpatients with uncertain recovery nearing the end of life: the ImproveCare feasibility cluster RCT. Health Technol Assess 2020; 23:1-150. [PMID: 31594555 DOI: 10.3310/hta23550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients admitted to hospital with a terminal illness and uncertain recovery often receive inconsistent care and do not have the opportunity to die in their preferred place of death. Previous end-of-life care packages, such as the Liverpool Care Pathway for the Dying Patient, have sometimes been badly implemented. The AMBER (Assessment; Management; Best practice; Engagement; Recovery uncertain) care bundle was developed to remedy this. It has not been evaluated in a randomised trial, but a definitive trial would face many hurdles. OBJECTIVE To optimise the design of and determine the feasibility of a pragmatic, multicentre, cluster randomised controlled trial of the AMBER care bundle compared with best standard care. DESIGN A feasibility cluster randomised controlled trial including semistructured interviews with patients and relatives, focus groups with health-care professionals, non-participant observations of multidisciplinary team meetings, a standard care survey, heat maps and case note reviews. Retrospective data were collected from the family or close friends of deceased patients via a bereavement survey. SETTING Four general medical wards at district general hospitals in England. PARTICIPANTS There were 65 participants (control, n = 36; intervention, n = 29). There were 24 interviews, four focus groups, 15 non-participant meeting observations, six case note reviews and three heat maps, and 15 of out 23 bereavement, standard care surveys were completed. INTERVENTION The AMBER care bundle is implemented by a nurse facilitator. It includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status and daily plan revisiting. The AMBER care bundle encourages staff, patients and families to talk openly about their preferences and priorities should the worst happen. MAIN OUTCOME MEASURES Two 'candidate' primary outcomes were selected to be evaluated for a future definitive trial: Integrated Palliative care Outcome Scale patient/family anxiety and communication subscale and 'howRwe'. The secondary outcome measures were Integrated Palliative care Outcome Scale symptoms, Australian-modified Karnofsky Performance Status scale, EuroQol-5 Dimensions, five-level version, Client Service Receipt Inventory, recruitment rate, intervention fidelity and intervention acceptability. RESULTS Data were collected for 65 patients. This trial was not powered to measure clinical effectiveness, but variance and changes observed in the Integrated Palliative care Outcome Scale subscale indicated that this measure would probably detect differences within a definitive trial. It was feasible to collect data on health, social and informal care service use and on quality of life at two time points. The AMBER care bundle was broadly acceptable to all stakeholders and was delivered as planned. The emphasis on 'clinical uncertainty' prompted health-care professional awareness of often-overlooked patients. Reviewing patients' AMBER care bundle status was integrated into routine practice. Refinements included simplifying the inclusion criteria and improving health-care professional communication training. Improvements to trial procedures included extending the time devoted to recruitment and simplifying consent procedures. There was also a recommendation to reduce data collected from patients and relatives to minimise burden. LIMITATIONS The recruitment rate was lower than anticipated. The inclusion criteria for the trial were difficult to interpret. Information sheets and consent procedures were too detailed and lengthy for the target population. Health-care professionals' enthusiasm and specialty were not considered while picking trial wards. Participant recruitment took place later during hospital admission and the majority of participants were lost to follow-up because they had been discharged. Those who participated may have different characteristics from those who did not. CONCLUSIONS This feasibility trial has demonstrated that an evaluation of the AMBER care bundle among an acutely unwell patient population, although technically possible, is not practical or feasible. The intervention requires optimisation. TRIAL REGISTRATION Current Controlled Trials ISRCTN36040085. National Institute for Health Research (NIHR) Portfolio registration number 32682. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 55. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Emel Yorganci
- Cicely Saunders Institute, King's College London, London, UK
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Deokhee Yi
- Cicely Saunders Institute, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute, King's College London, London, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Irene Higginson
- Cicely Saunders Institute, King's College London, London, UK
| | - Halle Johnson
- Cicely Saunders Institute, King's College London, London, UK
| | - Rebecca Wilson
- Cicely Saunders Institute, King's College London, London, UK
| | | | | | - Catherine Evans
- Cicely Saunders Institute, King's College London, London, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
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15
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The impact of patient navigation on length of hospital stay and satisfaction in patients undergoing primary hip or knee arthroplasty. Int J Orthop Trauma Nurs 2020; 41:100799. [PMID: 32873507 DOI: 10.1016/j.ijotn.2020.100799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/26/2020] [Accepted: 07/04/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Healthcare organizations are implementing innovative ways to deliver patient centered care, which includes the addition of the orthopedic nurse navigator role. PURPOSE The purpose of this study was to examine length of hospital stay and patient satisfaction following the implementation of an orthopedic surgery CNS-patient navigator. METHODS This prospective descriptive study (n = 226) examined length of stay, location of discharge, and readmission to hospital by reviewing the participants' electronic hospital record. Patient satisfaction was examined by telephone using the Patient Satisfaction with Interpersonal Relationship with Navigator scale, and generic health related quality of life and patient experience were measured by the howRu/howRwe scale. RESULTS The mean length of hospital stay was 2.8 (±1.0), which was less than the provincial mean length of stay for the same time period. The majority of participants were discharged to home, and only 1.3% of participants were readmitted to the same hospital within 30 days following discharge. All participants were satisfied with the care they received from the navigator, and reported a positive patient experience and health related quality of life. CONCLUSION The mean length of stay in our hospital was lower than the provincial mean. Participants were satisfied with the care provided by the navigator.
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Jansson M, Vuorinen AL, Harjumaa M, Similä H, Koivisto J, Puhto AP, Vesty G, Pikkarainen M. The digital patient journey solution for patients undergoing elective hip and knee arthroplasty: Protocol for a pragmatic randomized controlled trial. J Adv Nurs 2020; 76:1436-1448. [PMID: 32133684 DOI: 10.1111/jan.14343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe a randomized controlled trial (RCT) protocol that will evaluate the effectiveness of a digital patient journey (DPJ) solution in improving the outcomes of patients undergoing total hip and knee arthroplasty. BACKGROUND There is an urgent need for novel technologies to ensure sustainability, improve patient experience, and empower patients in their own care by providing information, support, and control. DESIGN A pragmatic RCT with two parallel arms. METHODS The participants randomized assigned to the intervention arm (N = 33) will receive access to the DPJ solution. The participants in the control arm (N = 33) will receive conventional care, which is provided face to face by using paper-based methods. The group allocations will be blinded from the study nurse during the recruitment and baseline measures, as well as from the outcome assessors. Patients with total hip arthroplasty will be followed up for 8-12 weeks, whereas patients with total knee arthroplasty will be followed up for 6-8 weeks. The primary outcome is health-related quality of life, measured by the EuroQol EQ-5D-5L scale. Secondary outcomes include functional recovery, pain, patient experience, and self-efficacy. The first results are expected to be submitted for publication in 2020. IMPACT This study will provide information on the health effects and cost benefits of using the DPJ solution to support a patient's preparation for surgery and postdischarge surgical care. If the DPJ solution is found to be effective, its implementation into clinical practice could lead to further improvements in patient outcomes. If the DPJ solution is found to be cost effective for the hospital, it could be used to improve hospital resource efficiency.
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Affiliation(s)
- Miia Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| | | | | | - Heidi Similä
- VTT Technical Research Centre of Finland, Oulu, Finland
| | - Jonna Koivisto
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland
| | - Gillian Vesty
- School of Accounting, RMIT University, Melbourne, Australia
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,VTT Technical Research Centre of Finland, Oulu, Finland.,Martti Ahtisaari Institute, Oulu Business School, Oulu University, Oulu, Finland
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17
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Benson T, Bowman C. Comparison of staff and resident health status ratings in care homes. BMJ Open Qual 2020; 9:e000801. [PMID: 32188739 PMCID: PMC7078726 DOI: 10.1136/bmjoq-2019-000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/17/2019] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many care home residents cannot self-report their own health status. Previous studies have shown differences between staff and resident ratings. In 2012, we collected 10 168 pairs of health status ratings using the howRu health status measure. This paper examines differences between staff and resident ratings. METHOD HowRu is a short generic person-reported outcome measure with four items: pain or discomfort (discomfort), feeling low or worried (distress), limited in what you can do (disability) and require help from others (dependence). A summary score (howRu score) is also calculated. Mean scores are shown on a 0-100 scale. High scores are better than low scores. Differences between resident and staff reports (bias) were analysed at the item and summary level by comparing distributions, analysing correlations and a modification of the Bland-Altman method. RESULTS AND CONCLUSIONS Distributions are similar superficially but differ statistically. Spearman correlations are between 0.55 and 0.67. For items, more than 92.9% of paired responses are within one class; for the howRu summary score, 66% are within one class. Mean differences (resident score minus staff score) on 0-100 scale are pain and discomfort (-1.11), distress (0.67), discomfort (1.56), dependence (3.92) and howRu summary score (1.26). The variation is not the same for different severities. At higher levels of pain and discomfort, staff rated their discomfort and distress as better than residents. On the other hand, staff rated disability and dependence as worse than did residents. This probably reflects differences in perspectives. Red amber green (RAG) thresholds of 10 and 5 points are suggested for monitoring changes in care home mean scores.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Thatcham, Berkshire, UK
- Institute of Health Informatics, UCL, London, UK
| | - Clive Bowman
- Health Sciences, City University School of Health Sciences, London, UK
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18
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Benson T. Measure what we want: a taxonomy of short generic person-reported outcome and experience measures (PROMs and PREMs). BMJ Open Qual 2020; 9:e000789. [PMID: 32198234 PMCID: PMC7103852 DOI: 10.1136/bmjoq-2019-000789] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Health and care systems are complex and multifaceted, but most person-reported outcome and experience measures (PROMs and PREMs) address just one aspect. Multiple aspects need measuring to understand how what we do impacts patients, staff and services, and how these are affected by external factors. This needs survey tools that measure what people want, are valid, sensitive, quick and easy to use, and suitable for people with multiple conditions. METHODS We have developed a coherent family of short generic PROMs and PREMs that can be used in combination in a pick-and-mix way. Each measure has evolved iteratively over several years, based on literature review, user inputs and field testing. Each has has a common format with four items with four response options and is designed for digital data collection with standardised analytics and data visualisation tools. We focused on brevity and low reading age. RESULTS The results are presented in tabular format and as a taxonomy. The taxonomy is categorised by respondent type (patient or staff) and measure type. PROMs have subdomains: quality of life, individual care and community; PREMs have subdomains: service provided, provider culture and innovation. We show 22 patient-reported measures and 17 staff-reported measures. Previously published measures have been validated. Others are described for the first time. DISCUSSION AND CONCLUSIONS This family of measures is broad in scope but is not claimed to be comprehensive. Measures share a common look and feel, which enables common methods of data collection, reporting and data visualisation. They are used in service evaluation, quality improvement and as key performance indicators. The taxonomy helps to organise the whole, explain what each measure does and identify gaps and overlaps.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Thatcham, UK
- Institute of Health Informatics, UCL, London, UK
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19
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Ziabakhsh S, Albert A, Houlihan E. Development and Validation of a Brief Hospital-Based Ambulatory Patient Experience Survey Tool. HEALTHCARE POLICY = POLITIQUES DE SANTE 2020; 15:100-114. [PMID: 32077848 DOI: 10.12927/hcpol.2019.25968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Recognition of the value of the patient perspective on services has led healthcare organizations to measure patient care experiences. A brief, generic and psychometrically sound scale to measure patient experiences in ambulatory/outpatient settings in Canada would be useful and is currently lacking. The purpose of this study was to develop and validate an English-language hospital-based ambulatory patient experience survey tool in a Canadian context. Based on a review of more than 20 instruments measuring experiences predominately in non-acute care settings, we initially selected 27 items to be included in the questionnaire, addressing quality dimensions of access, communication, continuity and coordination, shared decision making, emotional support, trust/confidence, privacy, patient-reported impact and physical environment. The survey instrument was subsequently tested among 1,219 ambulatory patients, and its psychometric properties were assessed. A final questionnaire was produced with 14 items and two emerging subscales: Patient-Provider Communication and Overall Quality of Experience, as determined by a factor analysis. The items within the scale showed high construct validity. Reliability was also excellent for the instrument. The applicability of this tool in supporting quality improvement initiatives is discussed.
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Affiliation(s)
- Shabnam Ziabakhsh
- Evaluation Specialist, BC Women's Hospital + Health Centre, Vancouver, BC
| | - Arianne Albert
- Biostatistician, Women's Health Research Institute, Vancouver, BC, Adjunct Associate Professor, University of British Columbia, Vancouver, BC
| | - Edwina Houlihan
- Senior Director, Patient Care Services, BC Women's Hospital + Health Centre, Vancouver, BC
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20
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Ziabakhsh S, Albert A, Houlihan E. Development and Validation of a Brief Hospital-Based Ambulatory Patient Experience Survey Tool. Healthc Policy 2019; 15. [PMID: 32077848 PMCID: PMC7020806 DOI: 10.12927/hcpol.2019.26068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Recognition of the value of the patient perspective on services has led healthcare organizations to measure patient care experiences. A brief, generic and psychometrically sound scale to measure patient experiences in ambulatory/outpatient settings in Canada would be useful and is currently lacking. The purpose of this study was to develop and validate an English-language hospital-based ambulatory patient experience survey tool in a Canadian context. Based on a review of more than 20 instruments measuring experiences predominately in non-acute care settings, we initially selected 27 items to be included in the questionnaire, addressing quality dimensions of access, communication, continuity and coordination, shared decision making, emotional support, trust/confidence, privacy, patient-reported impact and physical environment. The survey instrument was subsequently tested among 1,219 ambulatory patients, and its psychometric properties were assessed. A final questionnaire was produced with 14 items and two emerging subscales: Patient-Provider Communication and Overall Quality of Experience, as determined by a factor analysis. The items within the scale showed high construct validity. Reliability was also excellent for the instrument. The applicability of this tool in supporting quality improvement initiatives is discussed.
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Affiliation(s)
- Shabnam Ziabakhsh
- Evaluation Specialist, BC Women's Hospital + Health Centre, Vancouver, BC
| | - Arianne Albert
- Biostatistician, Women's Health Research Institute, Vancouver, BC, Adjunct Associate Professor, University of British Columbia, Vancouver, BC
| | - Edwina Houlihan
- Senior Director, Patient Care Services, BC Women's Hospital + Health Centre, Vancouver, BC
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21
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Konerding U, Bowen T, Elkhuizen SG, Faubel R, Forte P, Karampli E, Malmström T, Pavi E, Torkki P. Development of a universal short patient satisfaction questionnaire on the basis of SERVQUAL: Psychometric analyses with data of diabetes and stroke patients from six different European countries. PLoS One 2019; 14:e0197924. [PMID: 31622359 PMCID: PMC6797181 DOI: 10.1371/journal.pone.0197924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/10/2018] [Indexed: 11/18/2022] Open
Abstract
Objective A short questionnaire which can be applied for assessing patient satisfaction in different contexts and different countries is to be developed. Methods Six items addressing tangibles, reliability, responsiveness, assurance, empathy, and communication were analysed. The first five items stem from SERVQUAL (SERVice QUALity), the last stems from the discussion about SERVQUAL. The analyses were performed with data from 12 surveys conducted in six different countries (England, Finland, Germany, Greece, the Netherlands, Spain) covering two different conditions (type 2 diabetes, stroke). Sample sizes for included participants are 247 in England, 160 in Finland, 231 in Germany, 152 in Greece, 316 in the Netherlands and 96 in Spain for the diabetes surveys; and 101 in England, 139 in Finland, 107 in Germany, 58 in Greece, 185 in the Netherlands, and 92 in Spain for the stroke surveys. The items were tested by (1) bivariate correlations between the items and an item addressing ‘general satisfaction’, (2) multivariate regression analyses with ‘general satisfaction’ as criterion and the items as predictors, and (3) bivariate correlations between sum scores and ‘general satisfaction’. Results The correlations with ‘general satisfaction’ are 0.48 for tangibles, 0.56 for reliability, 0.58 for responsiveness, 0.47 for assurance, 0.53 for empathy, and 0.56 for communication. In the multivariate regression analysis, the regression coefficient for assurance is significantly negative while all other regression coefficients are significantly positive. In a multivariate regression analysis without the item ‘assurance’ all regression coefficients are positive. The correlation between the sum score and ‘general satisfaction’ is 0.608 for all six items and 0.618 for the finally remaining five items. The country specific results are similar. Conclusions The five items which remain after removing ‘assurance’, i.e. the SERVQUAL-MOD-5, constitute a short patient satisfaction index which can usefully be applied for different medical conditions and in different countries.
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Affiliation(s)
- Uwe Konerding
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany.,Trimberg Research Academy, University of Bamberg, Bamberg, Germany
| | - Tom Bowen
- The Balance of Care Group, London, England, United Kingdom
| | - Sylvia G Elkhuizen
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Raquel Faubel
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Joint Research Unit in Biomedical Engineering (IIS La Fe- Universitat Politècnica de València), Valencia, Spain
| | - Paul Forte
- The Balance of Care Group, London, England, United Kingdom
| | - Eleftheria Karampli
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Tomi Malmström
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Elpida Pavi
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Paulus Torkki
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland.,Department of Public Health, Helsinki University, Helsinki, Finland
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Sheard L, Marsh C, Mills T, Peacock R, Langley J, Partridge R, Gwilt I, Lawton R. Using patient experience data to develop a patient experience toolkit to improve hospital care: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07360] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Patients are increasingly being asked to provide feedback about their experience of health-care services. Within the NHS, a significant level of resource is now allocated to the collection of this feedback. However, it is not well understood whether or not, or how, health-care staff are able to use these data to make improvements to future care delivery.
Objective
To understand and enhance how hospital staff learn from and act on patient experience (PE) feedback in order to co-design, test, refine and evaluate a Patient Experience Toolkit (PET).
Design
A predominantly qualitative study with four interlinking work packages.
Setting
Three NHS trusts in the north of England, focusing on six ward-based clinical teams (two at each trust).
Methods
A scoping review and qualitative exploratory study were conducted between November 2015 and August 2016. The findings of this work fed into a participatory co-design process with ward staff and patient representatives, which led to the production of the PET. This was primarily based on activities undertaken in three workshops (over the winter of 2016/17). Then, the facilitated use of the PET took place across the six wards over a 12-month period (February 2017 to February 2018). This involved testing and refinement through an action research (AR) methodology. A large, mixed-methods, independent process evaluation was conducted over the same 12-month period.
Findings
The testing and refinement of the PET during the AR phase, with the mixed-methods evaluation running alongside it, produced noteworthy findings. The idea that current PE data can be effectively triangulated for the purpose of improvement is largely a fallacy. Rather, additional but more relational feedback had to be collected by patient representatives, an unanticipated element of the study, to provide health-care staff with data that they could work with more easily. Multidisciplinary involvement in PE initiatives is difficult to establish unless teams already work in this way. Regardless, there is merit in involving different levels of the nursing hierarchy. Consideration of patient feedback by health-care staff can be an emotive process that may be difficult initially and that needs dedicated time and sensitive management. The six ward teams engaged variably with the AR process over a 12-month period. Some teams implemented far-reaching plans, whereas other teams focused on time-minimising ‘quick wins’. The evaluation found that facilitation of the toolkit was central to its implementation. The most important factors here were the development of relationships between people and the facilitator’s ability to navigate organisational complexity.
Limitations
The settings in which the PET was tested were extremely diverse, so the influence of variable context limits hard conclusions about its success.
Conclusions
The current manner in which PE feedback is collected and used is generally not fit for the purpose of enabling health-care staff to make meaningful local improvements. The PET was co-designed with health-care staff and patient representatives but it requires skilled facilitation to achieve successful outcomes.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Laura Sheard
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Claire Marsh
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas Mills
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rosemary Peacock
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | | | - Ian Gwilt
- Lab4Living, Sheffield Hallam University, Sheffield, UK
| | - Rebecca Lawton
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
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Bull C, Byrnes J, Hettiarachchi R, Downes M. A systematic review of the validity and reliability of patient-reported experience measures. Health Serv Res 2019; 54:1023-1035. [PMID: 31218671 PMCID: PMC6736915 DOI: 10.1111/1475-6773.13187] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To identify patient-reported experience measures (PREMs), assess their validity and reliability, and assess any bias in the study design of PREM validity and reliability testing. DATA SOURCES/STUDY SETTING Articles reporting on PREM development and testing sourced from MEDLINE, CINAHL and Scopus databases up to March 13, 2018. STUDY DESIGN Systematic review. DATA COLLECTION/EXTRACTION METHODS Critical appraisal of PREM study design was undertaken using the Appraisal tool for Cross-Sectional Studies (AXIS). Critical appraisal of PREM validity and reliability was undertaken using a revised version of the COSMIN checklist. PRINCIPAL FINDINGS Eighty-eight PREMs were identified, spanning across four main health care contexts. PREM validity and reliability was supported by appropriate study designs. Internal consistency (n = 58, 65.2 percent), structural validity (n = 49, 55.1 percent), and content validity (n = 34, 38.2 percent) were the most frequently reported validity and reliability tests. CONCLUSIONS Careful consideration should be given when selecting PREMs, particularly as seven of the 10 validity and reliability criteria were not undertaken in ≥50 percent of the PREMs. Testing PREM responsiveness should be prioritized for the application of PREMs where the end user is measuring change over time. Assessing measurement error/agreement of PREMs is important to understand the clinical relevancy of PREM scores used in a health care evaluation capacity.
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Affiliation(s)
- Claudia Bull
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Joshua Byrnes
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Ruvini Hettiarachchi
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Martin Downes
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
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Managing uncertain recovery for patients nearing the end of life in hospital: a mixed-methods feasibility cluster randomised controlled trial of the AMBER care bundle. Trials 2019; 20:506. [PMID: 31419994 PMCID: PMC6697995 DOI: 10.1186/s13063-019-3612-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The AMBER (Assessment, Management, Best Practice, Engagement, Recovery Uncertain) care bundle is a complex intervention used in UK hospitals to support patients with uncertain recovery. However, it has yet to be evaluated in a randomised controlled trial (RCT) to identify potential benefits or harms. The aim of this trial was to investigate the feasibility of a cluster RCT of the AMBER care bundle. METHODS This is a prospective mixed-methods feasibility cluster RCT. Quantitative data collected from patients (or proxies if patients lack capacity) were used (i) to examine recruitment, retention and follow-up rates; (ii) to test data collection tools for the trial and determine their optimum timing; (iii) to test methods to identify the use of financial resources; and (iv) to explore the acceptability of study procedures for health professionals and patients. Descriptive statistical analyses and thematic analysis used the framework approach. RESULTS In total, 894 patients were screened, of whom 220 were eligible and 19 of those eligible (8.6%) declined to participate. Recruitment to the control arm was challenging. Of the 728 patients screened for that arm, 647 (88.9%) were excluded. Overall, 65 patients were recruited (81.3% of the recruitment target of 80). Overall, many were elderly (≥80 years, 46.2%, n = 30, mean = 77.8 years, standard deviation [SD] = 12.3 years). Over half (53.8%) had a non-cancer diagnosis, with a mean of 2.3 co-morbidities; 24.6% patients (n = 16) died during their hospital stay and 35.4% (n = 23) within 100 days of discharge. In both trial arms, baseline IPOS subscale scores identified moderate patient anxiety (control: mean 13.3, SD 4.8; intervention: mean 13.3, SD 5.1), and howRwe identified a good care experience (control: mean 13.1, SD 2.5; intervention: mean 11.5, SD 2.1). Collecting quantitative service use and quality of life data was feasible. No patient participants regarded study involvement negatively. Focus groups with health professionals identified concerns regarding (i) the subjectivity of the intervention's eligibility criteria, (ii) the need to prognosticate to identify potential patients and (iii) consent procedures and the length of the questionnaire. CONCLUSIONS A full trial of the AMBER care bundle is technically feasible but impractical due to fundamental issues in operationalising the intervention's eligibility criteria, which prevents optimal recruitment. Since this complex intervention continues to be used in clinical care and advocated in policy, alternative research approaches must be considered and tested. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number (ISRCTN) Register, ISRCTN36040085 .
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Hinsley K, Kelly PJ, Davis E. Experiences of patient‐centred care in alcohol and other drug treatment settings: A qualitative study to inform design of a patient‐reported experience measure. Drug Alcohol Rev 2019; 38:664-673. [DOI: 10.1111/dar.12965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/29/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Kathryn Hinsley
- Illawarra Health and Medical Research Institute and School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Peter J. Kelly
- Illawarra Health and Medical Research Institute and School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Esther Davis
- Illawarra Health and Medical Research Institute and School of PsychologyUniversity of Wollongong Wollongong Australia
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Benson T, Potts HWW, Bark P, Bowman C. Development and initial testing of a Health Confidence Score (HCS). BMJ Open Qual 2019; 8:e000411. [PMID: 31259277 PMCID: PMC6568167 DOI: 10.1136/bmjoq-2018-000411] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/17/2019] [Accepted: 05/26/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction Patients need to feel confident about looking after their own health. This is needed to improve patient outcomes and clinical support. With few suitable tools available to measure self-care health confidence, we developed and validated a short, generic survey instrument for use in evaluation and quality improvement. Methods The Health Confidence Score (HCS) was developed through literature review, patient and expert focus groups and discussions. This paper reports an initial survey (n = 1031, study 1) which identified some issues and a further face-to-face survey (n = 378, study 2) to test the construct and concurrent validity of the final version. Scores were correlated against the My Health Confidence (MHC) rating scale, howRu (health status measure) and relevant demographics. Results The HCS is short (50 words) with good readability (reading age 8). It has four items covering health knowledge, capability to self-manage, access to help and shared decision-making; each has four response options (strongly agree, agree, neutral disagree). Items are reported independently and as a summary score.The mean summary score was 76.7 (SD 20.4) on 0-100 scale. Cronbach's alpha = 0.82. Exploratory factor analysis suggested that the four items relate to a single dimension. Correlation of the HCS summary score with MHC was high (Spearman r = 0.76). It was also associated with health status (Spearman r = 0.49), negatively with number of medications taken (r=-0.29) and age (r=-0.22) and not with ethnicity, having children or education level. Conclusions The HCS is short, easy to use, with good psychometric properties and construct validity. Each item is meaningful independently and the summary score gives an overall picture of health confidence.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Thatcham, UK
- Institute of Health Informatics, UCL, London, UK
| | | | - Pippa Bark
- Institute of Health Informatics, UCL, London, UK
| | - Clive Bowman
- School of Health Sciences, City, University of London, London, UK
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Benson T, Sladen J, Done J, Bowman C. Monitoring work well-being, job confidence and care provided by care home staff using a self-report survey. BMJ Open Qual 2019; 8:e000621. [PMID: 31259287 PMCID: PMC6567942 DOI: 10.1136/bmjoq-2018-000621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/15/2019] [Accepted: 05/19/2019] [Indexed: 11/03/2022] Open
Abstract
Background and method In care homes, staff well-being, job confidence and opinion of the care provided to residents are central to morale and care quality. In this study, care home staff in the East Midlands region of England completed self-reported outcome and experience surveys in two rounds. Mean scores for each home are shown using a scale from 0 (all chose lowest option) to 100 (all chose highest option). High scores are good. Results In round 1, 332 staff in 15 homes submitted responses; in round 2, 207 staff in 9 homes. Mean scores in round 1 and round 2 were similar, although those of some homes scores differed significantly, cancelling each other out. Overall, Work Wellbeing mean score was 83 (care home range 48-97), with worthwhileness (92) the highest ranked item and anxiety at work (78) the lowest. Job Confidence mean score was 84 (range 59-94), with able to manage the work (86) highest and involvement in decisions that affect staff (79) lowest. Care Provided mean score was 86 (range 59-97), with treat people kindly (91) highest and well organised (80) lowest. Homes rated as outstanding by the Care Quality Commission had higher scores on average than those rated good, which were higher than those rated as needing improvement. Conclusions This study has demonstrated the practicality of measuring staff views of their Work Wellbeing, Job Confidence and Care Provided in care homes. Rather than wait for adverse quality outcomes to be detected, this approach offers a way to track staff morale and declared capability over time.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Thatcham, UK
- Institute of Health Informatics, UCL, London, UK
| | | | | | - Clive Bowman
- City University School of Health Sciences, London, UK
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Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go. J Clin Med 2019; 8:jcm8040555. [PMID: 31022916 PMCID: PMC6518292 DOI: 10.3390/jcm8040555] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/16/2022] Open
Abstract
The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.
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Marsh C, Peacock R, Sheard L, Hughes L, Lawton R. Patient experience feedback in UK hospitals: What types are available and what are their potential roles in quality improvement (QI)? Health Expect 2019; 22:317-326. [PMID: 31016863 PMCID: PMC6543142 DOI: 10.1111/hex.12885] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND & OBJECTIVES The comparative uses of different types of patient experience (PE) feedback as data within quality improvement (QI) are poorly understood. This paper reviews what types are currently available and categorizes them by their characteristics in order to better understand their roles in QI. METHODS A scoping review of types of feedback currently available to hospital staff in the UK was undertaken. This comprised academic database searches for "measures of PE outcomes" (2000-2016), and grey literature and websites for all types of "PE feedback" potentially available (2005-2016). Through an iterative consensus process, we developed a list of characteristics and used this to present categories of similar types. MAIN RESULTS The scoping review returned 37 feedback types. A list of 12 characteristics was developed and applied, enabling identification of 4 categories that help understand potential use within QI-(1) Hospital-initiated (validated) quantitative surveys: for example the NHS Adult Inpatient Survey; (2) Patient-initiated qualitative feedback: for example complaints or twitter comments; (3) Hospital-initiated qualitative feedback: for example Experience Based Co-Design; (4) Other: for example Friends & Family Test. Of those routinely collected, few elicit "ready-to-use" data and those that do elicit data most suitable for measuring accountability, not for informing ward-based improvement. Guidance does exist for linking collection of feedback to QI for some feedback types in Category 3 but these types are not routinely used. CONCLUSION If feedback is to be used more frequently within QI, more attention must be paid to obtaining and making available the most appropriate types.
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Affiliation(s)
- Claire Marsh
- Bradford Institute for Health Research, Bradford, UK
| | | | - Laura Sheard
- Bradford Institute for Health Research, Bradford, UK
| | - Lesley Hughes
- Bradford Institute for Health Research, Bradford, UK
| | - Rebecca Lawton
- Bradford Institute for Health Research, Bradford, UK.,University of Leeds, Leeds, UK
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Benson T, Sladen J, Liles A, Potts HWW. Personal Wellbeing Score (PWS)-a short version of ONS4: development and validation in social prescribing. BMJ Open Qual 2019; 8:e000394. [PMID: 31206049 PMCID: PMC6542444 DOI: 10.1136/bmjoq-2018-000394] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/17/2023] Open
Abstract
Aims Our aim was to develop a short generic measure of subjective well-being for routine use in patient-centred care and healthcare quality improvement alongside other patient-reported outcome and experience measures. Methods The Personal Wellbeing Score (PWS) is based on the Office of National Statistics (ONS) four subjective well-being questions (ONS4) and thresholds. PWS is short, easy to use and has the same look and feel as other measures in the same family of measures. Word length and reading age were compared with eight other measures. Anonymous data sets from five social prescribing projects were analysed. Internal structure was examined using distributions, intra-item correlations, Cronbach’s α and exploratory factor analysis. Construct validity was assessed based on hypothesised associations with health status, health confidence, patient experience, age, gender and number of medications taken. Scores on referral and after referral were used to assess responsiveness. Results Differences between PWS and ONS4 include brevity (42 vs 114 words), reading age (9 vs 12 years), response options (4 vs 11), positive wording throughout and a summary score. 1299 responses (60% female, average age 81 years) from people referred to social prescribing services were analysed; missing values were less than 2%. PWS showed good internal reliability (Cronbach’s α=0.90). Exploratory factor analysis suggested that all PWS items relate to a single dimension. PWS summary scores correlate positively with health confidence (r=0.60), health status (r=0.58), patient experience (r=0.30) and age group (r=0.24). PWS is responsive to social prescribing intervention. Conclusions The PWS is a short variant of ONS4. It is easy to use with good psychometric properties, suitable for routine use in quality improvement and health services research.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Thatcham, UK.,Institute of Health Informatics, UCL, London, UK
| | - Joe Sladen
- R-Outcomes Ltd, Thatcham, UK.,Wessex AHSN, Southampton, UK
| | - Andrew Liles
- R-Outcomes Ltd, Brighton, UK.,School of Management, Royal Holloway University of London, Egham, UK
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Benson T. Digital innovation evaluation: user perceptions of innovation readiness, digital confidence, innovation adoption, user experience and behaviour change. BMJ Health Care Inform 2019; 26:0. [PMID: 31039121 PMCID: PMC7062319 DOI: 10.1136/bmjhci-2019-000018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 03/02/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Innovation spread is a key policy objective for health systems world-wide, but adoption success varies enormously. We have developed a set of short generic user-reported measures to help understand how and why healthcare innovations spread. This work builds on the literature and on practical experience in developing and using patient-reported outcome measures. MEASURES The Innovation Readiness Score measures user perceptions of how much they are open to and up-to-date with new ideas, and whether their organisations are receptive to and capable of innovation. It is based on Rogers' classification of innovativeness (innovator, early adopter, early majority, etc).The Digital Confidence Score rates users' digital literacy and confidence to use digital products, with dimensions of familiarity, social pressure, support and digital self-efficacy.The Innovation Adoption Score rates the adoption process in terms of coherence and reflective thought before, during and after implementation. It is based on Normalisation Process Theory.The User Satisfaction measure assesses a digital product in terms of usefulness, ease of use, support and satisfaction.The Behaviour Change measure covers user perceptions of their capability, opportunity and motivation to change behaviour, based on the COM-B model.These measures have been mapped onto Greenhalgh's NASSS Framework (non-adoption, abandonment and challenges to scale-up, spread and sustainability of health and care technologies). CONCLUSION These tools measure different aspects of digital health innovations and may help predict the success of innovation dissemination, diffusion and spread programmes.
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Affiliation(s)
- Tim Benson
- R-Outcomes Ltd, Newbury, UK
- UCL Institute of Health Informatics, London, UK
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Aalbers S, Fusar‐Poli L, Freeman RE, Spreen M, Ket JCF, Vink AC, Maratos A, Crawford M, Chen X, Gold C. Music therapy for depression. Cochrane Database Syst Rev 2017; 11:CD004517. [PMID: 29144545 PMCID: PMC6486188 DOI: 10.1002/14651858.cd004517.pub3] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Depression is a highly prevalent mood disorder that is characterised by persistent low mood, diminished interest, and loss of pleasure. Music therapy may be helpful in modulating moods and emotions. An update of the 2008 Cochrane review was needed to improve knowledge on effects of music therapy for depression. OBJECTIVES 1. To assess effects of music therapy for depression in people of any age compared with treatment as usual (TAU) and psychological, pharmacological, and/or other therapies.2. To compare effects of different forms of music therapy for people of any age with a diagnosis of depression. SEARCH METHODS We searched the following databases: the Cochrane Common Mental Disorders Controlled Trials Register (CCMD-CTR; from inception to 6 May 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; to 17 June 2016); Thomson Reuters/Web of Science (to 21 June 2016); Ebsco/PsycInfo, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and PubMed (to 5 July 2016); the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, the National Guideline Clearing House, and OpenGrey (to 6 September 2016); and the Digital Access to Research Theses (DART)-Europe E-theses Portal, Open Access Theses and Dissertations, and ProQuest Dissertations and Theses Database (to 7 September 2016). We checked reference lists of retrieved articles and relevant systematic reviews and contacted trialists and subject experts for additional information when needed. We updated this search in August 2017 and placed potentially relevant studies in the "Awaiting classification" section; we will incorporate these into the next version of this review as appropriate. SELECTION CRITERIA All randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing music therapy versus treatment as usual (TAU), psychological therapies, pharmacological therapies, other therapies, or different forms of music therapy for reducing depression. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated standardised mean difference (SMD) for continuous data and odds ratio (OR) for dichotomous data with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic. MAIN RESULTS We included in this review nine studies involving a total of 421 participants, 411 of whom were included in the meta-analysis examining short-term effects of music therapy for depression. Concerning primary outcomes, we found moderate-quality evidence of large effects favouring music therapy and TAU over TAU alone for both clinician-rated depressive symptoms (SMD -0.98, 95% CI -1.69 to -0.27, 3 RCTs, 1 CCT, n = 219) and patient-reported depressive symptoms (SMD -0.85, 95% CI -1.37 to -0.34, 3 RCTs, 1 CCT, n = 142). Music therapy was not associated with more or fewer adverse events than TAU. Regarding secondary outcomes, music therapy plus TAU was superior to TAU alone for anxiety and functioning. Music therapy and TAU was not more effective than TAU alone for improved quality of life (SMD 0.32, 95% CI -0.17 to 0.80, P = 0.20, n = 67, low-quality evidence). We found no significant discrepancies in the numbers of participants who left the study early (OR 0.49, 95% CI 0.14 to 1.70, P = 0.26, 5 RCTs, 1 CCT, n = 293, moderate-quality evidence). Findings of the present meta-analysis indicate that music therapy added to TAU provides short-term beneficial effects for people with depression if compared to TAU alone. Additionally, we are uncertain about the effects of music therapy versus psychological therapies on clinician-rated depression (SMD -0.78, 95% CI -2.36 to 0.81, 1 RCT, n = 11, very low-quality evidence), patient-reported depressive symptoms (SMD -1.28, 95% CI -3.75 to 1.02, 4 RCTs, n = 131, low-quality evidence), quality of life (SMD -1.31, 95% CI - 0.36 to 2.99, 1 RCT, n = 11, very low-quality evidence), and leaving the study early (OR 0.17, 95% CI 0.02 to 1.49, 4 RCTs, n = 157, moderate-quality evidence). We found no eligible evidence addressing adverse events, functioning, and anxiety. We do not know whether one form of music therapy is better than another for clinician-rated depressive symptoms (SMD -0.52, 95% CI -1.87 to 0.83, 1 RCT, n = 9, very low-quality evidence), patient-reported depressive symptoms (SMD -0.01, 95% CI -1.33 to 1.30, 1 RCT, n = 9, very low-quality evidence), quality of life (SMD -0.24, 95% CI -1.57 to 1.08, 1 RCT, n = 9, very low-quality evidence), or leaving the study early (OR 0.27, 95% CI 0.01 to 8.46, 1 RCT, n = 10). We found no eligible evidence addressing adverse events, functioning, or anxiety. AUTHORS' CONCLUSIONS Findings of the present meta-analysis indicate that music therapy provides short-term beneficial effects for people with depression. Music therapy added to treatment as usual (TAU) seems to improve depressive symptoms compared with TAU alone. Additionally, music therapy plus TAU is not associated with more or fewer adverse events than TAU alone. Music therapy also shows efficacy in decreasing anxiety levels and improving functioning of depressed individuals.Future trials based on adequate design and larger samples of children and adolescents are needed to consolidate our findings. Researchers should consider investigating mechanisms of music therapy for depression. It is important to clearly describe music therapy, TAU, the comparator condition, and the profession of the person who delivers the intervention, for reproducibility and comparison purposes.
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Affiliation(s)
- Sonja Aalbers
- University of Applied SciencesSocial Work and Arts TherapiesRengerslaan 8LeeuwardenFrieslandNetherlands8917 DD
- Vrije Universiteit AmsterdamClinical, Neuro & Developmental PsychologyAmsterdamNetherlands
| | - Laura Fusar‐Poli
- University of PaviaDepartment of Brain and Behavioral Sciencesvia Bassi 21PaviaItaly27100
| | - Ruth E Freeman
- Central and North West London NHS Foundation TrustPsychiatryLondonUK
| | - Marinus Spreen
- Stenden University of Applied SciencesSchool of Social Work and Art TherapiesLeeuwardenNetherlands
| | - Johannes CF Ket
- Vrije Universiteit AmsterdamMedical LibraryDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Annemiek C Vink
- ArtEZ School of MusicMusic Therapy Dept.Van Essengaarde 10EnschedeNetherlands7511 PN
| | - Anna Maratos
- Central and North West London NHS Foundation TrustArts TherapiesGreater London HouseHampstead RoadLondonUKNW1 7QY
| | - Mike Crawford
- Imperial College LondonDepartment of Psychological MedicineClaybrook Centre37 Claybrook RoadLondonUKW6 8LN
| | - Xi‐Jing Chen
- Institute of Psychology, Chinese Academy of ScienceCAS Key Laboratory of Mental HealthBeijingChina
| | - Christian Gold
- Uni ResearchGAMUT ‐ The Grieg Academy Music Therapy Research Centre, Uni Research HealthLars Hilles gate 3BergenNorway5015
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Bjertnaes O, Iversen HH, Holmboe O, Danielsen K, Garratt A. The Universal Patient Centeredness Questionnaire: reliability and validity of a one-page questionnaire following surveys in three patient populations. PATIENT-RELATED OUTCOME MEASURES 2016; 7:55-62. [PMID: 27350761 PMCID: PMC4902142 DOI: 10.2147/prom.s102732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background This study developed and tested the reliability and validity of the Universal Patient Centeredness Questionnaire (UPC-Q). Methods The UPC-Q developed in this study has three parts: 1) the aspects that patients consider the most important when receiving a relevant health care service, rating the health care services on these aspects and their prioritization, 2) the overall experiences of patients using the relevant health care service, and 3) suggestions for improvements. The UPC-Q was tested in four different patient-experience surveys in 2015, including psychiatric inpatients (n=109), general practitioner (GP) patients (n=1,059), and inpatients from two hospital samples (n=973, n=599). The UPC-Q was tested for item completeness and ceiling effects, while the UPC-Q scale consisting of the first part of the UPC-Q was tested for internal consistency reliability and construct validity. Results The percentage of patients rating at least one aspect was 70.6% for psychiatric inpatients, 77.6% for hospital inpatients, and 90.6% for GP patients, while 88.9% of the psychiatric inpatients, 93.1% of the hospital inpatients, and 95.3% of the GP patients were able to prioritize the aspects. The internal consistency reliability of the UPC-Q scale was acceptable in all samples (Cronbach’s alpha >0.7), and construct validity was supported by 20 of 21 significant associations between the UPC-Q and related variables. The UPC-Q total score was skewed toward positive evaluations, but the ceiling effect was smaller for an unbalanced response scale than for a balanced scale. Conclusion The UPC-Q includes ratings of what is most important for individual patients, while at the same time providing data for improving the quality of health care and making it possible to monitor trends within and across patient populations. This study included psychiatric inpatients, hospital inpatients, and GP patients, and found that the UPC-Q performed well in terms of acceptance, internal consistency reliability, and construct validity.
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Affiliation(s)
- Oyvind Bjertnaes
- Unit for Patient-Reported Quality, Norwegian Institute of Public Health, Oslo, Norway
| | - Hilde Hestad Iversen
- Unit for Patient-Reported Quality, Norwegian Institute of Public Health, Oslo, Norway
| | - Olaf Holmboe
- Unit for Patient-Reported Quality, Norwegian Institute of Public Health, Oslo, Norway
| | - Kirsten Danielsen
- Unit for Patient-Reported Quality, Norwegian Institute of Public Health, Oslo, Norway
| | - Andrew Garratt
- Unit for Patient-Reported Quality, Norwegian Institute of Public Health, Oslo, Norway
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Hendriks SH, Rutgers J, van Dijk PR, Groenier KH, Bilo HJG, Kleefstra N, Kocks JWH, van Hateren KJJ, Blanker MH. Validation of the howRu and howRwe questionnaires at the individual patient level. BMC Health Serv Res 2015; 15:447. [PMID: 26431695 PMCID: PMC4592573 DOI: 10.1186/s12913-015-1093-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The howRu and howRwe are new short questionnaires which are meant to measure health-related quality of life and patient experience. However, validation at the individual patient level has not yet taken place. We aimed to investigate the validity of both questionnaires at the individual patient level. METHODS In this prospective validation study, patients were asked to complete both questionnaires and comment on their answers in a semi-structured in-depth interview. Based on the transcribed interviews, a panel of 45 general practitioners and 45 patients filled out the questionnaires as they thought the patients had completed them. The questionnaires were considered valid instruments when a reliable and acceptable level of agreement was reached between the patient's score and the score of a review panel, defined as a concordance correlation coefficient (CCC) of ≥0.70. Bland-Altman plots were also made. RESULTS Ninety patients were included. The CCC of the howRu total score of the review panel and patients was 0.80 (95 % CI 0.73 to 0.86). Bland-Altman plots showed a mean difference of -0.96 and the limits of agreement ranged from -2.87 to 0.95. The CCC of the howRwe total score was 0.57 (95 % CI 0.42 to 0.69). The mean difference on the Bland-Altman plots was -0.54 and the limits of agreement ranged from -3.59 to 2.52. CONCLUSIONS The howRu seems to be a valid questionnaire for measuring health-related quality of life at the individual patient level. We do not advice to use the tested version of the howRwe questionnaire for assessing patient experience at the individual patient level. TRIAL REGISTRATION The study was registered at clinicaltrials.gov NCT01830803 . Registration date: 5 April 2013.
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Affiliation(s)
| | | | | | - Klaas H Groenier
- Department of General Practice, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands.
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands. .,Department of Internal Medicine, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands. .,Department of Internal Medicine, Isala, Zwolle, The Netherlands.
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands. .,Department of Internal Medicine, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands. .,Langerhans Medical Research Group, Zwolle, The Netherlands.
| | - Janwillem W H Kocks
- Department of General Practice, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands.
| | | | - Marco H Blanker
- Department of General Practice, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands.
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