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Kaufman EJ, Whitehorn G, Orji W, Chreiman K, Jackson S, Holena D, Lane-Fall M, Jacoby SF. Patient Experiences of Acute and Postacute Care After Trauma. J Surg Res 2023; 291:303-312. [PMID: 37506429 DOI: 10.1016/j.jss.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/13/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Traumatic injury can transform a healthy, independent individual into a patient with complex health needs. Little is known about how injured patients understand their health and healthcare needs during postacute recovery, limiting our ability to optimize care. This multiple-methods study explored injured patients' experiences of care up to 30 days after discharge. METHODS Injured adults admitted to an urban, Level I trauma center August 1, 2019-November 30, 2020 were sampled purposively to balance blunt and penetrating injuries. Patient experience and health status were assessed at baseline and 30 days postdischarge using the Quality of Trauma Care Patient-Reported Experience Measure. Fifteen qualitative interviews were conducted with a purposive subset and analyzed using qualitative content analysis. RESULTS Of 67 participants (76% male, 73% Black, 51% penetrating, median age 34 years), 37 completed follow-up surveys. Quality of acute care was rated 9-10/10 by 81% of the sample for acute and 65% for postacute care (P = 0.09). Thirty percent described fair or poor mental health, but only mental health concerns were addressed for only 2/3. Pain control was inadequate in 31% at baseline and for 46% at follow-up (P = 0.09). Qualitative analysis revealed general satisfaction with acute care but challenges in recovery with unmet needs for communication and care coordination. CONCLUSIONS Trauma patients appreciated the quality of their acute care experiences but identified opportunities for improvement in prognostic communication, pain management, and mental health support. Unmet mental and physical care needs persist at least 1 month after hospital discharge and reinforce the need for interventions that optimize postacute trauma care.
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Affiliation(s)
- Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Gregory Whitehorn
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Whitney Orji
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristen Chreiman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sunny Jackson
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Daniel Holena
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sara F Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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Yeung M, Hagel BE, Bobrovitz N, Stelfox TH, Elliot A, MacPherson A, McBeth P, Schuurmann N, Yanchar NL. Between paradigms: Comparing experiences for adolescents treated at pediatric and adult trauma centres. Injury 2023:S0020-1383(23)00363-7. [PMID: 37147145 DOI: 10.1016/j.injury.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Injured adolescents may be treated at pediatric trauma centres (PTCs) or adult trauma centres (ATCs). Patient and parent experiences are an integral component of high-quality health care and can influence patient clinical trajectory. Despite this knowledge, there is little research on differences between PTCs and ATCs with respect to patient and caregiver-reported experience. We sought to identify differences in patient and parent-reported experiences between the regional PTC and ATC using a recently developed Patient and Parent-Reported Experience Measure. METHODS We prospectively enrolled patients (caregivers) aged 15-17 (inclusive), admitted to the local PTC and ATC for injury management (01/01/2020 - 31/05/2021) We provided a survey 8-weeks post-discharge to query acute care and follow-up experience. Patient and parent experiences were compared between the PTC and ATC using descriptive statistics, chi-square tests for categorical and independent t-tests for continuous variables. RESULTS We identified 90 patients for inclusion (51 PTC, and 39 ATC). From this population, we had 77 surveys (32 patient and 35 caregiver) completed at the PTC, and 41 (20 patient and 21 caregiver) at the ATC. ATC patients tended to be more severely injured. We identified few differences in reported experience on the patient measure but identified lower ratings from caregivers of adolescents treated in ATCs for the domains of information and communication, follow-up care, and overall hospital scores. Patients and parents reported poorer family accommodation at the ATC. CONCLUSION Patient experiences were similar between centres. However, caregivers report poorer experiences at the ATC in several domains. These differences are multifaceted, and may reflect differing patient volumes, effects of COVID-19, and healthcare paradigms. However, further work should target information and communication improvement in adult paradigms given its impact on other domains of care.
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Affiliation(s)
- Matthew Yeung
- Cumming School of Medicine, University of Calgary; Health Sciences Centre, Foothills campus, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Brent E Hagel
- Alberta Children's Hospital Research Institute, University of Calgary, Room 293, Heritage Medical Research Building, 3330 Hospital Dr. NW, Calgary, AB T2N 4N1, Canada
| | - Niklas Bobrovitz
- Temerty Faculty of Medicine, University of Toronto, Temerty Faculty of Medicine, 1 King's College Circle Medical Sciences Building, Room 2109, Toronto, ON M5S 1A8, Canada
| | - Thomas H Stelfox
- Department of Critical Care, University of Calgary, Foothills Medical Centre, 1403 29St NW, Calgary, AB T2N 2T9, Canada
| | - April Elliot
- Department of Pediatrics, Alberta Children's Hospital, 29 Oki Drive, Calgary, AB T2B 6A8, Canada
| | - Alison MacPherson
- Faculty of Health, York University, 337 Norman Bethune College, 170 Campus Walk, North York, ON M3J 1P3, Canada
| | - Paul McBeth
- Department of Surgery, University of Calgary, North Tower, Foothills Medical Centre, 1403 29St NW, Calgary, AB T2N 2T9, Canada
| | - Nadine Schuurmann
- Department of Geography, RCB 6119/7134, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Natalie L Yanchar
- Natalie L Yanchar: Department of Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada.
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Zhang L, Chen H, Mao Y, Zheng S, Zheng P. Development of a simplified version of the smoking rationalization belief scale for Chinese male smokers. Front Psychiatry 2023; 14:1044929. [PMID: 36890984 PMCID: PMC9986291 DOI: 10.3389/fpsyt.2023.1044929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
Objective The goal of this study was to simplify the smoking rationalization belief (SRB) scale among Chinese male smokers and provide a convenient measuring tool with good reliability and validity to promote the assessment and further intervention of SRB among smokers. Methods Through purposive sampling, a questionnaire survey was conducted among adult male smokers in three districts in Shanghai, and 1,307 valid questionnaires were collected. Exploratory factor analysis was used to analyze the simplified scale, and Pearson correlation analysis, multiple linear regression, and Cronbach's α were used to test the reliability and validity of the simplified scale. Results The SRB scale was simplified from 26 items to 8 items and had good overall reliability (Cronbach's α = 0.757). There was a strong correlation between the simplified scale and the original scale (P < 0.001, r = 0.911), and the scores of SRB measured by the two scales were both negatively associated with a willingness to quit smoking (P < 0.001), which reflected the practical effectiveness of the simplified version. Conclusion The simplified version of the SRB scale showed good reliability and validity among Chinese smokers, which facilitates smoking cessation-related research and practice.
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Affiliation(s)
- Lingyun Zhang
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Hao Chen
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Yimeng Mao
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Shichen Zheng
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
| | - Pinpin Zheng
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
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Yeung M, Hagel BE, Bobrovitz N, Stelfox TH, Yanchar NL. Development of the quality of teen trauma acute care patient and parent-reported experience measure. BMC Res Notes 2022; 15:304. [PMID: 36138467 PMCID: PMC9503226 DOI: 10.1186/s13104-022-06194-x] [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: 11/05/2021] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Patient-Reported Experience Measures (PREMs) provide valuable patient feedback on quality of care and have been associated with clinical outcomes. We aimed to test the reliability of a modified adult trauma care PREM instrument delivered to adolescents admitted to hospital for traumatic injuries, and their parents. Modifications included addition of questions reflecting teen-focused constructs on education supports, social network maintenance and family accommodation. Results Forty adolescent patients and 40 parents participated. Test-retest reliability was assessed using Cohen’s kappa, weighted kappa, and percent agreement between responses. Directionality of changed responses was noted. Most of the study ran during the COVID-19 pandemic. We established good reliability of questions related to in-hospital and post-discharge communication, clinical and ancillary care and family accommodation. We identified poorer reliability among constructs reflecting experiences that varied from the norm during the pandemic, which included “maintenance of social networks”, “education supports”, “scheduling clinical follow-ups” and “post-discharge supports”. Parents, but not patients, demonstrated more directionality of change of responses by responding with more negative in-hospital and more positive post-discharge experiences over time between the test and retest periods, suggesting risk of recall bias. Situational factors due to the COVID-19 pandemic and potential risks of recall bias may have limited the reliability of some parts of the survey. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06194-x.
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Affiliation(s)
- Matthew Yeung
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Brent E Hagel
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Niklas Bobrovitz
- Department of Critical Care, University of Calgary, Calgary, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Thomas H Stelfox
- Department of Critical Care, University of Calgary, Calgary, Canada
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Goodman MS, Ackermann N, Pierce KA, Bowen DJ, Thompson VS. Development and Validation of a Brief Version of the Research Engagement Survey Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10020. [PMID: 34639323 PMCID: PMC8507896 DOI: 10.3390/ijerph181910020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022]
Abstract
The Research Engagement Survey Tool (REST) examines the level of partner engagement in research studies. This study used mixed methods, including web-based surveys (N = 336), a modified Delphi process (N = 18), and cognitive response interviews (N = 16), with convenience sampling to develop and validate a short version of the REST. We conducted factor analysis and calculated internal consistency for the condensed REST. We validated the condensed REST against the comprehensive REST. All analyses were carried out on two scales (quality and quantity) based on Likert-type response options. We examined convergent validity with other measures theoretically associated with the REST (e.g., the Community Engagement Research Index and the Partnership Self-Assessment Tool). This study produced a 9-item condensed version of the REST. The condensed REST loads on 1 factor, has high internal consistency (Cronbach's alpha = 0.92 for the quantity scale; 0.94 for the quality scale), is significantly correlated (ρ = 0.97; p < 0.001 for both scales) with the comprehensive (32-item) REST, and has negligible, low, and moderate correlation with other measures (e.g., the Partnership Assessment In community-based Research, trust in medical researchers, and the Coalition Self-Assessment Survey). Use of the condensed REST will reduce participant burden and time to complete. This standardized and validated quantitative measure is useful to compare engagement across projects or within a project over time.
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Affiliation(s)
- Melody S. Goodman
- School of Global Public Health, New York University, New York, NY 10003, USA;
| | - Nicole Ackermann
- Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Kristyn A. Pierce
- School of Global Public Health, New York University, New York, NY 10003, USA;
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA;
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Hall EC, Tyrrell R, Scalea TM, Stein DM. Trauma Transitional Care Coordination: protecting the most vulnerable trauma patients from hospital readmission. Trauma Surg Acute Care Open 2018; 3:e000149. [PMID: 29766133 PMCID: PMC5887824 DOI: 10.1136/tsaco-2017-000149] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 12/17/2022] Open
Abstract
Background Unplanned hospital readmissions increase healthcare costs and patient morbidity. We hypothesized that a program designed to reduce trauma readmissions would be effective. Methods A Trauma Transitional Care Coordination (TTCC) program was created to support patients at high risk for readmission. TTCC interventions included call to patient (or caregiver) within 72 hours of discharge to identify barriers to care, complete medication reconciliation, coordination of appointments, and individualized problem solving. Information on all 30-day readmissions was collected. 30-day readmission rates were compared with center-specific readmission rates and population-based, risk-adjusted rates of readmission using published benchmarks. Results 260 patients were enrolled in the TTCC program from January 2014 to September 2015. 30.8% (n=80) of enrollees were uninsured, 41.9% (n=109) reported current substance abuse, and 26.9% (n=70) had a current psychiatric diagnosis. 74.2% (n=193) attended outpatient trauma appointments within 14 days of discharge. 96.3% were successfully followed. Only 6.6% (n=16) of patients were readmitted in the first 30 days after discharge. This was significantly lower than both center-specific readmission rates before start of the program (6.6% vs. 11.3%, P=0.02) and recently published population-based trauma readmission rates (6.6% vs. 27%, P<0.001). Discussion A nursing-led TTCC program successfully followed patients and was associated with a significant decrease in 30-day readmission rates for patients with high-risk trauma. Targeted outpatient support for these most vulnerable patients can lead to better utilization of outpatient resources, increased patient satisfaction, and more consistent attainment of preinjury level of functioning or better. Level of evidence Level IV.
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Affiliation(s)
- Erin C Hall
- Department of Surgery, Division of Trauma, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Rebecca Tyrrell
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Deborah M Stein
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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