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Walløe S, Beck M, Lauridsen HH, Morsø L, Simonÿ C. Quality in care requires kindness and flexibility - a hermeneutic-phenomenological study of patients' experiences from pathways including transitions across healthcare settings. BMC Health Serv Res 2024; 24:117. [PMID: 38254059 PMCID: PMC10801984 DOI: 10.1186/s12913-024-10545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The number of people living with chronic conditions is increasing worldwide, and with that, the need for multiple long-term complex care across care settings. Undergoing transitions across healthcare settings is both challenging and perilous for patients. Nevertheless, knowledge of what facilitates quality during transitions in healthcare settings from the lifeworld perspective of patients is still lacking. Therefore, we aimed to explore the lived experience in healthcare quality for Danish adult patients during healthcare pathways including transitions across settings. METHODS Within a hermeneutic-phenomenological approach, interviews were conducted with three women and five men with various diagnoses and care paths between 30 and 75 years of age. Data underwent a three phased thematic analysis leading to three themes. RESULTS Patients with various illnesses' experiences of quality of care is described in the themes being powerless in the face of illness; burdensome access and navigation; and being in need of mercy and striving for kindness. This highlights that patients' experiences of quality in healthcare pathways across settings interweaves with an overall understanding of being powerless at the initial encounter. Access and navigation are burdensome, and system inflexibility adds to the burden and enhances powerlessness. However, caring care provided through the kindness of healthcare professionals supports patients in regaining control of their condition. CONCLUSIONS This hermeneutical-phenomenological study sheds light on the lived experiences of people who are at various stages in their care paths with transitions across healthcare settings. Although our findings are based on the lived experiences of 8 people in a Danish context, in light of the discussion with nursing theory and other research, the results can be reflected in two main aspects: I) kind and merciful professional relationships and II) system flexibility including access and navigation, were essential for their experiences of care quality during healthcare transitions. This is important knowledge when striving to provide patients with a clear voice regarding quality in care pathways stretching across settings.
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Affiliation(s)
- Sisse Walløe
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3. Floor, 5000, Odense C, Denmark.
- Department of Physio- and Occupational Therapy, Research- and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Fælledvej 2C, 4200, Slagelse, Denmark.
| | - Malene Beck
- Department of Paediatrics, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Henrik Hein Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 39, 5230, Odense, Denmark
| | - Lars Morsø
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3. Floor, 5000, Odense C, Denmark
| | - Charlotte Simonÿ
- Department of Health, Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Research- and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Fælledvej 2C, 4200, Slagelse, Denmark
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Dobra R, Davies J, Elborn S, Kee F, Madge S, Boeri M. A discrete choice experiment to quantify the influence of trial features on the decision to participate in cystic fibrosis trials. J Cyst Fibros 2024; 23:73-79. [PMID: 38042750 DOI: 10.1016/j.jcf.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/20/2023] [Accepted: 04/09/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Patient-centred trial design optimises recruitment and retention, reduces trial failure rates and increases the diversity of trial cohorts. This allows safe and effective treatments to reach clinic more quickly. To achieve this, patients' views must be incorporated into trial design. METHODS A discrete choice experiment was used to quantify preferences of pwCF for trials features; medicine type, trial location, stipend, washout, drug access on trial completion and trial design. Respondents were presented pairs of hypothetical trial scenarios with different level combinations assigned through experimental design. Respondents were asked to pick their preferred option or decline both. The cross-sectional data were explored using a Random Parameters Logit model. RESULTS We received 207 eligible responses between Oct2020-Jan2021. The strongest influence on the decision to participate was trial location; pwCF favour participation at their usual clinical centre. Greater travel distances made respondents less willing to participate. Post-trial drug access ranked second. pwCF would rather participate in modulator trials than trials of other drugs. In general, pwCF did not favour a washout period, but were more prepared to washout non-modulators than modulators. Stipend provision was not ranked highly, but higher stipends increased intention to participate. Trial design (placebo vs open-label) had minimal influence on the decision to participate. There are complex interactions between placebos and washouts. CONCLUSIONS We used quantitative methods to systematically elicit preferences of pwCF for clinical trials' features. We explore the relevance of our findings to trial design and delivery in the current CF trials landscape.
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Affiliation(s)
- Rebecca Dobra
- National Heart and Lung Institute, Imperial College London, UK; Department of Paediatrics, Royal Brompton Hospital, London, UK.
| | - Jane Davies
- National Heart and Lung Institute, Imperial College London, UK; Department of Paediatrics, Royal Brompton Hospital, London, UK
| | - Stuart Elborn
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University, Belfast, UK
| | - Susan Madge
- Department of Adult Cystic Fibrosis, Royal Brompton Hospital, London, UK
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Fabian A, Rühle A, Domschikowski J, Trommer M, Wegen S, Becker JN, Wurschi G, Boeke S, Sonnhoff M, Fink CA, Käsmann L, Schneider M, Bockelmann E, Treppner M, Mehnert-Theuerkauf A, Nicolay NH, Krug D. Satisfaction with radiotherapy care among cancer patients treated in Germany-secondary analysis of a large multicenter study. Strahlenther Onkol 2023:10.1007/s00066-023-02176-5. [PMID: 37975882 DOI: 10.1007/s00066-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Patient satisfaction with healthcare has been linked to clinical outcomes and regulatory agencies demand its regular assessment. Therefore, we aimed to investigate patient satisfaction with radiotherapy care and its determinants. METHODS This is a secondary analysis of a multicenter prospective cross-sectional study. Eligible cancer patients anonymously completed questionnaires at the end of a course of radiotherapy. The outcome variable was overall patient satisfaction with radiotherapy care measured with a 10-point Likert scaled single-item. Given patient satisfaction was defined for patients scoring ≥ 8 points. Determinants of given patient satisfaction were assessed by univariable and multivariable analyses. A p-value < 0.05 was considered statistically significant. RESULTS Out of 2341 eligible patients, 1075 participated (participation rate 46%). Data on patient satisfaction was provided by 1054 patients. There was a right-skewed distribution towards more patient satisfaction (mean = 8.8; SD = 1.68). Given patient satisfaction was reported by 85% (899/1054) of the patients. Univariable analyses revealed significant associations of lower patient satisfaction with tumor entity (rectal cancer), concomitant chemotherapy, inpatient care, treating center, lower income, higher costs, and lower quality of life. Rectal cancer as tumor entity, treating center, and higher quality of life remained significant determinants of patient satisfaction in a multivariable logistic regression. CONCLUSION Overall patient satisfaction with radiotherapy care was high across 11 centers in Germany. Determinants of patient satisfaction were tumor entity, treating center, and quality of life. Although these data are exploratory, they may inform other centers and future efforts to maintain high levels of patient satisfaction with radiotherapy care.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Alexander Rühle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Maike Trommer
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, 50931, Cologne, Germany
| | - Simone Wegen
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, 50937, Cologne, Germany
| | - Jan-Niklas Becker
- Department of Radiotherapy and Special Oncology, Medical School Hannover, 30625, Hannover, Germany
| | - Georg Wurschi
- Department of Radiotherapy and Radiation Oncology, Jena University Hospital, 07747, Jena, Germany
| | - Simon Boeke
- Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Mathias Sonnhoff
- Center for Radiotherapy and Radiation Oncology, 28239, Bremen, Germany
| | - Christoph A Fink
- Department of Radiation Oncology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
- Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), 81377, Munich, Germany
- Partner Site Munich, German Cancer Consortium (DKTK), 81377, Munich, Germany
| | - Melanie Schneider
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Elodie Bockelmann
- Department of Radiotherapy and Radiation Oncology, University Hospital Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Martin Treppner
- Institute of Medical Biometry and Statistics, University Hospital Freiburg, 79106, Freiburg, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, 04103, Leipzig, Germany
| | - Nils H Nicolay
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, 04103, Leipzig, Germany
- Partner Site Leipzig, Cancer Center Central Germany, 04103, Leipzig, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Kim S, Chang H, Kim T, Cha WC. Patient Anxiety and Communication Experience in the Emergency Department: A Mobile, Web-Based, Mixed-Methods Study on Patient Isolation During the COVID-19 Pandemic. J Korean Med Sci 2023; 38:e303. [PMID: 37821083 PMCID: PMC10562183 DOI: 10.3346/jkms.2023.38.e303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Anxiety and communication difficulties in the emergency department (ED) may increase for various reasons, including isolation due to coronavirus disease 2019 (COVID-19). However, little research on anxiety and communication in EDs exists. This study explored the isolation-related anxiety and communication experiences of ED patients during the COVID-19 pandemic. METHODS A prospective mixed-methods study was conducted from May to August 2021 at the Samsung Medical Center ED, Seoul. There were two patient groups: isolation and control. Patients measured their anxiety using the State-Trait Anxiety Inventory (STAI X1) at two time points, and we surveyed patients at two time points about factors contributing to their anxiety and communication experiences. These were measured through a mobile web-based survey. Researchers interviewed patients after their discharge. RESULTS ED patients were not anxious regardless of isolation, and there was no statistical significance between each group at the two time points. STAI X1 was 48.4 (standard deviation [SD], 8.0) and 47.3 (SD, 10.9) for early follow-up and 46.3 (SD, 13.0) and 46.2 (SD, 13.6) for late follow-up for the isolation and control groups, respectively. The clinical process was the greatest factor contributing to anxiety as opposed to the physical environment or communication. Communication was satisfactory in 71.4% of the isolation group and 66.7% of the control group. The most important aspects of communication were information about the clinical process and patient status. CONCLUSION ED patients were not anxious and were generally satisfied with medical providers' communication regardless of their isolation status. However, patients need clinical process information for anxiety reduction and better communication.
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Affiliation(s)
- Sumin Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hansol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Digital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Crubezy M, Douay C, Michel P, Haesebaert J. Using patient comments from a standardised experience survey to investigate their perceptions and prioritise improvement actions: a thematic and syntactic analysis. BMC Health Serv Res 2023; 23:988. [PMID: 37710317 PMCID: PMC10503051 DOI: 10.1186/s12913-023-09953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Although patient experience surveys flourish in many countries with the aim to improve quality of care, questions remain concerning their ability to become effective drivers of change within institutions. The patient comments from the French national patient experience hospital survey were analysed using an innovative structured approach to characterise patient experience and identify field actions for the institutions. METHODS The comments were taken from the two open-ended questions comprised in the patient experience survey of the Hospices Civils de Lyon between 2018 and 2019. The comments analysis methodology consisted in three steps: thematic analysis; syntactic analysis; generation of statistics for the creation of a patient journey and prioritisation of sub-themes. The STROBE statement checklist was followed. RESULTS Over a year, 79.7% of the 7 362 respondents left at least one comment at the end of the survey and were included in the study, for a total of 5 868 surveys and 10 061 comments. These led to the identification of 28 general themes and 184 specific sub-themes. From the patient journey created, 23 sub-themes were prioritised and gathered into four key categories: relationship between patient and staff; environment; surgery and pain management; information and care coordination. For each of them, the actions and expectations formulated by the respondents were described. CONCLUSIONS The analysis of patient comments obtained from a standardised survey allowed to characterise the patient journey using data that describes patient experience, enabling a prioritisation of actions aiming to improve practice and quality of care at the institution, department, and staff level.
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Affiliation(s)
- Marion Crubezy
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
- Institut d'études KPAM, Paris, France.
| | | | - Philippe Michel
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Direction Qualité Usagers Et Santé Populationnelle, Hospices Civils de Lyon, Lyon, France
| | - Julie Haesebaert
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Pôle de Santé Publique, Service de Recherche Et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, France
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Frank L, Concannon TW, Harrison JM, Zelazny S. Policy Decisionmaking in Long-Term Care: Lessons from Infection Control During the COVID-19 Pandemic. Rand Health Q 2023; 10:4. [PMID: 37333671 PMCID: PMC10273890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The COVID-19 pandemic focused attention on long-term care facilities' need for infection-control policies that balanced community safety and individual well-being. Infection-control policies were often developed, implemented, and mandated without the input or involvement of those who are most affected: residents and their family members, administrators, and staff. This failure led to declines in residents' physical and mental health. The pandemic exposed an opportunity-and an imperative-to reimagine long-term care in a way that is centered on the needs and preferences of those who receive care, their family members, and those who provide care. This study lays the groundwork for cultural change and a move toward inclusive policy decisionmaking in long-term care through a review of infection-control policy decisions and action items proposed in guided discussions with a diversity of stakeholders-long-term care residents, direct care staff, and consumer advocates to facility administrators, clinicians, researchers, and industry organizations. Transforming the culture of long-term care to elevate the needs of residents will require attention to facility leadership, along with steps to increase inclusiveness, transparency, and accountability in decisionmaking.
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Heath C, Bavich P, Sommerfield A, von Ungern-Sternberg BS. Kids Voices, the perioperative experience of emergency surgery from children's perspectives: A qualitative study. Patient Educ Couns 2023; 110:107674. [PMID: 36848717 DOI: 10.1016/j.pec.2023.107674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The study aimed to better understand children's emergency perioperative experience, a little researched topic. Current literature shows discrepancies between child and adult perceptions for the same healthcare experience. Acquisition of knowledge from the child's perspective can be utilized to improve perioperative care. METHOD This qualitative study included children (4-15 years) undergoing emergency surgery requiring general anesthesia for manipulation under anesthesia (MUA) and appendicectomy. Recruitment was opportunistic with the aim to recruit a minimum of 50 per surgical subgroup, with 109 children interviewed via telephone postoperatively. Data analysis was performed using qualitative content analysis. Participants varied in terms of age, gender, diagnosis and previous perioperative experience. RESULTS Qualitative content analysis found three overarching themes in association with the perioperative process: (1) fearful/apprehensive, (2) perception of powerlessness and (3) perception of trust and security. Two overarching themes were found from data relevant to the perioperative environment: (1) poor adaptation of the care environment to the children's needs and (2) positive adaptation of the care environment to the children's needs. CONCLUSION AND PRACTICE IMPLICATIONS The themes identified provide valuable insight into children's perioperative experience. Findings are of value to stakeholders in healthcare and are expected to inform strategies to optimize the quality of healthcare.
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Affiliation(s)
- Chloe Heath
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - Paige Bavich
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia.
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Breslau J, Barnes-Proby D, Bhandarkar M, Cantor JH, Hanson R, Kofner A, Li R, Malika N, Mendoza-Graf A, Pincus HA. Availability and Accessibility of Mental Health Services in New York City. Rand Health Q 2022; 10:6. [PMID: 36484081 PMCID: PMC9718065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Mental health services are critical components of public health infrastructure that provide essential supports to people living with psychiatric disorders. In a typical year, about 20 percent of people will have a psychiatric disorder, and about 5 percent will experience serious psychological distress, indicating a potentially serious mental illness. Nationally, the use of mental health services is low, and the use of care is not equitably distributed. In the United States as a whole and in New York City (NYC), non-Hispanic white individuals are more likely to use mental health services than non-Hispanic black individuals or Hispanic individuals. The challenges of ensuring the availability of mental health services for all groups in NYC are particularly acute, given the size of the population and its diversity in income, culture, ethnicity, and language. Adding to these underlying challenges, the coronavirus disease 2019 (COVID-19) pandemic has disrupted established patterns of care. To advance policy strategy for addressing gaps in the mental health services system, RAND researchers investigate the availability and accessibility of mental health services in NYC. The RAND team used two complementary approaches to address these issues. First, the team conducted interviews with a broad group of professionals and patients in the mental health system to identify barriers to care and potential strategies for improving access and availability. Second, the team investigated geographic variations in the availability of mental health services by compiling and mapping data on the locations and service characteristics of mental health treatment facilities in NYC.
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Saghebdoust S, Dayyani M, Rouhbakhsh Zahmatkesh MR, Abbasi B, Soltani G, Zare R. Launching awake craniotomy technique in a resource-limited center: new insights into the patient experience, costs, long-term outcomes, and a narrative review of the literature. World Neurosurg 2022; 168:246-257.e4. [PMID: 36150602 DOI: 10.1016/j.wneu.2022.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Awake craniotomy (AC) with brain mapping is a standard surgical technique for the excision of lesions located in eloquent areas. Herein, we aimed to assess the clinical challenges, patient experience, costs, and long-term outcomes of AC in a resource-limited setting (RLS). METHODS In this cross-sectional study, electronic documents of 12 subjects who underwent AC with functional brain mapping were prospectively collected from August 2017 to October 2020. Patient characteristics, surgical specifications, hospitalization period, intra- and postoperative events, functional outcome, patients' satisfaction, costs, and survivals were collected and analyzed. RESULTS Twelve patients with a median age of 42.5 (IQR = 13.5) were enrolled, of which eight were male (66.7%), and nine (75%) were harboring grade 2 glioma. Of the subjects, 8.34%, 33.34%, and 58.33% had partial, subtotal, and gross total excision of the tumors, respectively. The intraoperative seizure was the only complication and occurred in two cases (16.67%). At one-year follow-up, none of the patients experienced any ND. Eleven patients (91.6%) had a satisfactory opinion about reappearing in the AC. At 38-month follow-up, mortality rate was 8 % for AC group and 25% among the historically matched controls who had surgery under general anesthesia (P= 0.27). The major portion of costs belonged to the neurosurgery team (43%), and the overall expenses were reduced by 13% compared to a putatively well-equipped setting in our country. CONCLUSION In carefully selected individuals, AC with brain mapping for excision of gliomas could be a safe, effective, and affordable strategy in RLS and can be successfully performed with satisfactory outcomes.
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Affiliation(s)
| | - Mojtaba Dayyani
- Division of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, California, United States
| | | | - Bita Abbasi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghasem Soltani
- Department of Anesthesiology, Razavi Hospital, Mashhad, Iran
| | - Reza Zare
- Department of Neurosurgery, Razavi Hospital, Mashhad, Iran.
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Jang SG, Park E, Lee J, Choi JE, Lee SI, Han H, Park E, Lee W. An Exploration Into Patients' Experiences That Make Them Feel Safe During Hospitalization: A Qualitative Study. J Korean Med Sci 2022; 37:e256. [PMID: 35996933 PMCID: PMC9424743 DOI: 10.3346/jkms.2022.37.e256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patient safety is a crucial indicator of health care quality. It is necessary to check the subjective perception of patient safety from the patient's point of view as a consumer of healthcare services. To identify patients' experiences of safety and the themes that constitute the patients' feeling of safety during hospitalization. METHODS A qualitative study, comprising five focus group discussions (seven people each), was conducted in South Korea between May and July 2018. Patients who were hospitalized for at least three days within one year were included. Researchers analyzed the transcribed script, and a content analysis was performed to describe patients' hospitalized experiences of safety. RESULTS A total of 35 patients with an average age of 45.4 years participated in the study, and had experience of hospitalization for up to 32 days. The findings revealed four core themes and 14 sub-themes. Patients wanted to take initiative in controlling his/her reception of information and wanted healthcare providers to make the patient feel safe. Patients felt safe when hospitals provided unstinted and generous support. Also, public sentiment about national healthcare and safety made an effect on patient safety sentiment. CONCLUSION Patients felt safe during hospitalization not only because of the explanation, attitude, and professionalism of the healthcare providers but also because of the support, system, and procedure of the medical institution. Healthcare providers and medical institutions should strive to narrow the gap in patient safety awareness factors through activities with patients. Furthermore, the government and society should make an effort to create a safe medical environment and social atmosphere.
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Affiliation(s)
| | - Eunji Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jessie Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ji Eun Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sang-Il Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Haerim Han
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Eunjung Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Won Lee
- Department of Nursing, Chung-Ang University, Seoul, Korea.
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Ahluwalia SC, Vegetabile BG, Edelen MO, Setodji CM, Rodriguez A, Scherling A, Phillips J, Farmer CM, Harrison JM, Bandini J, Huang W, Schulson L, Walling A, Dalton S, Martineau M, Hall O, Schlang D, Bradley MA, Ast K. MACRA Palliative Care Quality Measure Development-Testing Summary Report: Measure Name: Feeling Heard and Understood. Rand Health Q 2022; 9:3. [PMID: 35837526 PMCID: PMC9242575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Palliative care has expanded rapidly in the past 20 years, especially in the ambulatory (office) setting, and there is growing consensus regarding the need to systematically measure and incentivize high-quality care. The Centers for Medicare & Medicaid Services entered a cooperative agreement with the American Academy of Hospice and Palliative Medicine (AAHPM) as part of the Medicare Access and CHIP Reauthorization Act of 2015 to develop two patient-reported measures of ambulatory palliative care experience: Feeling Heard and Understood and Receiving Desired Help for Pain. Under contract to AAHPM, RAND Health Care researchers developed and tested both measures over a three-year project period. Researcher efforts included identifying, developing, testing, and validating appropriate patient-reported data elements for each measure; developing and fielding a survey instrument to collect necessary data in a national beta field test with 44 ambulatory palliative care programs; and collecting and analyzing data about measure reliability and validity to establish measure performance and final specifications. Further, the authors elicited provider and program perspectives on the use and value of the performance measures and their implementation and elicited the perspectives of patients from racial and ethnic minorities to understand their experience of ambulatory palliative care and optimal approaches to measurement. In this study, the authors present results from their test of the Feeling Heard and Understood performance measure, which they demonstrate to be a reliable and valid measure that is ready for use in quality improvement and quality payment programs.
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Ahluwalia SC, Vegetabile BG, Edelen MO, Setodji CM, Rodriguez A, Scherling A, Phillips J, Farmer CM, Harrison JM, Bandini J, Huang W, Schulson L, Walling A, Dalton S, Martineau M, Hall O, Schlang D, Bradley MA, Ast K. MACRA Palliative Care Quality Measure Development-Testing Summary Report: Measure Name: Receiving Desired Help for Pain. Rand Health Q 2022; 9:4. [PMID: 35837522 PMCID: PMC9242580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Palliative care has expanded rapidly in the past 20 years, especially in the ambulatory (office) setting, and there is growing consensus regarding the need to systematically measure and incentivize high-quality care. The Centers for Medicare & Medicaid Services entered a cooperative agreement with the American Academy of Hospice and Palliative Medicine (AAHPM) as part of the Medicare Access and CHIP Reauthorization Act of 2015 to develop two patient-reported measures of ambulatory palliative care experience: Feeling Heard and Understood and Receiving Desired Help for Pain. Under contract to AAHPM, RAND Health Care researchers developed and tested both measures over a three-year project period. Researcher efforts included identifying, developing, testing, and validating appropriate patient-reported data elements for each measure; developing and fielding a survey instrument to collect necessary data in a national beta field test with 44 ambulatory palliative care programs; and collecting and analyzing data about measure reliability and validity to establish measure performance and final specifications. Further, the authors elicited provider and program perspectives on the use and value of the performance measures and their implementation and elicited the perspectives of patients from racial and ethnic minorities to understand their experience of ambulatory palliative care and optimal approaches to measurement. In this study, the authors present results from their test of the Receiving Desired Help for Pain performance measure, which they demonstrate to be a reliable and valid measure that is ready for use in quality improvement and quality payment programs.
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Marques S, Cruz JAW, da Cunha MAVC, Tuon FF, de Moraes TP, Daiane Zdziarski A, Bomher ST, Donnelly LF, Capasso R. Patient and family experience with telemedicine and in-person pediatric and obstetric ambulatory encounters throughout 2020, during the COVID-19 epidemic: the distance effect. BMC Health Serv Res 2022; 22:659. [PMID: 35578239 PMCID: PMC9109949 DOI: 10.1186/s12913-022-08037-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 05/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Telemedicine has grown significantly in recent years, mainly during the COVID-19 pandemic, and there has been a growing body of literature on the subject. Another topic that merits increased attention is differences in patient and family experience between telehealth and in-person visits. To our team's knowledge, this is the first study evaluating pediatric and obstetrics outpatients experience with telemedicine and in-person visit types in an academic maternal and children's hospital, and its correlation with geographic distance from the medical center throughout 2020, during the COVID-19 crisis. METHODS We aim to evaluate and compare patients' telemedicine and in-person experience for ambulatory encounters based on survey data throughout 2020, during the COVID-19 pandemic, with particular focus on the influence of distance of the patient's home address from the medical facility. A total of 9,322 patient experience surveys from ambulatory encounters (6,362 in-person and 2,960 telemedicine), in a maternal and children's hospital during 2020 were included in this study. The percentage of patients who scored the question "Likelihood to recommend practice" with a maximum 5/5 (top box) score was used to evaluate patient experience. The k-means model was used to create distance clusters, and statistical t-tests were conducted to compare mean distances and Top Box values between telemedicine and in-person models. Logistic regression analysis was used to evaluate the correlation between Top Box scores and patients' distance to the hospital. RESULTS Top Box likelihood to recommend percentages for in-person and telemedicine were comparable (in-person = 81.21%, telemedicine = 81.70%, p-value = 0.5624). Mean distance from the hospital was greater for telemedicine compared to in-person patients (in-person = 48.89 miles, telemedicine = 61.23 miles, p-value < 0.01). Patients who live farther displayed higher satisfaction scores regardless of the visit type (p-value < 0.01). CONCLUSIONS There is a direct relationship between the family experience and the distance from the considered medical center, during year 2020, i.e., patients who live farther from the hospital record higher Top Box proportion for "Likelihood to Recommend" than patients who live closer to the medical center, regardless of the approach, in-person or telemedicine.
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Chen X, Zhang Y, Zhao W, Yuan J, Zhang Y. The In patient Experience with Nursing Care Scale (IPENCS): Development, Validation and Psychometric Properties. J Nurs Manag 2021; 30:570-581. [PMID: 34783114 DOI: 10.1111/jonm.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/20/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
AIM To develop a patient experience with nursing care scale and to evaluate its psychometric properties. BACKGROUND Patient experience is increasingly recognized as one of the pillars of quality in healthcare. Nevertheless, few instruments reflecting the preferences, needs and values of the healthcare recipients were developed to measure and improve patient experience with nursing care. METHODS Instrument development and psychometric analysis were used, and a total of 1050 individuals participated in this study. The validity and reliability of the scale were evaluated. RESULTS An exploratory factor analyses yielded a seven-dimension structure, and explained 70.785% of the variance. Confirmatory factor analyses supported the factor structure of the instrument. The content validity was very good (Mean I-CVI 0.96). Criterion validity was demonstrated with the general satisfaction question. Internal consistency reliability was found to be acceptable, as indicated by a Cronbach's alpha of 0.945, split-half reliability of 0.878 and item-total correlations of 0.328-0.803, respectively. CONCLUSIONS This study produced a 30-item instrument, which exhibits good psychometric properties. IMPLICATIONS FOR NURSING MANAGEMENT This scale could be used to determine to what extent patients' nursing care needs are met, examine the strength and weakness of current care delivery, and analyze the gap between patients' expectations and healthcare providers' behaviors.
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Affiliation(s)
- Xiao Chen
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yuhong Zhang
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Wenjuan Zhao
- Department of Nursing, Zhongliu Hospital of Fudan University, Shanghai, People's Republic of China
| | - Jie Yuan
- Department of Nursing, Shanghai Fengxian District Hospital of traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, People's Republic of China
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Komber H, Little D, Cade S, Graham R, Redman S. Comparing the patient experience between a novel 360° gamma camera (VERITON-CT) and a conventional dual head gamma camera. J Nucl Med Technol 2021; 50:jnmt.121.262627. [PMID: 34750232 PMCID: PMC9168651 DOI: 10.2967/jnmt.121.262627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022] Open
Abstract
Aims: To explore whether the novel 360° gamma camera design of VERITON-CT adversely affects the rate of scan non-completion due to claustrophobia or other patient experience factors, when compared to a standard dual-headed gamma camera. Methods: Single centre prospective study of all nuclear medicine studies on either of two gamma cameras; the VERITON-CT (Spectrum Dynamics Medical) and Discovery NM/CT 670 (GE Healthcare). It was recorded whether the patient had completed the scan as protocoled or, due to claustrophobia, had a shortened scan or no scan. The patients were also offered a patient experience questionnaire, with domains of comfort, scan time, scan noise and claustrophobia assessed using a five-point Likert scale. Results: Over a four-month period, there were 296 patients scanned on the Discovery scanner and 274 patients scanned on the VERITON-CT scanner. There was a scan non-completion rate, due to claustrophobia, of 1.35 % for the Discovery and 1.46 % for the VERITON-CT scanner. 354/570 (62%) of all patients involved returned their questionnaires. There was no statistical difference between the responses for comfort, scan time, scan noise and feelings of claustrophobia. Conclusion: The study provides evidence that the novel 360° gamma camera design of VERITON-CT does not lead to a significantly increased scan failure rate due to claustrophobia and there is no change in the subjective experience for patients.
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Affiliation(s)
- Hend Komber
- Royal United Hospitals Bath NHS Trust, United Kingdom
| | - David Little
- Royal United Hospitals Bath NHS Trust, United Kingdom
| | - Sarah Cade
- Royal United Hospitals Bath NHS Trust, United Kingdom
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Chen EK, Ahluwalia SC, Shetty K, Pillemer F, Etchegaray JM, Walling A, Kim AY, Martineau M, Phillips J, Farmer CM, Ast K. Development of Palliative Care Quality Measures for Outpatients in a Clinic-Based Setting: A Report on Information Gathering Activities. Rand Health Q 2021; 9:2. [PMID: 34484874 PMCID: PMC8383842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Palliative care has expanded rapidly in recent years. Hence, there has been a growing awareness of and emphasis on the importance of developing quality measures specific to palliative care. This article describes information-gathering activities conducted by RAND to develop two measures of palliative care quality for patients receiving such care in outpatient, clinic-based settings. The authors describe the consensus that has developed for measurement priorities in the palliative care community, provide a summary of clinical practice guidelines, and review the evidence base for palliative care. The authors also review current relevant regulations, existing measures of patient and caregiver experience, findings from a gap analysis on palliative care assessment, and findings from provider focus groups and interviews with patients and caregivers or family members.
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Yim HH, Hwang HS, Park HK, Park KY, Park M. Association between Patient Experience and Medication Compliance of Dyslipidemia: Using Korea National Health and Nutrition Examination Survey (2015). Korean J Fam Med 2021; 42:116-122. [PMID: 33784799 PMCID: PMC8010440 DOI: 10.4082/kjfm.19.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 06/13/2020] [Indexed: 12/02/2022] Open
Abstract
Background This study aimed to examine the relationship between patient experience and medication compliance of patients with dyslipidemia. Methods Based on data from the Korea National Health and Nutrition Examination Survey in 2015, the study examined 764 patients treated with dyslipidemia medication. Subjects who responded to the question “Do you currently take medication to lower your blood cholesterol?” with “daily taking” were categorized as the compliant group, and the remaining subjects were classified under the non-compliant group. The patient experience survey included four indicators, in which subjects were divided into groups with a positive and negative patient experience. Data on sociodemographic factors, health-related behaviors, and self-reported comorbid conditions were also collected. Results After adjusting the variables, the group with a positive response for the patient experience indicator “doctor spends enough time with the patient during consultation” was 1.89 times more compliant than the group with a negative response (95% confidence interval [CI], 1.03–3.48; P=0.04). For the indicator “doctor provides easy-to-understand explanations,” the group that showed a positive response was 2.74 times more compliant than the group with a negative response (95% CI, 1.39–5.39; P=0.004). For the indicator “doctor involves patients in decisions about care or treatment,” the group that showed a positive response was 2.07 times more compliant than the group with a negative response (95% CI, 1.02–4.22; P=0.04). However, for the indicator “doctor provides the patient a chance to ask questions about treatment,” positive patient experience had no significant association with medication compliance (95% CI, 0.77–2.36; P=0.30). Conclusion Building a good doctor-patient relationship with positive patient experiences can result in better outcomes for patient care through high medication compliance.
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Affiliation(s)
- Ho-Hyoun Yim
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Miso Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
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Chekijian S, Kinsman J, Taylor RA, Ravi S, Parwani V, Ulrich A, Venkatesh A, Agrawal P. Association between patient-physician gender concordance and patient experience scores. Is there gender bias? Am J Emerg Med 2020; 45:476-482. [PMID: 33069544 DOI: 10.1016/j.ajem.2020.09.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias. OBJECTIVE Examine the effect of patient and physician gender concordance on patient satisfaction with emergency care. METHODS We performed a cross-sectional analysis of electronic health record and Press Ganey patient satisfaction survey data of adult patients discharged from the emergency department (2015-2018). Logistic regression models were used to examine relationships between physician gender, patient gender, and physician-patient gender dyads. Binary outcomes included: perfect care provider score and perfect overall assessment score. RESULTS Female patients returned surveys more often (n=7 612; 61.55%) and accounted for more visits (n=232 024; 55.26%). Female patients had lower odds of perfect scores for provider score and overall assessment score (OR: 0.852, 95% CI: 0.790, 0.918; OR: 0.782, 95% CI: 0.723, 0.846). Female physicians had 1.102 (95% CI: 1.001, 1.213) times the odds of receiving a perfect provider score. Physician gender did not influence male patients' odds of reporting a perfect care provider score (95% CI: 0.916, 1.158) whereas female patients treated by female physicians had 1.146 times the odds (95% CI: 1.019, 1.289) of a perfect provider score. CONCLUSION Female patients prefer female emergency physicians but were less satisfied with their physician and emergency department visit overall. Over-representation of female patients on patient satisfaction surveys introduces bias. Patient satisfaction surveys should be deemphasized from physician compensation and promotion decisions.
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Affiliation(s)
- Sharon Chekijian
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Jeremiah Kinsman
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shashank Ravi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Stanford University School of Medicine, USA
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Allenbaugh J, Spagnoletti CL, Rack L, Rubio D, Corbelli J. Health Literacy and Clear Bedside Communication: A Curricular Intervention for Internal Medicine Physicians and Medicine Nurses. MedEdPORTAL 2019; 15:10795. [PMID: 30800995 PMCID: PMC6376895 DOI: 10.15766/mep_2374-8265.10795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/29/2018] [Indexed: 05/30/2023]
Abstract
Introduction Communication remains the backbone of patient-provider relationships, and many health outcomes have been directly attributed to both effective and ineffective communication. We developed an educational intervention to improve bedside communication and increase use of health literacy principles, in part as a response to suboptimal inpatient satisfaction scores. Methods Our intervention consisted of a beside communication curriculum among 37 attending medicine physicians, 76 internal medicine residents, and 85 bedside nurses. The 1- to 1.5-hour curriculum included a didactic session to teach health literacy principles, video demonstrations, group discussion, and role-play. Attending physicians' health literacy knowledge, attitudes, and confidence were evaluated using pre- and postsurveys. Evaluation of the curriculum included Likert-type questions and free-text responses. Results Attending physicians' knowledge and confidence improved (74% correct pre, 100% correct post, p < .001; 4.41 pre, 4.68 post, p = .002, respectively). Certain attitude domains also improved, including importance of team introductions and nurse contributions to bedside rounds (p < .001). Both residents and nurses found the curriculum valuable and planned to incorporate it into their bedside rounding. Discussion A brief, low-cost curricular intervention focusing on clear communication skills and health literacy principles resulted in significant improvements in knowledge and attitudes of attending physicians and was readily incorporated by resident physicians and nurses. This curriculum can be easily implemented in a variety of settings to improve bedside patient-physician communication.
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Affiliation(s)
- Jill Allenbaugh
- Assistant Professor of Medicine, Division of General Internal Medicine, Lewis Katz School of Medicine at Temple University
| | | | - Laurie Rack
- Clinical Director, Patient Support Services, University of Pittsburgh Medical Center Presbyterian/Shadyside Hospitals
| | - Doris Rubio
- Professor, Department of Medicine, University of Pittsburgh School of Medicine
- Director, Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine
| | - Jennifer Corbelli
- Associate Professor, Department of Medicine, University of Pittsburgh School of Medicine
- Program Director, Internal Medicine Residency Training Program, Department of Medicine, University of Pittsburgh School of Medicine
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Gunalda J, Hosmer K, Hartman N, Smith L, Chapman B, Jones W, Irick M, Pariyadath M. Satisfaction Academy: A Novel Residency Curriculum to Improve the Patient Experience in the Emergency Department. MedEdPORTAL 2018; 14:10737. [PMID: 30800937 PMCID: PMC6342346 DOI: 10.15766/mep_2374-8265.10737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022]
Abstract
Introduction Patient satisfaction is a key indicator of health care value and an increasingly important metric used to assess emergency physician performance and often reimbursement. To our knowledge, there is no standardized curriculum within emergency medicine (EM) residency programs that focuses on the patient experience in EM. Methods Our novel resident curriculum is an organized approach to enhancing patient-centered care by optimizing the patient experience. It spans the academic year, with key topics organized into a quarterly time line. Topics include physician courtesy and respect, pain management, discussion of diagnostic and therapeutic interventions, timely communication, and delivery of quality care. Each quarter has three components: introduction/didactics, an interactive workshop, and stories and reflection. The instructional methods used include didactic lectures, role-playing, and group reflection and storytelling. Results Of 44 participants, 54.5% completed a preintervention survey, and 45.5% completed a postintervention survey. The surveys consisted of 5-point Likert scales measuring degree of agreement with statements that reflected desired behaviors and/or attitudes. On the postintervention survey, participants gave scores indicating general agreement with desired behaviors including sitting at the bedside, acknowledging all persons in the room, and giving an anticipated disposition, as well as with feeling more knowledgeable about patient satisfaction. Discussion Our Satisfaction Academy has filled a significant gap related to enhancing the patient experience. This curriculum is generalizable to other EM residency programs, and the interactive peer-to-peer format is both engaging and customizable.
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Affiliation(s)
- Jonah Gunalda
- Assistant Professor, Department of Emergency Medicine, University of Mississippi School of Medicine
| | - Kathleen Hosmer
- Assistant Professor, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Nicholas Hartman
- Assistant Professor, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Lane Smith
- Assistant Professor, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Bradley Chapman
- Resident, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Warren Jones
- Resident, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Michael Irick
- Resident, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Manoj Pariyadath
- Assistant Professor, Department of Emergency Medicine, Wake Forest Baptist Medical Center
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Kimman ML, Rotteveel AH, Wijsenbeek M, Mostard R, Tak NC, van Jaarsveld X, Storm M, Wijnsma KL, Gelens M, van de Kar NCAJ, Wetzels J, Dirksen CD. Development and Pretesting of a Questionnaire to Assess Patient Experiences and Satisfaction with Medications (PESaM Questionnaire). Patient 2018; 10:629-642. [PMID: 28357591 PMCID: PMC5605609 DOI: 10.1007/s40271-017-0234-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The aim of this study was to develop, together with the Lung Foundation Netherlands and Dutch Kidney Patients Association, patients and clinicians, a measure to evaluate patient experiences with the orphan drugs pirfenidone (for idiopathic pulmonary fibrosis [IPF]) and eculizumab (for atypical haemolytic uraemic syndrome [aHUS]), as well as a generic measure of patient experiences and satisfaction with medications. Methods Development of the Patient Experiences and Satisfaction with Medications (PESaM) questionnaire consisted of four phases: literature review (phase I); focus groups and individual patient interviews (phase II); item generation (phase III); and face and content validity testing (phase IV). Literature review aimed to identify existing disease-specific and generic patient experience measures to provide guidance on the domains of medication use relevant to patients, the number of items and type of response categories, and to generate an initial pool of items. Subsequent focus groups and patient interviews were conducted to gain insight into the perceived effectiveness of the therapies, the burden of side effects, and how the medication impacted on a patient’s daily life. Focus groups and interviews were recorded and transcribed verbatim. Coding was carried out by highlighting passages in the text and assigning each passage a code representing the following predefined categories: (1) perceived effectiveness; (2) side effects; (3) ease of use; and (4) impact of medication. Using data from phase I and II, a panel of experts selected items relevant for inclusion in the questionnaire. Individual patient interviews with IPF and aHUS patients (n = 18), using a retrospective verbal probing technique, were conducted to assess face validity, time needed to fill out the questionnaire, and content validity. Results The PESaM questionnaire that was developed consisted of two disease-specific modules that assessed patient experiences with pirfenidone for the treatment of IPF, and eculizumab for the treatment of aHUS, a generic module, applicable to any medication, and a module to assess patient expectations. Review of the literature identified multiple disease- or medication-specific questionnaires and two generic patient satisfaction questionnaires. Common domains across most questionnaires were effectiveness, side effects, ease of use and overall satisfaction. Patient interviews revealed the social impact (e.g. unable to go outside) of side effects such as photosensitivity associated with pirfenidone and the risk of infection associated with eculizumab. Each PESaM module focuses on patients’ perceived effectiveness of the medication, side effects, and ease of use, and the impact these aspects have on physical and emotional health and daily life. The generic module additionally includes items related to satisfaction with the medication. Individual interviews with patients in phase IV confirmed, in general, that questions and response options of the modules were clear and content validity was good. The mean time to complete the modules ranged from 6 min for the disease-specific (aHUS) module to 9 min for the generic module. Conclusions We developed the PESaM questionnaire to quantitatively assess patient experiences and satisfaction with medications. A validation study is currently underway to examine the psychometric properties of the PESaM questionnaire. Electronic supplementary material The online version of this article (doi:10.1007/s40271-017-0234-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Adrienne H Rotteveel
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marlies Wijsenbeek
- Department of Respiratory Medicine, Erasmus Medical Centre, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Rémy Mostard
- Department of Pulmonary Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Nelleke C Tak
- Department of Respiratory Medicine, Erasmus Medical Centre, University Hospital Rotterdam, Rotterdam, The Netherlands
| | | | | | - Kioa L Wijnsma
- Department of Paediatric Nephrology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Marielle Gelens
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Nicole C A J van de Kar
- Department of Paediatric Nephrology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Jack Wetzels
- Department of Internal Medicine, Division of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
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Holt K, Zavala I, Quintero X, Mendoza D, McCormick MC, Dehlendorf C, Lieberman E, Langer A. Women's preferences for contraceptive counseling in Mexico: Results from a focus group study. Reprod Health 2018; 15:128. [PMID: 30012157 PMCID: PMC6048723 DOI: 10.1186/s12978-018-0569-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/04/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Client-centered contraceptive counseling is critical to meeting demand for contraception and protecting human rights. However, despite various efforts to optimize counseling, little is known outside of the United States about what individuals themselves value in counseling. In the present study we investigate women's preferences for contraceptive counseling in Mexico to inform efforts to improve service quality. METHODS We conducted applied qualitative research, using six focus group discussions with 43 women in two cities in Mexico with distinct sizes and sociocultural contexts (Mexico City and Tepeji del Río, Hidalgo) to assess contraceptive counseling preferences. We used a framework approach to thematically code and analyze the transcriptions from focus groups. RESULTS Consistent with quality of care and human rights frameworks for family planning service delivery, participants expressed a desire for privacy, confidentiality, informed choice, and respectful treatment. They expanded on usual concepts of respectful care within family planning to include avoidance of sexual assault or harassment-in line with definitions of respectful care in maternal health. In contrast to counseling approaches with method effectiveness as the organizing principle, participants preferred counseling centered on personalized assessments of needs and preferences. Many, particularly older, less educated women, highly valued hearing provider opinions about what method they should use, based on those personalized assessments. Participants highlighted the necessity of clinical assessments or physical exams to inform provider recommendations for appropriate methods. This desire was largely due to beliefs that more exhaustive medical exams could help prevent negative contraceptive outcomes perceived to be common, in particular expulsion of intra-uterine devices (IUDs), by identifying methods compatible with a woman's body. Trust in provider, built in various ways, was seen as essential to women's contraceptive needs being met. CONCLUSIONS Findings shed light on under-represented perspectives of clients related to counseling preferences. They highlight specific avenues for service delivery improvement in Mexico to ensure clients experience privacy, confidentiality, informed choice, respectful treatment, and personalized counseling-including around reasons for higher IUD expulsion rates postpartum-during contraceptive visits. Findings suggest interventions to improve provider counseling should prioritize a focus on relationship-building to foster trust, and needs assessment skills to facilitate personalization of decision-making support without imposition of a provider's personal opinions. Trust is particularly important to address in family planning given historical abuses against women's autonomy that may still influence perspectives on contraceptive programs. Findings can also be used to improve quantitative client experience measures.
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Affiliation(s)
- Kelsey Holt
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
- Women and Health Initiative, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Family and Community Medicine, University of California, San Francisco, USA
- Program in Woman-Centered Contraception, University of California, San Francisco, USA
| | - Icela Zavala
- Mexican Family Planning Foundation, Mexico City, Mexico
| | | | | | - Marie C. McCormick
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California, San Francisco, USA
- Program in Woman-Centered Contraception, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
| | - Ellice Lieberman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Ana Langer
- Women and Health Initiative, Harvard T.H. Chan School of Public Health, Boston, USA
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O’Hare AM, Richards C, Szarka J, McFarland LV, Showalter W, Vig EK, Sudore RL, Crowley ST, Trivedi R, Taylor JS. Emotional Impact of Illness and Care on Patients with Advanced Kidney Disease. Clin J Am Soc Nephrol 2018; 13:1022-1029. [PMID: 29954826 PMCID: PMC6032592 DOI: 10.2215/cjn.14261217] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/02/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The highly specialized and technologically focused approach to care inherent to many health systems can adversely affect patients' emotional experiences of illness, while also obscuring these effects from the clinician's view. We describe what we learned from patients with advanced kidney disease about the emotional impact of illness and care. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS As part of an ongoing study on advance care planning, we conducted semistructured interviews at the VA Puget Sound Healthcare System in Seattle, Washington, with 27 patients with advanced kidney disease between April of 2014 and May of 2016. Of these, ten (37%) were receiving center hemodialysis, five (19%) were receiving peritoneal dialysis, and 12 (44%) had an eGFR≤20 ml/min per 1.73 m2 and had not started dialysis. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory methods. RESULTS We here describe three emergent themes related to patients' emotional experiences of care and illness: (1) emotional impact of interactions with individual providers: when providers seemed to lack insight into the patient's experience of illness and treatment, this could engender a sense of mistrust, abandonment, isolation, and/or alienation; (2) emotional impact of encounters with the health care system: just as they could be affected emotionally by interactions with individual providers, patients could also be affected by how care was organized, which could similarly lead to feelings of mistrust, abandonment, isolation, and/or alienation; and (3) emotional impact of meaning-making: patients struggled to make sense of their illness experience, worked to apportion blame, and were often quick to blame themselves and to assume that their illness could have been prevented. CONCLUSIONS Interactions with individual providers and with the wider health system coupled with patients' own struggles to make meaning of their illness can take a large emotional toll. A deeper appreciation of patients' emotional experiences may offer important opportunities to improve care.
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Affiliation(s)
- Ann M. O’Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care
- Nephrology Section, Hospital and Specialty Medicine Service, and
- Departments of Medicine
| | - Claire Richards
- Center of Innovation for Veteran-Centered and Value-Driven Care
- Health Services, and
| | - Jackie Szarka
- Center of Innovation for Veteran-Centered and Value-Driven Care
| | | | | | - Elizabeth K. Vig
- Geriatrics and Extended Care, VA Puget Sound Health Care System, Seattle, Washington
- Departments of Medicine
| | - Rebecca L. Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
- Geriatrics and Extended Care, San Francisco VA Medical Center, San Francisco, California
| | - Susan T. Crowley
- Veterans Health Administration, Specialty Care Services/Office of Policy and Services, and
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ranak Trivedi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California; and
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
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24
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Peikes D, Dale S, Ghosh A, Taylor EF, Swankoski K, O'Malley AS, Day TJ, Duda N, Singh P, Anglin G, Sessums LL, Brown RS. The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians. Health Aff (Millwood) 2018; 37:890-899. [PMID: 29791190 DOI: 10.1377/hlthaff.2017.1678] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.
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Affiliation(s)
- Deborah Peikes
- Deborah Peikes ( ) is a senior fellow at Mathematica Policy Research in Princeton, New Jersey
| | - Stacy Dale
- Stacy Dale is a senior researcher at Mathematica Policy Research in Chicago, Illinois
| | - Arkadipta Ghosh
- Arkadipta Ghosh is a senior researcher at Mathematica Policy Research in Princeton
| | - Erin Fries Taylor
- Erin Fries Taylor is a vice president and managing director of Health Policy Assessment at Mathematica Policy Research in Washington, D.C
| | - Kaylyn Swankoski
- Kaylyn Swankoski is a health analyst at Mathematica Policy Research in Princeton
| | - Ann S O'Malley
- Ann S. O'Malley is a senior fellow at Mathematica Policy Research in Washington, D.C
| | - Timothy J Day
- Timothy J. Day is a health services reseacher in the Research and Rapid-Cycle Evaluation Group, Center for Medicare and Medicaid Innovation, in Baltimore, Maryland
| | - Nancy Duda
- Nancy Duda is a senior survey researcher at Mathematica Policy Research in Oakland, California
| | - Pragya Singh
- Pragya Singh is a researcher at Mathematica Policy Research in Princeton
| | - Grace Anglin
- Grace Anglin is a senior researcher at Mathematica Policy Research in Oakland
| | - Laura L Sessums
- Laura L. Sessums is the director of the Division of Advanced Primary Care in the Seamless Care Models Group, Center for Medicare and Medicaid Innovation, in Baltimore, Maryland
| | - Randall S Brown
- Randall S. Brown is director of health research at Mathematica Policy Research in Princeton
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Maria Orlando E, Barbara J G, Adam J R, Sangeeta A, Amy Soo Jin D, Michael Stephen D, Shira H F, Wenjing H, David J K, Steven M, Francesca P, Tepring P, Victoria S, Regina A S, Cathy D S, Brian D S. Development and Maintenance of Standardized Cross Setting Patient Assessment Data for Post-Acute Care: Summary Report of Findings from Alpha 1 Pilot Testing. Rand Health Q 2018; 7:1. [PMID: 29416941 PMCID: PMC5798963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Centers for Medicare & Medicaid Services (CMS) contracted with the RAND Corporation to identify and/or develop standardized items to include in the post-acute care patient assessment instruments. RAND was tasked by CMS with developing and testing items to measure seven areas of health status for Medicare beneficiaries: (1) vision and hearing; (2) cognitive status; (3) depressed mood; (4) pain; (5) care preferences; (6) medication reconciliation; and (7) bladder and bowel continence. This article presents results of the first Alpha 1 feasibility test of a proposed set of items for measuring each of these health status areas. Conducted between August and October 2016, the test is one of two Alpha tests that will be completed by mid-2017 to assess the feasibility of proposed items. The results of these small-scale feasibility tests will inform a national Beta test designed to determine how well the measures perform when implemented in post-acute care settings. The Alpha 1 testing phase was successfully completed, in that all items were pilot tested among 133 patients. Items from all content areas were assessed on interrater reliability and feasibility; items from some content areas were assessed on other metrics. Items have now been revised, when necessary, based on the findings of the Alpha 1 test. Alpha 2 testing is under way with the updated, revised items.
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26
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Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D. Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity. Gates Open Res 2017; 1:1. [PMID: 29355215 PMCID: PMC5764229 DOI: 10.12688/gatesopenres.12756.1] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Globally, substantial health inequities exist with regard to maternal, newborn and reproductive health. Lack of access to good quality care-across its many dimensions-is a key factor driving these inequities. Significant global efforts have been made towards improving the quality of care within facilities for maternal and reproductive health. However, one critically overlooked aspect of quality improvement activities is person-centered care. Main body: The objective of this paper is to review existing literature and theories related to person-centered reproductive health care to develop a framework for improving the quality of reproductive health, particularly in low and middle-income countries. This paper proposes the Person-Centered Care Framework for Reproductive Health Equity, which describes three levels of interdependent contexts for women's reproductive health: societal and community determinants of health equity, women's health-seeking behaviors, and the quality of care within the walls of the facility. It lays out eight domains of person-centered care for maternal and reproductive health. Conclusions: Person-centered care has been shown to improve outcomes; yet, there is no consensus on definitions and measures in the area of women's reproductive health care. The proposed Framework reviews essential aspects of person-centered reproductive health care.
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Affiliation(s)
- May Sudhinaraset
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA.,Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Patience Afulani
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA
| | - Nadia Diamond-Smith
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA
| | | | - France Donnay
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Dominic Montagu
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, 94105, USA
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27
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Kohler G, Sampalli T, Ryer A, Porter J, Wood L, Bedford L, Higgins-Bowser I, Edwards L, Christian E, Dunn S, Gibson R, Ryan Carson S, Vallis M, Zed J, Tugwell B, Van Zoost C, Canfield C, Rivoire E. Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes. Int J Health Policy Manag 2017; 6:661-668. [PMID: 29179292 PMCID: PMC5675584 DOI: 10.15171/ijhpm.2017.27] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 02/20/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice.
Methods: The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach.
Results: The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide.
Conclusion: This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability.
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Affiliation(s)
- Graeme Kohler
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Tara Sampalli
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ashley Ryer
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Judy Porter
- Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Les Wood
- Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lisa Bedford
- Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Irene Higgins-Bowser
- Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lynn Edwards
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Erin Christian
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Susan Dunn
- Public Engagement, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Rick Gibson
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Michael Vallis
- Behaviour Change Institute, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Joanna Zed
- Dalhousie Family Medicine, Halifax, NS, Canada
| | - Barna Tugwell
- Endocrinology, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Colin Van Zoost
- General Internal Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Eleanor Rivoire
- Canadian Foundation Healthcare Improvement, Ottawa, ON, Canada
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Abstract
OBJECTIVES Clinical management of giant cell arteritis (GCA) involves balancing the risks and burdens arising from the disease with those arising from treatment, but there is little research on the nature of those burdens. We aimed to explore the impact of giant cell arteritis (GCA) and its treatment on patients' lives. METHODS UK patients with GCA participated in semi-structured telephone interviews. Inductive thematic analysis was employed. RESULTS 24 participants were recruited (age: 65-92 years, time since diagnosis: 2 months to >6 years). The overarching themes from analysis were: ongoing symptoms of the disease and its treatment; and 'life-changing' impacts. The overall impact of GCA on patients' lives arose from a changing combination of symptoms, side effects, adaptations to everyday life and impacts on sense of normality. Important factors contributing to loss of normality were glucocorticoid-related treatment burdens and fear about possible future loss of vision. CONCLUSIONS The impact of GCA in patients' everyday lives can be substantial, multifaceted and ongoing despite apparent control of disease activity. The findings of this study will help doctors better understand patient priorities, legitimise patients' experiences of GCA and work with patients to set realistic treatment goals and plan adaptations to their everyday lives.
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Affiliation(s)
- Jennifer Liddle
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Roisin Bartlam
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - James A Prior
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Toby Helliwell
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jane C Richardson
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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Niedermier J. Understanding Patient Experience: A Course for Residents. MedEdPORTAL 2017; 13:10558. [PMID: 30800760 PMCID: PMC6342057 DOI: 10.15766/mep_2374-8265.10558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/08/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A 4-hour curriculum was developed to provide residents with information about the concepts of patient satisfaction and experience. The course focuses on the competencies of professionalism and interpersonal and communication skills. It is designed to allow participants to reflect on current knowledge of the patient experience and service principles and to develop a greater appreciation of these concepts' utility and importance to everyday work. METHODS Thirty-two residents in 2015 and nine incoming residents in 2016 participated in weekly hour-long sessions over 4 weeks. The curriculum also included an optional fifth component, in which patient satisfaction data were provided to the residents. Residents participated in pre- and postcurriculum survey assessments regarding their awareness of concepts involving patient experience. RESULTS Preliminary results suggested that residents found the curriculum beneficial and that it helped to increase their understanding of the relevance of patient satisfaction and experience education to their practice. Quarterly feedback from patient surveys was provided to residents, identifying strengths and opportunities for improvement. DISCUSSION Given the growing importance and utilization of patient satisfaction surveys, residents participated in this educational intervention to determine if a novel curriculum and proactive approach to resident understanding and utilization of satisfaction data could result in increased patient satisfaction with resident interactions. The study is ongoing and longitudinal, with initial results encouraging.
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Affiliation(s)
- Julie Niedermier
- Associate Professor, Department of Psychiatry, The Ohio State University
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Williams AM, Lester L, Bulsara C, Petterson A, Bennett K, Allen E, Joske D. Patient Evaluation of Emotional Comfort Experienced (PEECE): developing and testing a measurement instrument. BMJ Open 2017; 7:e012999. [PMID: 28122833 PMCID: PMC5278251 DOI: 10.1136/bmjopen-2016-012999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/19/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The Patient Evaluation of Emotional Comfort Experienced (PEECE) is a 12-item questionnaire which measures the mental well-being state of emotional comfort in patients. The instrument was developed using previous qualitative work and published literature. DESIGN Instrument development. SETTING Acute Care Public Hospital, Western Australia. PARTICIPANTS Sample of 374 patients. INTERVENTIONS A multidisciplinary expert panel assessed the face and content validity of the instrument and following a pilot study, the psychometric properties of the instrument were explored. MAIN OUTCOME MEASURES Exploratory and confirmatory factor analysis assessed the underlying dimensions of the PEECE instrument; Cronbach's α was used to determine the reliability; κ was used for test-retest reliability of the ordinal items. RESULTS 2 factors were identified in the instrument and named 'positive emotions' and 'perceived meaning'. A greater proportion of male patients were found to report positive emotions compared with female patients. The instrument was found to be feasible, reliable and valid for use with inpatients and outpatients. CONCLUSIONS PEECE was found to be a feasible instrument for use with inpatient and outpatients, being easily understood and completed. Further psychometric testing is recommended.
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Affiliation(s)
- A M Williams
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - L Lester
- Health Promotion Evaluation Unit, School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - C Bulsara
- School of Nursing and Midwifery, Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - A Petterson
- SolarisCare Foundation, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - K Bennett
- School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - E Allen
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - D Joske
- Department of Haematology, Sir Charles Gairdner Hospital, The University of Western Australia, Crawley, Western Australia, Australia
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Kennedy BM, Rehman M, Johnson WD, Magee MB, Leonard R, Katzmarzyk PT. Healthcare Providers versus Patients' Understanding of Health Beliefs and Values. Patient Exp J 2017; 4:29-37. [PMID: 29308429 PMCID: PMC5751953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE This study examined how well healthcare providers perceive and understand their patients' health beliefs and values compared to patients' actual beliefs, and to determine if communication relationships maybe improved as a result of healthcare providers' understanding of their patients' illness from their perspective. METHODS A total of 61 participants (7 healthcare providers and 54 patients) were enrolled in the study. Healthcare providers and patients individually completed survey instruments and each participated in a structured focus group. RESULTS Healthcare provider and patient differences revealed that patients perceived greater meaning of their illness (p = 0.038), and a greater preference for partnership (p = 0.026) compared to providers. The three qualitative themes most important for understanding patients' health beliefs and values as perceived by healthcare providers were education, trust, and culture. Educating patients was perceived as having the greatest impact and also the easiest method to implement to foster providers' understanding, with at least one patient focus group in agreement of same. Likewise, three themes were derived from patients' perspectives as relatively more important in understanding providers' beliefs and values; bidirectional communication, comprehensive treatment, and discipline. Overwhelmingly, bidirectional communication was perceived as a critical factor as having the greatest impact and may also be easiest to implement according to these patients. CONCLUSION When patients and healthcare providers listen and communicate with each other, they are likely to develop a shared understanding that may improve future decision making and quality of care patients receive.
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Affiliation(s)
- Betty M Kennedy
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana (B.M.K., W.D.J., M.B.M., R.L., P.T.K.); and the LSU Health System Lallie Kemp Medical Center, Independence, Louisiana (M.R.)
| | - Matloob Rehman
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana (B.M.K., W.D.J., M.B.M., R.L., P.T.K.); and the LSU Health System Lallie Kemp Medical Center, Independence, Louisiana (M.R.)
| | - William D Johnson
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana (B.M.K., W.D.J., M.B.M., R.L., P.T.K.); and the LSU Health System Lallie Kemp Medical Center, Independence, Louisiana (M.R.)
| | - Michelle B Magee
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana (B.M.K., W.D.J., M.B.M., R.L., P.T.K.); and the LSU Health System Lallie Kemp Medical Center, Independence, Louisiana (M.R.)
| | - Robert Leonard
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana (B.M.K., W.D.J., M.B.M., R.L., P.T.K.); and the LSU Health System Lallie Kemp Medical Center, Independence, Louisiana (M.R.)
| | - Peter T Katzmarzyk
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana (B.M.K., W.D.J., M.B.M., R.L., P.T.K.); and the LSU Health System Lallie Kemp Medical Center, Independence, Louisiana (M.R.)
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Jones MM, Kamenetzky A, Manville C, Ghiga I, MacLure C, Harte E, Spisak A, Kirtley A, Grant J. The National Institute for Health Research at 10 Years: An Impact Synthesis: 100 Impact Case Studies. Rand Health Q 2017; 6:13. [PMID: 28845351 PMCID: PMC5568167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The National Institute for Health Research (NIHR) funds and supports world-leading clinical and applied health and social care research, as well as research infrastructure in the NHS. Providing £1 billion of funding each year, NIHR aims to: drive the faster translation of new treatments, technologies and diagnostics to improve outcomes for health and care services; promote the wealth of the nation, including via inward investment from the health research community; pull basic science discoveries through into tangible benefits for patients and the public; and provide research evidence to support more effective and cost-effective NHS delivery. To mark its tenth anniversary, the Department of Health commissioned the Policy Research in Science and Medicine unit to consider the question: "What are the ways in which NIHR has benefited the health research landscape in the past ten years?" This study identifies and celebrates 100 examples of positive change resulting from NIHR's support of research. A synthesis of 100 case studies is provided, which highlights the benefits and wider impacts of research, capacity building, and other activities undertaken with NIHR's support since its creation in 2006. The study concludes with a reflection of how the NIHR has transformed R&D in and for the NHS and wider health service, and the people they serve. The study draws together---for the first time---examples of the breadth of NIHR's impacts in a single resource. It will be of interest to healthcare professionals involved in research, academics working in health and social care, and members of the public wishing to understand the value of research in the NHS and the wider health and care system.
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Abstract
AIM This study aimed to explore and describe the experience of making a healthy lifestyle change among the patients with chronic illness. BACKGROUND Despite the existence of different evidence on the critical role of lifestyle in the prevention and management of chronic diseases, many people face challenges in terms of starting and maintaining a healthy lifestyle. METHODS A descriptive qualitative study with in-depth semi-structured interviews was carried out in 2015 in Iran. Thirty-four patients with common chronic illnesses were invited to the study using purposive sampling. The collected data were analysed by content analysis. FINDINGS The main themes were: trying to remove the perceived threat, considering and trying to do physical activities, considering and planning for a healthy diet, striving to manage stress and having gradual acceptance of new habits and coping with them. LIMITATIONS The participants were selected from among those with chronic illness. However, there is also a need to assess the family and healthcare providers' perspectives. CONCLUSION AND IMPLICATIONS FOR NURSING The perceived threat of the disease plays an important role in the process of changing to a healthy lifestyle in Iranian with chronic illnesses. It is necessary for healthcare providers, especially nurses, to use this threat as a golden opportunity to accelerate changes in patients' behaviours. IMPLICATIONS FOR NURSING POLICY Findings may help policy makers become aware of the need for nurses to create community-based nursing in Iran. Community nurses can remind patients of perceived threats to their health to motivate them for continued healthy behaviours. Therefore, nursing curricula should be revised and educational programs utilise a community-based health approach.
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Affiliation(s)
- H Vahedparast
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - E Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - F Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Carrillo JE, Carrillo VA, Guimento R, Mucaria J, Leiman J. The NewYork-Presbyterian Regional Health Collaborative: a three-year progress report. Health Aff (Millwood) 2016; 33:1985-92. [PMID: 25367994 DOI: 10.1377/hlthaff.2014.0408] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Washington Heights-Inwood section of Manhattan is a predominantly poor Hispanic community with disproportionately high rates of chronic disease, including asthma, diabetes, and congestive heart failure. In October 2010, NewYork-Presbyterian Hospital, in association with the Columbia University Medical Center, launched an integrated network of patient-centered medical homes that were linked to other providers and community-based resources and formed a "medical village." Three years later, a study of 5,852 patients who had some combination of diabetes, asthma, and congestive heart failure found that emergency department visits and hospitalizations had been reduced by 29.7 percent and 28.5 percent, respectively, compared to the year before implementation of the network. Thirty-day readmissions and average length-of-stay declined by 36.7 percent and 4.9 percent, respectively. Patient satisfaction scores improved across all measures. Financially, NewYork-Presbyterian experienced a short-term return on investment of 11 percent. Some of the gain was a result of increased reimbursements from New York State. Nonetheless, these findings demonstrate that academic medical centers can improve outcomes for poor communities by building regional care models centering on medical homes that incorporate patient-centered processes and are linked through information systems and service collaborations to hospitals, specialty practices, and community-based providers and organizations.
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Affiliation(s)
- J Emilio Carrillo
- J. Emilio Carrillo is vice president of community health, NewYork-Presbyterian Hospital, in New York City
| | - Victor A Carrillo
- Victor A. Carrillo is director of community health development at NewYork-Presbyterian Hospital
| | - Robert Guimento
- Robert Guimento is vice president of ambulatory care at NewYork-Presbyterian Hospital
| | - Jaclyn Mucaria
- Jaclyn Mucaria is senior vice president of ambulatory care and patient-centered services at NewYork-Presbyterian Hospital
| | - Joan Leiman
- Joan Leiman is a special lecturer in health policy and management and in international and public affairs at the Mailman School of Public Health, Columbia University, in New York City
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Sampalli T, Desy M, Dhir M, Edwards L, Dickson R, Blackmore G. Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping. Int J Health Policy Manag 2015; 4:459-66. [PMID: 26188810 DOI: 10.15171/ijhpm.2015.76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/31/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely - an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. METHODS Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. RESULTS The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. CONCLUSION Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.
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Affiliation(s)
- Tara Sampalli
- Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada.,Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Michel Desy
- Performance Excellence, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Minakshi Dhir
- Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lynn Edwards
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Robert Dickson
- Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Gail Blackmore
- Performance Excellence, Nova Scotia Health Authority, Halifax, NS, Canada
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Abstract
It is vital to involve children, young people and families in the design, delivery and improvement of their care. Their involvement can range from individuals giving feedback, such as patient stories, to collaborative work including patient groups and communities helping to develop and commission services. The methods for involving individuals and families include questionnaires and innovative ideas such as feedback Apps. Other methods include the 15 Steps Challenge which helps an organisation to view the care it delivers through a patients eyes and includes a 'walk around' involving a patient, carer, staff member and board member. The Experience Based Design approach is another method of reviewing a service and involves assessing how staff and patients feel when delivering and receiving care. Involving patient groups can be facilitated by working with schools and children's centres. The type of involvement will vary, but if carefully designed can allow meaningful participation and improvement of services.
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Affiliation(s)
- Sophie Robertson
- Paediatric Department, Portsmouth Hospitals NHS Trust, , Portsmouth, UK
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