Health Services Research Commons^™

Stroke Outreach In The Lao Community, Noor A. Dythavon

Master's Projects and Capstones

CNL Abstract

A community health needs assessment for the service area prompted concern regarding access to quality healthcare for non-English speaking Southeast Asians (SEA) in the area. Goals of an initial investigation and subsequent implementation of sustainable stroke health fairs for non-English speaking communities were evaluated to assess primary healthcare concerns that the SEA community face and to suggest long-term solutions to these issues. Initial investigation required researching population-specific minority health statistics to quantify the prevalence of chronic diseases and conditions which were prioritized in terms of needs versus disparities. Research came from evidence base practice guidelines and personal concern …

Envisioning Mechanisms For Success: Evaluation Of Ebcd At Cheo, Kristina Rohde, Mireille Brosseau, Diane Gagnon, Jennifer Schellinck, Christine Kouri

Patient Experience Journal

To advance patient engagement (PE) and more comprehensively involve patients, families, and staff in quality improvement (QI) at the Children’s Hospital of Eastern Ontario (CHEO), the Experience Based Co-Design (EBCD) approach was piloted. Set against the backdrop of envisioning factors that would facilitate success, an evaluation was designed to assess five domains: strengthening of mutual understanding, collaboration, and partnerships between patients/families and staff; a greater involvement of patients, families, and staff in QI; satisfaction with the process; the ability of EBCD to generate clear and useful data to ascertain the patient/family and staff experience; and the ability of EBCD to …

Patient Advisors: How To Implement A Process For Involvement At All Levels Of Governance In A Healthcare Organization, Marie-Pascale Pomey, Edith Morin, Catherine Neault, Veronique Biron, Lise Houle, Louise Lavigueur, Guy Bouvette, Nicole St-Pierre, Martin Beaumont

Patient Experience Journal

Patient involvement at the operational (clinical care and services), tactical (management), and strategic (board of directors and executive management) levels of establishments is increasingly sought after. To address this specific challenge, a Canadian healthcare organization, the Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec, has developed an integrated strategy based on three principles: (1) shared leadership between a patient and a manager to build the strategy; (2) a clear process for recruiting, training, and coaching patient advisors (PA) so that they can participate in decision-making at the various levels of governance of the establishment; and (3) …

Using Patient Value Statements To Develop A Culture Of Patient-Centred Care: A Case Study Of An Ontario, Canada Hospital, Erica Bridge, Madelyn P. Law, Miya Narushima

Patient Experience Journal

Patient-centred care (PCC) is not a new concept; however, in recent years it has garnered increasing attention in the research literature and clinical practice. PCC in clinical practice has been found to improve clinical outcomes, resource allocation, and the patient experience. In response to the need for PCC and quality in healthcare, the Ontario, Canada government developed the Excellent Care for All Act (ECFAA) in 2010. The ECFAA imposes six obligations to Ontario hospitals, one of which is developing and publishing a Patient Declaration of Values (PDoV). The purpose of this study was to explore how a leading patient-centred Ontario …

Improving The Patient Experience Through A Commit To Sit Service Excellence Initiative, Cari D. Lidgett

Patient Experience Journal

Effective communication between nurses and patients positively impacts patient care, outcomes, and the patient experience.While in the hospital, patients receive information from multiple caregivers and are often overwhelmed and confused. Nurses make up the majority of interactions with patients and are in an ideal position to improve the patient experience from the front lines. The purpose of implementing the Commit to Sit service excellence initiative was to positively impact the patient’s perception of nurse communication by nurses sitting with their patients during each shift. Outcomes were measured by the overall nurse communication composite on the Press Ganey survey, as well …

Beyond Patient-Centered Care: Enhancing The Patient Experience In Mental Health Services Through Patient-Perspective Care, Timothy A. Carey Prof

Patient Experience Journal

Delivering mental health services as patient-centered care has been an international priority for more than 50 years. Despite its longevity there is still not widespread agreement regarding how it should be defined or how it should guide the delivery of services. Generally, though, prioritizing the patient’s values and preferences seem to be at the core of this particular approach. It is not clear, however, that services attend to patient values and preferences as closely as they should. Terms such as “treatment resistant” and “noncompliant” seem to belie an attitude where the therapist’s opinion is privileged rather than the patients. To …

Why Do They Do That?: Looking Beyond Typical Reasons For Non-Urgent Ed Use Among Medicaid Patients, Cynthia J. Sieck, Jennifer L. Hefner, Randy Wexler, Chris A. Taylor, Ann S. Mcalearney

Patient Experience Journal

Barriers to accessing primary care, including lack of transportation and inadequate appointment times, are common reasons for non-urgent emergency department (ED) use yet even when these barriers are addressed, the problem persists. This study explored non-urgent ED use by Medicaid enrollees through interviews with patients and providers and sought to identify themes beyond the commonly mentioned logistical and access issues. Qualitative interviews with 23 Medicaid enrollees and 31 PCP and ED providers utilizing a semi-structured interview guide focused on reasons for seeking care in the ED and issues associated with PCP appointments. We identified overlap as well as surprising differences …

Uninsured Free Clinic Patients’ Experiences And Perceptions Of Healthcare Services, Community Resources, And The Patient Protection And Affordable Care Act, Akiko Kamimura, Jeanie Ashby, Ha Trinh, Liana Prudencio, Anthony Mills, Jennifer Tabler, Maziar Nourian, Fattima Ahmed, Justine Reel

Patient Experience Journal

Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. There has been a paucity of free clinic research with the few studies employing a quantitative design. The purpose of this study is to conduct an in-depth qualitative exploration of free clinic patients’ experience and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act (ACA). Free clinic adult patients (n=35) participated in four focus groups between June and July 2014 (one Spanish group in June, and two English groups and one Spanish group in July) …

Why Human Resources Policies And Practices Are Critical To Improving The Patient Experience, Shari Berman

Patient Experience Journal

While providing patient-centered care seems to be a goal for many organizations, delivering on this goal requires practices which are embedded in the organization, which incent patient-centered behavior. The author argues Human Resources (HR) policies, procedures and programs are key to supporting an organizations’ vision and culture. This means an HR executive partnering with the CEO who sets the vision and HR builds programs to support the vision. As the organization understands what is important to patients and how to best serve them, HR can build patient care improvement into every aspect of the organization. The author describes how competency …

‘First, Do No Harm’: Shifting The Paradigm Towards A Culture Of Health, Karen Luxford

Patient Experience Journal

Over the past 17 years since the release of the Institute of Medicine report ‘To Err is Human’,¹ health services and agencies around the world have increasingly focused on improving the safety and quality of health care. Historically, the commitment by health care professionals to ‘first do no harm’ has produced a focus on the absence of interventions that may cause adverse outcomes. This clinical approach links to the Hippocratic Oath which includes the promise "to abstain from doing harm". The Oath reminds clinicians to first consider the possible harm that any intervention might do. This approach to interactions …

The Experience Era Is Upon Us, Jason A. Wolf Phd

Patient Experience Journal

In this moment in healthcare, the challenges for those in the system are dynamically shifting and the perspectives, desires and needs of the healthcare consumer are putting positive and lasting pressures on how healthcare works that will shift healthcare from where it has been to where it must go. At the heart of this transition are the ideas framing an experience era, where collaborative, consumer-focused and purposeful actions can and will lead to a healthcare system returning to its fundamental calling, that of human beings caring for human beings. In doing so we can change the nature of healthcare and …

Chemical Reactions: Marijuana, Opioids, And Our Families, Denise A. Hines Ph.D, Staci Gruber Ph.D, John F. Kelly Ph.D, Kathleen M. Palm Reed, Hilary Smith Connery M.D., Ph.D.

Mosakowski Institute for Public Enterprise

Chemical Reactions: Marijuana, Opioids, and Our Families is the seventh Massachusetts Family Impact Seminar. This seminar was designed to emphasize a family perspective in policymaking on issues related to the legalization of marijuana and managing the opioid abuse crisis in the Commonwealth. In general, Family Impact Seminars analyze the consequences an issue, policy, or program may have for families.

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

Increasing Access To Primary Care Using Np’S: The Framework For An Academic Based Nurse-Managed Center In California, Prabjot (Jodie) Sandhu

Doctor of Nursing Practice (DNP) Projects

The dynamics of health care delivery and the role of health care providers is a changing canvas in the United States. The implementation of the Affordable Care Act (ACA), sets a goal to increase access to health care. The systems that support the ACA are constantly under scrutiny as failing to provide key answers to provider shortage and health care access issues. Nurse Practitioners (NPs) who are recognized by the ACA as a comprehensive part of this revolution are in a unique place to find opportunities to promote increased access to health and primary care services. While NPs in California …

Public Health Spending And Its Contributions To The Total Spend On Health, Glen P. Mays

Health Management and Policy Presentations

This presentation provides an overview of recent research on governmental public health expenditures and their interaction with medical spending, carried out through the Robert Wood Johnson Foundation supported initiatives on Public Health Services and Systems Research (PHSSR) and the new Systems for Action research program. This work illustrates the value of tracking resource use across multiple sectors that influence health and well-being in American communities. As such, this work can inform the ongoing dialogue about methodologies for summarizing total health spending for the U.S. and for state and local areas.

Learning From Geographic Variation And Change In Preparedness: The 2016 National Health Security Preparedness Index, Glen P. Mays

Health Management and Policy Presentations

The 2016 release of the National Health Security Preparedness Index tracks the nation's progress in preparing for disasters and other emergencies that create health risks for large groups of people. Recent improvements in the Index computational methodologies and measures allow results to be compared validly across states and over time. The Index aggregates more than 130 individual measures from nearly 60 data sources into valid composite measures for 6 domains and 19 subdomains that reflect core functional areas of emergency preparedness and response. Improvements in normalization, weighting, imputation, and confidence interval construction enhance the validity and reliability of Index estimates …

Health Information Exchange: A Strategy For Improving Access For Rural Veterans In The Maine Flex Rural Veterans Health Access, Karen B. Pearson Mlis, Ma, Amanda Burgess Mppm, John A. Gale Ms, Andrew F. Coburn Phd, Anush Yousefian Hansen Ms, Ma

Access / Insurance

This paper reports on the design and implementation of a first-in-the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …

The Story Of Emily, Lori L. Jennings Ms, Barb O'Neil, Kim Bossy, Denise Dodman, Jill Campbell

Patient Experience Journal

This case study describes Bluewater Health’s quest to weave the philosophy and practice of patient and family-centered care from the boardroom to the bedside by introducing Emily. Emily’s image is a composite of photographs of staff, physicians, volunteers, patients and families exemplifying that each has a role in Emily’s care. Emily represents every patient and family of the past, present, and future. Emily’s journey started with the launch of Bluewater Health‘s 2013-2015 strategic plan and moved throughout the organization as patient councils were established and the organization embedded three foundational patient and family-centered RNAO Best Practice Guidelines into daily practice …

Applying Experience-Based Co-Design With Vulnerable Populations: Lessons From A Systematic Review Of Methods To Involve Patients, Families And Service Providers In Child And Youth Mental Health Service Improvement, Alison Mulvale, Ashleigh Miatello, Christina Hackett, Gillian Mulvale

Patient Experience Journal

The objective was to identify methods used to involve patients, family and service providers in child and youth mental health service improvement research. We analyzed the alignment of methods used with Experience-Based Co-Design (EBCD) methodology, and how power imbalances among participants were addressed. A systematic review of the English-language peer review literature since 2004 was carried out. The EMBASE, Scholar’s Portal, PubMed, Web of Science databases and the Ontario College of Art and Design University libraries were searched electronically for variations of ‘child’, ‘mental health’, ‘experience-based co-design’, ‘participatory research’ and ‘health care services’. Textual data was systematically extracted and analyzed. …

Impact Of Logo Wear On Provider Perception Of Patient, Bill R. Gombeski Jr

Patient Experience Journal

Patient’s appearance affects provider perception of patients and subsequent provider behavior. Based on anecdotal information, it was hypothesized that wearing a health organization’s brand would result in a more positive perception of a patient by providers and subsequently a better patient experience. A study of 121 individuals with patient contact was conducted. Using photos of patients with and without a health care brand on their shirts, study subjects rated the attractiveness and willingness to engage with photos of patients. Patients with a Mayo brand and UK HealthCare brand showed some significant positive attractiveness over the same patient without the brand. …

Developing Approaches To The Collection And Use Of Evidence Of Patient Experience Below The Level Of National Surveys, Elizabeth J. Gibbons, Chris Graham, Jenny King, Kelsey Flott, Crispin Jenkinson Professor, Raymond Fitzpatrick Professor

Patient Experience Journal

National approaches to collecting patient feedback provide trust level information which although can provide a benchmark for trusts often doesn’t provide information about specific services or patients experiences of pathways of care. This more granular level of data could be more informative for local service development and improvement. This research explored the feasibility and usefulness of such approaches. A conceptual model and standard questionnaire of patient experience was developed that might work across a range of services and pathways of care. Seven trusts were recruited as collaborating sites in which the model and survey instrument was tested. These were from …

Impact Of Hospital Diagnosis-Specific Quality Measures On Patients’ Experience Of Hospital Care: Evidence From 14 States, 2009-2011, Emily M. Johnston, Kenton J. Johnston, Jaeyong Bae, Jason M. Hockenberry, Arnold Milstein, Edmund Becker

Patient Experience Journal

In order to assess consistency across quality measures for Untied States hospitals, this paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in hospital-reported patient experience-of-care scores by diagnosis-specific process and outcome measures for acute myocardial infarction, heart failure, and pneumonia. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores for 195 out of 230 relationships between HCAHPS patient experience-of-care scores and 23 diagnosis-specific process and outcomes measures. We …

Please Tick The Appropriate Box: Perspectives On Patient Reported Experience, Mette Sandager, Morten Freil, Janne Lehmann Knudsen

Patient Experience Journal

Patient experience surveys are increasingly used as a method for evaluating important aspects of quality of care and the results are used politically to support general decision-making. However, there have been limited attempts to summarize the newest and most essential knowledge on how to measure and interpret patient experience data. This paper aims to summarize knowledge on the association between delivered care and patient reported experience and the factors influencing this association, and to outline a conceptual model illustrating the association. The method employed is integrative literature review. Quantitative and qualitative studies as well as theoretical and discussion papers that …

Patient Perceptions Of An Aidet And Hourly Rounding Program In A Community Hospital: Results Of A Qualitative Study, Tosha Allen, Tyne Rieck, Stacie Salsbury

Patient Experience Journal

Quantitative evidence links patient satisfaction scores to the use of communication strategies such as AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you) and Hourly Rounding. However, little is known about patient perceptions of these tools in regards to their hospital experience. Qualitative interviews were conducted with a convenience sample of 14 adult medical/surgical inpatients in one mid-sized, community hospital, following hospital discharge. The interview data was transcribed and opened coded, utilizing constant comparison to identify common themes. Themes emerged in four topical areas: (a) patient experience of hospitalization, (b) AIDET, (c) Hourly Rounding, and (d) unexpected findings. Patients placed significant …

Does She Think She’S Supported? Maternal Perceptions Of Their Experiences In The Neonatal Intensive Care Unit, Emily A. Lilo, Richard J. Shaw, Julia Corcoran, Amy Storfer-Isser, Sarah M. Horwitz

Patient Experience Journal

Parents’ involvement in the care of their infants in the neonatal intensive care unit (NICU) is critically important, leading many NICUs to implement policies and practices of family-centered care (FCC). Analyzing narrative interviews, we examined whether mothers of premature infants who participated in an intervention to help reduce anxiety, stress, and depression felt that their NICU experience reflected four key nursing behaviors previously identified as being necessary to achieving FCC. Fifty-six narratives derived from semi-structured interviews with the mothers were analyzed qualitatively and quantitatively to examine whether the women experienced emotional support, parent empowerment, welcoming environment, and parent education, as …

A Call To Excellence In Patient Experience, Geoffrey A. Silvera

Patient Experience Journal

In this address, the incoming associate editor describes his early experience with the Patient Experience Journal (PXJ) and issues a call to action to the PXJ community. In the call to action, the PXJ community is asked to build upon our collective history of scholastic and practical excellence. The combination of practical relevance and methodological rigor in our contributions will help to ensure a future in which patient experience is paramount in health service delivery conversations. In addition, gaps in the patient experience literature and emergent opportunities for theoretical and practical contributions are recommended.

Patient Experience: Driving Outcomes At The Heart Of Healthcare, Jason A. Wolf Phd

Patient Experience Journal

There is no longer a question that patient experience matters in healthcare today. It matters for those that are cared for and served and matters to all those working each and every day to provide the best in care at all touch points across the healthcare continuum. With this recognition, there too needs to be a change in mindset about patient experience itself. When addressing the topic of patient experience, the conversation is about something much broader than the “experience of care”, as identified in the triple aim. The idea of experience reflects our biggest opportunity in healthcare, where experience …

Measuring Progress To Comprehensive Public Health Systems, National Preparedness, And A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

This update describes recent progress on two national health measurement initiatives: The National Health Security Preparedness Index and the National Longitudinal Survey of Public Health Systems. These longitudinal data sources offer valuable perspectives on how health security practices and public health delivery systems are changing across the U.S.

Learning From Variation And Change: The 2016 Release Of The National Health Security Preparedness Index, Glen P. Mays

Health Management and Policy Presentations

The 2016 release of the National Health Security Preparedness Index uses an improved computational methodology and validated set of measures to more accurately track national and state progress in protecting the public from the health effects of disasters, outbreaks and other large-scale emergencies. This presentation provides a preview of the new methodology and results.