Health Services Research Commons^™

Using Patient Experience In Optimizing The Total Knee Arthroplasty Patient Journey, Nienke Wolterbeek, Dieuwertje J. Hiemstra, Fiona A. Van Der Hoeven, Kiem G. Auw Yang

Patient Experience Journal

Information was used to improve the patient journey and to achieve patient-centered care. Patients (>18 years, purposive sampling) were interviewed once at one point of their total knee arthrosis journey within the hospital setting. Patients were accompanied and observed during their hospital visit by one of the 19 healthcare professionals which were trained as interviewers. A qualitative research approach with in-depth and semi-structured interviews using a standardized interview guide were used to gather an in-depth understanding of the perceptions of patients. Interviews were written out with the emphasis on positive and negative feedback, quotes and observations that were made. …

How Do Healthcare Staff Respond To Patient Experience Feedback Online? A Typology Of Responses Published On Care Opinion, Lauren Paige Ramsey, Laura Sheard Dr, Rebecca Lawton Professor, Jane O'Hara Dr

Patient Experience Journal

Patients are increasingly describing their healthcare experiences publicly online. This has been facilitated by digital technology, a growing focus on transparency in healthcare and the emergence of a feedback culture in many sectors. Due to this area being previously unexplored, the objective of this study was to identify a typology of responses that healthcare staff provide on Care Opinion (www.careopinion.org.uk), a not-for-profit online platform on which patients are able to provide narrative feedback about health and social care in the UK. Framework analysis was used to qualitatively analyse a purposive sample of 486 stories regarding hospital care, and their 475 …

Can Doctors Improve The Patient Experience By Rearranging The Furniture And Equipment In Their Office? A Video Recorded Simulation, Moyez Jiwa, Catherine Krejany, Lee Gaedtke, Epi Kanjo, Ruthra Nagendran, Carolyn O'Shea, Iain Greenlees

Patient Experience Journal

The design of this study is a video-recorded simulated consultation. Its aim is to evaluate the effect of changing seating arrangements and stethoscope visibility on patient enablement and non-verbal behaviour. Twelve simulated consultations with six actor-patients and a ‘real’ doctor were video recorded. Either the ‘real’ doctor or actor-patient, blind to the hypothesis sat in large executive office chair during the consult. The patient entered the room afresh for each consult. Consultation quality and outcomes were independently evaluated on three measures: The Patient Enablement Index (PEI), the Leicester Assessment Package (LAP); Non-Verbal Communication (NVC). Both expert reviewers were also blind …

Tell Me More: Promoting Compassionate Patient Care Through Conversations With Medical Students, Danielle Qing, Anjali Narayan, Kristin Reese, Sarah Hartman, Taranjeet Ahuja, Alice Fornari

Patient Experience Journal

Tell Me More^® (TMM) is a medical student driven project that represents a movement amongst the rising generation of physicians to practice humanistic, patient-centered medicine through a collaborative approach. Students interviewed patients to create individualized posters designed to build rapport and trust between patients and clinicians, remind patients of their special strengths by highlighting their unique interests and qualities, and encourage more personal and compassionate patient-clinician interactions in order to enhance the patient experience. Students asked each patient three questions: 1. “How would your friends describe you?” 2. “What are your strengths?” 3. “What has been most meaningful to …

Perceptions Of Patient-Centered Care Among Veterans With Gastroesophageal Reflux Disease On Proton Pump Inhibitor Therapy, Salva N. Balbale, Andrew Gawron, Sherri L. Lavela Phd, Mph, Mba

Patient Experience Journal

The aim of this study was to explore perceptions of patient-centered care (PCC) among Veterans with gastroesophageal reflux disease (GERD) on proton pump inhibitor (PPI) therapy using patient-reported outcome (PRO) measures. We used three validated surveys to measure PCC concepts in a national sample of Veterans with GERD on PPI therapy. The Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness (COMRADE) measures patient experiences with risk communication and decision-making. The Patient Activation Measure (PAM) evaluates confidence and knowledge needed for self-management. The Patient Assessment of Care for Chronic Conditions (PACIC) assesses views of chronic care received. We …

A Photo-Elicitation Study Of Homeless And Marginally Housed Veterans’ Experiences With Patient-Centered Care, Samuel F. Sestito, Keri L. Rodriguez, Kristina L. Hruska, James W. Conley, Michael A. Mitchell, Adam J. Gordon

Patient Experience Journal

As part of a qualitatively-driven mixed-methods study, this analysis aimed to describe Veterans Affairs (VA) Homeless Patient Aligned Care Team patients’ experiences with patient-centered care. Veterans participated in audio-recorded, semi-structured photo-elicitation interviews about their health and VA health care. Transcripts were analyzed by two coders using template analysis. In 31/36 interviews, 19/20 participants discussed patient-centered care. Veterans noted Picker’s Patient-Centered Care Principles; 1) access to care, 2) respect for patient-centered values, preference and expressed needs, 3) information, communication, and education, and 4) coordination and care integration were most commonly discussed, followed by 5) physical comfort, 6) transition and …

Racial/Ethnic And Geographic Differences In Access To A Usual Source Of Care That Follows The Patient-Centered Medical Home Model: Analyses From The Medical Expenditure Panel Survey Data, Zo Ramamonjiarivelo, Delawnia Comer-Hagans, Shamly Austin, Karriem Watson, Alicia Kaye Matthews

Patient Experience Journal

This study examined racial and geographic differences in access to a usual source of care (USC) and it further explored these differences among individuals who had a USC that followed the patient-centered medical home (PCMH) model. Using cross-sectional data from the Household Component of the Medical Expenditure Panel Survey (2008-2013), our sample consisted of non-institutionalized US civilians ages 18-85 (n= 146,233; weighted n = 229,487,016). Our analysis included weighted descriptive statistics and weighted logistic regressions. Although 76% of the respondents had a USC, only 11% of them had a USC that followed the PCMH model. Among respondents who had a …

Exploring Workforce Confidence And Patient Experiences: A Quantitative Analysis, Katie M. Owens, Stephanie Keller

Patient Experience Journal

Confidence is recognized as one of the most influential factors to affect performance. Individual, leader, and team confidence play essential roles in achieving success and the absence of confidence has been connected with failure. While confidence is not a substitute for competency, it creates trusting relationships, empowerment, and resiliency to persevere when challenges arise. Objective: In this study, we examined workforce confidence in the patient experience and patient perceptions of their experience of care. Methods: We compared responses to the Patient-Centered Excellence Survey (PCES) from 41 United States hospitals, measuring workforce confidence in the patient experience provided, to patient’s ratings …

Patient Experiences In A Linguistically Diverse Safety Net Primary Care Setting: Qualitative Study, Rachel L. Berkowitz, Nimeka Phillip, Lyn Berry, Irene H. Yen

Faculty Research, Scholarly, and Creative Activity

Background:

The patient-centered medical home model intends to improve patient experience and primary care quality. Within an urban safety net setting in Northern California, United States, these desired outcomes are complicated by both the diversity of the patient community and the care continuity implications of a residency program.

Objective:

The objective of our study was to understand the patient experience beyond standardized satisfaction measures.

Methods:

We conducted a qualitative study, interviewing 19 patients from the clinic (English-, Spanish-, or Mien-speaking patients).

Results:

Some themes, such as the desire to feel confident in their doctor, emerged across language groups, pointing to …

“We Were Learning Together And It Felt Good That Way.” A Case Study Of A Participatory Group Music Program For Cancer Patients, Laurie Sadowski

Patient Experience Journal

Though there are similarities to music therapy, the field of community music in healthcare, while in its infancy, is steadily growing. This case study explored how semi-formal, active music-making can play a role in illness and recovery and provide patients with a sense of voice, connection, and community, and the efficacy of community music programming in a hospital. Six participants began and three participants completed a 6-week music class learning the ukulele. Interpretative Phenomenological Analysis (IPA) was used as a method for data analysis from semi-structured pre-questionnaires, transcribed classes, transcribed post-interviews, and weekly questionnaires from both the participants and the …

Using Appreciative Inquiry As A Framework To Enhance The Patient Experience, Kerry Moorer Mba, Schawan Kunupakaphun, Elilzabeth Delgado, Matthew Moody, Christina Wolf Msn, Rn, Cnl, Karen Moore Rn, Ms, Fache, Pracha Eamranond Md, Mph

Patient Experience Journal

The following case depicts the journey of a non-profit hospital in an under-served community and its attempts to turn around suffering patient experience. The Hospital turned to the theories of Appreciative Inquiry and the power of a strengths-based approach to create a framework to support the patient experience initiatives. Hospital leadership led the formation of a Patient Experience Team to implement ten initiatives in order increase the top box score in the domain of willingness to recommend the hospital, as that was selected as a global measure of success for the overall improvement project.

Healthcare Providers Versus Patients' Understanding Of Health Beliefs And Values, Betty M. Kennedy, Matloob Rehman, William D. Johnson, Michelle B. Magee, Robert Leonard, Peter T. Katzmarzyk

Patient Experience Journal

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. 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. Healthcare provider and patient differences revealed that patients perceived greater meaning of their illness (p = 0.038), and a greater preference for partnership (p = …

Patient-Centered Outcomes Measurement: Does It Require Information From Patients?, Leif I. Solberg, Stephen E. Asche, John Butler, David Carrell, Christine K. Norton, Jeffrey G. Jarvik, Rebecca Smith-Bindman, Juliana O. Tillema, Robin R. Whitebird, Ann M. Werner, Jeanette Y. Ziegenfuss

Journal of Patient-Centered Research and Reviews

Purpose: Since collecting outcome measure data from patients can be expensive, time-consuming, and subject to memory and nonresponse bias, we sought to learn whether outcomes important to patients can be obtained from data in the electronic health record (EHR) or health insurance claims.

Methods: We previously identified 21 outcomes rated important by patients who had advanced imaging tests for back or abdominal pain. Telephone surveys about experiencing those outcomes 1 year after their test from 321 people consenting to use of their medical record and claims data were compared with audits of the participants’ EHR progress notes over the time …

Experience-Based Co-Design: A Method For Patient And Family Engagement In System-Level Quality Improvement, Bianca Fucile, Erica Bridge, Charlene Duliban, Madelyn P. Law Dr.

Patient Experience Journal

Integrating patient and family member needs, wants and preferences in healthcare is of utmost importance. However, a standardized patient and family engagement model to understand these needs, wants and preferences in order to translate into high quality improvement activities is lacking. Experience based co-design (EBCD) is an approach that enables patients, family members and healthcare providers to co-design improvement initiatives together. In this study, EBCD was employed to: 1) assess the current state of information and educational resources at a local oncology center and 2) partner with patients, family members, and healthcare providers to create quality improvement initiatives targeting identified …

Patient Experiences Of Cancer Care: Scoping Review, Future Directions, And Introduction Of A New Data Resource: Surveillance Epidemiology And End Results-Consumer Assessment Of Healthcare Providers And Systems (Seer-Cahps), Michelle A. Mollica, Lisa M. Lines, Michael T. Halpern, Edgardo Ramirez, Nicola Schussler, Matthew Urato, Ashley Wilder Smith, Erin E. Kent

Patient Experience Journal

The shift towards providing high value cancer care has placed increasing importance on patient experiences. This scoping review summarizes patient experience literature, highlights research gaps, and provides future research directions. We then introduce a new resource that links the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program with the Centers for Medicare and Medicaid Services Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and longitudinal medical claims data. We conducted a scoping review to identify relevant research within the Medicare CAHPS domain that examine factors associated with patient-reported experiences with their cancer care. Gaps indicate a need …

Patient Perspectives On Quality Family Planning Services In Underserved Areas, Debora Goldberg, Bhakthi Sahgal, Tishra Beeson, Susan F. Wood, Holly Mead, Aliyah Abdul-Wakil, Hallie Stevens, Pinyao Rui, Sara Rosenbaum

Patient Experience Journal

Ongoing challenges impede efforts to improve the quality of family planning services in underserved communities, which by definition lack sufficient numbers of physicians and other health professionals. Challenges to improving the quality of family planning services include financing difficulties, lack of standards, training deficiencies, as well as little understanding and attention to patient preferences. The objectives of this study were to explore female patients’ preferences for family planning services in underserved areas and to develop a framework to help providers improve patient-centered care. The methodology for this paper included mixed methods research including a survey of women between the ages …

“What Matters To You?”: A Pilot Project For Implementing Patient-Centered Care, Anthony M. Digioia Md, Iii, Sarah B. Clayton, Michelle B. Giarrusso

Patient Experience Journal

This project was intended to enhance the delivery of patient-centered care by asking patients what matters to them before and after total joint replacement (TJR) surgery. In Phase I, pre-operatively, patients undergoing total joint replacement (TJR) surgery were asked, “What matters to you before surgery, during your hospital stay, and in the first 3 months following surgery?” and “What matters to you moving forward after you’ve recovered from your joint replacement?” Four weeks post-operatively they were asked, “Now that that you’ve been through the surgery and first 4 weeks of recovery, can you identify new concerns that you didn’t have …

The Comparative Impact Of Different Patient-Centered Medical Home Domains On Satisfaction Among Individuals Living With Type Ii Diabetes, Jon Mills, Allyson Hall, Rebecca Tanner, Jeffrey Harman, David L. Wood, Charles Lorbeer

Patient Experience Journal

Chronic illnesses like type 2 diabetes are costly and difficult to treat. Patient-centered medical homes (PCMH) have the potential to improve patient satisfaction in this population. However, which domains have the most impact on patient satisfaction has not been established. The aim of this study was to assess the relative strength of association between seven PCMH domains and two measures of satisfaction. Cross-sectional data were used in this observational study collected from a random sample of adults aged 18-89 with type 2 diabetes (n=1301) seen at 4 PCMHs. The Ambulatory Care Experiences Survey instrument was used to assess all measures. …

A Vision For Using Online Portals For Surveillance Of Patient-Centered Communication In Cancer Care, Hardeep Singh, Neeraj K. Arora, Kathleen M. Mazor, Richard L. Street Jr

Patient Experience Journal

The Veterans Health Administration (VHA) is charged with providing high-quality health care, not only in terms of technical competence but also with regard to patient-centered care experiences. Patient-centered coordination of care and communication are especially important in cancer care, as deficiencies in these areas have been implicated in many cases of delayed cancer diagnosis and treatment. Additionally, because cancer care facilities are concentrated within the VHA system, geographical and system-level barriers may present prominent obstacles to quality care. Systematic assessment of patient-centered communication (PCC) may help identify both individual veterans who are at risk of suboptimal care and opportunities for …

Using A Process Improvement Tool To Improve Staff Skills & Enhance The Urgent Needs Patient Experience In A Women’S Health Center, Kenneth J. Feldman, Molly Lopez, Morris Gagliardi

Patient Experience Journal

NYC Health + Hospitals / Gouverneur serves more patients than any other diagnostic and treatment center in New York State. As part of the NYC Health + Hospitals public health care system, which serves 1.4 million patients and is the largest municipal health care delivery system in the United States, Gouverneur strives to serve the needs of both scheduled and unscheduled patients. Within Gouverneur, the Women’s Health department treats approximately 1,600 patients per month through approximately 2,100 visits. In September 2014, Gouverneur’s Women’s Health department launched a weeklong process improvement initiative known as a Rapid Improvement Event (RIE). Structured through …

Implementing Shared Decision-Making: Consider All The Consequences, Glyn Elwyn, Dominick L. Frosch, Sarah Kobrin

Dartmouth Scholarship

The ethical argument that shared decision-making is “the right” thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and efficiency. It is helpful, therefore, when evaluating new approaches such as shared decision-making to conceptualize potential consequences in a way that is broad, long-term, and as relevant as possible to multiple stakeholders. Yet, so far, evaluation metrics for shared decision-making have been mostly focused on short-term outcomes, such as cognitive or affective consequences in patients. The …

Book Review: The Language Of Caring Guide For Physicians: Communication Essentials For Patient-Centered Care (2nd Edition), Chet Wyman Md

Patient Experience Journal

In thie book review for Wendy Leebov and Carla Rotering’s The Language of Caring Guide for Physicians: Communication Essentials for Patient-Centered Care (2nd edition), the author/reviewer conveys his perspective on the essential value of this publication. He offers his recommendation of this book for anyone who wants to improve their own communication skills and also for physician leaders responsible for initiatives to engage physicians and improve service quality, patient outcomes, and CAHPS scores for a department or organization, noting it is an essential read in today’s healthcare environment.

Are We Providing Patient-Centered Care? Preferences About Paracentesis And Thoracentesis Procedures, Jeffrey H. Barsuk, Sarah E. Kozmic, Jordan Scher, Joe Feinglass, Aimee Hoyer, Diane B. Wayne

Patient Experience Journal

Procedures performed at the bedside are as safe and less expensive than Interventional Radiology (IR) procedures. Patient preferences regarding location are rarely taken into account. Therefore, in this study we compared patient satisfaction with bedside and IR paracentesis and thoracentesis procedures, and identified reasons for patient location preferences. We performed a cross-sectional survey of medical inpatients undergoing paracentesis or thoracentesis procedures at a tertiary care academic medical center. The survey had eight domains: overall experience, pain control, expertise, courtesy, bedside manner of the physician, time required, explanation of risks/benefits, comfort and privacy. Patients were also asked about their preference for …

To Serve Patients Is Our Greatest Privilege, David T. Feinberg Md, Mba

Patient Experience Journal

In his guest editorial, Dr. David Feinberg of UCLA Health System reminds us of the power of patient voice and the lessons we should be open to learning from those we serve every day. He offers, "It is a blessing for us to work in an environment where we have the opportunity every day to touch someone’s life so deeply. We must never lose sight of that. It is our responsibility to not just treat our patients, but also to embrace them."

Factors In Patients’ Experience Of Hospital Care: Evidence From California, 2009–2011, Edmund R. Becker Phd, Jason M. Hockenberry Phd, Jaeyong Bae Ma, Ariel C. Avgar Phd, Sandra S. Liu Phd, Mba, Ira Wilson Md, Msc, Arnold Milstein Md, Mph

Patient Experience Journal

The use of measures of patient-centered care to evaluate hospital care is mandated by The Patient Protection and Affordable Care Act of 2010. Using three years of data from 315 California acute-care hospitals and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, we seek to evaluate patients’ hospital-care experience by (1) analyzing patients’ experience-of-care scores in light of these hospitals’ patient profiles, structural characteristics, and outcomes in 2011, and (2) determining and analyzing the extent of changes in patients’ experience of care over the three-year period 2009–2011. For 2011, we find significant …

Patchy ‘Coherence’: Using Normalization Process Theory To Evaluate A Multi-Faceted Shared Decision Making Implementation Program (Magic), Amy Lloyd, Natalie Joseph-Williams, Adrian Edwards, Andrew Rix, Glyn Elwyn

Dartmouth Scholarship

Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals' perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. The MAGIC …

A Decentralized, Patient-Centered Approach To Diabetes Disease Management In The Primary Care Setting, Michael Toscani, John P. O'Connor, David B. Nash

College of Population Health Faculty Papers

Although many disease management programs have been developed for diabetes, no single design has proved best for all providers and patient populations. Cost effectiveness is especially relevant to diabetes programs because significant costs of the disease may come from complications that occur later in life, while the costs of the program are incurred immediately. For this reason, diabetes disease management programs with positive outcomes and low implementation costs are of particular importance. We report here on the outcomes of a pilot test of the Steps to Health program developed by Abbott Laboratories. The Steps to Health program was designed to …