Health Services Research Commons^™

Patient Experiences In Intensive Care Units: A Systematic Review, Serpil Topçu, Şule Ecevit Alpar, Bilgi Gülseven, Ayda Kebapçı

Patient Experience Journal

The aim of this systematic review is to analyze the data gathered from studies conducted to determine patient experiences in intensive care and levels of the recollection of the intensive care period that were published between December, 1998 – April, 2013. The systematic review was carried out screening of the related publications. The findings of the systematic review were studied under the following two titles: “remembering the intensive care period” and “recalled experiences” of patients. Studying 15 papers which were found suitable to the inclusion criteria of the review indicated that majority of the patients had recollection of the intensive …

Patient Experience Of Taking Adjuvant Endocrine Therapy For Breast Cancer: A Tough Pill To Swallow, Kuang-Yi Wen, Rita Smith, Aruna Padmanabhan, Lori Goldstein

Patient Experience Journal

Adjuvant endocrine therapy (AET) has substantially improved the mortality rate among breast cancer survivors. Despite the proven efficacy, the non-adherence rate to therapy is still high. This study is aimed to examine women’s challenges related to AET adherence and management. Semi-structured interviews were conducted with six Caucasian and six African American breast cancer survivors who were prescribed for AET. The transcripts of audio-taped interviews were qualitatively analyzed. Key themes were: 1) positive beliefs in AET, 2) uncertainty about long-term adherence, 3) experiences with side effects, 4) forgetting and remembering, 5) other concerns and information needs, 6) potential intervention format, and …

Exploratory Pilot Testing Of The Psychometric Properties Of The Person Engagement Index Instrument Among Older, Community-Dwelling Adults, Ellen Swartwout, Taya Irizarry, Annette Devito Dabbs, Scott Barnett

Patient Experience Journal

The objective of this paper was to evaluate the psychometric properties of the Person Engagement Index with community dwelling older adults and determine the factors that impact this population’s capacity to engage in healthcare. This non-experimental pilot evaluation of the psychometrics of the Person Engagement Index was performed in a convenience sample of 100 community-dwelling older adults. Exploratory factor analysis was conducted using dimension reduction to determine the underlying structure of a person’s capacity to engage in healthcare. Results indicated good internal consistency with Cronbach’s alpha=.882 for the overall scale. Exploratory factor analysis with varimax rotation was conducted resulting …

Operationalizing Person-Centered Care Practices In Long-Term Care: Recommendations From A “Resident For A Day” Experience, Jennifer L. Johs-Artisensi

Patient Experience Journal

As the senior population continues to age, long-term care is positioned for growth and care recipients are demanding more person-centered care. While long-term care leaders may understand and believe in the value of person-centered care, sometimes operationalizing practices to ensure its delivery can be challenging. Using an ethnographic approach, over three years, 159 long-term care administrator-in-training practicum students each lived as a resident for 24 hours in a nursing home. Following the experience, using the Picker Institute’s framework, each participant identified and justified an Always Experience® – an optimal experience they believed should routinely occur for every long-term care resident. …

The Impact Of Provider Service Networks In Florida Medicaid Managed Care On Enrollees’ Satisfaction, Sinyoung Park, Jeffrey S. Harman, Allyson G. Hall

Patient Experience Journal

Two counties in Florida were selected as pilots in 2006 for the Medicaid Demonstration Program. In reform counties, Medicaid enrollees were required to pick a managed care plan; either a Health Maintenance Organization or a Provider Service Network (PSN). PSNs are a form of managed care that provides health care services directly through a provider or network of organizations to a defined population without an intermediary. There are two types of PSNs: Physician-based PSNs and Healthcare system-based PSNs. The objective of this study is to find the differences in enrollees’ satisfaction between two different types of PSNs. To assess the …

Maintaining Public Health Insurance Benefits: How Primary Care Clinics Help Keep Low-Income Patients Insured, Rose L. Harding, Jennifer D. Hall, Jennifer Devoe, Heather Angier, Rachel Gold, Christine Nelson, Sonja Likumahuwa-Ackman, John Heintzman, Aleksandra Sumic, Deborah J. Cohen

Patient Experience Journal

Low-income families struggle to obtain and maintain public health insurance. We identified strategies used by Community Health Centers (CHCs) to assist patients with insurance applications, and assessed patients’ receptivity to these efforts. Observational cross-case comparative study with four CHCs in Oregon. We observed insurance assistance processes, and interviewed 26 clinic staff and 18 patients/family members. Qualitative data were analyzed using a grounded theory approach. Patients’ understanding of eligibility status, reapplication schedules, and how to apply, were major barriers to insurance enrollment. Clinic staff addressed these barriers by reminding patients when applications were due, assisting with applications as needed, and tracking …

Patient Safety: Just Ask. Patients As Reporters Of Real-Time Safety Data; A Pilot Project To Improve Patient Safety In Secondary Care, Thomas A. Cairns Dr, Iain Mccallum Mr

Patient Experience Journal

The Berwick review into patient safety recommended ‘involving patients in the healthcare organisation and seeking out the patient voice as an essential asset to monitor safety.’ (1) However routine data collection from patients in our institution is retrospective and doesn't focus on safety. Our objective was to create a patient-centred mechanism to monitor patient-perceived safety concerns and provide immediate resolution of highlighted issues. A pragmatic 6-question questionnaire was developed containing 4 scored and 2 free text questions. This questionnaire was piloted and adjusted before being administered to all inpatients meeting the inclusion criteria in our institution on one day. Safety …

Patient And Provider Experiences With Relationship, Information, And Management Continuity, Jeanette Jackson, Gail Mackean, Tim Cooke, Markus Lahtinen

Patient Experience Journal

From 2003 to 2014, the Health Quality Council of Alberta (HQCA) monitored patient experiences with healthcare services through a biennial Satisfaction and Experience with Healthcare Services (SEHCS) survey. The findings consistently showed a direct link between coordination of care, an aspect of continuity of care, and healthcare outcomes. Specifically, it showed that better coordination is linked to positive outcomes; the reverse is also true. Given the critical role continuity of care plays in the healthcare system, the HQCA conducted in-depth interviews, interactive feedback sessions and focus groups with patients and providers to explore factors that influence both seamless and fragmented …

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 = …

Rebalancing The Patient Experience: 20 Years Of A Pendulum Swing, Tiffany Christensen

Patient Experience Journal

This essay looks back at two decades of the patient experience movement. The evolution of patient experience includes moving from a belief system in which patients and families are solely the recipients of care to a model in which patients and families are co-designing treatment plans, systems and policies. This evolution has taken time and continues to evolve to this day. As the pendulum swings, we see that we have made great progress and, simultaneously, found ourselves with all new challenges to overcome.

Accelerating Patient Experience Performance: Collaboration And Engagement As Drivers For Success, Sidney Klajner

Patient Experience Journal

The efforts at Albert Einstein Jewish Hospital in São Paulo, Brazil have been focused on principles of excellence for many years as realized in engagement in and commitment to some of the leading global healthcare practices over the last decade. In reinforcing a commitment to excellence and continuous improvement, the patient experience efforts at Einstein have evolved from an operating structure for patient experience efforts to a truly integrated program for action in address all elements in the organization impacting and ultimately driving patient experience outcomes. By grounded efforts in core evidence-based practice, while engaging the hearts and minds of …

The Patchwork Perspective: A New View For Patient Experience, Jason A. Wolf Phd

Patient Experience Journal

As Patient Experience Journal has continued to contribute to the expanding patient experience conversation, we too recognize this has been a significant year of progress for the patient experience movement. This progress has emerged in a number of ways in research, practice and programs that reveal a comprehensive and integrated approach is now more than ever a central consideration in a commitment to experience. This idea of interwoven efforts, begins to frame an image – a patchwork of clear, critical and comprehensive pieces that while operating distinctly each have value, yet when bringing them together have an exponential opportunity to …

The Path To Health Equity Through Multidisciplinary Collaboration, Cynthia Haq

Journal of Patient-Centered Research and Reviews

The author, a guest editor for this special issue of the Journal of Patient-Centered Research and Reviews dedicated to health disparities and inequities, comments on recent studies demonstrating poorer health outcomes among various patient populations in the United States despite its having higher spending per capita than any other nation. Noting that health inequities are defined as avoidable differences, the author encourages health professionals to work to narrow these gaps.

Measuring The Impact Of Patient-Engaged Research: How A Methods Workshop Identified Critical Outcomes Of Research Engagement, Ellis C. Dillon, Leah Tuzzio, Sarah Madrid, Heather Olden, Robert T. Greenlee

Journal of Patient-Centered Research and Reviews

Purpose: While strategies to evaluate the influence of engaging patient partners in research, such as the Patient-Centered Outcomes Research Institute (PCORI) WE-ENACT surveys, are beginning to emerge, a systematic set of measures for assessing the impact of patient engagement in research (PER) on study approaches and outcomes is lacking. This article describes a workshop and process used to identify and develop Critical Outcomes of Research Engagement (COREs). It proposes preliminary measures for assessing the impact of PER on the research process and outcomes of research studies.

Methods: A group of 24 researchers and 5 patient partners participated in a PCORI-funded …

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 …

Health Care Disparities Knowledge, Attitudes, And Behaviors In Resident Physicians, Rebecca Hammarlund, Diana Hamer, Kathleen Crapanzano, Rachel Bernard, Carine Nzodom, Courtney James, Angie Johnson, Diane Kirby, Laura Hetzler, Chris Woodward, Jesse Sulzer, Lauren Rabalais, Laurinda Calongne

Journal of Patient-Centered Research and Reviews

Purpose: Health care disparities are an important but sometimes underrepresented topic in graduate medical education. In this study we measured the impact of educational and behavioral interventions on resident knowledge about and attitudes toward health care disparities.

Methods: Faculty from 6 residency programs designed and presented an hour-long educational intervention to emphasize the importance of and increase resident knowledge about health care disparities. Selected residents then helped design a month-long behavioral intervention to engage their peers in conversations about disparities with patients. Surveys were administered pre- and post-educational intervention as well as post-behavioral intervention in order to measure the impact …

Improved Service Efficiency Improves Racial Disparity In Diabetic Care, Abel Irena, Kushal Patel, David Thompson, Gregory Schleis, Abiy Gesese, Richard Battiola

Journal of Patient-Centered Research and Reviews

Background: Racial disparities in diabetes care have been documented. Disparities also have been shown to affect service quality and outcome of diabetic care. Analysis of our internal medicine residency clinic diabetic care management performance across REAL-G (race, ethnicity, age, preferred language and/or gender) showed race-based disparity on two outcome measures: 1) measurement of glycohemoglobin (A1C) at least twice a year; and 2) target blood pressure of < 140/90.

Purpose: Develop interventions to decrease racial disparities in diabetes care among patients managed by an internal medicine residency clinic, as part of the Alliance of Independent Academic Medical Center’s National Initiative V project.

Methods: …

Decreasing Time To Broad Spectrum Antibiotics For Septic Patients In The Emergency Department, Joseph J. Zieminski, Emily E. Bryant

Journal of Patient-Centered Research and Reviews

Background: Timely administration of broad spectrum antibiotics has been shown to be directly correlated with decreased mortality for patients with severe sepsis and septic shock. As such, both the Surviving Sepsis Campaign and the SEP-1 CMS measure recognize timely antibiotic administration as a cornerstone of therapy for patients with severe sepsis or septic shock.

Purpose: Decrease time to broad spectrum antibiotic administration for septic patients in the emergency department (ED) of Aurora St. Luke’s Medical Center.

Methods: An alert within the electronic medical record was created to more rapidly identify potentially septic patients in the ED. After receiving the alert, …

Variations In Practice Of Apnea Test For Brain Death: Review From A Multihospital Health Care System, Jeffrey Stein, Marvi V. Rijhwani, Ernesto Brauer

Journal of Patient-Centered Research and Reviews

Background: Ventilation encompasses both active and passive processes. Air is initially drawn into the lungs due to a negative intrathoracic pressure created using the respiratory muscles, most importantly the diaphragm. In contrast, expiration is the passive relaxation of the respiratory muscles. Oxygenation occurs when oxygen diffuses across the alveolar-capillary membrane. The ability to oxygenate without ventilation has been termed apneic diffusion oxygenation or apneic oxygenation. We believe it is crucial to keep alveoli open in order for adequate oxygenation to occur. This can be achieved with the aid of positive end-expiratory pressure (PEEP). We investigated this concept in patients who …

Identifying And Targeting Age-Related Colorectal Cancer Screening Rate Disparities In Family Medicine Residency Clinics, Jonathan J. Blaza, Jasmine R. Wiley, Matthew Gill, Alonzo Jalan, Will Lehmann, Deborah Simpson, Jeffrey A. Stearns

Journal of Patient-Centered Research and Reviews

Background: Health care systems continuously seek to improve patient care through population-level analysis of clinical quality metrics and patient characteristics to identify disparities in care. Nationally, disparities in colorectal cancer (CRC) screening rates have been identified with lower screening rates reported for patients who are uninsured and/or lower socioeconomic status, African American/black, Asian, and non-English-speaking Hispanic patients. No age-related CRC screening rate disparities with associated interventions have been reported.

Purpose: Determine and address CRC screening disparities in care provided to eligible patients > 50 years old in two primary care residency clinics.

Methods: Retrospective analysis using REAL-G (race, ethnicity, age, preferred …