Academic literature on the topic 'Patient satisfaction; instrument design; coordination of health care'

Background:Cross-sectoral coordination of treatment plans and efficient management of patients with chronic diseases and co-morbidities are of great importance. In rheumatoid arthritis (RA) it is essential to orchestrate information available for a patient at various locations, to allow (cost) efficient data use, to optimize management processes and to avoid redundant diagnostics. The information and communication platform developed in the Horizon2020 funded PICASO project (www.picaso-project.eu) supports the management of patients and their data along the continuum of care, consisting of hospitals, outpatient departments, practices, other health service providers via remote health monitoring. The platform might empower patients to improve their self-management of their illnesses.Objectives:What technological expertise and resources do RA patients and physicians have, who are willing to participate in a proof-of-concept study using a modern ICT platform? What is the user satisfaction? What are platform`s clinical implications?Methods:PICASO pursued a user-centered design approach. Platform`s user requirements were determined through workshops and interviews with physicians from various disciplines, patients and other stakeholders in the health care system (e.g. data protection officers). The development was accompanied by so-called “expert walkthroughs” to ensure a user-friendly design. An evaluation concept assessing the usability of the applications, user satisfaction and clinical relevance of the platform was part of the 6-month proof-of-concept study with RA patients and their physicians (rheumatologists and family doctors). A positive ethics vote was obtained.Results:111 user requirements were identified and used to develop the platform. Conformity with the GDPR as well as national regulations were precisely adhered to. All developments are based on the new ‘Fast Healthcare Interoperability Resources’ standard enabling data exchange with other software systems in the healthcare sector. This offers many advantages, e.g. a semantic model for describing the smallest units in the health care system (e.g. medication intake times, diagnostic procedures). Thus information can be linked and made available across sectors. Data can remain with the data owner and role-specific data access is ensured.30 RA patients (80% female) participated, mean age was 58.6±10.8 years, disease duration 12.6±8.5 years, DAS28 2.6±0.9, average number of comorbidities 3.0±1.6. Patients’ IT-experience was heterogeneous. After 6 months evaluations showed a good platform acceptance with an overall rating of 2.3±1.1 (n=27, Likert scale (LS) 1-6) and evaluation of ‘ease of use’ at 2.3±1.2 (n=27, LS 1-6). Usability tests showed that for patients the presentation of (1) tasks to be performed for the management of their disease, (2) results from their remote health monitoring, and (3) patient-reported outcome instruments in a dashboard was clear and easy to understand. Time required for documentation and daily tasks was rated as appropriate by 75.9% of the patients. No major technical problems or impairments due to RA where experienced when using the dashboard. 8 physicians (37.5 % female) participated in the evaluation; overall the platform was rated at 2.2±0.5 (LS 1-6).Conclusion:The platform offers cross-sectoral orchestration of patient data and thus innovative capabilities for modern management processes (e.g. treat-to-target, tele-monitoring). The PICASO platform is available for RA patients as well as for other chronic diseases.Acknowledgments:This project received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 689209.Disclosure of Interests:None declared

Event notification systems (ENS) are being deployed to provide timely alerts to participating providers when their patients are being admitted, discharged or transferred (ADT) from participating hospitals. Hospitals and health information exchanges (HIE) are implementing ENS in an effort to reduce costly hospital readmissions and to improve the overall quality of patient care through improved care coordination. Today, there are numerous ENS actively facilitating care coordination across the country. For those participating providers and hospitals, coordination has been significantly improved and hospital readmissions have been reduced. Furthermore, patients and clinicians report improved patient care and care coordination, and report higher levels of patient satisfaction. Despite reported success, the application and implementation of ENS vary across the country. Some of the variability stems from the challenges that are inherent to the design of the ENS. These challenges, discussed herein, require careful consideration in order to fully realize ENS benefits.

Purpose This paper aims to examine the major factors affecting patients’ satisfaction and loyalty at a health-care organization in India. Design/methodology/approach A conceptual model has been developed that includes the behavioural dimensions of total quality management (TQM), patient satisfaction and loyalty. This study is exploratory in nature and has used the existing literature to build the conceptual model. Findings A solution for improving the quality of health-care services can be found in the application of total relationship management and TQM, together with a customer orientation strategy. Practical implications The results can be used creatively by hospitals to re-engineer and redesign their quality management processes and reorient the future directions of their more effective health-care quality strategies. Originality/value In this research, a study is described involving a new instrument and a new method which assure a reasonable level of relevance, validity and reliability, while being explicitly change-oriented.

148 Background: Care coordination (CC) has been identified by the IOM as critically important for the delivery of quality medical care. Coordination of care is especially important in oncology due to multiple encounters, many physicians, significant toxicities and several care transition points. Standard patient satisfaction surveys do not accurately measure CC and there are few instruments to measure a patient’s perspective of CC directly. In this project, multiple PDSA cycles were utilized with oncology patients to develop a Care Coordination Instrument (CCI) that was then used to compare the level of CC in two distinct practices. Methods: Survey questions were initially prepared by the research team after review of existing literature, submitted to oncology RNs, NPs and MDs and then modified based on their feedback. A new survey was then administered to 30 patients. This was again modified to eliminate or improve questions that were confusing to patients. A third survey instrument was developed and administered to an additional 30 patients. Statistical analysis identified that several questions were too structured leading to many “not applicable” responses. These were changed to a more conceptual framework. The survey was then administered to 30 patients in the myeloma practice and 30 in the GI oncology practice. Results: The CCI included questions from 4 areas of coordination (patient-physician; between health providers; during inpatient-to-ambulatory care transitions; during transitions across different phases of care) and 3 domains (Communication, Operational, Navigation). The GI oncology practice scored significantly better than the myeloma practice on the communication and navigation domains (p < 0.01). There was no significant difference in the operational domain. Conclusions: Testing to date suggests that the CCI is a useful instrument in measuring an oncology patient’s perception of CC. For two distinct practices, significant differences in the delivery of CC were identified. Further refinement is necessary to modify or eliminate questions with high levels of missing data due to non-responsiveness. Separate sub-scores across domains help identify specific targets for quality improvement interventions.

Background: Patient satisfaction in palliative care is an important dimension that can describe a patient’s experience acceptable of care. Patient satisfaction is used to evaluate performance and improve the quality of palliative care. Objective: This study aimed to know the description of patient satisfaction of palliative cancer against palliative care which has been given in IRNA I RSUP Dr.Sardjito Yogyakarta based on a ranking that includes 5 subscales of satisfaction in palliative care. Method: Type of research was mixed methods with sequential explanatory design, collecting data began from collecting quantitative data and followed by collecting qualitative data. Subject of study involved cancer patient in Central Hospital of Dr. Sardjito Yogyakarta during September and October 2016 number of respondent was 48 patients and 8 participants. Sampling technique in quantitative research used purposive sampling, while the qualitative research used the techniques sampling criterion. Instrument used FAMCARE-P to measure satisfaction and the interview based on interview guideline. Quantitative data analysis used descriptive analysis and analysis of qualitative data used the content analysis. Integration of the results of quantitative research and qualitative used the joint displays. Results: Cancer patients have a high satisfaction on the subscale of support in decision-making with a mean (4,60±0,49), followed by a subscale of symptom management (3,96±0,42), communication and information (3,93±0,35), coordination and consistency (3,8±0,38) and accessibility (3,7±0,44). Qualitative research gained eight categories. Conclusion: Cancer patient satisfaction on palliative care was high with score on every subscales above mean score. Keyword: Satisfaction, Cancer Patient, Mixed Method, Palliative Care

The study focuses on developing a tool to measure the engagement of diabetes patients and to explore its dimensions. This study was based on descriptive research design and purposive sampling method. Personal interview was conducted among the doctors to ascertain the face and content validity of the questionnaire. Subsequently, interview was conducted with the patients and exploratory factor analysis was used to reduce the number of items in the diabetes patient engagement scale. Diabetes patient engagement measurement model resulted in seven dimensions consisting of 21 items. The dimensions patient satisfaction, patient initiatives, organized health care, informed choice, health promotion, and prevention are unidimensional factors, and the dimension self-management (routine and clinical assessment) is multidimensional. This study confirmed the validity of the new multidimensional diabetes patient engagement scale to assess and measure the intensity of engagement of the patient with their respective care towards doctor and hospital. Practical implication is to facilitate in predicting and determining the engagement level of patient with their health care provider, which increases good health outcomes and quality of life.

167 Background: The relationship between the physician and patient is directly associated with positive patient satisfaction. High patient satisfaction is associated with improved health outcomes, treatment adherence, and quality of life. The goal was to explore patients’ perceptions on their hospital experience, focusing on quality of care. Methods: A mixed-methods study design with a sample of 58 patients at Yale New Haven Hospital. Data were from patient interviews and observation of rounds. Results: Two themes emerged: patient experience and patient communication with physicians. Within patient experience positive factors identified were feeling attended to (45.9%), nurses (43.2%), staff (27.0%), doctors (27.0%), facility (10.8%) and coordination of care (8.1%). Negative factors were low quality of life (82.8%), lack of physician emotional support, attentiveness and availability (24.1%), and poor coordination of care (20.7%). Within physician communication positive factors included effectively engaging the patient (27.5%) and attending to patient needs (7.5%). Negative factors were nature of distilling information (17.5%), lack of coordination of care (15.0%), inadequate involvement of the patient and/or family (12.5%), use of medical jargon (10.0%), and inability to elicit patients’ perspective (7.5%). The quantitative data supported qualitative results of overall satisfaction with 72.4% of patients (n = 58) rating their experience as an ‘A’. Areas of dissatisfaction (an ‘A’ rating < 70% of time) included describing team member roles, explaining next steps in care or treatment to the patient and/or family, and meeting patients’ needs. Conclusions: Our findings, demonstrate that physician attentiveness or lack thereof defines the quality of patient experience, is an important theme in communication and that patients perceive their needs are not being fully addressed. Agreement in themes from mixed-method approach shows effectiveness of methods in exploring patients’ perceptions on quality of care. The study intends to inform clinical and operational practices physicians can incorporate into their patient relationships. These data are being used to design a faculty development program to address physician communication.

Purpose The New South Wales International Dental Graduate (N-IDG) programme was an Australian state government workforce initiative to support rural public dental services. The purpose of this paper is to evaluate patient satisfaction following dental treatment provided by an IDG workforce. Design/methodology/approach This cross-sectional descriptive study used a validated questionnaire survey instrument to measure patient satisfaction (n=813) following treatment provided by IDGs enroled in the N-IDG programme, compared to their mentors. Domains included dentists’ professional competency, personality and the dental surgery organisation. Analysis of closed and open question responses was performed using domain grouping, frequency and χ2 analysis. Findings Patient satisfaction across the IDG and mentor workforce was similar and very positively skewed with differences detected across perceived treatment quality (p=0.03), clinician efficiency (p=0.05) and answering of questions (p=0.05). These results favoured treatment provided by IDGs over mentors. This study demonstrated few differences between IDGs under limited registration and their mentors in terms of perceived patient satisfaction, suggesting patient perceived parity in care. Originality/value Patient satisfaction was used innovatively to IDGs as an indicator of dental workforce programme effectiveness.

Purpose – Patient satisfaction has been recognized as an important variable affecting healthcare behavior. However, there are limited data on the relationship between doctor post-graduate year (PGY) status and patient satisfaction with provider interpersonal skills and humanistic qualities. The authors aims to assess this relationship using an American Board of Internal Medicine (ABIM) questionnaire. Design/methodology/approach – Participants were: patients attending a primary care clinic at a large urban academic hospital; and physicians treating them. The survey questionnaire was the ABIM patient satisfaction instrument; ten questions pertaining to humanistic qualities and communication skills with responses from poor to excellent. Mann Whitney U test and multi-variable logistic regression analyses were used to explore score differences by PGY level. Findings – The postgraduate year one (PGY1) had higher patient-satisfaction levels compared to PGY2/PGY3 residents. The PGY1 level residents were more likely to score in the 90th percentile and this remained constant even after adjusting for confounders. Research limitations/implications – The research was a single-center study and may have been subject to confounding factors such as patient personality types and a survey ceiling effect. The survey's cross-sectional nature may also be a potential limitation. Practical implications – Patient satisfaction varies significantly with PGY status. Though clinical skills may improve with increasing experience, findings imply that interpersonal and humanistic qualities may deteriorate. Originality/value – The study is the first to assess patient satisfaction with PGY status and provides evidence that advanced trainees may need support to keep their communication skills and humanistic qualities from deteriorating as stressors increase to ensure optimal patient satisfaction.

e18088 Background: Patient navigation (PN) is a model of health care coordination designed to ameliorate health disparities by reducing barriers to achieving optimal health outcomes. Systematic reviews that evaluate whether PN is associated with higher patient satisfaction with cancer care are lacking. Methods: We conducted a systematic review to synthesize evidence of comparative studies evaluating the effectiveness of PN programs to improve satisfaction with cancer-related care. We included studies reported in English that: 1) evaluated a PN intervention designed to increase satisfaction with cancer care; and 2) involved a randomized controlled trial (RCT) or observational design. We abstracted data from studies using standardized forms, and evaluated these studies for methodological quality. Data were summarized qualitatively and synthesized under a random effects model. Results: The initial search yielded 831 citations, of which 3 RCTs and 6 observational studies met inclusion criteria. These nine studies involving 4,200 surveyed patients revealed either a neutral or positive effect in patient satisfaction in the majority of studies of PN and cancer-related care. However, only 5 studies (1 RCT and 4 observational) had adequate datato include in the meta-analysis. Methodological quality of eight of the included studies ranged from weak to moderate to strong, with half rated as weak. Findings of the RCT showed a statistically significant increase in satisfaction with cancer care involving PN [standardized mean difference (SMD) = 2.30; 95% Confidence Interval (CI): 1.79, 2.80, p < .001]. Pooled results from non-RCTs showed no significant association between PN and satisfaction with cancer-related care (SMD = 0.39; 95% CI: -0.02, 0.80, p = .06). Conclusions: More systematic reviews are needed to characterize the relationship between PN and satisfaction with cancer-related care across the cancer care continuum and across different types of cancer.

Despite the many interventions and trials aimed at improving coordination of health care, there is currently no accepted measurement of coordination. My professional interests and an opportunity provided by the Care Plus (Coordinated Care) Trial in the ACT led me to consider client perceptions as a potentially appropriate measure. My research question is “can coordination of health care be usefully measured through client perceptions?” ¶ I addressed this question by developing and testing an instrument to measure perceptions of coordination called the Client Perceptions of Coordination Questionnaire (CPCQ). In the thesis I describe the processes of developing the instrument, testing it through use in several studies and considering how useful such an instrument may be for health services research. In addition to the Coordinated Care Trial, I conducted two validation studies - in a chronic pain population and a general practice sample. ¶ In Part 1 of the results I demonstrate good face, content and discriminant validity, and reliability of the instrument. Psychometric analysis of the CPCQ did not support scaling, and identified areas were the instrument could be improved. Nevertheless the underlying construct of client perception of coordination as a measure is entirely new, and it is therefore worthwhile to explore its associations with other health outcome data. In Part 2 I use a single item from the CPCQ, “how often did you feel the care you received was well-coordinated?” to explore this construct. I explore the influences upon on client perceptions of coordination, and examine its associations with service utilisation and health outcome data. ¶ The construct of ‘perceived coordination’, and the capacity of the CPCQ to measure it accurately show considerable promise as measures of health care. Consistent trends were found that suggested coordination was a complex construct, and that a stronger theoretical base was needed to interpret this complexity. Theory is the first of the ‘phases’ of instrument development, and so I revisit these in order to summarise the strengths and weaknesses of the current CPCQ. Overall, the perceptions of coordination have surprisingly plausible associations with other health data, the effort to improve the instrument should be worthwhile for a wide range of health service evaluation and research.