Using Data on Patient Experience to Improve Clinical Care

2017 ◽  
pp. 178-185
Author(s):  
Seth Glickman ◽  
Abhi Mehrotra
Keyword(s):  
Patient Experience ◽  
Clinical Care ◽  
Using Data

scholarly journals Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

2019 ◽  
Vol 8 (4) ◽  
pp. 555 ◽  
Author(s):  
Cátia Caneiras ◽  
Cristina Jácome ◽  
Sagrario Mayoralas-Alises ◽  
José Ramon Calvo ◽  
João Almeida Fonseca ◽  
...  
Keyword(s):  
Clinical Research ◽  
Patient Experience ◽  
Clinical Care ◽  
Research Priorities ◽  
Specific Patient ◽  
Quality Healthcare ◽  
Body Of Knowledge ◽  
Number Of Patients ◽  
Patient Reported ◽  
System Sustainability

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.

scholarly journals The Value of Real-World Data in Understanding Prostate Cancer Risk and Improving Clinical Care: Examples from Swedish Registries

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 875
Author(s):  
Kerri Beckmann ◽  
Hans Garmo ◽  
Ingela Franck Lissbrant ◽  
Pär Stattin
Keyword(s):  
Prostate Cancer ◽  
Real World ◽  
Clinical Care ◽  
Prostate Cancer Risk ◽  
Real World Data ◽  
Level Of Evidence ◽  
World Data ◽  
Cancer Data ◽  
Using Data ◽  
Randomised Controlled

Real-world data (RWD), that is, data from sources other than controlled clinical trials, play an increasingly important role in medical research. The development of quality clinical registers, increasing access to administrative data sources, growing computing power and data linkage capacities have contributed to greater availability of RWD. Evidence derived from RWD increases our understanding of prostate cancer (PCa) aetiology, natural history and effective management. While randomised controlled trials offer the best level of evidence for establishing the efficacy of medical interventions and making causal inferences, studies using RWD offer complementary evidence about the effectiveness, long-term outcomes and safety of interventions in real-world settings. RWD provide the only means of addressing questions about risk factors and exposures that cannot be “controlled”, or when assessing rare outcomes. This review provides examples of the value of RWD for generating evidence about PCa, focusing on studies using data from a quality clinical register, namely the National Prostate Cancer Register (NPCR) Sweden, with longitudinal data on advanced PCa in Patient-overview Prostate Cancer (PPC) and data linkages to other sources in Prostate Cancer data Base Sweden (PCBaSe).

scholarly journals PERFIL EPIDEMIOLÓGICO DA LEISHMANIOSE VISCERAL NO BRASIL NO PERÍODO DE 2007 A 2017; EPIDEMIOLOGICAL PROFILE OF VISCERAL LEISHMANIASIS IN BRAZIL IN THE PERIOD FROM 2007 TO 2017

2021 ◽  
Vol 7 (4) ◽  
pp. 29-33
Author(s):  
NOELY DE CARVALHO LEITE ◽  
Jordana Lucio Garcia ◽  
Itamar Magalhães Gonçalves
Keyword(s):  
Visceral Leishmaniasis ◽  
Clinical Care ◽  
Epidemiological Data ◽  
Developed Countries ◽  
Epidemiological Surveillance ◽  
Neglected Diseases ◽  
Eastern Region ◽  
Incidence And Mortality ◽  
Using Data ◽  
Epidemiological Profile

RESUMO A Leishmaniose Visceral (LV) é uma antropozoonose generalizada, de evolução crônica e sistêmica, que, apesar de ser passível de tratamento e cura, possui elevadas taxas de incidência e letalidade. Tipicamente, afeta países subdesenvolvidos, com uma preferência pela população mais vulnerável socioeconomicamente, e possui ampla distribuição territorial, sendo o Brasil um dos principais países acometidos. Objetivo: analisar dados epidemiológicos da doença no país no período estabelecido. Métodos: Trata-se de um estudo epidemiológico descritivo, realizado a partir de busca de dados de acesso livre do Sistema de Informação de Agravos de Notificação no período de janeiro de 2007 a dezembro de 2017. Resultados e discussões: No intervalo em questão, foram documentados 40.786 casos de LV, com uma variação pouco heterogênea entre os anos estudados. Destes, 2011 registrou o maior número de casos, contando com 4.039 registros. As populações mais afetadas incluem: sexo masculino (média de 2.362 casos/ano), faixa etária de 1-4 anos (média de 978 casos/ano), raça parda (média de 2.750 casos/ano) e baixa escolaridade – a maioria entre a primeira e a quarta série (média de 405 casos/ano). Além disso, excluindo-se os casos ignorados/brancos, 10% do total dos indivíduos apresentaram coinfecção da LV com HIV. A região Nordeste demonstrou maior incidência da doença, com 52,7% do total dos casos. O principal estado atingido é o Maranhão, que apresentou um número de 6.070 casos durante o período estudado. Conclusão: Considerando a relevância do alto número de casos apontados nesse trabalho, mostra-se necessária a implantação de políticas públicas voltadas para a prevenção da transmissão, busca ativa de casos e educação em saúde. Nesse quadro, para maior eficácia, deve existir integração entre vigilância epidemiológica e assistência clínica, acesso aos serviços, capacitação dos profissionais e empoderamento da população. Palavras-chave: Leishmaniose visceral; Epidemiologia; Doenças Negligenciadas; Zoonose. ABSTRACT Visceral Leishmaniasis (VL) is a generalised anthropozoonosis whose evolution is chronic and systemic, with high rates of incidence and mortality, even though it can be treated and cured. VL typically occurs in non-developed countries and affects preferentially the most socioeconomically vulnerable population. Brazil is one of the most affected countries from this disease. Objective: To analyse the epidemiological data on VL in Brazil regarding the study period. Methods: This is a descriptive epidemiological study using data obtained from the Brazilian Case Registry Database corresponding to the period between January 2007 and December 2017. Results: A total of 40,786 cases of VL were recorded for the study period, with slightly heterogeneous variation among the years. The highest number of cases stood at 4,039 in the year of 2011. The most affected populations were men (mean of 2,362 cases/year), children in the age group of 1-4 years (mean of 978 cases/year), Afro-descendant individuals (mean of 2,750 cases/year) and those with low educational level, that is, first to fourth year of elementary school (mean of 405 cases /year). Moreover, not considering the ignored/blank cases, 10% of all individuals were co-infected with HIV. The Brazilian north-eastern region has the highest incidence of the disease, with 52.7% of all cases. The State of Maranhão is the most affected as there were 6,070 cases in the study period. Conclusion: Considering the high number of cases of VL found in the present study, it is necessary to implement public policies aimed at preventing the transmission of the disease, actively seeking cases and providing health education. In this context, there should be integration among epidemiological surveillance, clinical care, access to services, qualification of professionals and empowerment of population. Key-words: Visceral leishmaniasis; Epidemiology; Neglected diseases; Zoonoses.

scholarly journals Exploring the Patient’s Experience of Receiving Clinical Care Which Incorporates the Use of Mobile Technology at the Bedside

2021 ◽  
Author(s):  
J Warrilow ◽  
L Pho ◽  
C Murley ◽  
A Jones ◽  
G Fairbrother
Keyword(s):  
Patient Experience ◽  
Mobile Technology ◽  
Digital Health ◽  
Clinical Care ◽  
Hospital Setting ◽  
Care Quality ◽  
Patient’S Experience ◽  
Post Test ◽  
One Year ◽  
Views And Perceptions

Objective: Research-based insight into patient’s experiences of mobile technology at the bedside in the hospital setting remains limited. This research project aims to explore patient’s experience. Methods: This mixed method pre and post study aimed to explore the patient experience in relation to this and also test whether introducing further bedside technology (beyond the workstation on wheels) had an effect on the patient experience. Questionnaires and interviews were conducted among inpatient samples prior to and one year post introduction of a suite of new bedside technologies. Results: Pre and post patient survey results (pre: n=82; post: n=98) suggested that mixed views and perceptions existed and that some of these were associated with primary demographics such as age. At post-test, attitudes about bedside technology were found to be more positive, and feedback about care quality was found to be unchanged, Baseline patient interview findings (n=15) highlight the social ubiquity of technology as a driver of positive attitude in the digital health context. Conclusion: The addition of new bedside technology is very well received by patients and was not perceived to impact on care quality.

scholarly journals The Newcastle ENDOPREM™: a validated patient reported experience measure for gastrointestinal endoscopy

2021 ◽  
Vol 8 (1) ◽  
pp. e000653
Author(s):  
Laura J Neilson ◽  
Linda Sharp ◽  
Joanne M Patterson ◽  
Christian von Wagner ◽  
Paul Hewitson ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Patient Experience ◽  
Clinical Care ◽  
Phase 1 ◽  
Cognitive Interviews ◽  
Phase 2 ◽  
Phase 3 ◽  
Gi Endoscopy ◽  
Patient Reported ◽  
Experience Measure

ObjectivesMeasuring patient experience of gastrointestinal (GI) procedures is a key component of evaluation of quality of care. Current measures of patient experience within GI endoscopy are largely clinician derived and measured; however, these do not fully represent the experiences of patients themselves. It is important to measure the entirety of experience and not just experience directly during the procedure. We aimed to develop a patient-reported experience measure (PREM) for GI procedures.DesignPhase 1: semi-structured interviews were conducted in patients who had recently undergone GI endoscopy or CT colonography (CTC) (included as a comparator). Thematic analysis identified the aspects of experience important to patients. Phase 2: a question bank was developed from phase 1 findings, and iteratively refined through rounds of cognitive interviews with patients who had undergone GI procedures, resulting in a pilot PREM. Phase 3: patients who had attended for GI endoscopy or CTC were invited to complete the PREM. Psychometric properties were investigated. Phase 4 involved item reduction and refinement.ResultsPhase 1: interviews with 35 patients identified six overarching themes: anxiety, expectations, information & communication, embarrassment & dignity, choice & control and comfort. Phase 2: cognitive interviews refined questionnaire items and response options. Phase 3: the PREM was distributed to 1650 patients with 799 completing (48%). Psychometric properties were found to be robust. Phase 4: final questionnaire refined including 54 questions assessing patient experience across five temporal procedural stages.ConclusionThis manuscript gives an overview of the development and validation of the Newcastle ENDOPREM™, which assesses all aspects of the GI procedure experience from the patient perspective. It may be used to measure patient experience in clinical care and, in research, to compare patients’ experiences of different endoscopic interventions.

scholarly journals Ordinal Prediction Model of 90-Day Modified Rankin Scale in Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Michelle Y. Zhang ◽  
Michael Mlynash ◽  
Kristin L. Sainani ◽  
Gregory W. Albers ◽  
Maarten G. Lansberg
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Prediction Model ◽  
Functional Outcomes ◽  
Prediction Models ◽  
Clinical Care ◽  
External Validation ◽  
Modified Rankin Scale ◽  
Forward Selection ◽  
Using Data

Background and Purpose: Prediction models for functional outcomes after ischemic stroke are useful for statistical analyses in clinical trials and guiding patient expectations. While there are models predicting dichotomous functional outcomes after ischemic stroke, there are no models that predict ordinal mRS outcomes. We aimed to create a model that predicts, at the time of hospital discharge, a patient's modified Rankin Scale (mRS) score on day 90 after ischemic stroke.Methods: We used data from three multi-center prospective studies: CRISP, DEFUSE 2, and DEFUSE 3 to derive and validate an ordinal logistic regression model that predicts the 90-day mRS score based on variables available during the stroke hospitalization. Forward selection was used to retain independent significant variables in the multivariable model.Results: The prediction model was derived using data on 297 stroke patients from the CRISP and DEFUSE 2 studies. National Institutes of Health Stroke Scale (NIHSS) at discharge and age were retained as significant (p < 0.001) independent predictors of the 90-day mRS score. When applied to the external validation set (DEFUSE 3, n = 160), the model accurately predicted the 90-day mRS score within one point for 78% of the patients in the validation cohort.Conclusions: A simple model using age and NIHSS score at time of discharge can predict 90-day mRS scores in patients with ischemic stroke. This model can be useful for prognostication in routine clinical care and to impute missing data in clinical trials.

scholarly journals Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

2015 ◽  
Vol 3 (3) ◽  
pp. 1-304 ◽  
Author(s):  
Jill Maben ◽  
Peter Griffiths ◽  
Clarissa Penfold ◽  
Michael Simon ◽  
Elena Pizzo ◽  
...  
Keyword(s):  
Patient Safety ◽  
Patient Experience ◽  
Clinical Care ◽  
Temporary Increase ◽  
Infection Rates ◽  
Hospital Design ◽  
Single Room ◽  
Working Practices ◽  
The Impact

BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Improving Cancer Care Through the Patient Experience: How to Use Patient-Reported Outcomes in Clinical Practice

2017 ◽  
pp. 695-704 ◽  
Author(s):  
Kathi Mooney ◽  
Donna L. Berry ◽  
Meagan Whisenant ◽  
Daniel Sjoberg
Keyword(s):  
Patient Experience ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Clinical Care ◽  
Population Data ◽  
Population Level ◽  
Clinical Work ◽  
Aggregated Data ◽  
Individual Level ◽  
Patient Reported

Poorly controlled symptoms are common and debilitating during cancer treatment and can affect functional status and quality of life, health care resource utilization, treatment adherence, and cancer survivorship. Historically, the patient experience, including symptoms during treatment, has not been tracked or documented in the patient health record. Measurement of patient-reported outcomes (PROs), including symptoms, is an essential component to cancer care focused on the illness impact to the patient and family. PROs can be useful at the individual level for monitoring and promoting symptom care both in the clinic and remotely and at the population level for aggregating population data for use in research and quality improvement initiatives. Implementation of PROs in cancer clinical care requires a carefully thought out process to overcome challenges related to integrating PROs into existing electronic health records and clinical work flow. Issues with implementing PRO collection may include making decisions about measurement tools, modes of delivery, frequency of measurement, and interpretation that are guided by a clarification of the purpose for collecting PROs. We focus on three aspects of PRO use: (1) improving care for individual patients, (2) analyzing aggregated data to improve care and outcomes overall, and (3) considerations in implementing PRO collection.

A person-centered e-proms multi-faceted intervention to improve patient experience and health outcomes: A multi-site implementation study in diverse ambulatory oncology practices.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 182-182 ◽  
Author(s):  
Doris Howell ◽  
Madeline Li ◽  
Zeev Rosberger ◽  
Nicole Montgomery ◽  
Carole Mayer ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Patient Experience ◽  
Clinical Care ◽  
Emergency Department Visits ◽  
Practice Change ◽  
Assessment System ◽  
Team Collaboration ◽  
Symptom Screening ◽  
Ambulatory Oncology ◽  
Patient Reported

182 Background: The Improving Patient Experience and Health Outcomes Collaborative (iPEHOC) aims to improve health outcomes through uptake of electronic patient reported outcome measures (e-PROMs) in oncology practices in Ontario and Quebec. Building on screening with the Edmonton Symptom Assessment System (ESAS), e-PROMs were triggered based on cut scores to focus multidimensional assessment and management of pain (BPI), fatigue (CFS), anxiety (GAD-7) and depression (PHQ-9). Methods: Multifaceted implementation strategies and practice change coaching facilitated the use of e-PROMs to improve symptom outcomes. A mixed-method, pre-post quasi-experimental design assessed process and impact of the intervention on symptom screening rates, symptom burden, patient experience and activation, clinician satisfaction, team collaboration and health care use. Mann-Whitney U statistics examined significance of change from baseline to the 8-month post comparison. Qualitative data explored uptake of e-PROMs in practice. Results: Over the implementation period 10,248 ESAS screens were completed in iPEHOC clinics; 17.5% triggered an additional e-PROM. A slight improvement was noted in person-centeredness of communication (mean change of 1.43 to 1.37; four-point scale of 1 = very satisfied, 4 = very dissatisfied) and in team collaboration. A significant increase in patient activation levels (p = 0.045) was related to decreased emergency department visits (2% pre/post change, p = 0.81) and hospitalization within 30 days of an e-PROMs completion (2.2% change, p = 0.034) in Ontario. Patients and clinicians perceived e-PROMs as valuable to focus communication in the clinic visit and for shared treatment planning. Focus group data suggests that patients use e-PROMs as a ‘self-check-in’, to communicate their symptoms and normalize disclosure of depression in clinical care. Conclusions: Uptake of e-PROMs in diverse settings is complex and demanding. Improving symptom management quality requires PROM data to be fed-back for ‘real-time’ use in the clinical encounter and practice change facilitation for meaningful use in routine care.

Editorial

2015 ◽  
Vol 14 (4) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Decision Maker ◽  
Patient Experience ◽  
Early Warning ◽  
Clinical Care ◽  
Clinical Decision ◽  
Poor Quality ◽  
Early Warning Score ◽  
Rapid Review ◽  
Medicine Quality

Quality in health care is difficult to measure. Detailed retrospective reviews of patients’ admission records often reveal areas where quality can be improved, but are time consuming and subjective. In our search for simple, reliable and reproducible measures, we end up using surrogate markers; things which we can collect easily, rather true markers of quality in what we achieve. The Society for Acute Medicine quality standards, which have formed the basis of the SAMBA audits over recent years, are no exception to this. The standards stipulate that patients should be assessed using an early warning score on arrival in the AMU, be seen by a clinical decision maker within 4 hours and a consultant within 14 hours, while quality indicators include the proportion of patients being discharged directly from the AMU and 7 day readmission rates. While these can provide a useful benchmark for comparison between units or evidence of improvement over time, they clearly cannot provide a complete picture of the quality of care delivered on the AMU. Timely assessment is important, but undertaking an early warning score does not necessarily mean that an abnormal score was acted upon promptly; rapid review by a ‘clinical decision maker’ is only valuable if an appropriate clinical decision is taken. Consideration for the patient’s experience on the AMU is also a key element in delivering a high quality service. This year’s SAMBA audit included a modified version of the ‘Friends and Family’ questionnaire in an attempt to provide a snapshot of patient experience of acute medical care. The results of this are presented here in the first instalment of the data analysis from SAMBA15. The usual ‘health warnings’ apply to these data – a single day in June is not necessarily representative of the remainder of the year, while not all participating organisations submitted patient experience data, introducing the possibility of selection bias. However some interesting themes emerge, many of which will be familiar to those who have worked (or been patients) on acute medical units. It is encouraging that positive comments outnumbered negative by 3:1, while positive comments about staff attitude were over 40 times more numerous than criticisms, despite recognition of the workload faced by staff on the AMU. Concerns about noise levels and catering were common themes, but the importance of timely assessment and care emerges in both categories; patients clearly appreciate being seen and treated rapidly and are frustrated by delays. Our pursuit of better measures of quality should not lose sight of the importance of measuring, and improving the speed with which we deliver care. The importance of honest feedback is a theme in this month’s ‘viewpoint’ article on ‘bad presentations’ by Ross Fisher; he asks why, when we wouldn’t accept poor quality clinical care, we appear to be so accepting of the poor quality Powerpoint. Apparently it is all our own fault – and of course he’s right. We need to challenge, and be prepared to be critical in our feedback. I am frequently guilty of opening a conference question with ‘I enjoyed your presentation….’, irrespective of the quality of what went before. Ross is an evangelist on this subject, and I am delighted that he has agreed to write a series of articles over coming editions outlining how our presentation practice could improve. How we measure this quality improvement is a challenge for another day.

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