scholarly journals Identifying positive deviants in healthcare quality and safety: a mixed methods study

2018 ◽  
Vol 111 (8) ◽  
pp. 276-291 ◽  
Author(s):  
Jane K O’Hara ◽  
Katja Grasic ◽  
Nils Gutacker ◽  
Andrew Street ◽  
Robbie Foy ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Statistical Modelling ◽  
Service Level ◽  
Knee Surgery ◽  
Mixed Methods Study ◽  
Quality And Safety ◽  
Hospital Data ◽  
Local Improvement ◽  
Patient Reported ◽  
Hip And Knee Surgery

Objective Solutions to quality and safety problems exist within healthcare organisations, but to maximise the learning from these positive deviants, we first need to identify them. This study explores using routinely collected, publicly available data in England to identify positively deviant services in one region of the country. Design A mixed methods study undertaken July 2014 to February 2015, employing expert discussion, consensus and statistical modelling to identify indicators of quality and safety, establish a set of criteria to inform decisions about which indicators were robust and useful measures, and whether these could be used to identify positive deviants. Setting Yorkshire and Humber, England. Participants None - analysis based on routinely collected, administrative English hospital data. Main outcome measures We identified 49 indicators of quality and safety from acute care settings across eight data sources. Twenty-six indicators did not allow comparison of quality at the sub-hospital level. Of the 23 remaining indicators, 12 met all criteria and were possible candidates for identifying positive deviants. Results Four indicators (readmission and patient reported outcomes for hip and knee surgery) offered indicators of the same service. These were selected by an expert group as the basis for statistical modelling, which supported identification of one service in Yorkshire and Humber showing a 50% positive deviation from the national average. Conclusion Relatively few indicators of quality and safety relate to a service level, making meaningful comparisons and local improvement based on the measures difficult. It was possible, however, to identify a set of indicators that provided robust measurement of the quality and safety of services providing hip and knee surgery.

scholarly journals Investigating the causes of patient anxiety at induction of anaesthesia: A mixed methods study

2020 ◽  
pp. 175045892093693
Author(s):  
Andrew B Lumb ◽  
Gary J Latchford ◽  
Hilary L Bekker ◽  
Anna R Hetmanski ◽  
Caroline R Thomas ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Biological Response ◽  
Mixed Methods Study ◽  
Qualitative Assessment ◽  
Patient Anxiety ◽  
Anaesthetic Induction ◽  
Cardiovascular Changes ◽  
Patient Reported ◽  
Theatre Staff ◽  
Induction Of Anaesthesia

Aim To investigate patient anxiety at anaesthetic induction and whether this is affected by anaesthetic room interventions. Methods A mixed methods study was carried out: pre-induction interventions were directly observed. Patient anxiety was assessed quantitatively with cardiovascular changes, the visual analogue scale and the state-trait anxiety inventory. Interviews allowed qualitative assessment. Results Patient-reported anxiety did not correlate with cardiovascular changes. Anaesthetic room interventions were not predictive of anxiety. Postoperative interviews identified five sources of anxiety, mostly related to preparation for surgery. Staff responses to anxiety were also highlighted. Discussion Patient-reported anxiety and its biological response are not correlated. Pre-induction interventions do not contribute to anxiety. Anxiety levels at induction are similar to or lower than earlier in the preoperative period. Conclusions On induction of anaesthesia, patients have little control over their situation but are actively reassured and distracted by theatre staff. Our data suggest staff are good at this. More could still be done to reduce preoperative sources of anxiety.

Primary care physician’s (PCP) perceived value of patient-reported outcomes (PROs) in clinical practice: a mixed methods study

2021 ◽  
pp. bmjqs-2020-012206
Author(s):  
Danny Mou ◽  
Daniel M Horn ◽  
Marilyn Heng ◽  
Manuel Castillo-Angeles ◽  
Keren Ladin ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Mixed Methods ◽  
Clinical Setting ◽  
Patient Reported Outcomes ◽  
Mixed Methods Study ◽  
Clinic Efficiency ◽  
Wide Range ◽  
Patient Reported ◽  
Semistructured Interviews

BackgroundPatient-reported outcomes (PROs) can promote patient engagement, shared-decision making and improve the overall experience of care. However, PRO integration in the primary care clinical setting is limited. Exploring the perspectives of primary care physicians (PCPs) on PROs is key to understanding how they are being used in the clinical setting. We sought to elucidate this clinical perspective at one of the largest US health systems that has integrated a wide range of PROs into routine primary care.MethodsMixed methods study with both anonymous online surveys and in-person qualitative semistructured interviews conducted with PCPs to understand their clinical perspectives on the applications of the existing PROs. PCPs from the 19 affiliated clinics were prompted to complete the survey. Interviewed PCPs were selected via a combination of random and purposive selection from the PCP directory.ResultsOf 172 PCPs, 117 (68%) completed the online survey and 28 completed semistructured interviews. Most PCPs (77%) reviewed PRO responses with their patients. PCPs endorsed that PROs improve clinic efficiency and clinical management. However, PCPs have heterogeneous perspectives on the relevance of PROs in clinical practice, likely due to variations in clinic practice. For specific PRO instruments, PCPs reported anxiety and depression screening PROs to be most helpful. PCPs felt that PROs assisted with completing screening questions that are required by regulatory bodies. Barriers to using PROs include poor user-interface for both clinicians and patients and inadequate training.ConclusionsMost PCPs regularly use PRO data though there are mixed opinions about their clinical relevance. An adaptable, user-friendly PRO system has the potential to have meaningful clinical applications in primary care.

Abstract P167: Patient Perspectives on Experience During Collection, Results Communication and Overall Impact of Patient-reported Outcomes in Heart Failure: A Mixed Methods Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Favel L Mondesir ◽  
Susan Zickmund ◽  
Patrick Galyean ◽  
Serena Yang ◽  
Grace Perry ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mixed Methods ◽  
Cardiovascular Health ◽  
Well Being ◽  
Routine Care ◽  
Patient Reported Outcome ◽  
Mixed Methods Study ◽  
Successful Implementation ◽  
Quantitative Survey ◽  
Patient Reported

Background: Patient-reported outcome (PRO) assessments are commonly used in clinical heart failure (HF) trials and have been shown to be valid, reliable, sensitive measures of patients’ symptoms, function and quality of life, as well as prognostic of clinical events. To be used in routine care, they also need to be interpretable to providers and patients. Patients’ perspectives on PRO collection and results communication have not been studied. Methods: We conducted a mixed methods study of 24 ambulatory adult HF patients (50% men) who completed PROs as part of care at a HF clinic. Study procedures included (1) qualitative telephone interviews and (2) quantitative surveys following interviews. We employed thematic analysis to analyze and code transcripts using an iterative coding process and descriptive statistics to analyze the survey. Qualitative findings were purposefully linked to quantitative results. Findings: Three themes in qualitative analyses were linked to the quantitative survey: 1. Utility of data: Most participants noted that PRO questionnaires were a useful tool to better understand their health if their providers discussed the results with them, and to provide additional information to help improve their treatment. Ninety-two % (22/24) of participants strongly agreed or agreed (SA/A) and 8% (2/24) were neutral that completing the questionnaires changed their care and improved their health. Ninety-six % (23/24) of participants SA/A and 4% (1/24) were neutral that completing the questionnaires would make evaluation of their well-being more accurate. 2. Length and frequency of data collection: Most participants felt that questionnaire length (13-29 questions completed in 3-8 minutes on average) and frequency of implementation (at every visit) were satisfactory. Sixty-three % (15/24) and 37% (9/24) of participants felt that maximum number of questions should be 5-15 and >15, respectively. Eighty-three % (20/24) and 17% (4/24) of participants felt that maximum time required for completion should be 5 or 10 and >10 minutes, respectively. 3. Communication with providers: Most participants noted that their providers discussed results of PRO questionnaires with them only once or not at all and participants who had this discussion with their providers felt that providers understood their responses. Sixty-two % (15/24), 21% (5/24) and 17% (4/24) of participants SA/A, were neutral and disagreed or strongly disagreed that their providers effectively discussed results of their PROs with them. Conclusions: Qualitative results provided depth and interpretability of quantitative survey results. These results indicate successful implementation and utility of PRO questionnaires in the HF clinic, while highlighting a need for more frequent discussion of PRO results between providers and patients. Further use of PROs may lead to improved cardiovascular health and prognosis in HF.

Association between caregiver engagement and patient-reported healthcare utilization after stroke: a mixed-methods study

2019 ◽  
Vol 27 (1) ◽  
pp. 1-7
Author(s):  
Chelsea Liu ◽  
Victoria Marino ◽  
Orla C. Sheehan ◽  
Jin Huang ◽  
David L. Roth ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Healthcare Utilization ◽  
Mixed Methods Study ◽  
Patient Reported
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