Perceptions of Health Care Providers' Communication: Relationships Between Patient-Centered Communication and Satisfaction

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

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Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

Qualitative Health Research ◽

10.1177/10497323211003861 ◽

2021 ◽

pp. 104973232110038

Author(s):

Cecilie Fromholt Olsen ◽

Astrid Bergland ◽

Jonas Debesay ◽

Asta Bye ◽

Anne Gudrun Langaas

Keyword(s):

Health Care ◽

Older People ◽

Health Care Providers ◽

Transitional Care ◽

Care Pathway ◽

Patient Flow ◽

Care Pathways ◽

Care Providers ◽

Patient Centered ◽

Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

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Consent, Refusal, and Waivers in Patient-Centered Dysphagia Care: Using Law, Ethics, and Evidence to Guide Clinical Practice

American Journal of Speech-Language Pathology ◽

10.1044/2016_ajslp-15-0041 ◽

2016 ◽

Vol 25 (4) ◽

pp. 453-469 ◽

Cited By ~ 8

Author(s):

Jennifer Horner ◽

Maria Modayil ◽

Laura Roche Chapman ◽

An Dinh

Keyword(s):

Health Care ◽

Public Policy ◽

Clinical Practice ◽

Health Care Providers ◽

Clinical Decision Making ◽

Clinical Decision ◽

Care Providers ◽

Patient Centered ◽

Legal Advice ◽

Medical Context

PurposeWhen patients refuse medical or rehabilitation procedures, waivers of liability have been used to bar future lawsuits. The purpose of this tutorial is to review the myriad issues surrounding consent, refusal, and waivers. The larger goal is to invigorate clinical practice by providing clinicians with knowledge of ethics and law. This tutorial is for educational purposes only and does not constitute legal advice.MethodThe authors use a hypothetical case of a “noncompliant” individual under the care of an interdisciplinary neurorehabilitation team to illuminate the ethical and legal features of the patient–practitioner relationship; the elements of clinical decision-making capacity; the duty of disclosure and the right of informed consent or informed refusal; and the relationship among noncompliance, defensive practices, and iatrogenic harm. We explore the legal question of whether waivers of liability in the medical context are enforceable or unenforceable as a matter of public policy.ConclusionsSpeech-language pathologists, among other health care providers, have fiduciary and other ethical and legal obligations to patients. Because waivers try to shift liability for substandard care from health care providers to patients, courts usually find waivers of liability in the medical context unenforceable as a matter of public policy.

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Abstract 002: Patient Provider Communication and Patient-centered Outcomes Among Patients With Atherosclerotic Cardiovascular Disease in United States: Medical Expenditure Panel Survey 2010-2013

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.002 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Victor Okunrintemi ◽

Erica Spatz ◽

Joseph Salami ◽

Haider Warraich ◽

Salim Virani ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Medical Expenditure Panel Survey ◽

Medical Expenditure ◽

Atherosclerotic Cardiovascular Disease ◽

Care Providers ◽

Patient Centered ◽

Patient Reported ◽

Centered Care ◽

Nationally Representative

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

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Instilling the core concept of inter professional education

Health Renaissance ◽

10.3126/hren.v9i3.5591 ◽

1970 ◽

Vol 9 (3) ◽

pp. 201-206

Author(s):

S Bhattacharya ◽

SK Bhattacharya ◽

AP Gautam

Keyword(s):

Health Care ◽

Health Professional ◽

Health Care Providers ◽

Professional Education ◽

Care Delivery ◽

Care Providers ◽

Patient Centered ◽

Innovative Teaching ◽

Centered Care ◽

Teaching Learning

The Inter Professional Education (IPE) is an innovative teaching learning intervention in Health Professions’ Education during which members of more than one health profession learn interactively together to improve collaborative practice and/health of the patients. Thus this approach provides positive outcomes for students enhancing their awareness towards other professional groups, improving knowledge and understanding of how to work in an inter professional team and strengthening their communication and collaboration skills. Within the hierarchical nature of many clinical settings, the aims of IPE courses intersect with socialization of health professional (HP) students into roles of responsibility and authority. The IPE in HP courses emphasizes the practice of frequent high quality communication, strong relationships and partnerships among health care providers to maximize the quality of care thus improving the efficiency of care thereby improving clinical outcomes. Health Professional Schools are this motivated to opt for inter professional education to improve the learning of the students, health care delivery and patient outcomes. Keywords: Inter professional relations; patient centered care; education DOI: http://dx.doi.org/10.3126/hren.v9i3.5591 HR 2011; 9(3): 201-206

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A Consensus-Based Set of Measures for Oral Health Care

Journal of Dental Research ◽

10.1177/0022034517702331 ◽

2017 ◽

Vol 96 (8) ◽

pp. 881-887 ◽

Cited By ~ 10

Author(s):

F. Baâdoudi ◽

A. Trescher ◽

D. Duijster ◽

N. Maskrey ◽

F. Gabel ◽

...

Keyword(s):

Health Care ◽

Oral Health ◽

Health Care Providers ◽

Health Care Systems ◽

Routine Data ◽

Oral Health Care ◽

Care Providers ◽

Patient Centered ◽

Dental Practitioners ◽

Care Systems

Increasingly more responsive and accountable health care systems are demanded, which is characterized by transparency and explicit demonstration of competence by health care providers and the systems in which they work. This study aimed to establish measures of oral health for transparent and explicit reporting of routine data to facilitate more patient-centered and prevention-oriented oral health care. To accomplish this, an intermediate objective was to develop a comprehensive list of topics that a range of stakeholders would perceive as valid, important, and relevant for describing oral health and oral health care. A 4-stage approach was used to develop the list of topics: 1) scoping of literature and its appraisal, 2) a meeting of experts, 3) a 2-stage Delphi process (online), and 4) a World Café discussion. The aim was to create consensus through structured conversations via a range of stakeholders (general dental practitioners, patients, insurers, and policy makers) from the Netherlands, Germany, the United Kingdom, Ireland, Hungary, and Denmark. The study was part of the ADVOCATE project, and it resulted in a list of 48 topics grouped into 6 clusters: 1) access to dental care, 2) symptoms and diagnosis, 3) health behaviors, 4) oral treatments, 5) oral prevention, and 6) patient perception. All topics can be measured, as they all have a data source with defined numerators and denominators. This study is the first to establish a comprehensive and multiple-stakeholder consented topic list designed for guiding the implementation of transparent and explicit measurement of routine data of oral health and oral health care. Successful measurement within oral health care systems is essential to facilitate learning from variation in practice and outcomes within and among systems, and it potentiates improvement toward more patient-centered and prevention-oriented oral health care.

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Disclosing Gender-Based Violence During Health Care Visits: A Patient-Centered Approach

Journal of Interpersonal Violence ◽

10.1177/0886260517720733 ◽

2017 ◽

Vol 35 (23-24) ◽

pp. 5552-5573 ◽

Cited By ~ 6

Author(s):

Jessica R. Williams ◽

Rosa M. Gonzalez-Guarda ◽

Valerie Halstead ◽

Jacob Martinez ◽

Laly Joseph

Keyword(s):

Health Care ◽

Human Trafficking ◽

Health Care System ◽

Health Care Providers ◽

Qualitative Content Analysis ◽

Care Providers ◽

Gender Based Violence ◽

Patient Centered ◽

Gender Based ◽

Care System

The purpose of this study was to better understand victims’ perspectives regarding decisions to disclose gender-based violence, namely, intimate partner violence (IPV) and human trafficking, to health care providers and what outcomes matter to them when discussing these issues with their provider. Twenty-five participants from racially/ethnically diverse backgrounds were recruited from a family justice center located in the southeastern United States. Two fifths had experienced human trafficking, and the remaining had experienced IPV. Upon obtaining informed consent, semistructured, in-depth interviews were conducted. Interviews were audio recorded and transcribed verbatim. Qualitative content analysis was used to examine interview data. Five primary themes emerged. Three themes focused on factors that may facilitate or impede disclosure: patient–provider connectedness, children, and social support. The fourth theme was related to ambiguity in the role of the health care system in addressing gender-based violence. The final theme focused on outcomes participants hope to achieve when discussing their experiences with health care providers. Similar themes emerged from both IPV and human trafficking victims; however, victims of human trafficking were more fearful of judgment and had a stronger desire to keep experiences private. Cultural factors also played an important role in decisions around disclosure and may interact with the general disparities racial/ethnic minority groups face within the health care system. Recognizing factors that influence patient engagement with the health care system as it relates to gender-based violence is critical. The health care system can respond to gender-based violence and its associated comorbidities in numerous ways and interventions must be driven by the patient’s goals and desired outcomes of disclosure. These interventions may be better served by taking patient-centered factors into account and viewing the effectiveness of intervention programs through a behavioral, patient-centered lens.

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Shared decision-making in food allergy management

Journal of Food Allergy ◽

10.2500/jfa.2020.2.200009 ◽

2020 ◽

Vol 2 (1) ◽

pp. 124-127

Author(s):

Meera Patrawala ◽

Gerald Lee ◽

Brian Vickery

Keyword(s):

Health Care ◽

Decision Making ◽

Food Allergy ◽

Shared Decision Making ◽

Health Care Providers ◽

Decision Aids ◽

Shared Decision ◽

Care Providers ◽

Patient Centered ◽

Evidenced Based

Historically, the role of the health-care provider in medical practice has been primarily paternalistic by offering information, compassion, and decisive views with regard to medical decisions. This approach would exclude patients in the decision-making process. In a shift toward more patient-centered care, health-care providers are routinely encouraged to practice shared decision making (SDM). SDM uses evidence-based information about the options, elicitation of patient preferences, and decision support based on the patient’s needs with the use of decision aids or counseling. Although there are well-known benefits of SDM, including improvements in psychological, clinical, and health-care system domains providers have found it challenging to apply SDM in everyday clinical practice. In allergy, we have a unique role in the treatment of children and adults, and SDM should be applied appropriately when engaging with these specific groups. There are many situations in which there is not a clear best option (food allergy testing, food introduction and challenges, and immunotherapy). Therefore, decision aids specific to our field, coupled with evidenced-based information that ultimately leads to a decision that reflects the patient’s values will make for a vital skill in practice. In this article, we defined SDM, the benefits and barriers to SDM, unique situations in SDM, and approach to SDM in food allergy.

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A Four-Component Framework Toward Patient-Centered, Integrated Mental Healthcare in Kenya

Frontiers in Public Health ◽

10.3389/fpubh.2021.756861 ◽

2021 ◽

Vol 9 ◽

Author(s):

Manasi Kumar ◽

Thomas L. Osborn ◽

Cyrus Mugo ◽

Hossein Akbarialiabad ◽

Osman Warfa ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Health Care Providers ◽

Professional Training ◽

Fast Track ◽

Mental Healthcare ◽

Clear Understanding ◽

Care Providers ◽

Patient Centered ◽

Fast Tracking

Background: How can we fast-track the global agenda of integrated mental healthcare in low- and middle-income countries (LMICs) such as Kenya? This is a question that has become increasingly important for individuals with lived experiences, policymakers, mental health advocates and health care providers at the local and international levels.Discussion: This narrative synthesis and perspective piece encompasses an overview of mental health care competencies, best practices and capacity building needed to fast track patient responsive services. In that vein we also review key policy developments like UHC to make a case for fast-tracking our four-step framework.Results: While there is an increasingly global impetus for integrated mental healthcare, there is a lack of clarity around what patient-responsive mental healthcare services should look like and how to measure and improve provider readiness appropriately. Here, our collaborative team of local and international experts proposes a simple four-step approach to integrating responsive mental healthcare in Kenya. Our recommended framework prioritizes a clear understanding and demonstration of multidimensional skills by the provider. The four steps are (1) provider sensitization, (2) continuous supervision, (3) continuous professional training, and (4) leadership empowerment.Conclusion: Our proposed framework can provide pointers to embracing patient-centered and provider empowerment focused quality of care improvements. Though elements of our proposed framework are well-known, it has not been sufficiently intertwined and therefore not been integrated. We think in the current times our integrated framework offers an opportunity to “building back better” mental health for all.

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What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness (Preprint)

10.2196/preprints.14634 ◽

2019 ◽

Author(s):

Jing Liu ◽

Shengchao Hou ◽

Richard Evans ◽

Chenxi Xia ◽

Weidong Xia ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

A Priori ◽

Patient Experiences ◽

Study Patient ◽

Significant Heterogeneity ◽

Care Providers ◽

Patient Centeredness ◽

Patient Centered ◽

Wide Range

BACKGROUND Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences. OBJECTIVE The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences. METHODS First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients’ online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework. RESULTS In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74%) and the care environment (48,563/204,363, 23.76%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29%). Variation in the concerns across different countries’ patients were also observed. CONCLUSIONS Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients’ online complaints across different countries.

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