Abstract
BackgroundProvider recognition of level of functioning may be suboptimal in the dialysis setting, and this lack of recognition may lead to less patient-centered care. We aimed to assess whether delivery of an app-based, individualized functioning report would improve patients’ perceptions of patient-centeredness of care.MethodsIn this pre-post pilot study at three outpatient dialysis facilities in metropolitan Atlanta, an individualized functioning report—including information on physical performance, perceived physical functioning, and community mobility—was delivered to patients receiving hemodialysis (n = 43) and their providers. Qualitative and quantitative approaches were used to gather patient and provider feedback to develop and assess the report and app. Paired t test was used to test for differences in patient perception of patient-centeredness of care (PPPC) scores (range, 1 = most patient-centered to 4 = least patient-centered) 1 month after report delivery.ResultsDelivery of the reports to both patients and providers was not associated with a subsequent change in patients’ perceptions of patient-centeredness of their care (follow-up vs. baseline PPPC scores of 2.35 vs. 2.36; P > 0.9). However, patients and providers generally saw the potential of the report to improve the patient-centeredness of care and reacted positively to the individualized reports delivered in the pilot. Patients also reported willingness to undergo future assessments. However, while two-thirds of surveyed providers reported always or sometimes discussing the reports they received, most (98%) participating patients reported that no one on the dialysis care team had discussed the report with them within 1 month.ConclusionsPotential lack of fidelity to the intervention precludes definitive conclusions about effects of the report on patient-centeredness of care. The disconnect between patients’ and providers’ perceptions of discussions of the report warrants future study. However, this study introduces a novel, individualized, multi-domain functional report that is easily implemented in the setting of hemodialysis. Our pilot study provides guidance for improving its use both clinically and in future pragmatic research studies, both within and beyond the dialysis population.
Highlights
Provider recognition of level of functioning may be suboptimal in the dialysis setting, and this lack of recognition may lead to less patient-centered care
All stakeholder groups discussed the potential of the report to improve the patient-centeredness of care and, to track function longitudinally; patients and providers alike felt the utility of the report could be limited by the time and space restrictions of the dialysis facility and for patients whose function was either very low or high (Table 1)
We made changes to the pilot study protocol based on focus group feedback, including: (i) in-person training presentations at physician meetings and recorded webinars available on our study website [32]; (ii) delivery of reports to non-physician as well as physician providers; and (iii) delivery of electronic versions of the report to providers, both by email and uploaded to the electronic health record (EHR)
Summary
Provider recognition of level of functioning may be suboptimal in the dialysis setting, and this lack of recognition may lead to less patient-centered care. We aimed to assess whether delivery of an app-based, individualized functioning report would improve patients’ perceptions of patient-centeredness of care. Patient-provider discussion of physical functioning is outside the scope of usual dialysis care. Such discussions could lead to better recognition of function-related issues and to more patient-centered communication, which fosters the patient-provider relationship, responds to patient emotions, exchanges information, and enables shared decision-making and disease- and treatment-related patient behavior [3]. We aimed to design an app that can be used to collect data on physical functioning and generate an individualized report of patients’ relative multi-domain functional status. We conducted a pilot study to measure patient perceptions of patientcenteredness before and after delivery of the app-based report to patients receiving hemodialysis and their providers
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
