Client Satisfaction Survey Research Articles

Discovering a “sense of community”: patient experiences of connection in intentionally remote eating disorder care

BackgroundWhile some findings indicate high levels of patient satisfaction with remote eating disorder treatment, others reflect feelings of disconnection due to unique telehealth treatment challenges. The COVID-19 pandemic presented circumstances that likely impacted the findings established thus far. As such, the present study sought to understand patient experiences of connection in an intentionally remote eating disorder treatment program, specifically in a context outside of pandemic transition.MethodsA secondary analysis of de-identified qualitative data previously obtained for quality improvement purposes via a client satisfaction survey was conducted. Adult patient responses (N = 38) were analyzed via reflexive thematic analysis within a critical realist framework.ResultsFour themes were generated from the data: (1) Embracing one’s humanity paves the way for connection, (2) Discovering a “sense of community” in remote care, (3) “They made me feel I was worth recovering”: connection as a vehicle for healing, and (4) Aligning expectations and reality: reconceptualizing the journey to connection in remote eating disorder care.ConclusionsOverall, findings suggest that it is possible for patients to form strong, impactful connections in remote treatment. Importantly, patient perspectives indicated that there were shifts in how these connections were experienced as a result of the remote care environment (e.g., how support could be provided and by whom). Considerations unique to remote care (e.g., offering training to improve clients’ comfort with technology) may be important to fostering connection, thereby contributing to improved patient experiences and treatment outcomes.

"Like an umbrella, protecting me from the rain until I get to my destination": Evaluating the implementation of a tailored primary care model for urban marginalized populations.

Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework. Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis. Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20. The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.

Evaluation of the MARPOL 73/78 Surveyor Training Course Towards its Enhancement

This thesis investigated the effectiveness of the MARPOL 73/78 Surveyor Training Course offered by Oceanwide Maritime Services Corp. and identified potential areas for enhancement. The study assessed course content, instructor qualifications, delivery methods, facilities, equipment, and learning assessment using Kirkpatrick's Model. It engaged 110 maritime professionals through structured questionnaires and client satisfaction surveys. Findings indicated that the course was highly effective in terms of content, instructor qualifications, and assessment methods while teaching materials and course duration received lower scores. Recommendations included updating course content, increasing hands-on training, upgrading facilities, diversifying delivery methods, enhancing assessment techniques, extending course duration, and providing support for complex topics. In conclusion, the MARPOL 73/78 Surveyor’s Training Course is highly effective but needs improvements in teaching materials, course segments, and regular content updates to maintain training quality and relevance.

Equine-Assisted Therapy Pilot Program: A Post-Participation Study of Client Satisfaction

Equine-assisted therapy (EAT) is an emerging practice area that has been shown to decrease negative symptoms in individuals experiencing post-traumatic stress disorder (PTSD). While the research for equine-assisted therapy demonstrates effectiveness in decreasing PTSD symptoms, there is a lack of evidence to verify client satisfaction. The purpose of this mixed-methods study was to evaluate participant satisfaction using the eight-question “Client Satisfaction Survey” and compose recommendations based on participant feedback from a focus group after completing an Equine-Assisted Therapy Post-traumatic stress disorder (EAT-PTSD) program. Two participants attended an EAT-PTSD program that utilized the protocol developed by the Man O’ War project. Both participants attended all sessions and completed pre- and post-measures including the Post-Traumatic Stress Disorder Checklist Criterion Assessment, the 16-item Quick Inventory of Depressive Symptomatology Self-Report, informal numerical anxiety ratings, and a focus group for evaluation of program satisfaction and future recommendations. The results show that completion of an EAT-PTSD program decreases negative PTSD symptoms. Additionally, participants had an overall high satisfaction rate after completion of an EAT-PTSD program. Recommendations from program participants for future program delivery include increasing program length, using additional resources like talk and group therapy, and recruiting more participants to take part in the program.

Case Management for Social Needs of Youth and Families in School-Based Health Centers.

School-based health centers (SBHCs) are ideal settings to address social needs of youth and families. Case managers can play a vital role in social care interventions. We piloted a program to incorporate a Case Manager into the care team of 1 SBHC serving 2 local schools with over 900 students and their surrounding communities. This project's purpose was to evaluate program feasibility, utilization, and acceptability. Our mixed-methods evaluation included analyses of data from electronic health records, client satisfaction surveys, and staff interviews. During the 6-month pilot, the Case Manager served 133 clients (about one third of all SBHC clients served) through 593 contacts. Most contacts included referrals to support services (90%) and 37% addressed newcomer immigrant adjustment. All 37 respondents to the satisfaction survey during the 3-month administration period (44% response rate) reported that the Case Manager made them feel comfortable asking for help; 95% reported getting the help they needed. The 7 SBHC staff interviewed shared many program benefits, including increased time for clinical services. Inequities in children's health and educational achievement are influenced by structural factors. Results from our pilot program demonstrate that SBHCs may be well-positioned to deliver social care interventions and that case managers enhance the ability to deliver quality care. School-based programs to address unmet social needs are critical to supporting learning and wellness for all youth. Robust studies are needed to further test the impacts of case management in SBHCs.

The COVID-19 pandemic negatively impacted veterinary client satisfaction and loyalty.

To evaluate the temporal association of the COVID-19 pandemic with veterinary client loyalty and satisfaction. 318,693 client satisfaction surveys, available from CalPro Research, between March 5, 2018, and May 30, 2022, from 4 veterinary practice types: colleges of veterinary medicine, emergency/critical care clinics, general practices, and specialty private practices. Survey data on client loyalty score (CLS), which is the likelihood of a client to recommend a practice, and 5 clinic performance domains (professionalism, communication, convenience, perceived overall value, and personalized interaction) were compared between the pre-COVID-19 (2018 to 2020) and COVID-19 eras (2020 to 2022) and by practice type. Correlations among CLS performance domains were evaluated. CLS and all clinic performance domains decreased significantly during the COVID-19 era (P < .001), except professionalism. There was a significant correlation between each performance domain and overall CLS (P < .001). The most pronounced association with CLS during the COVID-19 era was for personalized interaction. Among clients who did not report a personalized interaction (ie, their dog or themselves being addressed by name), the CLS decreased from 9.47 to 4.88 (P < .001). Our study found that client loyalty scores for veterinary clinics dropped during the COVID-19 era, although veterinary professionalism was still considered high. These data suggest that improving communication, convenience, perceived overall value, and especially personalized interactions with clients could improve client loyalty. In particular, consistently addressing clients and pets by name provides a specific, measurable, and achievable intervention for clinics to potentially sustain client satisfaction and loyalty.

Experiences and needs of welfare benefit recipients regarding their welfare-to-work services and case workers

BackgroundThis study aimed to explore the experiences and needs of (ex-)welfare benefit recipients from a large urban municipality in the Netherlands regarding their welfare-to-work services and their case workers.MethodsQuantitative data from a client satisfaction survey that was filled out by 213 people (response rate 11%) who received welfare-to-work services was combined with results from four group interviews with a total of 15 people receiving welfare-to-work services. Verbatim transcripts from the interviews were analysed using inductive thematic analysis.ResultsThe survey results showed that most clients were reasonably satisfied with the welfare-to-work services they received. Four main themes emerged from the interviews: (1) experiences and needs related to the interactions between case workers and benefit recipients; (2) the need for tailored services; (3) the complicating role of the system the case workers operate within; and (4) the existence of differences between case workers regarding how strict they followed the rules and to what extent they connected with their clients on a personal level.ConclusionsOur findings show that clients were reasonably satisfied with the welfare-to-work services provided by their municipality but that there is still room for improvement. Case workers should have good social skills to build a trusting relationship with the client, welfare-to-work services should be tailored to the individual, and clear concise information should be given to welfare benefit recipients, especially with regard to what benefit recipients can expect of the municipality and the case workers, given their dual role in supporting (re-)integration to work and monitoring benefit eligibility.

Implementing One-at-a-Time Therapy in community addiction and mental health centres: a retrospective exploration of the implementation process and initial outcomes

BackgroundThe Department of Health of the Government of New Brunswick and Regional Health Authorities elected to implement Stepped Care 2.0 (SC2.0) in 2021, and began with One-at-a-Time (OAAT) therapy in Community Addiction and Mental Health Centres (CAMHCs) to facilitate rapid access to addiction and mental healthcare. This study: 1) explicated the process of implementing OAAT therapy as it aligned to evidence-based implementation frameworks and strategies; 2) assessed readiness for change among providers during the implementation; and 3) evaluated initial client and system outcomes.MethodsThe process of implementing OAAT therapy within CAMHCs was documented and retrospectively aligned with the Active Implementation Frameworks-Stages of Implementation, Consolidated Framework for Implementation Research, and incorporated strategies endorsed by the Expert Recommendations for Implementing Change. Providers working in CAMHCs completed online asynchronous courses in OAAT therapy and SC2.0, and were recruited to participate in research on perceptions of organizational readiness. Initial outcomes of the implementation were evaluated through client satisfaction surveys administered in CAMHCs and system performance indicators.ResultsAligning with implementation stages, key strategies included: 1) continuously monitoring readiness and soliciting stakeholder feedback for iterative improvement; 2) building a representative implementation team with engaged leaders; 3) creating a comprehensive implementation plan on staff training, communication, and system changes; and 4) supporting sustainability. Providers who participated in research (N = 170, ~ 50% response rate) agreed that their organization was ready for implementation, and that OAAT therapy delivered within a SC2.0 framework was acceptable, appropriate, and feasible. More than 3,600 OAAT therapy sessions were delivered during the initial implementation stage, and waitlists were reduced by 64.1%. The majority of clients who completed surveys (N = 1240, ~ 35% response rate) reported that their OAAT therapy session was helpful, with a minority reporting that additional intervention was needed.ConclusionsThoughtful planning and execution, aligned with evidence-based implementation frameworks and strategies, played an important role in this provincial change initiative. Implementation steps outlined can help inform others looking to enact large-scale change.

On-site communication skills education increases appointment-specific client satisfaction in four companion animal practices in Texas.

To assess the impact of a 15-month, in-practice communication skills intervention on client visit satisfaction. 4 purposely selected veterinary clinics, 9 veterinarians, and 930 appointment-specific client satisfaction surveys. The study was designed as a multipractice, preintervention-postintervention study. Practice teams participated in a 15-month communication skills intervention that included interactive group workshops and one-on-one communication coaching with the entire practice. Client Satisfaction Questionnaires were completed 3 months before (mean, 55 questionnaires/veterinarian) and after (mean, 48 questionnaires/veterinarian) the intervention. The impact of the intervention and factors associated with client visit satisfaction were evaluated with mixed logistic regression. Client satisfaction scores were dichotomized owing to extreme negative skewness. In total, 57% (284/496) of clients were completely satisfied on pretest questionnaires, and 67% (290/434) were completely satisfied on postintervention questionnaires. The odds of clients being completely satisfied were significantly higher after the communication skills intervention (OR = 1.56; P = .002). When controlling for the intervention, predictors of client visit satisfaction included appointment type (odds of being completely satisfied were significantly higher for recheck appointments than for preventative care appointments [OR = 1.71; P = .02] and health problem appointments [OR = 1.99; P = .003]) and duration of the veterinarian-client relationship (probability increased by 0.52 with each 1-year increase in relationship duration; P = .008). Results suggested that the client-centered, skills-based communication intervention resulted in increased client visit satisfaction. Findings contribute to current evidence that client-centered communication and duration of the veterinarian-client relationship promote client satisfaction during veterinary visits.

Status of Client Satisfaction for Sexual Reproductive Health Services: A Case Get Up Speak Out (GUSO) Program Implementation in Western Kenya

Young people face a wide range of barriers to accessing SRHR services from structural barriers: - Cost of services, waiting times, distance from health facilities, lack of privacy and confidentiality and lack of necessary commodities among others; Sociocultural barriers: - such as restrictive norms and culture that surround young people’s SRHR, inequitable gender norms among others; Individual barriers: - myths and misconceptions, limited knowledge on SRHR issues, limited knowledge on the SRH services and the sources of such services. Youth-friendly services are designed to address one of the main barriers mentioned above- Structural barriers. The youth-friendly services are tailored for young people to ensure their retention in the SRH seeking routine. TICH in the Get Up Speaks Out program, trained service providers in the various community link health facilities on youth-friendly services to ensure that the youth are attracted to access services at the health facilities. It is for this reason that TICH conducted a client satisfaction survey assessing the quality of services provided to the young people on the aspects of waiting time, availability of equipment and drugs, and satisfaction with service delivery among others. The study was conducted in 2019 among the young people aged 10 to 24 years (members of the TICH-GUSO youth groups) who had accessed the last SRHR services from the community health facilities. Semi-structured questionnaires were developed and administered to the respondents by the field officers. This study highlights the variance between services sought by young people and the ones they receive thereby demonstrating a gap in information among young people on SRH services available at the health facilities. Additionally, the study indicated secondary and primary school students utilise most SRH services among young people. Finally, the evidence indicated that young people appreciate short waiting times at the health facilities (of below 30 minutes). The findings therefore call for strategies to address waiting times at the health facilities and information on SRH services among young people for improved access to YFS among the young people.

Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini.

IntroductionUniversal access to antiretroviral therapy (ART) is a cornerstone of Eswatini’s national HIV strategy, and the number of people on ART in the country more than tripled between 2010 and 2019. Building on these achievements, the Ministry of Health (MOH) is scaling up differentiated service delivery, including less-intensive differentiated ART (DART) models for people doing well on treatment. We conducted a mixed-methods study to explore client and health care worker (HCW) perceptions of DART in Eswatini.MethodsThe study included structured site assessments at 39 purposively selected health facilities (HF), key informant interviews with 20 HCW, a provider satisfaction survey with 172 HCW and a client satisfaction survey with 270 adults.ResultsAll clients had been on ART for more than a year; 69% were on ART for ≥ 5 years. The most common DART models were Fast-Track (44%), Outreach (26%) and Community ART Groups (20%). HCW and clients appreciated DART, noting that the models often decrease provider workload and client wait time. Clients also reported that DART models helped them to adhere to ART, 96% said they were “very satisfied” with their current model, and 90% said they would recommend their model to others, highlighting convenience, efficiency and cost savings. The majority of HCW (52%) noted that implementation of DART reduced their workload, although some models, such as Outreach, were more labor-intensive. Each model had advantages and disadvantages; for example, clients concerned about stigma and inadvertent disclosure of HIV status were less interested in group models.ConclusionsClients in DART models were very satisfied with their care. HCW were also supportive of the new approach to HIV treatment delivery, noting its advantages to HF, HCW and to clients. Given the heterogeneous needs of people living with HIV, no single DART model will suit every client; a diverse portfolio of DART models is likely the best strategy.

Clients' Perspective for Quality of Services at One of the Urban Primary Health Centres (U-PHC) at Municipal Corporation Area in One of the cities of Western India

Introduction: Client satisfaction surveys are central to quality improvement at health facility. It helps in identifying areas of low satisfaction and steps to maximize patient satisfaction. Objectives: To assess client satisfaction towards services at Out Patient Department (OPD) of at an U-PHC under Ahmedabad Municipal Corporation (AMC), identify areas of low satisfaction and suggest feasible remedial measures for improvement. Method: Out of 74 U PHCs under AMC, 1 was selected through simple random sampling. Quality of care was evaluated through client’s feedback which was gathered through 10 check points (on structure, process and outcome) developed by state level quality team. Responses of 300 adult (&gt; 18 years) subjects and their mean ± standard deviation scores were calculated. These subjects were selected consecutively @ 25 cases (new cases who came first and were willing) on every 2nd and 4th Mondays for 6 months (Sep 2019 – Feb 2020). Results: While availability of drugs was perceived as very satisfying that of investigations was relatively an area of concern. Overall, only 1 client rated the services as average while all rest (99.6%) rated services as very good to excellent. Conclusion: Quality of services at this U PHC was good to excellent and had wider acceptability among its client.

Response time to an SMS link for a sexual health survey.

In November 2021, clients attending the Melbourne Sexual Health Centre were invited to participate in the Annual Client Satisfaction Survey by receiving an SMS link at 5:15pm on the day they attended the clinic. We analysed the response time data and found that most (60%; 168/278) individuals responded to the survey during the time period 5:00-5:59pm, which wasaround the time when they received the SMS. We concluded that individuals responded quickly to the survey via an SMS link.

Utilization of Maternal Care Services and Level of Satisfaction Among Clients in a Teaching Hospital in Ghana

The study investigates the extent to which mothers are satisfied with the maternity services they receive at Tamale Teaching Hospital. The study adopted a descriptive research design. Primary and secondary sources of data were used for the research. Likert scale questionnaires were used in the collection of the data. A quantitative approach was adopted to analyze the data. From the study, respondents agreed that they are provided with access to high-quality care throughout the phases of pregnancy, labour and delivery. They also averred that they receive screening at the maternal and child health to ensure safe delivery. Again, it emerged that respondents get education on proper diet during pregnancy and lactation and the benefits of physical exercises. Additionally, it came up that respondents do not receive considerate and respectful care at all times and under all circumstances, without recognition of their dignity, values and beliefs, respect the rights of the patient. Respondents do not know the name and professional status of those providing services to them. Respondents do know refusing treatment to the extent permitted by law and are informed of the medical consequences of that refusal in the Tamale Teaching Hospital. Thus, it is recommended that the management of Tamale Teaching Hospital should organize training for health providers to encourage them to communicate client information to them during the provider-client interaction. Management should work to improve on the waiting time and contact time for their clients to be satisfied with their service provision. Management of Tamale Teaching Hospital should carry out client satisfaction surveys routinely to improve the quality of Anti-Natal Care. The primary health care authorities should make adequate provision of maternal and child health services a priority given its importance in minimizing maternal and infant morbidity and mortality.

“Was it useful? Like, really?”: Client and Consultant Perceptions of Post-Session Satisfaction Surveys

Client satisfaction surveys have long been a cornerstone of writing center assessment, but to date, research on satisfaction surveys has largely focused on analyzing client responses from the survey and their administrative uses. Research rarely investigates why clients provide the responses they do and how consultants process these responses. This study, therefore, involved conducting separate client and consultant focus groups to learn about each population’s interactions with one writing center’s optional post-session satisfaction survey and the survey results. The findings revealed that while client participants used the survey to communicate high levels of satisfaction, client participants also thought about the survey in multifaceted ways that took into account complex factors, such as their relationship with the writing center and care for consultants’ feelings. The study also showed that consultant participants valued positive feedback from clients but that consultants found their survey responses to have limited utility for professional growth and that they craved more specific and constructive feedback. This article offers considerations for how writing center professionals can better communicate the purpose of surveys to both clients and consultants, and it proposes additional forms of assessment that could allow consultants and administrators to hear the nuanced feedback clients can offer.

Effects of combined decision-support and performance-based incentives on reported client satisfaction with maternal health services in primary facilities: A quasi-experimental study in the Upper East Region of Ghana.

BackgroundComputerized decision-support systems (CDSS) and performance-based incentives (PBIs) have potential to contribute to client satisfaction with health services. However, rigorous evidence is lacking on the effectiveness of these strategies in lower-income countries such as Ghana. This study aimed to determine the effect of a combined CDSS-PBI intervention on client satisfaction with maternal health services in primary facilities in the Upper East Region of Ghana.MethodsWe employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey. Our analysis used difference-in-difference logistic regression, controlling for potential covariates, to compare variables across intervention and comparison facilities at baseline and endline.ResultsThe combined CDSS-PBI intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline. Antenatal client difference-in-difference of mean satisfaction scores were significant at endline for intervention (n = 378) and comparison (n = 362) healthcare facilities for overall satisfaction (DiD 0.058, p = 0.014), perception of providers’ technical performance (DiD = 0.142; p = 0.006), client-provider interaction (DiD = 0.152; p = 0.001), and provider availability (DiD = 0.173; p = 0.001). Delivery client difference-in-difference of satisfaction scores were significant at endline for intervention (n = 318) and comparison (n = 240) healthcare facilities for overall satisfaction with delivery services (DiD = 0.072; p = 0.02) and client-provider interaction (DiD = 0.146; p = 0.02). However, mean overall satisfaction actually reduced slightly in intervention facilities, while DiD for technical performance and provider availability were not significant.ConclusionThis combined CDSS-PBI intervention was associated with greater antenatal and delivery client satisfaction with some aspects of maternity services within two years of implementation. It could be expanded elsewhere if funds allow, though further research is still required to assess cost-effectiveness and long-term effects on client satisfaction and maternal health outcomes.

Metamotivation Therapy: Is it time to Focus on Metamotivation in Severe Mental Illness?

Metamotivation Therapy targets motivational deficits in severe mental illness (SMI) by using the novel approach of enhancing meta-motivation and executive functioning skills. The current naturalistic, uncontrolled cohort study provides the rational for the Metamotivation Therapy approach and program evaluation data on pilot feasibility and efficacy. Pilot feasibility was assessed through utilization data and Client Satisfaction Survey (CSS-8). Pilot effectiveness was assessed using the Barkley Deficits in Executive Functioning for Adults and Quality of Life Enjoyment and Satisfaction Questionnaire. On average, participants completed 15/20 sessions; nine participants (9.4%) dropped out before four sessions. 90.5% of the 28 people providing satisfaction ratings expressed some level of satisfaction. Metamotivation Therapy participants who completed both baseline and follow up measures (n = 38) showed an improvement from baseline to follow-up on overall executive functioning, self-motivation, and quality of life. Given the results, a randomized controlled trial is warranted to optimize dosage and assess efficacy.

Amputation Care Quality and Satisfaction With Prosthetic Limb Services: A Longitudinal Study of Veterans With Upper Limb Amputation

This study sought to measure and identify factors associated with satisfaction with care among veterans. The metrics were colelcted for those receiving prosthetic limb care at the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) care settings and at community-based care providers.A longitudinal cohort of veterans with major upper limb amputation receiving any VA care from 2010 to 2015 were interviewed by phone twice, 1 year apart. Care satisfaction was measured by the Orthotics and Prosthetics User's Survey (OPUS) client satisfaction survey (CSS), and prosthesis satisfaction was measured by the OPUS client satisfaction with device (CSD), and the Trinity Amputation and Prosthetic Experience Scale satisfaction scales. The Quality of Care index, developed for this study, assessed care quality. Bivariate analyses and multivariable linear regressions identified factors associated with CSS. Wilcoxon Mann-Whitney rank tests and Fisher exact tests compared CSS and Quality of Care items at follow-up for those with care within and outside of the VA and DoD.The study included 808 baseline participants and 585 follow-up participants. Device satisfaction and receipt of amputation care in the prior year were associated with greater satisfaction with care quality. Persons with bilateral amputation were significantly less satisfied with wait times. Veterans who received amputation care in the VA or DoD had better, but not statistically different, mean (SD) CSS scores: 31.6 (22.6) vs 39.4 (16.9), when compared with those who received care outside the VA or DoD. Those with care inside the VA or DoD were also more likely to have a functional assessment in the prior year (33.7% vs 7.1%, P = .06), be contacted by providers (42.7% vs 18.8%, P = .07), and receive amputation care information (41.6% vs 0%, P =.002). No statistically significant differences in CSS, Quality of Care scores, or pain measures were observed between baseline and follow-up. In regression models, those with higher CSD scores and with prior year amputation care had higher satisfaction when compared to those who had not received care.Satisfaction with prosthetic limb care is associated with device satisfaction and receipt of care within the prior year. Veterans receiving amputation care within the VA or DoD received better care quality scores than those receiving prosthetic care outside of the VA or DoD. Satisfaction with care and quality of care were stable over the 12 months of this study. Findings from this study can serve as benchmarks for future work on care satisfaction and quality of amputation rehabilitative care.

Optimizing HIV Services for Key Populations in Public-Sector Clinics in Myanmar.

Key populations, ie, female sex workers, men who have sex with men, transgender people, people who inject drugs, and people in prisons and other closed settings, experience stigma, discrimination, and structural barriers when accessing HIV prevention and care. Public health facilities in Myanmar became increasingly involved in HIV service delivery, leading to an urgent need for healthcare workers to provide client-centred, key population-friendly services. Between July 2017–June 2018, the Myanmar Ministry of Health and Sports and National AIDS Programme collaborated with ICAP at Columbia University and the US Centers for Disease Control and Prevention to implement a quasi-experimental, multicomponent intervention including healthcare worker sensitization training with pre- and post- knowledge assessments, healthcare worker and client satisfaction surveys, and structural changes. We observed modest improvements among healthcare workers (n = 50) in knowledge assessments. Classification of clients into key population groups increased and fewer clients were classified as low risk. Key population clients reported favourable perceptions of the quality and confidentiality of care through self-administered surveys. Our findings suggest public health facilities can deliver HIV services that are valued by key population clients.

Service-Specific Surveying to Support Person-Centered HCBS for Older Adults and Their Caregivers

The Florida Department of Elder Affairs (DOEA) annually surveys clients receiving state funded home and community-based services (HCBS) to measure their satisfaction with services. Historically, the same survey instrument was used each year, to afford question-level comparisons across time. However, in 2015 internal contradictions were identified between individual-level satisfaction ratings and qualitative statements made by the respondents later in the survey. The high rates of satisfaction typical in survey responses were also contradicted by findings from a comprehensive program evaluation which revealed high percentages of clients who terminated their services and many caregivers reporting strain and varying types of personal crisis. To address these issues, the annual Client Satisfaction Survey and methodology was redesigned to be more specific regarding details about the delivery of direct services, and the sampling methodology was revised to constrain to the recipients of discreet service types. The results from these new service-level surveys will be presented for each of three direct services: case management, personal care, and homemaker. Findings revealed differences across regions in the state, and highlighted the frustration experienced by HCBS clients with high worker turnover and low training for special conditions, such as Alzheimer’s or related dementia. Complaints and suggestions collected from clients and caregivers were shared with program managers for consideration in changes to policies, training, and other areas of service improvement toward becoming more person-centered. Overall, this service-oriented approach to surveying has yielded more actionable results and has been adopted by DOEA as the preferred method for all client-level surveying.