Enhance Patient Experience Research Articles

Does Primary Care Model Effect Healthcare at the End of Life? A Population-Based Retrospective Cohort Study.

Comprehensive primary care may enhance patient experience at end of life. To examine whether belonging to different models of primary care is associated with end-of-life healthcare use and outcomes. Retrospective population cohort study, using health administrative databases to describe health services and costs in the last six months of life across three primary care models: enrolled to a physician remunerated mainly by capitation, with incentives for comprehensive care and access in some to allied health practitioners (Capitation); remunerated mainly from fee-for-service (FFS) with smaller incentives for comprehensive care (Enhanced FFS); and not enrolled, seeing physicians remunerated solely through FFS (Traditional FFS). People who died from April 1, 2010 to March 31, 2013 in Ontario, Canada. Health service utilization, costs, and place of death. Approximately two-thirds (62.7%) of decedents had more contact with a specialist than family physician. Those in Capitation models were more likely to have the majority of physician services provided by a family physician (44.9% vs. 38.6% in Enhanced FFS and 34.3% in Traditional FFS) and received more home care service days (mean 27.2 vs. 24.2 in Enhanced FFS and 21.7 in Traditional FFS). And 22.5% had a home visit by a family physician. Controlling for potential confounders, decedents spent significantly more days in an institution in Enhanced FFS (1.1, 95% confidence interval [CI]: 0.9-1.5) and Traditional FFS (2.2, 95% CI: 1.8-2.6) than in Capitation. Decedents in comprehensive primary care models received more care in the community and spent less time in institutions.

Dose Assessment and Considerations When a Radioactive Seed is Unrecoverable in a Breast Surgical Patient.

Excision of non-palpable breast tumors in cancer patients has been routinely performed using surgical clips and wires placed under mammographic or ultrasound guidance. An alternative method exists for performing these surgeries without surgical wires and this approach has become more widely used at Oncology Centers in the United States. Roswell Park Cancer Institute (RPCI) performs many of their breast surgeries with radioactive seeds and has enjoyed favorable outcomes along with an enhanced patient experience. There are some inherent difficulties with using radioactive seeds, and seed tracking can be a problem during surgical procedures. When a seed is misplaced, an extensive search is conducted in an effort to locate the misplaced seed. Every attempt to recover these radioactive seeds should be made unless patient safety is jeopardized. If the seed is unrecoverable, then a dose assessment must be performed and corrective action determined. It is important to have adequate policies and procedures in place to prevent these rare occurrences. They should be treated as a radioactive medical event.

Comprehensive Unit-based Safety Program (CUSP) to Improve Patient Experience: How a Hospital Enhanced Care Transitions and Discharge Processes

To determine whether Comprehensive Unit-based Safety Program (CUSP) teams could be used to enhance patient experience by improving care transitions and discharge processes in a 318-bed community hospital. In 2015, CUSP teams produced feasible solutions by participating in a design-thinking initiative, coupled with performance improvement tools involving data analytics and peer-learning communities. Teams completed a 90-day sprint challenge, involving weekly meetings, monthly department leader meetings, and progress trackers. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used, and the percent top (best) scores were reported for overall hospital ratings, discharge information, and care transitions. The percentage of patients choosing the top score increased from 61.0% preintervention to 68.0% postintervention for overall hospital rating and from 71.4% to 80.7% for recommending the hospital. The top scores increased from 76.0% preintervention to 84.5% postintervention for the discharge information domain and from 49.2% to 53.6% for the care transitions domain. CUSP teams improved patient experience. The teams could expand their scope to be the unit-level resource focused not only on safety but also on external quality measures to which patient experience is a broad category for HCAHPS scores, and potentially on value in future work.

Enhancing Patient Experience and Cath Lab Utilization: A Look at Turnaround Times

Enhancing Patient Experience and Cath Lab Utilization: A Look at Turnaround Times

Watson Health: A New Approach to Population Health and Research

Background/Aims: The population health management movement requires key strategies be employed by some of the nation’s largest and most prestigious physician groups and health systems (most included in the HCSRN) to automate the management of their populations and improve health outcomes. Watson Health represents a health information technology (IT) and big data insights approach to enhance patient experience, management and outcomes. We bring together common data sources for evidence that is consistent across platforms, including payers, providers and pharmaceuticals.

Mobile Nurse Services in Clinical Trials: Usage and Industry Perceptions.

With the pharmaceutical industry's increased attention on enhancing patient experiences during their participation in clinical trials, the use of mobile nurse (MN) services to support the conduct of clinical trial assessments in the home (or in alternative locations other than in investigational sites) has been gaining momentum. Because no quantitative data capturing industry-wide practices are available, in July 2014, Tufts Center for the Study of Drug Development and Hoffman-La Roche conducted an online survey to gather data on the prevalence and utilization of MN services in clinical trials taking into account the following factors: industry perceptions of the business model, risks barriers to adoption, vendor landscape, cost, and prospects for future growth. A total of 113 respondents answered the survey, with 53 respondents answering all questions. The use of MN services in clinical trials is an established and growing business practice. Utilization of MN services has so far been most prevalent in North America, followed by Western Europe. Sponsor companies that have adopted this model have done so mainly to improve patient retention and protocol compliance, as well as improve access to rare patients. Most of the companies surveyed work directly with vendors specializing in home nurse services. Experience with vendors was considered favorable in most cases. Building effective partnerships with 1 to 2 vendors is considered a key factor for long-term success.

PRM194 - Why Aren’t All Pro/Coa Clinical Trials Using Electronic Data Collection To Optimize Data Integrity And Patient Experience?

In this conceptual paper, we will explore reasons for continued use of paper data collection for Patient Reported Outcomes (PRO) and Clinical Outcome Assessments (COA). Reasons include instruments designed specifically for paper, the inability to determine true risks of paper-use, unknown true costs of electronic vs. paper administration, instrument author barriers (only allowing paper administration, costly requirements for migration), unclear translation expectations, and a general fear of the unknown. As electronic PRO/COA (ePRO/eCOA) offers several benefits over paper, including enhanced patient experience, improved compliance, and higher data quality, we will compare the advantages of electronically captured PRO/COA data to that captured via paper in order to show that ePRO/eCOA benefits far outweigh those of paper. The support and advocacy of ePRO/eCOA in clinical trials by regulatory authorities will be reviewed, along with describing current trends of the general population shifting towards the use of electronic devices in their daily routines. In focusing on patient centered clinical trials, ePRO/eCOA makes a significant contribution in reducing patient burden and optimizing their overall experience with making their required assessment entries. Additionally, this conceptual paper will focus on how PROs can be integrated into the eClinical solution to reduce the burden to patients, sites, and clinical teams and discuss this in relation to each phase of a clinical trial including set-up, management (also referred to as maintenance), and close-out. The risks and mitigation strategies in transitioning to ePRO/eCOA collection modes will be evaluated to provide guidance for the successful transition from paper to an integrated electronic PRO/COA solution. In this age of technological advancements, including an integration plan in clinical trials, can help to alleviate many of the obstacles in transitioning from paper to electronic PRO/COA while also mitigating potential risks and minimizing the burden to patients and clinical trial personnel.

Facilitating the Sharing of Patient Information Between Health Care Providers

The South Eastern Integrated Information Portal (SHIIP) is a portal-based technology solution that provides real-time feedback and summarized data to enhance and help plan care. This tool supports the Health Links program, which provides a new model for care in Ontario at the clinical level, in which all health care services in a community accessed by a patient are coordinated into a single plan. SHIIP provides the technology to enables a multi-agency care process by collecting patient demographic and clinical data from hospital databases. Some projected benefits include enhanced patient experience, reduced workflow and improvements in the efficiency of access to patient information.

Abstract IA27: NCORP cancer care delivery research: A new opportunity for studying cancer disparities

Abstract Limitations in the availability and quality of cancer care have been associated with poor outcomes in medically underserved populations, independent of any biological factors. Differential access and care variation have been documented for many types of cancer and in all phases of care from screening through end-of-life. Patient-level interventions have had a modest impact on cancer disparities that arise in the process of care delivery. Challenges to further understanding and addressing care disparities include reliance on secondary use of data collected for other purposes (e.g., SEER-Medicare) and primary data collection in settings not reflective of the community (e.g., integrated delivery systems). The NCI Community Oncology Research Program (NCORP) integrates a cancer care delivery component offering a new opportunity to study cancer disparities. Cancer care delivery research is defined as the development of “new and generalizable knowledge about the effectiveness, acceptability, cost, optimal delivery mode, active ingredients, and causal mechanisms that influence outcomes and affect the value of cancer care, across diverse settings and populations” (Kent EE et al. J Clin Oncol 2015; 33:2705-11). The ultimate goal is “evidence-based practice change [that will] improve clinical outcomes, enhance patient experiences, and optimize value” (Kent et al.). As is the case for all NCORP efforts, cancer care delivery research considers issues of the medically underserved, particularly racial/ethnic minorities and rural residents, a particular focus. This presentation will describe cancer care delivery research and provide examples of cancer care disparities research that could be conducted within NCORP. Citation Format: Ann M. Geiger. NCORP cancer care delivery research: A new opportunity for studying cancer disparities. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA27.

Impact of wearable technology on psychosocial factors of osteoarthritis management: a qualitative study

ObjectivesTo identify the impact the use of wearable technology could have in patients with osteoarthritis in terms of communication with healthcare providers and patients’ empowerment to manage their condition.DesignQualitative study...

Patient-centered Information System to Enhance Patient Experience for the Elderly and Provide Strategic Advantage for the Provider

Despite the widespread provider acceptance of health information systems (HIS), there is little empirical evidence and no clear understanding that patient-centered HIS enhance the patient experience. This is especially true for elderly patients, whose involvement in their own care, through the use of a HIS, may have a major impact on their experience. In this study, we review opportunities for developing HIS features that support the integration of services for elderly patients while providing strategic advantages for the provider. We use the customer resource life cycle (CRLC) concept to identify the needs of patients at all stages of dealing with provider throughout the care delivery. To do so, we developed a scale that contained multiple statements for each of the 13 stages of CRLC. Then, using Q-methodology, we asked elderly patients to sort the statements in regard to HIS features that they would find beneficial if they were available to them. Using partial least squares (PLS) analysis, we tested our structural model and hypotheses and found that the perceived benefit of a patient-centered HIS has a direct effect on perceived patient experience when mediated by patient education.

Protocol investigating the clinical outcomes and cost-effectiveness of cognitive-behavioural therapy delivered remotely for unscheduled care users with health anxiety: randomised controlled trial.

BackgroundHealth anxiety and medically unexplained symptoms cost the National Health Service (NHS) an estimated £3 billion per year in unnecessary costs with little evidence of patient benefit. Effective treatment is rarely taken up due to issues such as stigma or previous negative experiences with mental health services. An approach to overcome this might be to offer remotely delivered psychological therapy, which can be just as effective as face-to-face therapy and may be more accessible and suitable.AimsTo investigate the clinical outcomes and cost-effectiveness of remotely delivered cognitive–behavioural therapy (CBT) to people with high health anxiety repeatedly accessing unscheduled care (trial registration: NCT02298036).MethodA multicentre randomised controlled trial (RCT) will be undertaken in primary and secondary care providers of unscheduled care across the East Midlands. One hundred and forty-four eligible participants will be equally randomised to receive either remote CBT (6–12 sessions) or treatment as usual (TAU). Two doctoral research studies will investigate the barriers and facilitators to delivering the intervention and the factors contributing to the optimisation of therapeutic outcome.ResultsThis trial will be the first to test the clinical outcomes and cost-effectiveness of remotely delivered CBT for the treatment of high health anxiety.ConclusionsThe findings will enable an understanding as to how this intervention might fit into a wider care pathway to enhance patient experience of care.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-commercial, No Derivatives (CC BY-NC-ND) licence.

The Theory of Value-Based Payment Incentives and Their Application to Health Care.

ObjectivesTo present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value‐based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis.Data SourcesOriginal literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value‐based payment.Study DesignConceptual analysis and targeted review of theoretical research and empirical literature relevant to value‐based payment in health care.Principal FindingsAgency theory and secondarily behavioral economics have powerful implications for design of value‐based payment in health care. To achieve improved value—better patient experience, clinical quality, health outcomes, and lower costs of care—high‐powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value‐based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings.ConclusionsPayment contracts that are “incentive compatible”—which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate—will focus differentially on evidence‐based care processes, will right‐size and structure incentives to avoid crowd‐out of providers’ intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers.

Society of Behavioral Medicine (SBM) position statement: SBM supports increased efforts to integrate community health workers into the patient-centered medical home.

Integrating community health workers (CHWs) into health care systems has been associated with enhanced patient experience, improved population health, and reduced costs and unnecessary utilization of resources. Under the Affordable Care Act (ACA), care provided by CHWs is eligible for reimbursement. However, optimal integration of CHWs into health care requires purposeful implementation. This health policy brief is focused on the benefits of integrating CHWs specifically into the patient-centered medical home (PCMH). CHWs in the PCMH can serve as primary providers of culturally relevant information and advocacy, assist providers in understanding the influence of patients' environment on disease management, and enhance motivation for self-care management among patients with chronic diseases. Despite the important role of CHWs, there are some barriers to integration into existing systems of care. The Society of Behavioral Medicine (SBM) recommends overcoming these barriers by establishing standards that ensure a skilled CHW workforce, clearly defining roles for CHWs, and expanding the scope of reimbursable prevention and primary care services to include those provided by CHWs.

One-stop prostate imaging: multiparametric-MRI followed by TRUS-guided biopsy

Purpose The current role of prostate cancer imaging is to provide biopsy guidance and staging. Previously, magnetic resonance imaging (MRI) was used to pre-assess patients for radical therapy. Recently, multiparametric MRI (MP-MRI) has helped transform the diagnostic pathway through an improved yield in detecting and characterising cancer and is used prior to biopsy in many centres. At our centre, we have recently provided a one-stop same day service of MP-MRI to transrectal ultrasound (TRUS) for pre-selected patients. We investigate whether this service leads to a reduced time to management outcome. Methods and materials Three groups of 20 consecutive patients were identified: TRUS biopsy followed by staging MRI, MP-MRI after TRUS biopsy and the one-stop MP-MRI/TRUS biopsy patients. Date of referral to management outcome decision date was recorded from multi-disciplinary teams (MDT) and clinic letters. Results The mean days of referral to outcome is 75.0, 66.2 and 30.1 days for the TRUS biopsy followed by staging MRI, MP-MRI after TRUS biopsy and one-stop MP-MRI/TRUS biopsy respectively, with the latter group showing less variability. Conclusion A one-stop prostate imaging service in pre-selected patients allows localised staging prior to biopsy, identifies suspicious areas for a targeted biopsy, avoids the pitfalls of post biopsy artefact in MRI interpretation, expedites the MDT process and enhances patient experience. The current role of prostate cancer imaging is to provide biopsy guidance and staging. Previously, magnetic resonance imaging (MRI) was used to pre-assess patients for radical therapy. Recently, multiparametric MRI (MP-MRI) has helped transform the diagnostic pathway through an improved yield in detecting and characterising cancer and is used prior to biopsy in many centres. At our centre, we have recently provided a one-stop same day service of MP-MRI to transrectal ultrasound (TRUS) for pre-selected patients. We investigate whether this service leads to a reduced time to management outcome. Three groups of 20 consecutive patients were identified: TRUS biopsy followed by staging MRI, MP-MRI after TRUS biopsy and the one-stop MP-MRI/TRUS biopsy patients. Date of referral to management outcome decision date was recorded from multi-disciplinary teams (MDT) and clinic letters. The mean days of referral to outcome is 75.0, 66.2 and 30.1 days for the TRUS biopsy followed by staging MRI, MP-MRI after TRUS biopsy and one-stop MP-MRI/TRUS biopsy respectively, with the latter group showing less variability. A one-stop prostate imaging service in pre-selected patients allows localised staging prior to biopsy, identifies suspicious areas for a targeted biopsy, avoids the pitfalls of post biopsy artefact in MRI interpretation, expedites the MDT process and enhances patient experience.

Enhancing patient experience through personalization of health services.

Patient engagement is a challenge many leaders are facing, as consumer expectations of health services demand a more personalized approach to care. This article examines consumer trends that are influencing patient engagement and empowerment relative to the use of digital technologies. Informed by consumer and population health trends that can personalize health services, three strategies leaders can engage to strengthen patient experience include placing greater focus on personal health and wellness, shifting towards personalized rather than standardized healthcare, and facilitating the democratization of healthcare information.

The Power of Alignment: Pioneering New Collaborations During Transformational Change.

Both health care reform and the Triple Aim call for enhanced patient experience, improved health outcomes, and reduced costs. To achieve these goals, we must collaborate across health care and community organizations, across fields of expertise, and across the continuum of care. As collaboration is one of nursing's core competencies, nurses are ideally positioned to lead the drive toward the Triple Aim. This article outlines 3 key areas of collaboration and describes successful interventions that the Visiting Nurse Service of New York has developed in these areas: as community organizers, partnering with health, grassroots, and government agencies; as transitional integrators, partnering with acute-care facilities to reduce rehospitalizations; and across populations, partnering in new ways to help patients manage chronic and complex health issues in the context of their families and communities.

P152 What kind of information do patients want to see in sexual health clinic waiting rooms?

<h3>Background/introduction</h3> All sexual health clinics have noticeboards and leaflets in their waiting rooms carrying a range of information, but little is known about the kind of information patients find most useful. This survey was designed to gain insight into the type of information patients most prefer to see in order to enhance patient experience. <h3>Aim(s)/objectives</h3> To conduct a patient survey of preferences for information provided in sexual health clinic waiting rooms. <h3>Methods</h3> 133 consecutive patients attending the integrated clinic were asked to complete a simple questionnaire covering the following areas: (1) how much attention is given to the information available; (2) Which types of information are most useful; (3) Preference for pictures, written text or a combination; (4) Importance of information that can be taken away. <h3>Results</h3> 53% looked at most of the information, 32% only read what looked interesting or relevant while 15% took little notice. Facts about STI’s were the most useful (64%), followed by prevention messages (51%), contact details of other organisations/services (49%), information about local/national campaigns (41%) and boards with specific themes (e.g. Valentine’s day, Fresher’s Week) (33%). 55% preferred a combination of pictures and text, 41% mainly text and 37% mainly pictures. 74% attached a high importance to information which could be taken away. <h3>Discussion/conclusion</h3> 85% of patients paid significant attention to the information presented in the waiting room. Patients found factual information about STI’s to be most useful followed by prevention messages. There was a clear preference for messages that combined text with pictures.

Redesigning emergency patient flow with timely quality care at the Alfred.

The 4 h National Emergency Access Target was introduced in 2011. The Alfred Hospital in Melbourne implemented a hospital-wide clinical service framework, Timely Quality Care (TQC), to enhance patient experience and care quality by improving timeliness of interventions and investigations through the emergency episode and admission to discharge in 2012. We evaluated TQC's effect on achieving the National Emergency Access Target and associated safety and quality indicators. Retrospective analysis with piecewise regression of 215 125 ED attendances before/after implementation, November 2009 to August 2013; with comparison of proportions of patients discharged, admitted or transferred from ED within 4 h of arrival; left at risk; unplanned ED re-attendances up to 28 days; ED length of stay; and in-hospital mortality. The percentage of patients admitted, discharged or transferred within 4 h rose from 60% in 2010, to 74% in 2013. Median ED length of stay decreased significantly. Rate of unplanned ED re-presentations decreased by 27%, 22% and 17% within 24 h, 48 h and 7 days, respectively; and patient numbers leaving at risk halved from 8% to 4%. Mortality for admitted patients declined from 3.5% to 2.2%. All results were statistically significant. TQC resulted in improvement in timeliness of care for emergency patients without compromising safety and quality. Success is attributed to effective engagement of stakeholders with a hospital-wide approach to redesigning the care pathway and establishing a new set of principles that underpin care from the time of ED arrival.

Focus on emotional intelligence in medical education: From problem awareness to system-based solutions

Objective: To review emotional intelligence (EI) literature in the context of how its application can help mediate various stressors among medical students, physicians-in-training, and faculty. Also, discussed are potential barriers to why EI-based programs face challenges to full implementation in medical education. Literature Search: MEDLINE, PsychINFO, EMBASE, Google Scholar, and Web of Science were searched for English language articles using various combinations of the following terms: EI, medical students, medical education, graduate medical education, trainees (including intern, resident, and residency), practitioners, and physicians. Electronic publications and printed books referenced by primary sources were also included. Results: Although there is increasing evidence for EI implementation being favorably associated with physician wellness, decreasing burnout, building better physician-patient relationships, and even better patient outcomes, there has so far not been a large scale movement to integrate EI into medical school curricula. The main barriers to wider implementation of EI are general lack of awareness, insufficient time and resources, and paucity of qualified faculty. Conclusions: Despite a number of associated potential benefits, EI has been facing various implementation hurdles in the medical education setting. Increasing awareness of EI and its benefits could help medical schools and residency programs around the globe to more actively engage in the implementation of EI training into medical school and residency curricula. We expect that such interventions would have several desirable outcomes, including improved overall physician wellness, enhanced patient experience, and perhaps even improved patient outcomes. The following core competencies are addressed in this article: Practice-based Learning and Improvement, Patient care, Professionalism, Interpersonal and communication skills, Systems-based practice.