Patient-centered Care Outcomes Research Articles

Differences by Sexual Orientation in Patient-Centered Care Outcomes for Veterans Utilizing Primary Care Services at the Veterans Health Administration.

Purpose: This study examined the differences by sexual orientation in patient-centered care outcomes (including health care experiences and health-related screening) of veterans utilizing Veterans Health Administration (VHA) primary care. Methods: VHA's adapted version of the Consumer Assessment of Healthcare Providers and Systems was used to compare the health care experience of primary care services among sexual minority (SM) and heterosexual veterans. Health care experience measures were dichotomized to "always" versus "less" and stratified by SM status. Health-related screening measures were dichotomous. Survey data were weighted using provided sample weights. Descriptive statistics were performed on sociodemographic characteristics. Logistic regression coefficients were represented as adjusted odds ratios (aORs). A total of 66,348 veterans were included in the analytic sample, of which 2.9% (n = 1,935) identified as SM. Sexual orientation was ascertained by self-report measures by veterans. Results: SM veterans were significantly younger (56.95 years vs. 63.43 years, p < 0.001), were less likely to report that their provider showed respect for what they had to say (aOR: 0.76; 95% confidence interval [CI]: 0.61-0.95), that they were asked about difficulties taking care of their health (aOR: 0.81; 95% CI: 0.67-0.96), and their provider listened carefully to them (aOR: 0.71; 95% CI: 0.57-0.87) compared to heterosexual veterans. Conclusion: Health care experiences differed between SM and heterosexual veterans who sought VHA primary care, suggesting the need to increase provider trainings, which may improve cultural competency and promote a more welcoming and inclusive environment.

Mobile health platform for self-management of pediatric cystic fibrosis: Impact on patient-centered care outcomes

Previously, we adapted a mobile health platform (Genia) to the needs of patients and families in a pediatric CF center in the United States. In this feasibility study, we tested the impact of Genia on measures of patient-centered care. In a one-group pre-post study with adolescents with CF and caregivers of children with CF, we tested Genia's effect over 6 months on patient satisfaction with chronic illness care (PACIC) and shared decision-making (CollaboRate). Feasibility and acceptability were assessed with exit interviews and app analytics. The intervention included 40 participants: 30 caregivers of children with CF age ≤14 years and 10 patients with CF age ≥15 years. The use of Genia was associated with increased satisfaction with care (p=0.024), including delivery system and decision support (p=0.017), goal setting (p=0.006), and shared decision-making (p<0.001). The use of Genia was associated with nominal improvements in all QOL domains and symptom scales. The platform was feasible, with participants recording more than 4,400 observations (mean 84.2) and submitting 496 weekly reports (mean 13.8) and 70 quarterly reports (mean 1.8), and acceptable (95% retention rate). For participants, the most useful app feature was pre-visit reports (66.7%), and the top symptom trackers were those for cough (23.7%), appetite (21.1%), energy (18.4%), and medicines (18.4%). The use of Genia over 6 months was feasible, acceptable, and associated with improved measures of patient-centered care. Study results support wider use of Genia in clinical settings. Efficacy for clinical outcomes should be assessed in a randomized clinical trial.

Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes.

Several recently published studies and consensus statements have demonstrated that there is only modest (and in many cases, low-quality) evidence that mobile health (mHealth) can improve patient clinical outcomes such as the length of stay or reduction of readmissions. There is also uncertainty as to whether mHealth can improve patient-centered outcomes such as patient engagement or patient satisfaction. One principal challenge behind the “effectiveness” research in this field is a lack of common understanding about what it means to be effective in the digital space (ie, what should constitute a relevant outcome and how best to measure it). In this viewpoint, we call for interdisciplinary, conceptual clarity on the definitions, methodologies, and patient-centered outcomes frequently used in mHealth research. To formulate our recommendations, we used a snowballing approach to identify relevant definitions, outcomes, and methodologies related to mHealth. To begin, we drew heavily upon previously published detailed frameworks that enumerate definitions and measurements of engagement. We built upon these frameworks by extracting other relevant measures of patient-centered care, such as patient satisfaction, patient experience, and patient activation. We describe several definitional inconsistencies for key constructs in the mHealth literature. In an effort to achieve clarity, we tease apart several patient-centered care outcomes, and outline methodologies appropriate to measure each of these patient-care outcomes. By creating a common pathway linking definitions with outcomes and methodologies, we provide a possible interdisciplinary approach to evaluating mHealth technologies. With the broader goal of creating an interdisciplinary approach, we also provide several recommendations that we believe can advance mHealth research and implementation.

Assessing the Impact of Patient-Facing Mobile Health Technology on Patient Outcomes: Retrospective Observational Cohort Study.

BackgroundDespite the growth of and media hype about mobile health (mHealth), there is a paucity of literature supporting the effectiveness of widespread implementation of mHealth technologies.ObjectiveThis study aimed to assess whether an innovative mHealth technology system with several overlapping purposes can impact (1) clinical outcomes (ie, readmission rates, revisit rates, and length of stay) and (2) patient-centered care outcomes (ie, patient engagement, patient experience, and patient satisfaction).MethodsWe compared all patients (2059 patients) of participating orthopedic surgeons using mHealth technology with all patients of nonparticipating orthopedic surgeons (2554 patients). The analyses included Wilcoxon rank-sum tests, Kruskal-Wallis tests for continuous variables, and chi-square tests for categorical variables. Logistic regression models were performed on categorical outcomes and a gamma-distributed model for continuous variables. All models were adjusted for patient demographics and comorbidities.ResultsThe inpatient readmission rates for the nonparticipating group when compared with the participating group were higher and demonstrated higher odds ratios (ORs) for 30-day inpatient readmissions (nonparticipating group 106/2636, 4.02% and participating group 54/2048, 2.64%; OR 1.48, 95% CI 1.03 to 2.13; P=.04), 60-day inpatient readmissions (nonparticipating group 194/2636, 7.36% and participating group 85/2048, 4.15%; OR 1.79, 95% CI 1.32 to 2.39; P<.001), and 90-day inpatient readmissions (nonparticipating group 261/2636, 9.90% and participating group 115/2048, 5.62%; OR 1.81, 95% CI 1.40 to 2.34; P<.001). The length of stay for the nonparticipating cohort was longer at 1.90 days, whereas the length of stay for the participating cohort was 1.50 days (mean 1.87, SD 2 vs mean 1.50, SD 1.37; P<.001). Patients treated by participating surgeons received and read text messages using mHealth 83% of the time and read emails 84% of the time. Patients responded to 60% of the text messages and 53% of the email surveys. Patients were least responsive to digital monitoring questions when the hospital asked them to do something, and they were most engaged with emails that did not require action, including informational content. A total of 96% (558/580) of patients indicated high satisfaction with using mHealth technology to support their care. Only 0.40% (75/2059) patients opted-out of the mHealth technology program after enrollment.ConclusionsA novel, multicomponent, pathway-driven, patient-facing mHealth technology can positively impact patient outcomes and patient-reported experiences. These technologies can empower patients to play a more active and meaningful role in improving their outcomes. There is a deep need, however, for a better understanding of the interactions between patients, technology, and health care providers. Future research is needed to (1) help identify, address, and improve technology usability and effectiveness; (2) understand patient and provider attributes that support adoption, uptake, and sustainability; and (3) understand the factors that contribute to barriers of technology adoption and how best to overcome them.

Assessing Medicare Patients' Salient Beliefs to Improve Annual Wellness Visit Health Outcomes.

OBJECTIVE: To identify key beliefs that influence behavior, regarding Medicare's Annual Wellness Visit (AWV) and older patients' willingness to implement personalized prevention plans.<br/> DESIGN: Cross-sectional. In-depth semi-structured focus group sessions with Medicare patients in July 2018.<br/> SETTING: Two primary care physician-based practices.<br/> INTERVENTION: A trained moderator facilitated two focus group sessions, and used open-ended questions based on the theory of planned behavior to elicit behavioral, normative, and control beliefs associated with implementing personalized prevention plans.<br/> MAIN OUTCOME MEASURE: Content analysis of the focus groups' transcribed data was used to identify modal salient beliefs. Transcribed focus group sessions were analyzed utilizing grounded-theory methods for emergent themes.<br/> RESULTS: A total of 13 older patients participated in the focus group sessions. Prevalent behavioral beliefs among participants influenced by patient-centered care outcomes included improvement in physical activity, adopting a healthy balanced diet, and weight loss.<br/> Interpersonal and environmental disparities influenced commonly reported control factors such as lack of support at home and affordable fitness facilities. Macro-level influences such as physicians and social marketing by insurance providers, and health partners and spousal support were identified as important normative factors.<br/> CONCLUSION: Identified salient beliefs were congruent to social determinants of health in Medicare patients. Results of the study demonstrate perceived enablers and barriers of elderly patients regarding implementing health-promoting advice. AWV pharmacists should address perceived barriers to improve attitudes and self-efficacy; and incorporate enabling beliefs into adherence strategies to improve adoption of health recommendations.

Perceptions of patient-centered care among Veterans with gastroesophageal reflux disease on proton pump inhibitor therapy.

The aim of this study was to explore perceptions of patient-centered care (PCC) among Veterans with gastroesophageal reflux disease (GERD) on proton pump inhibitor (PPI) therapy using patient-reported outcome (PRO) measures. We used three validated surveys to measure PCC concepts in a national sample of Veterans with GERD on PPIs. The Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness (COMRADE) measures patient experiences with risk communication and decision-making. The Patient Activation Measure (PAM) evaluates confidence and knowledge needed for self-management. The Patient Assessment of Care for Chronic Conditions (PACIC) assesses views of chronic care received. We used descriptive statistics to describe patient characteristics and PCC outcomes. Respondents (n=444) were mostly male (95.1%) with a mean age of 67.7 years. The mean COMRADE score measuring patient experiences with risk communication was 55.3 (SD=19.0). The mean PAM score was 56.1 (SD=19.2); 47.8% of respondents were considered disengaged patients lacking confidence and knowledge for self-management. The mean PACIC summary score was 3.03 (SD=1.2), with highest scores in the Delivery System Design/Decision Support (3.38, SD=1.2) subscale, and lowest scores in Follow-up/Coordination (2.58, SD=1.3). Veterans reported that care was well-organized and supportive in enhancing decision-making. Potential gaps may exist in delivering follow-up care, enhancing patient activation, and informing patients about risks of available GERD treatments. This is the first study to evaluate patient perceptions of PCC in a national sample of Veterans with GERD on PPIs. Findings can inform further investigation and development of targeted interventions to enhance patient experiences among individuals with GERD.

Determinants of stigma in a cohort of hellenic patients suffering from multiple sclerosis: a cross-sectional study.

BackgroundPatients suffering from several neurologic disorders may bear the “stigma” of their disease, being disqualified from full social acceptance. Although stigma is considered to be present in Multiple Sclerosis (MS), the factors that influence its levels are ambiguous. Aim of our study was to examine, for the first time in the literature, the basic determinants of stigma in a Hellenic MS-patients cohort, as well as how stigma affects their Quality-of-Life (QoL) profiles.MethodsThree hundred forty two patients were recruited in this study. Data collected concerned sociodemographic and disease-related variables, mental illness assessment, Multiple-Sclerosis-QoL-54 (MSQoL-54) and Stigma-Scale-for-Chronic-Illness-24 (SSCI-24) questionnaires. Potential determinants were evaluated with univariate statistical analyses for their contribution to total, internalized (inner-self derived) and externalized (society derived) stigma. Important findings were further evaluated on hierarchical regression models.ResultsDisability levels were found to be the most powerful predictor in all stigma categories, followed by the presence of mental illness. Working and caregiving status were also ascertained as determinants of internalized stigma. Stigma levels displayed strong negative correlation with all composites of MSQoL-54.ConclusionsStigma is present in the social environment of MS patients and was confirmed as a barrier (according to the International Classification of Functioning, Disability and Health), with detrimental effects on their QoL levels and functioning performances. Disability and mental illness were shown as the principal determinants of stigma, while financial characteristics were not as equally involved. Further validation of these results in other MS populations may provide safer conclusions, towards more efficacious patient-centered care outcomes.

Tu1096 Perceptions of Patient-Centered Care Among Veterans With Gastroesophageal Reflux Disease on Proton Pump Inhibitor Therapy

Background. Limited data exist describing patient-centered care (PCC) outcomes among patients with gastroesophageal reflux disease (GERD) on proton pump inhibitor (PPI) therapy. The study purpose was to use a patient-reported outcome measure to explore perceptions of care among patients with GERD on PPI therapy. Methods. The Center for Evaluation of Practices and Experiences of Patient Centered Care (CEPEP) is a VA funded project to evaluate various PCC outcomes, using mailed validated surveys to Veterans with chronic conditions seen across 8 nationally representative VA centers. We analyzed the Patient Assessment of Care for Chronic Conditions (PACIC) in a subset of Veterans diagnosed with GERD and prescribed PPI therapy. The PACIC assesses patient views of the chronic care received and is organized into five subscales that address elements of patient-centered care as perceived by patients (Patient Activation, Delivery System Design/Decision Support, Goal Setting, Problem Solving/Contextual Counseling, and Follow-up/Coordination). Overall summary and subscale scores range from 1-5; higher scores indicate higher subjective ratings of health care received. We used descriptive statistics to describe patient characteristics and assess if PPI dosing (standard vs high dose) or duration of therapy (short term = 6 mo) was associated with perception of care received. Results. Veteran patients with GERD on PPI (n=501) were mostly male (94.6%), white/non-Hispanic (70.6%), and, on average, 68 years of age. 67.5% of respondents reported having 3 or more chronic conditions. Nearly all respondents (99.8%) reported having one or more recent outpatient visits; 24.8% reported one or more recent ER visits. 53.1% had high total daily dose initial PPI prescriptions; 46.9% had standard total daily dose initial prescriptions. A majority of respondents (87.6%) reported long-term PPI use. The mean PACIC summary score for the entire sample was 3.01 (SD=1.16). 39.0% of respondents achieved an overall PACIC summary score of 3.5 or higher. Respondents achieved highest scores overall in the Delivery System Design/Decision Support (3.36, SD=1.19) and Patient Activation subscales (3.23, SD=1.26); lowest scores were achieved in the Follow-up/Coordination subscale (2.56, SD=1.26) and the Goal Setting/Tailoring subscale (2.97, SD=1.27).Mean subscale score for Problem Solving/ Contextual Counseling was 3.21, SD=1.35. There were no differences in PACIC scores by PPI dose or duration of therapy. Conclusions. Veterans with GERD on PPI therapy were generally activated in their care and perceived care to be supportive in enhancing their own understanding of care. However, further efforts are needed to explore if PCC outcomes are associated with GERD symptom control, particularly in areas of follow-up support, tailored goal setting and coordination of care.

An Analysis of Posthospitalization Telephone Survey Data

As part of a study of patient-centered care outcomes that requires the ability to be interviewed by telephone after hospitalization, 4,600 adult patients on 118 medical-surgical units in 17 midwestern hospitals selected by stratified random sampling were identified as potential subjects. This article describes response-rate differences and reasons for nonparticipation by gender, age, ethnicity, and race. Issues related to understanding and reporting response rates, reducing losses due to ineligibility, dealing with refusals, and tailoring survey approaches to special populations are discussed.