Healthcare Experiences Of Patients Research Articles

Undocumented Immigration Status and Diabetes Care Among Mexican Immigrants In Two Immigration “Sanctuary” Areas

The objective of this study is to investigate the relationship between immigration status and the patient experience of health care, diabetes self-management, and clinical outcomes among Mexican immigrants with diabetes receiving health care in two immigration sanctuary cities. We used data from the Immigration, Culture and Health Care study, a cross-sectional survey and medical record study of low-income patients with diabetes recruited from public hospitals and community clinics in the San Francisco Bay Area and Chicago. Undocumented Mexican, documented Mexican immigrants, and US-born Mexican-Americans' health care experiences, diabetes self-management, and clinical outcomes were compared using multivariate linear and logistic regressions. We found no significant differences in reports of physician communication, or in measures of diabetes management between undocumented and documented immigrants. All three groups had similar clinical outcomes in glycemic, systolic blood pressure, and lipid control. These results indicate that, at least in some settings, undocumented Mexican immigrants with diabetes can achieve similar clinical outcomes and report similar health care experiences as documented immigrants and US-born Mexican-Americans.

Aspects of Culturally Competent Care are Associated With Less Emotional Burden Among Patients With Diabetes

Diabetes distress is associated with poor diabetes self-management and worse clinical outcomes. Whether there is an association between patient experience of health care and degree of emotional burden (EB) of diabetes distress is not known. To investigate whether aspects of culturally competent care are associated with the EB of diabetes distress. Cross-sectional survey consisting of face-to-face interviews. A total of 502 ethnically diverse patients with diabetes receiving care in safety-net clinics in 2 cities. The main outcome measure was high EB on the Diabetes Distress Scale (mean score ≥ 3). The predictors were 3 domains (Doctor Communication--Positive Behaviors, Trust, and Doctor Communication-Health Promotion) of the Consumer Assessment of Healthcare Providers and Systems--Cultural Competence (Consumer Assessments of Healthcare Providers and Systems' Cultural Competence Item Set) instrument. Of 502 patients, 263 (52%) reported high EB. In adjusted logistic regressions controlling for sociodemographic and clinical factors, patient report of optimal Doctor Communication-Positive Behaviors (adjusted odds ratio, 0.46; 95% confidence interval, 0.39-0.54), and optimal Trust (adjusted odds ratio, 0.65; 95% confidence interval, 0.54-0.78) were associated with lower EB. Doctor Communication-Health Promotion Communication was not associated with EB. Patient report of better doctor communication behavior and higher trust in physician are inversely associated with high EB among patients with diabetes. Further research should determine whether interventions improving patient physician communication and trust can lower the EB of diabetes.

Partnering With Family Members to Improve the Intensive Care Unit Experience

Family members play an important and varied role in a patient's health care experience, ranging from emotional support to surrogate health care decision making. The family role can be substantial in the intensive care unit setting, as the patients rely upon family members to make health care decisions for them. The core components of patient- and family-centered care include information sharing, a welcoming environment, respect for individual values and needs, comfort and support, and providing a helpful framework for developing a productive partnership with family members. Involving family members in daily operations and providing services that make it easier for family members to participate in the care process result in the best possible care for their loved one. Including the family perspective in quality improvement initiatives better ensures that any changes made will result in better care for future patients and family members.

Patient-Centered Care and Community Engagement

When you think of patient-centered care, do you immediately think of the hospitalized patient? Hospital-based care is only part of the picture. In the current regulatory environment, community engagement within a patient-centered framework has become increasingly important.CARING FOR THE COMMUNITYIn 2001, the Institute of Medicine (IOM) released its seminal report, Crossing the Quality Chasm: A New Health System for the 21st Century. This report identified six aims for improving the US healthcare system by asserting that care must be safe, effective, patient centered, timely, efficient, and equitable. The IOM further asserted that leaders can support accountability to individual patients while also assuming responsibility to the community at large for the populations they serve.Many patient-centered hospitals have expanded their approach beyond care to the hospitalized patient. Many offer quality and safety programs for community members. In addition, through prevention programs and other efforts, these hospitals focus on preventing disease and promoting health to meet the entire community's healthcare needs (Frampton et al. 2008).COMMUNITY HEALTH NEEDS ASSESSMENTHealthcare leaders must first identify and prioritize community health needs (IOM 2001). According to Section 9007 of the Patient Protection and Affordable Care Art (ACA), all 501(c)(3) hospitals must conduct a community health needs assessment (CHNA) every three years and adopt a strategy for its implementation in order to maintain their tax-exempt status (PPACA 2010).A CHNA seeks to understand and document health status, behaviors, and needs in the community served by the hospital (Bilton 2011). Collected data can then be used to develop strategies to address identified needs, with the goal of contributing to improvements in the community's health. The patient-centered model has been identified as a way to reduce avoidable emergency care use and hospitalizations and a resource-effective way to manage chronic disease and provide coordinated care among the population (Davey 2011). Overall, patient-centered care, whether in the hospital or in the community, can result in better healthcare delivery and improved patient outcomes (Patient-Centered Primary Care Collaborative 2012).PATIENT-CENTERED CARE AND THE COMMUNITYPlanetree has greatly advanced the concept of patient-centered care and is an internationally recognized leader in the field. Planetree has worked to personalize, humanize, and demystify the healthcare experience for patients and their families since 1978 (Planetree 2012). A key component of the Planetree philosophy is the creation of healthy communities; the group believes that hospitals are successfully redefining healthcare to include the health and wellness of the communities they serve (Planetree 2012). Many patient-centered hospitals have successfully engaged with their communities in the design and implementation of outreach programs, resulting in a positive impact on the quality of health. …

Risk of Smoking and Receipt of Cessation Services Among Veterans With Mental Disorders

The purpose of this study was to determine rates of smoking and receipt of provider recommendations to quit smoking among patients with mental disorders treated in U.S. Department of Veterans Affairs (VA) treatment settings. The authors conducted a secondary analysis of the yearly, cross-sectional 2007 Veterans Health Administration Outpatient Survey of Healthcare Experiences of Patients (N=224,193). Logistic regression was used to determine the independent association of mental health diagnosis and the dependent variables of smoking and receipt of provider recommendations to quit smoking. Patients with mental disorders had greater odds of smoking, compared with those without mental disorders (p<.05). Those with various mental disorders reported similar rates of receiving services (more than 60% to 80% reported receiving selected services), compared with those without these disorders, except that those with schizophrenia had more than 30% lower odds of receiving advice to quit smoking from their physicians (p<.05). Moreover, those who had co-occurring posttraumatic stress disorder or substance use disorders had significantly greater odds of reporting that they received advice to quit, recommendations for medications, and physician discussions of quitting methods, compared with those without these disorders (p<.05). Older patients, male patients, members of ethnic minority groups, those who were unmarried, those who were disabled or unemployed, and those living in rural areas had lower odds of receiving selected services (p<.05). The majority of patients with mental disorders served by the VA reported receiving cessation services, yet their smoking rates remained high, and selected groups were at risk for receiving fewer cessation services, suggesting the continued need to disseminate cessation services.

Patient Satisfaction as a Function of In-House Versus Contract Staffing Models in Veterans Affairs Community-Based Outpatient Clinics

As part of decision support for Central Arkansas Veterans Healthcare System, this research evaluated patient satisfaction differences associated with contract versus Veterans Affairs (VA) staffing of community-based outpatient clinics (CBOCs). The research question was as follows: What differences exist between contract versus VA-staffed outpatient clinics in the areas of patient perceptions of access, continuity of care, courtesy, education and information, emotional support, overall coordination, visit coordination, and patient preferences? The quarterly Survey of Healthcare Experiences of Patients provided satisfaction data necessary for this study. Results of Bonferonni-corrected z-tests of proportions indicated that the VA-staffed CBOCs had statistically higher scores for continuity of care, education and information, emotional support, overall coordination, and patient preferences. No statistically significant difference emerged for patient perception of access, courtesy, and visit coordination. The lack of finding associated with visit coordination coupled with the statistically significant difference for overall coordination suggests that coordination for non-VA-staffed CBOCs erodes after the patient encounter. In toto, patients reported higher satisfaction with in-house staffing solutions versus contractor solutions. The authors recommend additional cost-utility research to identify which of the two models, VA-staffed or non-VA-staffed, best meets the needs of all stakeholders.

P1-371 What's politics got to do with global healthcare? A multilevel examination of individual-patient reports of health system responsiveness in 45 low, middle and high income

IntroductionPatient responsiveness, often measured as patient experiences of healthcare, is a core dimension of health system functioning. Seldom is this investigated globally, with little known about the influence of politics...

The establishment of a primary spine care practitioner and its benefits to health care reform in the United States

It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs). Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome.

How GPs can help reduce inappropriate attendance

York District Hospital emergency department (ED) piloted a scheme in which GPs work alongside ED staff. By seeing and treating minor cases, the GPs allowed ED staff more time to care for acutely ill patients, thereby reducing waiting times and the rate of inappropriate attendance, and improving patient flow. This article discusses the scheme and a qualitative review of how staff perceived it. Findings from the review suggest that the introduction of GPs to EDs can improve the healthcare experience for staff and patients.

Characteristics and Correlates of Cigarette Use Among Recent U.S. Veterans

Little is known about the smoking habits and cessation efforts of veterans returning from Iraq and Afghanistan, many of whom will seek health care services in the public sector. This project documents rates of smoking and quit attempts among veterans receiving Veteran's Health Administration (VHA) health care and describes the relationship between current smoking use/cessation and demographic characteristics, quality of life, and potential alcohol misuse. A large representative sample of Iraq/Afghanistan era veterans was surveyed using the VA Survey of Healthcare Experiences of Patients (Wright, Craig, Campbell, Schafer, & Humble, 2006). One third of respondents reported smoking during the past year and 24% reported currently smoking. Current smoking status was more prevalent among those who reported less education and lower household income. Current smoking status was also related to lower mental and physical health quality of life and higher potential alcohol misuse scores. Quit attempts were significantly less common among reserve component veterans and quitters reported higher incomes and were slightly older. The frequency of cigarette smoking among recent veterans underscores the importance of addressing smoking cessation efforts within this population. Individual characteristics associated with current smoking, cessation efforts, and relapse may help tailor cessation treatment for this growing cohort of new veterans.

A brief questionnaire for assessing patient healthcare experiences in low-income settings

The aim of this study was to develop and to assess the validity and reliability of two brief questionnaires for assessing patient experiences with hospital and outpatient care in a low-income setting. Using literature review and data from focus groups (n = 14), we developed questionnaires to assess patient experiences with inpatient (I-PAHC) and with outpatient (O-PAHC) care in a low-income setting. Questionnaires were administered in person by trained interviewers. Construct validity was assessed with factor analysis; convergent validity was assessed by correlating summary scores for each scale with overall patient evaluations, and reliability was assessed with Cronbach's alpha coefficients. Eight health facilities in Ethiopia. Patients >18 years old who had a hospital stay >1 day (n = 230), and patients who received outpatient care (n = 486). Patient evaluations of health care experiences. The factor analysis revealed 12 items that loaded on five factors for the I-PAHC questionnaire. The O-PAHC showed similar results with 13 items that loaded on four factors. Summary scores for nearly all factors were significantly associated (P-value < 0.05) with the patient's overall evaluation score. The measure of reliability, Cronbach's alpha coefficients, showed good to excellent internal consistency for all scales. The I-PAHC on O-PAHC questionnaires can be useful in assessing patients' evaluations of care delivery in low-income settings. The questionnaires are brief and can be integrated into health systems strengthening efforts with the support of leadership at the health facility and the country levels.

Viewpoint: Canʼt Get No Satisfaction? The Real Truth Behind Patient Satisfaction Surveys

Viewpoint: Canʼt Get No Satisfaction? The Real Truth Behind Patient Satisfaction Surveys

Chronic Pancreatitis and Its Effect on Employment and Health Care Experience

Symptoms of chronic pancreatitis (CP) frequently hinder patients' ability to work. The aim of our study was to evaluate the impact of CP on employment patterns and health care experience. Patients with CP at 4 US pancreas centers were evaluated. A survey was given to each patient during an office visit between July 1, 2006 and October 31, 2007. One hundred eleven patient surveys were returned. The median age was 52 years; the median duration of CP symptoms was 8.2 years. Seventy-four percent had their work lives altered by CP, 60% reported an effect on their social lives, and 46% reported an effect on their spouse/significant other relationship (P < 0.03). Only 37% were currently employed. During the week before completing the survey, the patients who were employed reported absences from their job due to CP symptoms, a median of 14 hours. On at least 1 visit to the ED, 80% of respondents reported that they had not been treated with respect and dignity, 45% had been labeled an alcoholic, and 29% had been labeled a drug seeker. Chronic pancreatitis had a profound impact on employment patterns. Comprehensive efforts are needed to improve the health care experience of patients with this disease.

Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans

To compare the Veterans Health Administration (VHA) with the Medicare Advantage (MA) plans with regard to health outcomes. The Medicare Health Outcome Survey, the 1999 Large Health Survey of Veteran Enrollees, and the Ambulatory Care Survey of Healthcare Experiences of Patients (Fiscal Years 2002 and 2003). A retrospective study. Men 65+ receiving care in MA (N=198,421) or in VHA (N=360,316). We compared the risk-adjusted probability of being alive with the same or better physical (PCS) and mental (MCS) health at 2-years follow-up. We computed hazard ratio (HR) for 2-year mortality. Veterans had a higher adjusted probability of being alive with the same or better PCS compared with MA participants (VHA 69.2 versus MA 63.6 percent, p<.001). VHA patients had a higher adjusted probability than MA patients of being alive with the same or better MCS (76.1 versus 69.6 percent, p<.001). The HRs for mortality in the MA were higher than in the VHA (HR, 1.26 [95 percent CI 1.23-1.29]). Our findings indicate that the VHA has better patient outcomes than the private managed care plans in Medicare. The VHA's performance offers encouragement that the public sector can both finance and provide exemplary health care.

Veterans' perceptions of care by nurse practitioners, physician assistants, and physicians: A comparison from satisfaction surveys

To examine the differences in patient satisfaction with care provided by nurse practitioners (NPs), physician assistants (PAs), and physicians in the Veterans Health Administration (VHA) system. Secondary data was obtained from the VHA's Survey of Healthcare Experience of Patients (SHEP), a monthly survey designed to measure patient satisfaction. Descriptive statistics were calculated and categorical variables were summarized with frequency counts. Of the 2,164,559 surveys mailed to the veterans, 1,601,828 (response rate 64%) were returned. The study found that satisfaction scores increased by 5% when the number of NPs was increased compared to 1.8% when the number of physicians was increased and slightly increased or remained the same when the number of PAs was increased. Physician to PA/NP ratio was 7:3. The VHA is the largest healthcare system and the single largest employer of NPs and PAs in the country. This study shows that a majority of the primary care clinic patients prefer to see NPs as compared with PAs and physicians. Besides clinical care, NPs focus on health promotion, disease prevention, health education, attentiveness, and counseling. Physicians and PAs should be educated on these characteristics to promote patient satisfaction and expected outcomes.

A Longitudinal Analysis of Rural and Urban Veterans’ Health-Related Quality of Life

Cross-sectional studies have identified rural-urban disparities in veterans' health-related quality-of-life (HRQOL) scores. To determine whether longitudinal analyses confirmed that these disparities in veterans' HRQOL scores persisted. We obtained data from the SF-12 portion of the veterans health administration's (VA's) Survey of Healthcare Experiences of Patients (SHEP) collected between 2002 and 2006. During that time, the SHEP was randomly administered to approximately 250,000 veterans annually who had used VA outpatient services. We evaluated 163,709 responses from veterans who had completed 2 or more surveys during the years studied. Respondents were classified into rural-urban groups using ZIP Code-based rural-urban commuting area designations. We estimated linear regression models using generalized estimating equations to determine whether rural and urban veterans' HRQOL scores were changing at different rates over the time period examined. After adjustment for sociodemographic differences, we found that urban veterans had substantially better physical HRQOL scores than their rural counterparts and that these differences persisted over the study period. While urban veterans had worse mental HRQOL scores than rural veterans, those differences diminished over the time period studied. Rural-urban disparities in HRQOL scores persist when tracking veterans longitudinally. Reduced access among rural veterans to care may contribute to these disparities. Because rural soldiers are overrepresented in current conflicts, the VA should consider new models of care delivery to improve access to care for rural veterans.

Patients and family care givers' experiences around highly active antiretroviral therapy (HAART)

Even with advances in the medical management of HIV/AIDS, it remains an important cause of morbidity and mortality. Network members are a source of support and may be designated as the patient's surrogate therapeutic decision maker. However, little is known about the role of caregivers regarding highly active antiretroviral therapy (HAART) and adherence to medication, especially among low income and medically underserved HIV-infected individuals. The objective of this analysis was to explore patients and their caregivers' understanding, insight, and perceptions of HAART. This was a qualitative study conducted in an urban teaching hospital in the Bronx, NY, consisting of 144 adults with advanced HIV/AIDS and their informal/familial caregivers. Patients and caregivers completed in-depth interviews and brief questionnaires. The data were analyzed using standard qualitative techniques. Themes related to HAART efficacy, side effects, and adherence were identified in the discussions with both patients and their care providers. Looking for consistencies and discordant reports of patients–caregivers dyadic experience with HAART and their association with healthcare sentiment, it was found that the accounts of both members of the dyad were more likely to reflect positive feelings about the patient's healthcare experience when they shared perceptions about the treatment, and were more likely to have a negative viewpoint when the dyad was discordant about treatment. These findings support the importance for HIV healthcare providers to include both patients and their caregivers in discussions about HAART, in order to improve their understanding of and satisfaction with the medication, and, to ultimately contribute to patients' adherence. The study also suggests that healthcare teams may enhance dialog with patients and caregivers to create therapeutic decisions to accommodate the priorities and values of the patient and their family. Clinical, educational, and evaluating tools need to be further developed and evaluation to facilitate this process.

Associations Between Race and Ethnicity and Treatment for Chronic Pain in the VA

The purpose of this study was to identify racial and ethnic differences in patient-reported rates of treatment for chronic pain and ratings of pain-treatment effectiveness among veterans treated in Veterans Affairs (VA) facilities. This was a cross-sectional analysis of data from 255,522 veterans who participated in the VA Survey of the Healthcare Experiences of Patients (SHEP) in Fiscal Year 2005. Measures included demographics, the Veterans Rand Health Survey-12, a single item inquiring if the patient received treatment for chronic pain in the VA within the prior 12 months, and a single item asking the patient to rate the effectiveness of chronic pain care. In a logistic model adjusting for demographics, pain interference, and mental health status, male and female veterans who were Hispanic (OR 1.39 [95%CI 1.26-1.53] and OR 1.57 [1.02-2.43], respectively) or non Hispanic black (OR 1.43 [1.33-1.54] and OR 1.35 [1.02-1.78], respectively) were more likely to report receiving treatment for chronic pain in the prior 12 months compared to non Hispanic white veterans. Among veterans who reported receiving treatment for chronic pain, non Hispanic black men were less likely to rate pain-treatment effectiveness as very good or excellent, compared to non Hispanic white men (OR .809 [.720-.910]). In our study, Hispanic and non Hispanic black veterans reported receiving chronic pain treatment more frequently than white veterans. Among veterans reporting pain treatment, non Hispanic black men were somewhat less likely to report receiving highly effective treatment than white men. Further research is needed to understand the reasons for these differences and their potential clinical implications.

Cultural Competency in Health Care: Evaluating the Outcomes of a Cultural Competency Training Among Health Care Professionals

The purpose of this research was to examine the effectiveness of a cultural competency training program designed to improve the knowledge and skills of health care providers and administrators engaging in cross-cultural, clinical encounters. We conducted an evaluation study among 43 health care professionals (health care providers and health administrators) who attended a 4-hour cultural competency workshop. We used a post-then-pre method of self-reported evaluation to answer a key question: Does cultural competency training produce a measurable change in knowledge and skills relating to the care of patients from diverse cultural and ethnic backgrounds? The study findings suggest that there are statistically significant change in participants' self-report of knowledge and skills related to cultural competency. Our study shows that a cultural competency training program that integrates key topics as recommended by the Institute of Medicine and includes Culturally and Linguistically Appropriate Services in Health Care standards improves the knowledge and skills of health care providers and administrators. Following the training, the participants self-reported not only an enhanced understanding of the health care experiences of patients with diverse backgrounds, but also an improvement in their skills to effectively work in cross-cultural situations. In addition, our study offers a reliable, innovative, and time-efficient strategy--post-then-pre method-for evaluating the outcomes of 4-hour cultural competency training programs.

Associations Between Race and Ethnicity and Receipt of Advice About Alcohol Use in the Department of Veterans Affairs

This study sought to identify racial and ethnic differences in rates of alcohol-related advice given to veterans treated in Veterans Affairs (VA) facilities. This was a cross-sectional analysis of data from the VA Survey of the Healthcare Experiences of Patients (SHEP). Participants were 255,522 veterans treated in VA ambulatory clinics in fiscal year 2005. SHEP measures included alcohol consumption questions from the Alcohol Use Disorders Identification Test and an item inquiring whether a VA clinician had given advice about drinking. Logistic regression was used to examine relationships between race and ethnicity categories and receipt of alcohol-related advice. Covariate measures included demographic characteristics and physical and mental component summary scores from the Veterans RAND Health Survey (VR-12). Among veterans who consumed any alcohol, compared with veterans from the other racial or ethnic groups, Asian, Native Hawaiian, or Pacific Islander veterans were less likely to be in the medium and highest alcohol consumption categories and non-Hispanic white veterans were less likely to be in the highest alcohol consumption category (p<.001). In a model adjusting for demographic characteristics, physical and mental health status, and alcohol consumption category, among veterans who consumed any alcohol, those who were non-Hispanic black (odds ratio [OR]=1.65, 95% confidence interval [CI]=1.47-1.84), Hispanic (OR=1.56, CI=1.35-1.80), or non-Hispanic American Indian or Alaska Native (OR=1.56, CI=1.06-2.29) were more likely to report receiving alcohol-related advice, compared with non-Hispanic white veterans. The results suggest that veterans from certain minority groups are more likely than white veterans to report receiving alcohol-related advice in the VA, after the model is adjusted for demographic characteristics, health status, and alcohol consumption. Further research is needed to understand the underlying reasons for observed differences in receipt of alcohol-related advice and the potential clinical implications.