Healthcare Experiences Of Patients Research Articles

Effect on VA Patient Satisfaction of Provider's Use of an Integrated Viewer of Multiple Electronic Health Records.

To examine associations between patient perceptions that their provider was knowledgeable of their medical history and clinicians' early adoption of an application that presents providers with an integrated longitudinal view of a patient's electronic health records (EHR) from multiple healthcare systems. This retrospective analysis utilizes provider audit logs from the Veterans Health Administration Joint Legacy Viewer (JLV) and patient responses to the Survey of Patient Healthcare Experiences Patient-Centered Medical Home (SHEP/PCMH) patient satisfaction survey (FY2016) to assess the relationship between the primary care provider being an early adopter of JLV and patient perception of the provider's knowledge of their medical history. Multivariate logistic regression models were used to control for patient age, race, sex education, health status, duration of patient-provider relationship, and provider characteristics. The study used responses from 203,903 patients to the SHEP-PCMH survey in FY2016 who received outpatient primary care services from 11,421 unique providers. Most (91%) clinicians had no JLV utilization in the 6months prior to the studied patient visit. Controlling for patient demographics, length of the patient-provider relationship, and provider and facility characteristics, being an early adopter of the JLV system was associated with a 14% (adj OR 1.14, p < 0.000) increased odds that patients felt their provider was knowledgeable about their medical history. When evaluating the interaction between duration of patient-provider relationship and being an early adopter of JLV, a greater effect was seen with patient-provider relationships that were greater than 3years (adj OR 1.23, p < 0.000), compared to those less than 3years. Increasing the interoperability of medical information systems has the potential to improve both patient care and patient experience of care. This study demonstrates that early adopters of an integrated view of electronic health records from multiple delivery systems are more likely to have their patients report that their clinician was knowledgeable of their medical history. With provider payments often linked to patient satisfaction performance metrics, investments in interoperability may be worthwhile.

A network perspective of engaging patients in specialist and chronic illness care: The 2014 International Health Policy Survey.

BackgroundPatient engagement helps to improve health outcomes and health care quality. However, the overall relationships among patient engagement measures and health outcomes remain unclear. This study aims to integrate expert knowledge and survey data for the identification of measures that have extensive associations with other variables and can be prioritized to engage patients.MethodsWe used the 2014 International Health Policy Survey (IHPS), which provided information on elder adults in 11 countries with details in patient characteristics, healthcare experiences, and patient-physician communication. Patient engagement or support was measured with eight variables including patients’ treatment choices, involvement, and treatment priority setting. Three types of care were identified: primary, specialist and chronic illness care. Specialists were doctors specializing in one area of health care. Chronic illness included eight chronic conditions surveyed. Expert knowledge was used to assist variable selection. We used Bayesian network models consisting of nodes that represented variables of interest and arcs that represented their relationships.ResultsAmong 25,530 participants, the mean age was 68.51 years and 57.40% were females. The distributions of age, sex, education, and patient engagement were significantly different across countries. For chronic illness care, written plans provided by professionals were linked to treatment feasibility and helpfulness. Whether professionals contacted patients was associated with the availability of professionals they could reach for chronic illness care. For specialist care, if specialists provided treatment choices, patients were more likely to be involved and discuss about what mattered to them.ConclusionThe strategies to engage patients may depend on the types of care, specialist or chronic illness care. For the study on the observational IHPS data, network modeling is useful to integrate expert knowledge. We suggest considering other theory-based patient engagement in major surveys, as well as engaging patients in their healthcare by providing written plans and actively communicating with patients for chronic illnesses, and encouraging specialists to discuss and provide treatment options.

Embracing the wild profusion: A Foucauldian analysis of the impact of healthcare standardization on nursing knowledge and practice.

Standardization has emerged as the dominant principle guiding the organization and provision of healthcare, with standards resultantly shaping how nurses conceptualize and deliver patient care. Standardization has been critiqued as homogenizing diverse patient experiences and diminishing nurses' skills and critical thinking; however, there has been limited examination of the philosophical implications of standardization for nursing knowledge and practice. In this manuscript, I draw on Foucault's philosophy of order and categorization to inform an analysis of the consequences of healthcare standardization for the profession of nursing. I utilize three exemplars to illustrate the impact of the primacy of standardized thinking and practices on nurses, patients and families: pain assessments using the 0-10 pain scale; patient triage emergency departments through the Canadian Triage and Acuity Scale; and determination of cause of death within the context of the current opioid crisis. Through each exemplar, I demonstrate that standardization reductively constrains nursing knowledge and the health and healthcare experiences of patients and populations. I argue that the centrality of standardization must be re-envisioned to embrace the complexity of health and more effectively and meaningfully frame nursing knowledge and practice within healthcare systems.

The Role of Primary Care Experiences in Obtaining Treatment for Depression.

Managing depression in primary care settings has increased with the rise of integrated models of care, such as patient-centered medical homes (PCMHs). The relationship between patient experience in PCMH settings and receipt of depression treatment is unknown. In a large sample of Veterans diagnosed with depression, we examined whether positive PCMH experiences predicted subsequent initiation or continuation of treatment for depression. We conducted a lagged cross-sectional study of depression treatment among Veterans with depression diagnoses (n = 27,362) in the years before (Y1) and after (Y2) they completed the Veterans Health Administration's national 2013 PCMH Survey of Healthcare Experiences of Patients. We assessed patient experiences in four domains, each categorized as positive/moderate/negative. Depression treatment, determined from administrative records, was defined annually as 90days of antidepressant medications or six psychotherapy visits. Multivariable logistic regressions measured associations between PCMH experiences and receipt of depression treatment in Y2, accounting for treatment in Y1. Among those who did not receive depression treatment in Y1 (n = 4613), positive experiences in three domains (comprehensiveness, shared decision-making, self-management support) predicted greater initiation of treatment in Y2. Among those who received depression treatment in Y1 (n = 22,749), positive or moderate experiences in four domains (comprehensiveness, care coordination, medication decision-making, self-management support) predicted greater continuation of treatment in Y2. In a national PCMH setting, patient experiences with integrated care, including care coordination, comprehensiveness, involvement in shared decision-making, and self-management support predicted patients' subsequent initiation and continuation of depression treatment over time-a relationship that could affect physical and mental health outcomes.

Sufism and healing

ABSTRACTThe aspect of individual patient experience in health care has taken on greater role in contemporary times. Due to an increasingly diverse patient population, medical professionals are encountering individuals who utilize other forms of healing practices in addition to allopathic models of care. This is particularly relevant in mental health care, where concepts of “healing,” “well-being,” and “wellness” come to fore. This article examines the Islamic concept of Sufism, tasawwuf, and how concepts such as dhikr (recitation) and knowing one’s self can be overlayed to psychological principles of mindfulness and self-efficacy—showcasing the intersection of spirituality and mental health.

Abstract 170: Racial Disparities and Patient Reported Healthcare Experience Among Adults With Atherosclerotic Cardiovascular Disease

Background: Studies report that barriers to the relationship between patients and their healthcare providers contribute to racial disparities in healthcare experience. Although race is thought to play a major role in the disparities seen in patient report on healthcare experience, results reported by different scholars on the effect of race on patient provider communication and overall patient satisfaction has been heterogeneous. In this study, we explore the relationship between patient race/ethnicity and various domains of patient healthcare experience [patient provider communication, shared decision making and overall patient satisfaction] in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. We developed a weighted average score for each domain of patient report on healthcare experience, using responses to questions from the CAHPS survey related to patient provider communication, shared decision making and patient overall satisfaction. We compared these scores across patient race/ethnicity. Results: The proportion of ASCVD patients with an optimal score on all domains of patient reported experience was least among Asians (patient-provider communication 37.5%, shared decision making 36.1%, satisfaction 21.9%, p&lt;0.05). African Americans, Asians and Hispanics were less likely to report optimal patient experience when compared to non-Hispanic whites. Adjustments for covariates yielded mixed results. However, African Americans and Asians were 20% and 39% less likely to be satisfied with their healthcare providers respectively [African Americans (Adjusted OR 0.80, 95% CI 0.67-0.97), Asians (Adjusted OR 0.61, 95% CI 0.39-0.94). Conclusion: This study reveals a strong relationship between race and patent healthcare experience among individuals with ASCVD. Targeted policies focusing on reducing disparities and improving patient healthcare experience are needed among these vulnerable population.

Complex contradictions in conceptualisations of 'dignity' in palliative care.

Internationally, increasing attention is being paid to understanding patient experiences of health care. Within palliative care, the Views of Informal Carers - Evaluation of Services (VOICES) questionnaire is commonly used for this purpose. Among its objectives is to ask family members if their relatives were treated with dignity at the end of life. This is regarded as useful for understanding the quality of the health care received. To highlight the differences between family members' reports of dignity in the care provided to their relatives at the end of life, as reported in the VOICES questionnaire, and their narratives about the care their relatives received. A total of 21 cognitive interviews were conducted during a New Zealand pilot of the VOICES questionnaire. Discrepancies between ratings of dignity and the lived experience of care suggest that lay understandings of dignity may not be congruent with that of health care providers. Bereaved family members' self-reports of dignity in end-of-life care captured using survey methods alone are inadequate to understand the complex ways in which individuals conceptualise and experience dignity within a health care context. The authors advocate consideration of multiple, complementary approaches to gathering consumer experiences of end-of-life care, as well as research which enables service users to interrogate what dignity in care means in an end-of-life context.

Qualitative analysis and conceptual mapping of patient experiences in home health care

ABSTRACTThis study explored patient experiences in home health care through a literature review, focus groups, and interviews. Our goal was to develop a conceptual map of home health care patient experience domains. The conceptual map identifies technical and personal spheres of care, relating prior studies to new focus group and interview findings and identifying the most important domains of care. Study participants (n = 35) most frequently reported the most important domain as staff who are caring, supportive, patient, empathetic, respectful, and considerate (endorsed by 29% of participants). The conceptual map includes 114 discrete domains.

An examination of socioeconomic equity in health experiences in six Latin American and Caribbean countries.

ABSTRACTObjectiveMost Latin American and Caribbean (LAC) countries are working toward the provision of universal health coverage, and ensuring equity is a priority for those nations. The goal of this study was to examine the extent to which adults’ socioeconomic status was related to health care experience in six LAC countries.MethodsThis cross-sectional study examined the relationship between educational attainment and seven health experience outcomes in three areas: assessment of the health system, access to care, and experience with general practitioner. For this work, we used data from an Inter-American Development Bank survey of adults in Brazil, Colombia, El Salvador, Jamaica, Mexico, and Panama that was conducted in 2012-2014.ResultsBrazil and Jamaica, the two countries with unified public coverage, stood out for having substantially greater inequality, according to the results of bivariate analyses, with more-educated respondents reporting better health care experiences for five of the seven outcomes. For Jamaica, educational differences largely remained in multivariate analyses: college graduates were less likely (odds ratio (OR) = 0.37) than those with primary education to report their health system needs major reform and were more likely (OR = 2.57) to have a regular doctor. In Brazil, educational differences were mostly eliminated in multivariate models, though people with private insurance consistently reported better outcomes than those with public coverage. Colombia, in contrast, exhibited the least inequality despite having the highest income inequality of the six countries.ConclusionsFuture research is needed to understand the policies and strategies that have resulted in Colombia achieving high levels of equity in patient health care experience, and Jamaica and Brazil demonstrating high levels of inequality.

Improving Access to Patient Education

Introduction and Problem Description: Spinal Cord Injury (SCI) is a difficult, life-changing event with great emotional impact on those who sustain the SCI and their families. Patient education has the potential to provide patients and their families with the knowledge and skills necessary to care for themselves post SCI and help minimise secondary complications over time (Shepherd et al., 2012). At the Spinal Cord System of Care (SCSC) Programme in the National Rehabilitation Hospital (NRH) in Ireland patient education has predominately been delivered through paper-based materials or face to face interactions with members of the interdisciplinary team (IDT). However, an audit of patient education folders in 2013 revealed that only 12% of patients used their folder routinely during their rehabilitation. Patients reported that information in the folders was overwhelming and daunting and that they were consulting the internet for information. One key difficulty in providing patient education is that there is a lot to learn and limited time during a rehabilitation admission to do so. Factors such as a person’s level of education, preferred learning style, their psychological adjustment to the injury (learning readiness) and emotional support can influence their ability to learn and problem solve (Van Wyk et al., 2015). Impairments in hand function as a result of a SCI means that physical access to paper-based educational materials is very challenging (Shepherd, 2012). Another barrier to acquisition of knowledge, skills and behaviours from SCI patient education in Ireland is that once a person is discharged from the neuro-rehabilitation setting there is limited access to credible, quality information sources. Practice Change Implemented: The National Standards for Safer Better Healthcare highlight the importance of using feedback from service users to improve the quality of the services provided (HIQA, 2012). The internet has been identified as a preferred means of accessing information for people with SCI (Letts et al., 2011; Goodman et al., 2008; Matter et al., 2009). In addition, the proliferation of smart devices being used on wards and integrated into therapy has been recognised in the literature (Fager and Burnfield, 2013; Folan et al., 2015). This change project aimed to tap into the virtual context to maximise educational opportunities for people with SCI. Chou et al. (2012) suggest that by bringing information to the patient at the place and time of their choosing, e-learning has the potential to broaden the reach of existing services. The addition of e-learning resources for SCI patient education at the NRH is an additional channel rather than a substitute for verbal or paper-based education materials. Aim: That the addition of e-learning resources reviewed and adapted by staff and patients in a SCI rehabilitation programme will improve access to meaningful and appropriate SCI patient education. Theory of Change: The Health Service Executive (HSE) change model (Figure 2) was chosen to guide the project because it recognises the cyclical nature of change, the key role of leadership and aims to improve patient experiences in healthcare. This model helped staff participate actively in the change process and work collaboratively in teams to improve delivery of patient education (HSE, 2008).

Development of a framework for the delivery of integrated child healthcare: a commissioning support tool

Introduction : Designing a new model of healthcare for children is complex. There is a tendency to take a top-down ‘one-size-fits-all’ approach. At Connecting Care for Children (CC4C, an inner London integrated child healthcare scheme), we like to do something different and be the leaders of change! We offer an integrated approach to the care of children and young people based on a ‘whole population framework’ consisting of patient segments, covering the healthy child, the acutely unwell child and the child with long term illness1. It deviates away from pathways for specific conditions and redirects focus to the experience of the child with the condition, rather than just the medical aspects2. Policy context and objective : There is a need to improve outcomes and patient experience, without increasing costs. In order to build upon current services effectively, it is imperative to (i) understand the services already on offer, and (ii) identify areas where attention is needed. As such, CC4C devised a framework using a six patient segment model, to extend knowledge of services available across the sectors and act as an aid to strategic planning and commissioning. The framework lists the access points and services available to children and their families, across a population footprint. It also identifies important gaps in provision and issues relating to child health, with reference to the Child and Young People Joint Strategic Needs Assessments for the geographical area, as well as CHiMAT (National Child and Maternal Health Intelligence Network) data. Current initiatives that are underway or planned, are presented alongside the key issues, as an aid to ‘place-based’ commissioning. Targeted population : With new interest into commissioning in the form of accountable care organisations and partnerships3, this working document is especially helpful, and can be used as a tool in the planning of such partnerships and to allocate funding. The framework can be populated and grown with ideas generated from multi-agency input as well as patients themselves. Highlights : This easy to use, manageable framework aims to promote and deliver integrated care by identifying child health issues at a grassroots level. By identifying the issues at the ‘point-of-healthcare’, by both providing and receiving parties, we can define ‘never been seen before’ issues that have not previously been highlighted at the commissioning level, but that, when addressed, would have a real impact on patient experience. Transferability : Currently developed for child health, such a framework can be modified to be applicable across all age groups, populations and healthcare settings. It has already been adopted for use by three clinical commissioning groups for child health, and interest has been shown by the ‘care of the elderly’ sector. Conclusions : We believe this framework can be used as a building block for integrated care to allow all stakeholders to view current services, areas of need and thus offer solutions that really work. Through such an approach, we can truly connect with our patients and improve the patient healthcare experience. (Word count excluding references: 486) References : 1- Klaber B, Watson M. ‘A whole population approach: patient segments in child health. Connecting Care for Children North West London. Slideshow. 2014. Available from: www.londonpaediatrics.co.uk/wp/wp-content/uploads/2014/02/A-WholePopulation-Approach-Segments-in-Child-Health-Dec-13.pdf [Accessed 14th December 2016] 2- Klaber RE, Blair M, Lemer C, Watson M. Whole population integrated child health: moving beyond pathways. Arch Dis Child 2017;102:5-7. Published Online First: 23 May 2016. doi:10.1136/archdischild-2016-310485. Available from: http://adc.bmj.com/content/102/1/5 [Accessed 14th December 2016] 3- The King’s Fund. Accountable Care Organisations Explained. Available from: https://www.kingsfund.org.uk/topics/integrated-care/accountable-care-organisations-explained [Accessed 14th December 2016]

Physician verbal compliance-gaining strategies and patient satisfaction

PurposeThe patient healthcare experience is a complex phenomenon, as is encouraging patient compliance with medical advice. To address this multifaceted relationship, the purpose of this paper is to explore the ways resident physicians verbally encourage patient compliance and the relationship between these compliance-seeking strategies and patient satisfaction.Design/methodology/approachA total of 40 medical interviews between resident physicians and patients were audio-recorded, transcribed, coded, and analysed. Patient questionnaires were also administered and analysed.FindingsIt was found that resident physicians used indirect orders most frequently, followed by motivation, persuasion, scheduling, and direct orders. It was also found that female patients received (marginally) more messages than male patients; female residents used more messages with female patients than with male patients; female residents used more persuasion messages with female patients than with male patients; male residents were less likely than female residents to use motivational messages with female patients; and compliance was significantly correlated with expertise satisfaction, overall satisfaction, and communication satisfaction.Originality/valueThis study advances existing research by examining various ways in which residents verbally encourage patient compliance and the relationship between these messages and patient satisfaction. Findings can be used to inform physicians on strategies to encourage patient adherence to medication regimen, appointments, and lifestyle changes.

The 'auxiliary' white coat effect in hospitals: perceptions of patients and doctors.

A doctor's attire is important in making a positive first impression and enhancing the overall healthcare experience for patients. We conducted a study to examine the perceptions and preferences of patients and doctors regarding six types of dress codes used by doctors in different scenarios and locations. A total of 87 patients and 46 doctors participated in the study. Separate sets of questionnaires containing four demographic questions and 14 survey questions were distributed to the two groups. Most patients preferred doctors to dress formally in white coats regardless of the scenario or location, whereas the majority of doctors preferred formal attire without white coats. Both groups preferred operating theatre attire in the emergency department. Our findings confirmed that patients perceived doctors in white coats to be more trustworthy, responsible, authoritative, confident, knowledgeable and caring. There is a need to educate the public about the reasons for changes in doctors' traditional dress codes.

Associations Between Perceived Race-based Discrimination and Contraceptive Use Among Women Veterans in the ECUUN Study

To describe perceived race-based discrimination in Veterans Affairs (VA) health care settings and assess its associations with contraceptive use among a sample of women Veterans. This study used data from a national telephone survey of women Veterans aged 18-44 receiving health care in VA who were at risk of unintended pregnancy. Participants were asked about their perceptions of race-based discrimination while seeking VA health care and about their contraceptive use at last heterosexual intercourse. Logistic and multinomial regression analyses were used to examine associations between perceived race-based discrimination with use of prescription contraception. In our sample of 1341 women Veterans, 7.9% report perceived race-based discrimination when receiving VA care, with blacks and Hispanics reporting higher levels of perceived discrimination than white women (11.3% and 11.2% vs. 4.4%; P<0.001). In logistic and multinomial regression analyses adjusting for race/ethnicity, age, income, marital status, parity, and insurance, women who perceived race-based discrimination were less likely to use any prescription birth control than women who did not (odds ratio, 0.65; 95% confidence interval, 0.42-1.00), with the largest difference seen in rates of intrauterine device or implant use (odds ratio, 0.40; 95% confidence interval, 0.20-0.79). In this national sample of women Veterans, over 10% of racial/ethnic minority women perceived race-based discrimination when receiving care in VA settings, and perceived racial/ethnic discrimination was associated with lower likelihood of prescription contraception use, especially intrauterine devices and implants. VA efforts to enhance respectful interactions may not only improve patient health care experiences, but also represent an opportunity to improve reproductive health outcomes for women Veterans.

A network perspective on patient experiences and health status: the Medical Expenditure Panel Survey 2004 to 2011

BackgroundThere is a growing emphasis on the need to engage patients in order to improve the quality of health care and improve health outcomes. However, we are still lacking a comprehensive understanding on how different measures of patient experiences interact with one another or relate to health status. This study takes a network perspective to 1) study the associations between patient characteristics and patient experience in health care and 2) identify factors that could be prioritized to improve health status.MethodsThis study uses data from the two-year panels from the Medical Expenditure Panel Survey (MEPS) initiated between 2004 and 2011 in the United States. The 88 variables regarding patient health and experience with health care were identified through the MEPS documentation. Sex, age, race/ethnicity, and years of education were also included for analysis. The bnlearn package within R (v3.20) was used to 1) identify the structure of the network of variables, 2) assess the model fit of candidate algorithms, 3) cross-validate the network, and 4) fit conditional probabilities with the given structure.ResultsThere were 51,023 MEPS interviewees aged 18 to 85 years (mean = 44, 95% CI = 43.9 to 44.2), with years of education ranging from 1 to 19 (mean = 7.4, 95% CI = 7.40 to 7.46). Among all, 55% and 74% were female and white, respectively. There were nine networks identified and 17 variables not linked to others, including death in the second years, sex, entry years to the MEPS, and relations of proxies. The health status in the second years was directly linked to that in the first years. The health care ratings were associated with how often professionals listened to them and whether professionals’ explanation was understandable.ConclusionsIt is feasible to construct Bayesian networks with information on patient characteristics and experiences in health care. Network models help to identify significant predictors of health care quality ratings. With temporal relationships established, the structure of the variables can be meaningful for health policy researchers, who search for one or a few key priorities to initiate interventions or health care quality improvement programs.

Longer wait times affect future use of VHA primary care

BackgroundImproving access to the Veterans Health Administration (VHA) is a high priority, particularly given statutory mandates of the Veterans Access, Choice and Accountability Act. This study examined whether patient-reported wait times for VHA appointments were associated with future reliance on VHA primary care services. MethodsThis observational study examined 13,595 VHA patients dually enrolled in fee-for-service Medicare. Data sources included VHA administrative data, Medicare claims and the Survey of Healthcare Experiences of Patients (SHEP). Primary care use was defined as the number of face-to-face visits from VHA and Medicare in the 12 months following SHEP completion. VHA reliance was defined as the number of VHA visits divided by total visits (VHA+Medicare). Wait times were derived from SHEP responses measuring the usual number of days to a VHA appointment with patients’ primary care provider for those seeking immediate care. We defined appointment wait times categorically: 0 days, 1day, 2–3 days, 4–7 days and >7 days. We used fractional logistic regression to examine the relationship between wait times and reliance. ResultsMean VHA reliance was 88.1% (95% CI = 86.7% to 89.5%) for patients reporting 0day waits. Compared with these patients, reliance over the subsequent year was 1.4 (p = 0.041), 2.8 (p = 0.001) and 1.6 (p = 0.014) percentage points lower for patients waiting 2–3 days, 4–7 days and >7 days, respectively. ConclusionsPatients reporting longer usual wait times for immediate VHA care exhibited lower future reliance on VHA primary care. ImplicationsLonger wait times may reduce care continuity and impact cost shifting across two federal health programs.

Fostering Implementation of Staff’s Creative Ideas to Improve Patient Healthcare Experiences

Substantial improvements are needed to achieve the U.S. healthcare system aim of providing patient-centered care. Healthcare staff (e.g., physicians and nurses) may be an important source of creative ideas to improve patient care experiences. Thus, many healthcare organizations are encouraging staff creativity, i.e., the generation of novel and useful ideas. Our aim was to assess the impact of implementation of creative ideas on patient care experiences, the relationship between idea creativity and its implementation, and moderators of this relationship. We conducted a longitudinal study of 220 ideas generated by improvement team members from 12 community health centers over 18 months, and the experiences of 2,201 patients. We used data from patient surveys, quality improvement meeting transcripts, staff surveys, and wearable sociometric sensors. Creative idea implementation was positively associated with better patient care experiences, but such ideas were less likely to be implemented than other ideas. Three staff characteristics increased the likelihood of creative idea implementation: more collaborative relationships, longer organizational tenure, and a more central position in the organization’s social network. Results show the value and the challenges of fostering creative idea implementation to improve patient care experiences. Legitimizing creative idea implementation in healthcare organizations should advance quality improvement efforts.

The experiences and beliefs of patients with complex regional pain syndrome: An exploratory survey study

Objectives To determine the beliefs and describe the health care experiences of patients with complex regional pain syndrome. Methods A survey tool for patients with complex regional pain syndrome was designed for this study. The survey tool collected self-reported measures associated with pain, disability, health care experiences, education, beliefs, and treatments. Results Thirty-one patients attending physical therapy for complex regional pain syndrome (mean age 40.48; female n = 20) completed the survey. Patients with presented with high levels of pain and disability and reported various changes associated with altered neuroplasticity such as confused body part recognition, left/right discrimination, neglect, and spreading pain. The patients' experiences with diagnostic testing and interventions are not in line with the current pain science research and/or evidence-based practice. Overall, patients are ill-informed, confused, and receive conflicting information. Discussion The suffering associated with complex regional pain syndrome is real, as told by patients. This suffering coincides with a lack of consensus by health care providers and conflicting information on complex regional pain syndrome. Overall, patient experiences show health care providers are not up to date with the current best-evidence regarding complex regional pain syndrome.

Enabling intra-DHB patient-specific care for patients with intestinal failure

Patients with intestinal failure are medically fragile and need timely intervention when and wherever they present. Care is often fragmented across the care settings e.g. Starship (tertiary), DHBs (secondary) and GPs (primary) due to poor information systems interoperability. Patients want to be cared for in their own communities with the ability to access specialist care. The National Intestinal Failure Service’s connected care pilot supports patients with intestinal failure to have care delivered in their own DHB, while building local skills and capability. Patient-centred multidisciplinary intra-DHB teams, working in a virtual environment with patient-specific shared care plans provide care to patients in Hutt and Hawkes Bay DHBs. To improve patient safety and empower patients to self manage, relevant information must be easily and securely available to the patient, their whanau/family and multi-disciplinary team. An e-shared care solution was designed to place the patient and whanau at the centre of their healthcare, transforming their experience within the healthcare system in line with Simon Sinek’s Golden Circle communication model. Whanau Tahi Connected Care (WTCC) supports a secure shared care plan, accessible via mobile devices, and integrated within existing hospital systems such as Concerto. This enables the development of a personalised electronic care plan which is comprehensive and supports coordination of care in partnership with patients. The Shared Care snapshot summary allows clinicians providing acute care to view important and relevant clinical information e.g. allergies, diagnosis, medications, care plans and previous decisions. Each patient has a care coordinator, in this case either a community nurse or clinical specialist. The pilot began in late 2015 and is receiving positive interest from other DHBs who are managing patients with intestinal failure, for its potential to remove the barriers to equitable access and integrated healthcare provision through teamwork across healthcare environments. WTCC is available as a service and does not require additional on-site implementation. Already used throughout Auckland DHB and endorsed as the National Shared Care platform, WTCC can be easily extended to other DHBs as necessary. By mid-2016, approximately 20 children have shared care plans and 20 adults have been enrolled with shared care plans being developed. One to one training is provided by an ADHB trainer as each patient, family/whanau joins the pilot. In addition, WTCC’s scheduling and task management features are being applied to support some 30 other families. It is anticipated that the health care experience of patients and their family/whanau will improve over time as processes are tested, evaluated, refined and embedded in practice. This includes developing strategies to address perceived potential barriers to adopting a shared care such as computer/device literacy and patient and family/whanau discomfort with reliance of technology to access healthcare. One of the insights from the pilot is that the needs of patients with long term health conditions change as they age and electronic shared care plans should adapt as people transition through their lifespan and also across care settings. For example, enabling privacy settings to change as teens mature into adults and rely less on their parents.

US Healthcare Experiences of Hispanic Patients with Diabetes and Family Members: A Qualitative Analysis

ABSTRACTHispanics in the United States experience significant health disparities. Using focus groups conducted in Spanish, we explored the perspectives of 172 Hispanic adults regarding their healthcare experiences. Many participants were women (64.5%) and primarily from Mexico (80%). Four major qualitative themes emerged: (a) provide us with information, (b) want attentive and respectful relationships, (c) want better care, and (d) perceived discrimination. Suboptimal patient-provider interactions were described. Research is needed to explore interventions that address these issues. Incorporating person-centered care principles and practices such as clear and understandable communication, culturally competent care, and customer service skills may benefit provider interactions with Hispanics.