Patient Experience Research Articles

Utilization of big data analytics to identify population health trends and optimize healthcare delivery system efficiency

Big data analytics has emerged as an incredibly valuable tool in understanding population health trends and improving the effectiveness of healthcare delivery systems. By leveraging big data sources from various domains, including the patients’ electronic health records, claims data, wearables, and social media accounts, healthcare organizations can obtain novel and rich insights regarding population health characteristics, predisposing factors, and disease progression. The arrival of big data has transformed healthcare organizations by providing a scientific population health management and health system enhancement tool. Using superior analytical tools, healthcare entrepreneurs and policymakers can discover relations, rates, and patterns that are concealed in large data sets. Such knowledge can be used for early detection of possible interventions, management of resources, and prevention measures, thus leading to better health and less spending on health issues. Moreover, big data analytics helps in early diagnostics and the development of management strategies for high-risk groups, which in turn improves the functioning and effectiveness of healthcare systems. It is also important to note that big data solutions in healthcare are not limited to population health management, but also include functional aspects of healthcare organizations. Additionally, using data about patient movements, resource consumption, and clinical activity, it is possible to determine inefficiencies and opportunities to improve processes in healthcare organizations. This approach of collecting and analyzing data helps in decision making thus reducing time and improving patient flow and experience. However, incorporating real-time data into the clinical decision support systems can improve diagnostic capabilities, treatments offered, and patient tracking resulting in improved quality of services delivered.

Recent Advances in the Translational Application of Immunotherapy with Pulsed Dendritic Cell-Derived Exosomes (DEX)

This article explores recent advances in immunotherapy using exosomes derived from dendritic cells (DEXs), highlighting their potential as an innovative option in cancer treatment. DEXs have demonstrated the ability to activate robust and sustainable immune responses, overcoming the limitations of conventional therapies. Their low toxicity profile and capacity to induce long-term immunological memory position them as a viable alternative, especially for patients who do not respond to traditional treatments. The article analyzes the mechanisms of action of DEXs and details their optimized production using advanced pulsing techniques. Clinical trials in melanoma, lung cancer, and other resistant tumors underscore their efficacy and the potential for combining them with conventional treatments, thereby improving tolerance and increasing effectiveness by minimizing adverse reactions. Additionally, the article reviews the epicutaneous administration of DEXs, a strategy that enhances immune response while improving patient experience. The adaptability of DEXs to different types and stages of cancer makes them a fundamental tool in personalized oncology. The question is no longer whether this therapy is effective, but rather when and which low-cost implementation option will be chosen for clinical use, consolidating DEXs as an innovative and validated therapeutic line integrated into protocols that promote more precise and safer treatments with greater effectiveness.

Improving Patient Experience and Team Engagement with Environmental Services: Application of Watson's Theory of Human Caring.

Patient experience and team engagement are key performance indicators in organizational strategic planning. Health-care organizations have a seldom-used resource within acute care settings that expands the ability to improve patients' experiences of their care as well as their own team engagement. Environmental services (ES) staff, the second largest health-care workforce, spend an average of 10 min per patient day interacting with patients and families. Few studies highlight how nursing theory may influence patient experience outside of the nursing role. This paper explores how ES staff at a non-profit rural 974-bed academic medical center impacted patient experience using nursing theory to promote a caring environment. Applying Watson's Theory of Human Caring and Caritas Processes© with ES team members beginning at leadership levels increased team engagement and improved patient experience. ES team members benefited from a professional nursing framework and from being integrated as a valued partner in advancing human caring.

Patient Experiences With Group Teletherapy for the Treatment of Mental Illness: A Qualitative Study.

The authors sought to understand patient experiences with group teletherapy to inform improvements in service delivery. From December 2022 to October 2023, semistructured interviews were conducted with 20 adults with depression or bipolar disorder who had received outpatient group teletherapy in the past 2 years. A rapid thematic analysis was conducted by using a matrix to identify patterns and synthesize data. A logic model from the patients' perspective was developed by extracting common themes related to elements of effective group teletherapy. Telehealth allowed for more empowered engagement in group teletherapy and enabled better access and longitudinal attendance for many patients, compared with in-person group therapy. However, many patients reported a reduced sense of emotional intimacy and connectedness with telehealth, and some reported that technology challenges and distractions contributed to feelings of disconnection. Patients were divided in their modality preferences, but many expressed an interest in receiving at least some of their group therapy sessions by telehealth. Although group teletherapy has the potential to meet patients' needs and preferences, more work is needed to improve the quality of the experience for patients.

Low-Value Clinical Practices in Pediatric Trauma Care.

Reducing low-value care has the potential to improve patient experiences and outcomes and decrease the unnecessary use of health care resources. Research suggests that low-value practices (ie, the potential for harm exceeds the potential for benefit) in adult trauma care are frequent and subject to interhospital variation; evidence on low-value practices in pediatric trauma care is lacking. To estimate the incidence of low-value practices in pediatric trauma care and evaluate interhospital practice variation. A retrospective multicenter cohort study in a Canadian provincial trauma system was conducted. Children younger than 16 years admitted to any of the 59 provincial trauma centers from April 1, 2016, to March 31, 2022, were included. Low-value practices were identified from systematic reviews of clinical practice guidelines on pediatric trauma. The frequencies of low-value practices were evaluated by estimating incidence proportions and cases per 1000 admissions (low if ≤10% and ≤10 cases, moderate if >10% or >10 cases, and high if >10% and >10 cases) were identified. Interhospital variation with intraclass correlation coefficients (ICCs) were assessed (low if <5%, moderate if 5%-20%, and high if >20%). A total of 10 711 children were included (mean [SD] age, 7.4 [4.9] years; 6645 [62%] boys). Nineteen low-value practices on imaging, fluid resuscitation, hospital/intensive care unit admission, specialist consultation, deep vein thrombosis prophylaxis, and surgical management of solid organ injuries were identified. Of these, 14 (74%) could be evaluated using trauma registry data. Five practices had moderate to high frequencies and interhospital variation: head computed tomography in low-risk children (7.1%; 33 per 1000 admissions; ICC, 8.6%), pretransfer computed tomography in children with a clear indication for transfer (67.6%; 4 per 1000 admissions; ICC, 5.7%), neurosurgical consultation in children without clinically important intracranial lesions (11.6%; 13 per 1000 admissions; ICC, 15.8%), hospital admission in isolated mild traumatic brain injury (38.8%; 98 per 1000 admissions; ICC, 12.4%), and hospital admission in isolated minor blunt abdominal trauma (10%; 5 per 1000 admissions; ICC, 31%). In this cohort study, low-value practices appeared to be frequent and subject to interhospital variation. These practices may represent priority targets for deimplementation interventions, particularly as they can be measured using routinely collected data.

Collection and use of patient-reported experience measures: approach to improve health care

Abstract Background Patient experience is one of the fundamental determinants of healthcare quality. There is progress in the collection of PREM in national level for hospitalized patients since 2020 in Latvia. Aim Analyze (2020.-2022.) in-patients Top-box rates about communication, share-decision making, patient safety and Net Promoter Score (NPS). Methods Project starting point was 2019. Agreement with EC, Sant’Anna School, Ministry of Health and Centre for Disease Prevention and Control of Latvia. Since 2020, the collection of PREM has been taking place regularly in hospitals (around 40% from all hospitals) and on average 20% response rate of those who agreed to participate in the survey. PREM questionnaire according to HCAHPS (Consumer Assessment of Healthcare Providers and Systems) standards, including Picker Institute patient experience questions. In line with OECD (Organization for Economic Co-operation and Development) recommendations, patient safety issues are also included. Top-box rates (most positive response) and percentiles (25th - 75th) were calculated. Results Totally 17019 adult (18 years and more) patient responses were analyzed with response rate 20.3% (n = 83983). 74.6% (67.5-78.2) during hospital stay doctors always explain things in a way you could understand and sufficiently involved in the decision-making process of treatment - 75.0% (70.1-81.4). During hospital stay 4.1% (n = 601) experienced patient safety incidents which were patient-reported. The most common groups were wrong patients, medication errors, incl. adverse drug reactions and falls. Hospitals achieved a NPS of 61 for 3 year period (2020.-2022.). Conclusions Collecting information about the patient experience may be the starting point for engaging patients and moving to more patient-centered health care. The results of these in-patient PREM data can be used to identify areas of improvement and make changes to better meet the needs and expectations of their patients. Key messages • It is a good practice for the implementation of new health care quality data - patient experience reported measures at the national level. • Feedback about the patient experience on regular basis provides insight into patient needs, preferences and values, which can help to improve the quality and safety of care.

Experiences of Patients With Cancer Using Electronic Symptom Management Systems: Qualitative Systematic Review and Meta-Synthesis.

There are numerous symptoms related to cancer and its treatments that can affect the psychosomatic health and quality of life of patients with cancer. The use of electronic symptom management systems (ESMSs) can help patients with cancer monitor and manage their symptoms effectively, improving their health-related outcomes. However, patients' adhesion to ESMSs decreases over time, and little is known about their real experiences with them. Therefore, it is necessary to gain a deep understanding of patients' experiences with ESMSs. The purpose of this systematic review was to synthesize qualitative studies on the experiences of patients with cancer using ESMSs. A total of 12 electronic databases, including PubMed, Web of Science, Cochrane Library, EBSCOhost, Embase, PsycINFO, ProQuest, Scopus, Wanfang database, CNKI, CBM, and VIP, were searched to collect relevant studies from the earliest available record until January 2, 2024. Qualitative and mixed methods studies published in English or Chinese were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist) and the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) statement were used to improve transparency in reporting the synthesis of the qualitative research. The Critical Appraisal Skills Program (CASP) checklist was used to appraise the methodological quality of the included studies, and a meta-synthesis was conducted to interpret and synthesize the findings. A total of 21 studies were included in the meta-synthesis. The experiences of patients with cancer using ESMSs were summarized into three major categories: (1) perceptions and attitudes toward ESMSs; (2) the value of ESMSs; and (3) barriers, requirements, and suggestions for ESMSs. Subsequently, 10 subcategories emerged from the 3 major categories. The meta-synthesis revealed that patients with cancer had both positive and negative experiences with ESMSs. In general, patients recognized the value of ESMSs in symptom assessment and management and were willing to use them, but they still encountered barriers and wanted them to be improved. This systematic review provides implications for developing future ESMSs that improve health-related outcomes for patients with cancer. Future research should focus on strengthening electronic equipment and technical support for ESMSs, improving their functional contents and participation forms, and developing personalized applications tailored to the specific needs and characteristics of patients with cancer. PROSPERO CRD42023421730; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421730.

Valacyclovir induced neurotoxicity, with therapeutic drug monitoring, in a hospital-based setting in the Netherlands

Background: Valacyclovir-induced neurotoxicity is a rare side effect. The aim of this study was to perform a retrospective analysis of patients with valacyclovir-induced neurotoxicity and establish valacyclovir plasma concentrations in a tertiary hospital between January 2018 and November 2022. Case descriptions: In total 208 patients were identified with measured acyclovir concentrations, and the electronic health records of these patients were analysed. Based on the in- and exclusion criteria, 4 patents were identified in whom high plasma concentrations were linked to neurotoxicity. The first patient experienced balance and coordination problems, visual hallucinations, speaking difficulties and headaches. The second patient experienced a progressive decline of consciousness, resulting in coma. The third patient also experienced reduced consciousness and was found unconscious on the floor during the night. The fourth patient experienced vertigo after administration of acyclovir. Conclusion: Based on this study, neurotoxicity appears to be an underreported adverse effect of valacyclovir therapy in a hospital setting. This side effect may have a high impact on individuals as well as on the duration of hospitalization. In order to exclude valacyclovir as the cause, clinicians should consider requesting an acyclovir plasma concentration as standard hospital-based intervention whenever a patient experiences neurotoxic symptoms. Moreover, pharmacists and clinicians should be made better aware of the interaction between valacyclovir and cyclosporine and/or mycophenolic acid, in particular in elderly patients with impaired kidney function.

Exploring the Psychosocial Impact of Hospitalization for COVID-19: Insights from Patient Experiences

Abstract Background The COVID-19 pandemic has severely tested the organizational structure and operational effectiveness of healthcare systems. We aimed to explore the experiences of patients who have been hospitalized due to COVID-19. Methods Employing purposive sampling, semi-structured interviews were conducted covering eight topics: 1) the experience of COVID-19 diagnosis, 2) the most difficult moments during hospitalization, 3) difficulties related to hospital conditions and safety protocols, 4) interactions with healthcare professionals, 5) received support, 6) social stigma, 7) concerns about the future, and 8) post-COVID and long COVID syndrome. Twelve individuals (six women and six men; mean age 57.5 (SD = 13) years; mean length of stay 18.1 (SD = 3.1) days) participated. The data analysis was carried out using the phenomenological method according to Colaizzi. Results Patients reported a spectrum of emotions including loneliness, isolation, abandonment, disappointment, insecurity and fear of death. Interactions with healthcare professionals revealed a dichotomy: experiences of respectful, reassuring care contrasted with encounters lacking psycho-emotional support within an impersonal healthcare setting. Conclusions This study sheds light on the experiences of patients on the nursing wards and their psychosocial burden. Most of them reported negative emotions such as loneliness, isolation, sadness, fear and anxiety rather than positive experiences such as hope, interpersonal connectedness, self-identity, empathy, caring and safety. Key messages • The study highlights psychosocial challenges for COVID-19 patients, emphasizing the urgent need for robust support systems. • The study provides insights for future similar situations and highlights the need for adaptable care models based on principles such as empathy, safety and personalized approaches.

Patient and healthcare provider perspectives on a digital first general practice: mixed-method study

Abstract Background General practitioners (GPs) are facing an increased workload as a result of an aging population and a growing prevalence of chronic diseases. Utilizing eHealth may help to enhance healthcare accessibility and reduce costs. A digital platform was developed that integrates eHealth into the organizational aspects of general practices. This study aims to provide insight into the experiences of patients and healthcare professionals with this new, digital way of working. Methods A mixed-method study was conducted in three Dutch general practices working with the digital platform. The digital platform focuses on digital communication and remote healthcare delivery in primary care. Primary outcomes included acceptability, the implementation process, suggestions for improvement, and facilitators and barriers for future implementation. Patient perspectives were identified through online questionnaires and focus groups, and healthcare professionals’ experiences were explored through in-depth interviews. Results Five focus groups and ten in-depth interviews were held. The questionnaires were completed by 616 patients. Patient acceptability of the care concept was high (M = 3.9, SD = 1.0; on a scale from 1-5) and they were satisfied with received care (M = 30.1, SD = 3.4; on a scale from 8-32). Regarding the perceived quality of consults, patients were positive about the longer duration of physical consults (i.e., 20 instead of 10 minutes). Some participants indicated a less personal doctor-patient relationship, because care was provided by various GPs. Conclusions Overall, patients and healthcare professionals were positive about the digital platform. The study gives insights into how to improve the care concept, e.g., how to enhance the doctor-patient relationship. Key messages • Digital first general practices that integrate eHealth into the practice’s organizational aspects of are considered acceptable by patients and healthcare professionals. • Digital first general practices can help to improve healthcare accessibility for both patients and healthcare professionals.

Assessment of digital literacy and user experience in patients with cochlear implants

Abstract Introduction The cochlear implant (CI) is the treatment of choice for people affected by deafness or profound hearing loss. Patients with cochlear implants (PwCIs) can enhance their hearing outcomes using digital hearing training programs (dHTPs). Current technological trends leans towards personalized, AI-driven dHTPs, aiming to optimize user experience (UX) and adherence. This study aims to investigate the digital literacy skills and UX of PwCI before and after testing a prototype of a dHTP with an AI-driven design (TraiCI). Methods Two research-specific questionnaires developed by the Hearing Center Düsseldorf (QDL and QUX) were used to assess digital literacy skills and user experience in TraiCI. Additionally, the User Experience Questionnaire (UEQ) was employed to evaluate general user experience. The UEQ assesses software quality across dimensions such as transparency and stimulation using paired opposites. Results 22 outpatient PwCIs the Hearing Center Düsseldorf with unilateral or bilateral CI (mean age 54 years; SD = 15) were included. In QDL, PmCI demonstrated high levels of digital literacy skills. The majority of PmCI (80.6%) reported prior experience with dHTP. Usage of these programs occurred daily to multiple times per week within the first six months after CI treatment, with session durations predominantly ranging from 10 to 30 minutes. QUX data indicated a smooth initiation process (70.8%) and seamless login experience (95.5%). The UEQ addressed various aspects of user experience, with ‘transparency’ receiving the highest scores (MW = 1.9; SD = 0.6), while ‘stimulation’ received the least positive ratings (MW = 0.0; SD = 2.1). Conclusions The results show a high degree of digital literacy among PwCIs. They encountered minimal challenges in operating hardware and software components. Further refinement is necessary to align with PwCI’s expectations and maximize benefits. Early and iterative involvement of PwCIs in future projects could optimize outcomes. Key messages • The study highlights the proficient digital literacy skills of cochlear implant patients (PwCIs). • Further refinement of dHTPs is needed to better align with PwCIs’ expectations and maximize benefits, emphasizing the importance of iterative involvement for optimized outcomes.

Return to work after hip and knee arthroplasty: qualitative outcome from the Netherlands

Abstract Background Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are performed daily worldwide. More younger working-age patients are receiving a THA and/or TKA. Outcomes, including Quality-of-Life (QOL), patient satisfaction and Return-to-Work (RTW) are becoming more important and have implications for healthcare budget and health workforce. Clinical recovery pathways should improve patient outcomes and cost-effective care. Insight in patient experiences and expectations regarding RTW remains behind. This study aims to gain insight into influenceable factors in the recovery pathway after THA or TKA that could lead to improved care and enhanced patient participation. Methods In this single-center qualitative study, performed at Zuyderland Medical Center (Sittard-Geleen, the Netherlands), 12 patients (n = 6 THA; n = 6 TKA) aged under 65 years were approached to participate. During interviews 6-weeks after arthroplasty, this research explored their RTW experiences in both pre-, and postoperative, in- and outpatient settings. Results In total, 12 employed patients who received a THA (n = 6, mean age 56 ± 7.4 years; female: n = 4, 66%) or a TKA (n = 6, mean age 61 ± 2.6 years; female n = 3, 50%) participated. Own control regarding RTW and a minimal recovery time after the operation was necessary for all patients. During this time, focus on physical therapy and strengthening was most important. RTW was not expected to be the primary goal during the clinical recovery pathway. The RTW topic was said to belong to the occupational physician (OP) and employer. Patients however knowledge that the type of work should gain importance in the consultation room. Patients missed accessible communication between the orthopedic surgeon and OP. Conclusions Overall, patients are satisfied with the current clinical recovery pathway. Intercollegiate communication should be made more accessible. Own control and strengthening self-management in the RTW remain important for all patients. Key messages • Own control and strengthening self-management should have importance in the guidance of working-age patients after THA or TKA. • Intercollegiate communication should be made more accessible.

Health Impact Assessment in Personalized Prevention: three applications on pharmacogenomic testing

Abstract Background In recent years, literature on the efficacy of genetic and genomic tests has expanded, yet the impact of personalized prevention programs that include such tests remains understudied. Our study aims to test the use of the Health Impact Assessment (HIA) framework, traditionally applied in non-health policy evaluation, to assess the impacts of personalized prevention policies. Methods We selected a policy mandating dihydropyrimidine dehydrogenase (DPYD) genetic test use before prescribing fluoropyrimidine for colorectal cancer (CRC) patients. Three HIAs are being conducted in Italy, Portugal, and Finland to assess the applicability across different contexts. The assessment involves literature review, comparative risk modeling, and stakeholder interviews. Three national steering committees, comprising representatives from key interest groups and experts, will evaluate evidence to gauge policy impacts and offer recommendations. Results The potential impacts identified include CRC patients’ outcomes, economic, organizational, patient experience, clinician workload, and equity. Preliminary results show a consensus in literature and national guidelines on the ability of the DPYD test to reduce adverse events and enhance the quality of life of CRC patients. However, the assessment reveals context-specific effects regarding equity, influenced by the prevalence of ethnic groups and variations in access to health services across regions. Differences also emerged on organizational aspects like the availability of resources such as laboratories and personnel. A lack of literature was observed on patient acceptability and clinician attitudes towards the test. Conclusions The use of HIA in personalized prevention might assist in identifying policy impacts often overlooked through the involvement of key interest groups in the assessment process. Such effort can further emphasize the significance of evaluating these programs while considering the geographical context. Key messages • Our study innovatively applies the Health Impact Assessment framework to evaluate personalized prevention programs in pharmacogenomic, addressing a critical research gap. • Preliminary findings underscore the importance of considering geographical factors in public health policy evaluation, highlighting nuanced context-specific effects.

Implementation of digital patient decision support tools for Atrial Fibrillation treatment: systematic review

Abstract Background/ Introduction Treating atrial fibrillation (AF) involves complex decisions. Digital patient decision-support tools can facilitate shared decision making by significantly reducing decisional conflict and improving patient knowledge [1,2]. Yet, implementation in clinical practice is lagging [3]. Purpose To systematically review trials of digital patient decision-support tools for AF treatment decisions, focusing on factors influencing their implementation in clinical practice. Methods We conducted a systematic review following Cochrane methods. EMBASE, MEDLINE and Scopus were searched from 2005 to 2023. Eligible randomised controlled trials and quasi-experimental trials that evaluated digital patient decision-support tools for AF treatment decisions were included. Two independent reviewers screened title and abstract, extracted data and assessed risk of bias. The implementation outcomes included a description of when and how the tool was used, as well as its characteristics and user satisfaction. Results Thirteen articles reporting on eleven studies (5 RCTs and 6 quasi-experimental trials) met the inclusion criteria (2,714 participants; mean age 71±4.2 years; 26% women; 92% with non-valvular AF, remaining not reported). Risk of bias was low for 2 studies, moderate for one and high for seven studies. All tools (n=11) focused on anticoagulation choice (1: warfarin vs no warfarin; 1: aspirin vs warfarin; 7: Direct Oral Anticoagulants (DOAC) vs antiplatelet or warfarin; 2: unspecified choice). The tools were used either pre-visit (at home or in the waiting room) or during the consultation (n=5). Tools were delivered using a mobile application (n=4), web-based application (n=5), or a desktop (n=2). Of the eleven tools, 2 could automatically calculate individualized stroke risk using data from electronic health records. Most articles reported favourable user feedback regarding use of the digital patient decision-support tools, such as high perceived usefulness, user-friendliness, and overall satisfaction. No significant difference was found in encounter times between intervention and control arms (2 RCTs). Four tools were publicly available and 3 were implemented in healthcare delivery beyond research. Conclusion Despite demonstrated efficacy in reducing decisional conflict and improving patient knowledge, as well as positive clinician and patient experience, only 3 tools were implemented in clinical practice beyond their trial. Future tools could better leverage digital capabilities to integrate with Electronic Health Records, automate stroke and bleeding risk calculations, and personalise content based on patient values and preferences. Additional robust trials and implementation studies are warranted to understand barriers and enablers to the use of these tools.

Challenges to implementing AI in health care

Abstract Germany, renowned for its robust healthcare system, finds itself at the early stages of AI integration. This is a reality for many European countries, emphasizing that, despite general technological prowess, AI adoption remains in its absolute infancy. However, in Germany there are areas where AI shows promise, notably in fields like radiology. Beyond such niche applications though, Germany grapples with a significant challenge - the scarcity of robust data essential for meaningful AI utilization, particularly in the realm of public health. While these insights are specific to the German context, understanding the intricate hurdles impeding widespread AI implementation is a meaningful takeaway for countries around the world. In order to effectively leverage new technologies, there is an acute need for advancements in data infrastructure and governance to unlock the full potential of AI in healthcare. Overcoming barriers and charting a path towards a future where AI serves as a transformative force in German healthcare, could one day lead to enhanced system efficiencies and patient experiences, but for now we have to be thoughtful about the realities of implementing AI within current existing health system infrastructure.

Reevaluating Value-Based Care in Telemedicine: Clinical Opportunities in the Postpandemic Era.

Telehealth during the COVID-19 pandemic became one of the main means for patients to access the health care system. Rules, regulations, and reimbursement policies were loosened, allowing for its expansion into the clinical arena. Since the end of the pandemic, virtual care models have expanded. With a larger emphasis on value-based care, there is a need to understand how telehealth can be utilized to increase value, improve access, enhance the patient experience, improve outcomes, and decrease health inequalities. The article explores the use of telehealth as it relates to a value-based care model, which includes the patient experience, quality of care (access and health equity), provider/clinical practice, and health system/financial. Recommendations for strengthening the use of telehealth to ensure value-based care are provided.

Factors influencing hospital stay duration in an elective cardiac surgery cohort

Abstract Cardiac surgery has become more complex in recent years, with increases in patient age, complexity, and associated costs. The use of a multidisciplinary strategy to analyze and standardize patient management offers significant benefits. The development of Enhanced Recovery After Surgery (ERAS) programs has proven useful in various types of surgery, recently including cardiac surgery, yielding good results. One of the primary objectives of ERAS programs is the reduction of the Inpatients' length of stay (LOS), with the subsequent improvement in the patient experience and a reduction in costs. The aim of this study is to analyze preoperative and postoperative factors related to the LOS reduction in a cohort of elective cardiac surgery patients included in the Cardiac ERAS program at our hospital. All patients included in the ERAS program, corresponding to elective cardiac surgery, were included in the analysis. 138 patients were divided into four quartiles based on the inpatient’s LOS. An extensive search was conducted in our quality control database, which contains 470 variables on the factors more strongly associated with LOS. The results were analyzed using Chi-Square test for categorical and the Kruskal-Wallis test for continuous variables, generally of non-normal distribution. The results are summarized in the table. Age, poor mobility, surgery other than coronary bypass, and reoperation were the non-modifiable factors most associated with a prolonged LOS. Lower preoperative hemoglobin and albumin levels were associated with an increase in LOS. A class 3 or 4 NYHA functional class, chronic pulmonary disease, and anticoagulation use were associated with higher LOS. Classic cardiovascular risk factors, such as dyslipidemia, hypertension, and tobacco use, were not associated with differences in hospitalization duration. Postoperative and intraoperative factors associated with higher LOS included extubation in the operating room or within six hours, ICU stay duration, mobilization on postoperative days one and two, time to oral food tolerance and gut motility recovery, hyperglycemia on postoperative day one, the duration of arterial, venous, and urinary catheters, the amount of fluids on postoperative day one and the opioid use in POD 2. The complications most associated with a prolonged duration were any infectious complication, any respiratory complication, reoperation, readmission to intensive care, transfusion after 12 hours or at any time during hospitalization, prolonged postoperative sedation, and any rhythmic complication. Conclusion In our cohort of elective patients for cardiac surgery, factors traditionally addressed by ERAS programs were identified as being associated with a longer inpatient’s length of stay. Pre-operative nutritional and anemia optimization, early extubation and mobilization, and the prevention of respiratory and infectious complications should be targeted to improve hospital stay duration.

Experiences with paediatric hospital health care: a cross-sectional study among paediatric patients

Abstract Background The measurement of patient experiences is gaining importance in many healthcare systems, including the Slovenian one. The need for a national survey on patient experiences in the paediatric inpatient settings emerged recently. Methods The survey took into account various aspects of inpatient healthcare such as admission, hospital staff, safety, food and discharge from hospital. As part of the study, children/parents were able to give praise and suggestions for improvements. We used three different questionnaires adapted to the cognitive abilities of children - a child questionnaire for the age group 9-13 years in paper form, an online adolescent questionnaire for the age group 14-18 years, and an online parent questionnaire for the age group 0 (1 month)-8 years. The questionnaires were cognitively tested and piloted before national rollout. Results The national survey was conducted between September 2023 and March 2024 and included paediatric patients who spent at least one night in an acute paediatric hospital ward. The survey included 25 paediatric wards and totally 1965 questionnaires were valid for analysis. The rough response rate was 17,6 %. The first preliminary results of the qualitative analysis suggest that surveyed paediatric patients and their parents rate highly inpatient health care services received, however they point out also to areas that need improvement such as environmental factors (noise, temperature), food, infrastructure (outdated facilities &amp; equipment) and in some cases attitude of hospital staff. Conclusions National institute of public health carried out the first national survey on paediatric patient reported experience measures in acute hospitals in Slovenia. The results of this survey will be used to improve the quality of inpatient health care services in paediatric wards, as well renew focus on the requirements of European charter of children rights and United Nations Convention on the Rights of the Child. Key messages • National institute of public health carried out the first national survey on paediatric patient reported experience measures in hospitals in Slovenia. • The results of this survey will be used to drive hospital quality improvements.

From Data to Decisions: Analyzing PaRIS for Health Policy Insights

Abstract To inform countries on how well they perform from the perspective of people living with chronic conditions in comparison with other countries, we propose an analytical framework for the data collected in the PaRIS survey, detailing how the data will be analysed in a multilevel approach for cross-country comparison. The data structure of the PaRIS survey represents three levels: countries/health systems, primary care practices and patients. Multilevel analysis is used because of its accuracy in estimating country-level outcomes, its flexibility in modelling relationships, and its opportunities in connecting to relevant policy questions. Country-level outcomes will be estimated to facilitate cross-country comparison and (future) within-country comparison over time. A first indication for areas for cross-country learning and policy making is the distribution of variation over patients, care providers and countries. Characteristics of patients that potentially explain variation in patient-reported outcomes and experiences can be linked to primary care practice and country/health system characteristics. The second indication for areas for cross-country learning and policy making is the variation in the slope of the association between patient and practice characteristics and patient-reported outcomes and experiences. This makes it possible to address policy-relevant questions relating, e.g., to whether some health systems or providers are better able to produce positive outcomes and experiences for (e.g.) older patients, and to the impact of chronic care management on patients with a specific chronic condition. To ensure fair cross-country comparisons, all outcomes will be estimated for an OECD (age and sex standardised) reference population, also including case-mix adjustment where necessary. Analyses will be repeated using a country-specific standard population.

Patients’ perceptions on reluctance to undergo cataract surgery in Sedibeng district hospital, Gauteng province

Background: Over 50 million people are blind, and 135 million people suffer from severe visual impairments, with cataracts contributing to 51% of global blindness cases. Despite efforts to promote cataract surgery (CS), many patients remain hesitant, underscoring the importance of understanding their perspectives.Aim: This study aimed to explore and describe patients’ perceptions regarding reluctance to undergo CS to improve awareness and increase surgery uptake.Setting: The research was conducted in the Sedibeng District, Gauteng province, South Africa.Methods: A qualitative descriptive phenomenological design was employed to capture the lived experiences of patients through face-to-face, individual semi-structured interviews with 15 patients aged 38 – 72 years prior to their CS. Purposive sampling was used to select participants, and Colaizzi’s seven-step analysis was used for data analysis.Results: The findings highlight several barriers perceived by participants, including long waiting times; fear; lack of knowledge; limited financial, material and human resources; power outages; uncontrolled blood sugar levels; and coronavirus disease 2019 (COVID-19) pandemic restrictions. Nevertheless, some view it positively as a means to avert blindness and enhance vision.Conclusion: To address the challenges, the study recommends boosting the number of eye health care professionals, prioritising budget allocation, addressing electricity interruptions and conducting community outreach educational programmes to improve access to CS in the district.Contribution: The insights gained from this study can help health care providers and policymakers optimise care and support for CS patients through policy formulation and education. Addressing these knowledge gaps will likely increase surgery uptake and improve patients’ quality of life.