Patient-perceived Quality Research Articles

Patient Perceptions of Provider Race Concordance and Quality of Chronic Illness Care.

Black people are more likely to have hypertension and report lower quality of care than White people. Patient-provider race concordance could improve perceived quality of care, potentially lessening disparities. Investigate the association between patient-provider race concordance and patient-perceived quality of chronic disease care, as measured by the Patient Assessment of Chronic Illness Care (PACIC) scale. Cross-sectional analysis of baseline data from a randomized trial with Black patients with persistently uncontrolled hypertension. Participants received care at one of 69 rural primary care practices in Alabama and North Carolina. Three hundred and ninety-one Black patients with persistently uncontrolled hypertension enrolled in the Southeastern Collaboration to Improve Blood Pressure Control (SEC) trial. PACIC overall scores and subscale scores (patient activation, delivery system, goal setting, problem solving, follow-up). Of 1592 patients enrolled in the SEC trial, 391 participants self-reported race concordance data and completed the PACIC. Most participants were age < 60 (52.4%), 65.2% identified as women, and 50.1% were beneficiaries of either Medicare or Medicaid. Those with patient-provider race concordance reported higher overall PACIC scores (58.8% vs 46.1%, p < 0.05), with higher sub-scores of goal setting (60.9% vs 46.8%, p < 0.05) and problem-solving (62.7% vs 48.0%, p < 0.05) compared to those without race concordance. Poisson regression models of participants age ≥ 60years demonstrated that those with race concordance were more likely to have higher overall PACIC scores (RR 1.53, 95% CI 1.17-2.0, p = 0.002), goal-setting subscale scores (RR 1.63, 95% CI 1.24-2.15, p = 0.0005), and problem-solving subscale scores (RR 1.66, 95% CI 1.29-2.14, p < 0.0001). Those < 60years of age had no significant findings comparing those with and without race concordance. OlderBlack patients perceived greater quality of care if their providers were also Black.

P0614 Positive association of inflammatory bowel disease service research activity and adult patient-reported quality of care in the United Kingdom

Abstract Background Engagement with research has been shown to be associated with improved patient experience and outcomes at an institutional level in several disease areas1-3. However, this relationship has so far not been explored in inflammatory bowel disease (IBD). The aim of the present study was to assess the relationship between research activity of IBD services across the United Kingdom (UK) and patient-reported quality of care provided by that service. Methods Patient-reported care quality data was collected across the UK through the 2023 IBD UK Patient Survey. Patients rated the overall quality of their care in the preceding 12 months as “poor”, “fair”, “good”, “very good” or “excellent”. High-quality care was defined as responses of “excellent,” “very good,” or “good”. Data related to paediatric services and adult services with fewer than 5 patient responses were excluded. The proportion of patients reporting high quality care at each service was compared with the number of patients recruited to research studies registered with the national central portfolio management system (CPMS) within the previous three years (2020-2022). The CPMS is a cloud-based system that holds the National Institute for Health and Care Research (NIHR) clinical research network portfolio of studies in England, in addition to the network of portfolios in Northern Ireland, Scotland and Wales. Analyses were performed where recruitment identified IBD as the primary subspecialty and gastroenterology was the managing specialty. Results Research recruitment data from 32,432 recruited research participants across 192 IBD services were aligned with 11,738 care quality responses and included in the analysis. Overall, there was a positive correlation between the number of patients recruited to research studies in an IBD service and the proportion of patients reporting high quality care (Spearman r (95% CI) 0.2044 (0.06047-0.3400) p=0.0045). An iterative Grubbs’ Test identified 6 IBD services as outliers. After excluding these services, the positive correlation was maintained (Spearman r (95% CI) 0.1946 (0.04788-0.3331) p=0.0078; Figure 1). Conclusion This study identifies a positive association between the research activity of IBD services and patient-perceived quality of care, highlighting the benefits of active research engagement in IBD care. Acknowledgements We are grateful to the patients who submitted survey responses and to the IBD UK Board members.

Comprehensiveness in Primary Care: A Scoping Review.

Associated with system efficiency and patient-perceived quality, comprehensiveness is widely recognized as foundational to high-quality primary care. However, there is concern that comprehensiveness is declining and that primary care physicians are providing a narrower range of services. Efforts to address this perceived decline are hampered by the many different and sometimes vague definitions of comprehensiveness in current use. This scoping review explored how comprehensiveness in primary care is conceptualized and defined in order to map its attributes in support of being able to more clearly and precisely define this key concept in research, practice, and policy. We conducted a scoping review, following the methods of Arksey and O'Malley and Levac and colleagues. The search included terms for two key concepts: primary care and comprehensiveness. Developed in Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), the search was adapted for Cumulated Index in Nursing and Allied Health Literature (CINAHL) and Embase, as well as for gray literature. After a multistep review, included sources underwent detailed data extraction. A total of 360 sources were extracted; 57% were empirical studies and 65% were published between 2010 and 2022. Across these sources, we identified nine attributes of comprehensiveness in primary care. We mapped these attributes into two conceptual domains: breadth of care (services, settings, health needs and conditions, patients served, and availability) and approach to care (one-stop shop, whole-person care, referrals and coordination, and longitudinal care). Additionally, we identified three enablers of comprehensiveness, namely structures and resources, teams, and competency. The conceptual map of comprehensiveness in primary care offers a valuable tool that supports clarity for future use of the term comprehensiveness. The domains and attributes we identified can be used to develop definitions and measures that are appropriate to research, practice, and policy contexts, enabling more precise efforts to improve primary care systems.

Global health in axial spondyloarthritis: thresholds for the Assessment of SpondyloArthritis international Society Health Index and the EuroQol score: analysis of the ASAS-PerSpA study

Objectives In axial spondyloarthritis (axSpA), patient-perceived quality of life/global functioning and health (GH) can be assessed using disease-specific [Assessment of SpondyloArthritis international Society Health Index (ASAS-HI)] or generic [(3-level EuroQol 5 Dimensions (EQ-5D-3L)] scores. Our objectives were to explore the link between these scores and to define thresholds for good and poor GH. Method We conducted a post-hoc analysis of the cross-sectional ASAS-PerSpA study for patients fulfilling ASAS criteria for axSpA. The ASAS-HI and EQ-5D scores were analysed visually (distribution, scatterplot) and through Spearman correlation and agreement (deciles). To determine cut-offs for good and poor GH on EQ-5D based on the validated ≤5 and ≥12 cut-offs for ASAS-HI, respectively, receiver operating characteristics (ROC) curves and distribution-based methods were applied. Validity was assessed using crude concordance and prevalence-adjusted bias-adjusted kappa; discordance between groups was explored. Results In 2651 patients (median age 41.0 years, 66.5% men), the correlation between ASAS-HI and EQ-5D was high (r = −0.73) and agreement (between deciles) was moderate (weighted kappa = 0.51). Both ROC areas under the curve were 0.86; thresholds of 0.69 and 0.54 for EQ-5D were chosen for good and poor GH, respectively. Crude concordances and agreement were satisfactory (0.80–0.81 and 0.60–0.61, respectively). The EQ-5D cut-off for good GH performed better than that for poor GH. Conclusion ASAS-HI and EQ-5D were highly correlated but did not fully overlap. We propose EQ-5D thresholds corresponding to the ASAS-HI thresholds for good and poor GH; however, caution is needed when assessing poor GH with EQ-5D. These findings will be useful to compare GH when only one of the outcome measures is available.

QOL-05. COMPARING DISEASE-SPECIFIC QUALITY-OF-LIFE OUTCOMES OF MICROSURGERY, RADIOTHERAPY, AND OBSERVATION IN VESTIBULAR SCHWANNOMA PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract BACKGROUND Vestibular schwannoma (VS), also known as acoustic neuromas, are common tumors arising from the vestibulocochlear nerve and are located in the cerebellopontine angle. The benign tumor has a substantial impact on the patient-perceived quality of life (QoL) outcomes, which contribute to the decision regarding the ideal management plan. In this systematic review and meta-analysis, we aimed to compare the impact of microsurgery, radiotherapy, and observation on the QoL outcomes of VS patients. METHODS This study was conducted in accordance with the PRISMA guidelines and a total of four research databases were searched for eligible studies from inception to May 2024. The primary outcome of the study was the Penn Acoustic Neuroma Scale (PANQOL) total score and the secondary outcomes included the PANQOL subdomain scores. Data was pooled using the random-effects model and analyzed as OR (odds ratio) with 95% CI (confidence interval). RESULTS Compared to observation, radiotherapy was associated with superior QoL outcomes only in the face domain [MD (mean difference) = -4.59 [-7.29,-1.88]; I2= 85%; p = 0.0001], with observation being associated with superior outcomes across all others [PANQOL - total: MD = 4.94 [2.51,7.38]; I2= 85%; p = 0.0001]. Microsurgery, compared to radiotherapy, was associated with better outcomes only in the general domain [MD = -4.38 [-6.60,-2.16]; I2= 0%; p = 0.0001], with RT being associated with superior outcomes across all other domains [PANQOL - total: MD = 3.61 [1.29,5.93]; I2= 63%; p = 0.002]. Compared to microsurgery, observation was associated with superior QoL outcomes across all domains [PANQOL - total: MD = 9.22 [7.30,11.13]; I2= 64%; p = 0.0001]. CONCLUSION The findings indicate that, broadly, observation is associated with better QoL outcomes relative to both radiotherapy and microsurgery; with radiotherapy superseding microsurgery. However, the association with QoL improvement was not uniform across all domains.

Five-year long-term functional and quality of life outcomes in total glossectomy survivors.

Total glossectomy is proven to be a superior treatment option for advanced tongue cancer. Despite its efficacy, the procedure is associated with profound morbidity, notably impacting Speech, swallowing, and overall quality of life. Limited therapeutic benefits and the potential for considerable morbidity render total glossectomy a subject of controversy. We performed a multidimensional quality of life evaluation of long-term (more than 5 yrs.) total glossectomy survivors. In this study, we evaluated 25 total glossectomy survivors with comprehensive functional and quality of life outcomes using objective measures (London Speech Evaluation Scale, FOIS, 100ml Water Challenge, FEES) and Patient-reported outcomes (SHI, PSS HN, EORTC QLQ 30 & HN35). EORTC QLQ 30 showed overall good global health status (M = 80 ± 20) and functional scale mean scores ranging from 87 to 91, despite issues in pain (M = 31.6 ± 31), swallowing (M = 23.3 ± 24), and Speech (26.1 ± 1). Speech outcomes revealed 80% with moderate to severe intelligibility impairment. Swallowing outcomes showed 84% requiring special food preparation, 24% exhibiting aspiration, and 72% having pharyngeal residue. Speech outcomes showed 88% having moderate-severe speech impairment, and Patient-reported speech outcomes indicated a mean SHI score of (M = 47.2 ± 42). Patients undergoing total glossectomy report favourable long-term outcomes in global health-related quality of life despite moderate to severe impairments in objective speech and swallowing evaluations. These positive patient-reported outcomes support the consideration of total glossectomy as a viable treatment option if and when required, underscoring the importance of evaluating treatment outcomes through the patient-perceived quality of life.

The Surprise Question in Hemodialysis, Frailty, Nutrition, Patient-reported Quality of Life, and All-Cause Mortality: The Osaka Dialysis Complication Study (ODCS)

Rationale & ObjectiveA response “no” (SQ-No) to the surprise question (SQ) of whether a clinician would be surprised if a dialysis patient died in the next 6 months is associated with a higher risk of all-cause death. It is uncertain what domains are intuitively assessed with SQ. We hypothesized that SQ would be assessing the patient’s frailty, malnutrition, or patient-perceived health-related quality of life in a cohort of patients on maintenance hemodialysis. Study DesignCohort study Setting & ParticipantsA multi-center study including 994 patients on maintenance hemodialysis in Japan Predictors1) SQ answered by nurses, 2) frailty by modified Cardiovascular Health Study criteria, 3) malnutrition as evaluated by Geriatric Nutritional Risk Index (GNRI), and 4) patient-perceived health-related quality of life examined by the 36 Item Short-Form Health Survey (SF-36) physical component summary (PCS). OutcomesAll-cause mortality Analytical ApproachCox proportional hazard models ResultsMedian age and dialysis vintage were 66 and 5.9 years, respectively, and 35.8% were female, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 45.9%. Medians GNRI and SF-36 PCS were 96.3 and 36.9, respectively. During follow-up for 5 years, 247 patients died. Each of SQ-No, being frail, a low GNRI, and a low SF-36 PCS was a significant predictor of a higher risk for mortality independent of potential confounders. SQ-No remained a significant predictor after further adjustment for frailty or GNRI, but SQ-No was no longer significant when adjusted for SF-36 PCS. LimitationsWe did not assess the agreement of responses to SQ between different raters. ConclusionsPredictive ability of SQ was closely related to SF-36 PCS in hemodialysis patients. SQ by nurses appears to assess the physical domain of patient-perceived health-related quality of life rather than objectively assessed frailty or malnutrition.

Patient Perceived Quality Of Care And TheAssociated Factors For Selected InvasiveDiagnostic Procedures In Outpatient Departments

Background: Continuous assessment is essential for delivering high-quality care, particularly in outpatient departments, which serve as the gateway to hospital services. It is crucial to evaluate the quality of care provided during diagnostic procedures in this setting. This study aims to assess patient-perceived quality of care and the associated factors for selected invasive diagnostic procedures in the outpatient department of CMC Vellore. Materials and Method: A descriptive cross-sectional study was conducted to evaluate patient-perceived quality of care in the Medical, Surgical, and Orthopaedic Departments of Christian Medical College. Using Total Enumerative Sampling Technique, 140 subjects were enrolled and assessed through a Patient Perception Scale and a checklist developed by the investigator. Results: More than half of the patients (55%) reported receiving high-quality care during their procedure, while 34.29% perceived moderate quality, and only 10.71% indicated low overall care quality. A statistically significant association was found between the type of procedure, doctor's gender, and the quality of care perceived by patients. Additionally, there was a negative correlation between perceived quality of care and waiting time (r = -0.211)

Current Advances in Patient-Perceived Quality Assessment Within Romanian Healthcare.

The global healthcare landscape is shifting toward patient-centered care, emphasizing the integration of patient feedback into service delivery. Romania, aligning with this trend, has implemented patient-perceived quality assessment tools to enhance healthcare services and better meet patient needs and expectations. This study aims to review comprehensively the implementation and impact of these tools in Romania, focusing on their role in improving healthcare quality. By examining key assessment instruments such as the Patient Satisfaction Questionnaire (PSQ), the Service Quality (SERVQUAL) model, and the Romanian Healthcare Quality Assessment Survey (RHQAS), the research seeks to understand how these tools have been used to identify areas for improvement and drive advancements in patient care. Employing a comprehensive review methodology, the study will conduct a thorough literature search to identify relevant studies, reports, and publications, analyzing the PSQ, SERVQUAL, and RHQAS in detail to understand their measurement domains, psychometric properties, and application within Romania. Additionally, qualitative data from interviews with healthcare providers and patients may be collected to offer further insights into the use and effectiveness of these tools. The study's findings are expected to provide valuable insights into the role of patient-perceived quality assessment tools in enhancing healthcare in Romania, identifying strengths, weaknesses, and opportunities for improvement. The results will highlight the effectiveness of combining international methodologies with localized adaptations to address the specific needs of the Romanian healthcare system, ultimately contributing to the ongoing efforts to improve patient satisfaction and health outcomes by informing the development and refinement of patient-centered care initiatives in Romania.

Evaluating surgeon communication of pancreatic cancer prognosis using the VitalTalk ADAPT framework.

Few data exist to guide optimal communication practices for surgical oncologists. VitalTalk, an evidence-based communication skills training model for clinicians, offers the five-step ADAPT tool for discussing prognosis. This study aimed to characterize surgeon communication of pancreatic cancer prognosis using VitalTalk's ADAPT framework. Contemporaneous audio recordings from 12 initial surgeon-patient encounters for borderline resectable pancreatic cancer were transcribed. Directed qualitative content analysis based on ADAPT (Ask, Discover, Anticipate, Provide, and Track) was used to deductively code transcripts. All encounters contained at least one ADAPT step while only one (8%) incorporated four or five steps. Surgeons provided prognostic information (Provide) in all but one encounter (92%); most was qualitative and clustered into themes: serious illness, surgical candidacy, prognostic ambiguity, and cancer recurrence. Surgeons elicited understanding (Ask), requested information preferences (Discover), anticipated ambivalence (Anticipate), and responded to emotion (Track) in a minority of encounters (25%-42%); of 15 patient emotional cues, six were not addressed by surgeons. During an initial encounter for pancreatic cancer, surgeons focus heavily on providing information but omit critical prognostic communication steps. Future studies are needed to investigate if surgeon training in palliative care-based communicationis feasible and impacts patient-perceived quality of communication.

Health-related quality of life is a predictor of readmission following emergency laparotomy.

Health-related quality of life (HRQoL) is a multidimensional concept used to examine the impact of patient-perceived health status on quality of life. Patients' perception of illness affects outcomes in both medical and elective surgical patients; however, not much is known about how HRQoL effects outcomes in the emergency surgical setting. This study aimed to examine if patient-reported HRQoL was a predictor of unplanned readmission after emergency laparotomy. This study included 215 patients who underwent emergency laparotomy at the Copenhagen University Hospital, Herlev, between August 1, 2021, and July 31, 2022. Patient-reported HRQoL was assessed with the EuroQol group EQ5D index (EQ5D5L descriptive system and EQ-VAS). The population was followed from 0 to 180days after discharge, and readmissions and days alive and out of hospital were registered. A Cox proportional hazard model was used to examine HRQoL and the risk of readmission within 30 and 180days. Within 30days, 28.4% of patients were readmitted; within 180days, the number accumulated to 45.1%. Low self-evaluated HRQoL predicted 180-day readmission and was significantly associated with fewer days out of hospital within both 90 and 180days. Low HRQoL and discharge with rehabilitation were independent risk factors for short- (30-day) and long-term (180-day) emergency readmission. Patient-perceived quality of life is an independent predictor of 180-day readmission, and the number of days out of hospital was correlated to self-reported HRQoL.

Machine Learning for Evaluating Hospital Mobility: An Italian Case Study

This study delves into hospital mobility within the Italian regions of Apulia and Emilia-Romagna, interpreting it as an indicator of perceived service quality. Utilizing logistic regression alongside other machine learning techniques, we analyze the impact of structural, operational, and clinical variables on patient perceptions of quality, thus influencing their healthcare choices. The analysis of mobility trends has uncovered significant regional differences, emphasizing how the regional context shapes perceived service quality. To further enhance the analysis, SHAP (SHapley Additive exPlanations) values have been integrated into the logistic regression model. These values quantify the specific contributions of each variable to the perceived quality of service, significantly improving the interpretability and fairness of evaluations. A methodological innovation of this study is the use of these SHAP impact scores as weights in the data envelopment analysis (DEA), facilitating a comparative efficiency analysis of healthcare facilities that is both weighted and normative. The combination of logistic regression and SHAP-weighted DEA provides a deeper understanding of perceived quality dynamics and offers essential insights for optimizing the distribution of healthcare resources. This approach underscores the importance of data-driven strategies to develop more equitable, efficient, and patient-centered healthcare systems. This research significantly contributes to the understanding of perceived quality dynamics within the healthcare context and promotes further investigations to enhance service accessibility and quality, leveraging machine learning as a tool to increase the efficiency of healthcare services across diverse regional settings. These findings are pivotal for policymakers and healthcare system managers aiming to reduce regional disparities and promote a more responsive and personalized healthcare service.

Impact of an individualized pain plan to treat sickle cell disease vaso-occlusive episodes in the emergency department

AbstractTo address acute vaso-occlusive episodes (VOEs), the leading cause of emergency department (ED) visits among individuals with sickle cell disease (SCD), we conducted the clinical study, ALIGN (An Individualized Pain Plan with Patient and Provider Access for Emergency Department care of SCD), across 8 sites. We hypothesized an improvement of 0.5 standard deviations in perceived quality of ED pain treatment of a VOE after implementing individualized pain plans (IPPs) accessible to both patients and providers. Patients with SCD were aged 18 to 45 years, owned a cell phone, and had an ED VOE visit within 90 days prior. Patients completed the perceived quality of care surveys at baseline and within 96 hours after an ED VOE visit. Providers completed surveys regarding comfort managing VOEs at baseline and after managing an enrolled patient. Most of the 153 patients were African American (95.4%), female (64.7%), and had Hb SS/Sβ0 genotype (71.9%). The perceived quality of ED pain treatment was high at both baseline and after implementation of IPPs; our primary outcome hypothesis was not met, because no statistically significant change in the patient-perceived quality of ED treatment occurred. A total of 135 providers completed baseline and follow-up surveys. On a scale of 1 to 7, with 7 being extremely comfortable managing VOEs, 60.5% reported a score ≥6 after IPP implementation vs 57.8% at baseline. Almost all (97.6%) ordered the recommended medication, and 94.7% intended to use IPPs. In this implementation protocol, all sites successfully implemented IPPs. Patients and ED providers both endorsed the use of IPPs. This trial was registered at www.ClinicalTrials.gov as # NCT04584528.

#267 “Surprise question”, malnutrition, frailty, and health-related quality of life in predicting mortality in a cohort of haemodialysis patients

Abstract Background and Aims “Would I be surprised if this patient died in the next year (or six months)?” This question by a medical staff is called “surprise question” (SQ) and the answer “no” (SQ-No) was shown to predict a higher risk of mortality. However, it is unknown what is intuitively assessed by this question. We examined whether SQ is assessing the patient's malnutrition, frailty, or self-perceived health-related quality of life in haemodialysis patients. Method We analysed data from 994 patients on maintenance haemodialysis who participated in the Osaka Dialysis Complication Study (ODCS). Attending nurses answered to SQ. Malnutrition was evaluated by Geriatric Nutritional Risk Index (GNRI). Frailty was assessed by a modified CHS criteria. Patient-perceived health-related quality of life was examined by SF36 physical component summary (PCS). The associations of these exposures with 5-year all-cause mortality (ACM) were analysed by Cox proportional hazards model. Results Median of age and dialysis vintage was 66 and 5.9 years, 35.8% were female, and 39.6% had diabetic kidney disease. The prevalence of SQ-No and frailty was 19.7% and 46.2%. Medians of GNRI and SF36 PCS were 96.3 and 46.2, respectively. During follow-up, 250 patients died. Each of SQ-No, a low GNRI, being frail, and a low SF36 PCS was a significant predictor of a higher risk for ACM independent of potential confounders. SQ-No remained a significant predictor after further adjustment for GNRI or frailty, but SQ-No was no longer significant when adjusted for SF36 PCS. Conclusion Predictive ability of SQ was closely related to SF36 PCS in haemodialysis patients. SQ by nurses appears to assess patient-perceived health-related quality of life rather than objectively assessed malnutrition or frailty.

Patient-Perceived Quality Assessment in Orthopedics and Traumatology Departments during COVID-19 Pandemic.

The COVID-19 pandemic has led to significant disruptions in various healthcare systems. In Romania, the elective procedures in the orthopedic and traumatology specialty were one of the most affected. The study aims to investigate the influence of the COVID-19 pandemic on patient perceptions of quality in these departments. Standardized assessment tools were used, which consist of satisfaction questionnaires addressed to patients in order to assess the quality of health services in orthopedics and traumatology departments. Thus, a retrospective study was conducted using satisfaction questionnaires addressed to patients admitted to the orthopedics and traumatology departments of the County Clinical Emergency Hospital Bihor between January 2019 and December 2022. Eight reports, based on 746 questionnaires conducted during the studied period, were evaluated. To gauge patient satisfaction, Likert scales featuring five response options were used. A total of 627 questionnaires were valid, the exclusion criteria being incomplete questionnaires (the patients did not respond on all questions, n = 119). Four domains were analyzed: demographic data, hotel conditions, quality of medical care, and overall satisfaction. Demographic data highlight that patients exhibited an equitable distribution across residences, with 50.2% hailing from urban locales, while 53.5% (n = 333) were female. Regarding the overall impression, in 2020, there was a decline in the top rating of 5 compared to 2019, dropping to just 45.10% from 53.45%. Scores of 4 increased to 41.83%, while scores of 3 stayed under 8.5%. Scores of 2 and 1 were negligible. In 2021 and 2022, we can observe a sustained increase in the number of patients who awarded 5 points for overall impression and a decrease in the number of patients who awarded 4 points compared to previous years. The maximum difference between 2020 and 2021 and the period before and after this period was 27.24% (p-value < 0.001). The results indicate that while overall impressions of the hospital remained positive throughout the studied period, there were notable fluctuations in satisfaction levels during the pandemic. Patient satisfaction with attending physicians dipped in 2020 from 86.70% to 77.78% but recovered by 2022. The same trend can be observed with nurses and caregivers, as well as hotel services, during this period. These findings underscore the importance of addressing patient concerns and improving the quality of care delivery, particularly during times of crisis.

Patient perceived quality of cirrhosis care– adjunctive nurse-based care versus standard medical care: a pragmatic multicentre randomised controlled study

BackgroundCirrhosis treatment implies prevention and alleviation of serious disease events. Healthcare providers may, however, fail to meet patients’ expectations of collaboration and specific needs of information and support. Individualised nursing care could meet patients’ needs. The aim was thus to measure patient-perceived quality of care after adjunctive registered nurse-based intervention Quality Liver Nursing Care Model (QLiNCaM) compared with standard medical care.MethodsThis pragmatic multicentre study consecutively randomised patients to either adjunctive registered nurse-based care, or standard medical care for 24 months (ClinicalTrials.gov NCT02957253). Patients were allocated to either group at an equal ratio, at six Swedish outpatient clinics during 2016–2022. Using the questionnaire ‘Quality of care from the patient’s perspective’, patients rated their perceived lack of quality for the adjunctive registered nurse-based intervention compared with the control group at 12 and 24 months, respectively.ResultsIn total, 167 patients were recruited. Seven out of 22 items in the questionnaire supported the finding that ‘lacking quality’ decreased with adjunctive registered nurse-based care (p < 0.05) at 12 months follow-up; however, these differences could not be established at 24 months.ConclusionAdditional structured registered nurse-based visits in the cirrhosis outpatient team provided support for improved patient-perceived quality of care during the first 12 months. Registered nurses increase patient involvement and present easy access to cirrhosis outpatient care. Patients express appreciation for personalised information. This study reinforces registered nurses’ role in the outpatient cirrhosis team, optimising patient care in compensated and decompensated cirrhosis.Trial registrationRegistered at Clinical Trials 18th of October 2016, [https://www.clinicaltrials.gov], registration number: NCT02957253.

The effect of internet-administered support (carer eSupport) on preparedness for caregiving in informal caregivers of patients with head and neck cancer compared with support as usual: a study protocol for a randomized controlled trial

BackgroundInformal caregivers (ICs) of patients with cancer provide essential and mainly uncompensated care. A self-perceived preparedness to care for the patient is associated with a lower caregiver burden, described as the extent to which caregiving is perceived as having adverse effects on IC functioning and well-being. ICs’ well-being is associated with patient-perceived quality of care, suggesting that interventions to optimize ICs’ health are essential in order to improve patient care. Head and neck cancer (HNC) is the seventh most common malignant disease in the world. The disease and its treatment have a significant negative impact on the patient’s health and quality of life. Symptoms usually interfere with swallowing, food and fluid intake, breathing, speaking, and communication. ICs frequently manage patients’ symptoms and side effects, especially problems related to nutrition and oral pain, without being properly prepared. Carer eSupport is an Internet-administered intervention, based on focus group discussions with ICs, developed in collaboration with ICs and healthcare professionals, tested for feasibility, and deemed feasible. This study protocol outlines the methods of investigating the effects of Carer eSupport plus support as usual (SAU) on self-reported preparedness for caregiving, caregiver burden, and well-being in the ICs of patients with HNC, compared with ICs receiving SAU only.Methods and analysisIn this randomized controlled trial, 110 ICs of patients with HNC, undergoing radiotherapy combined with surgery and/or medical oncological treatment, will be randomized (1:1) to Carer eSupport plus SAU or SAU only. Data will be collected at baseline (before randomization), post-intervention (after 18 weeks), and 3 months after post-intervention. The primary outcome is self-reported preparedness for caregiving. Secondary outcomes are self-reported caregiver burden, anxiety, depression, and health-related quality of life. The effect of Carer eSupport plus SAU on preparedness for caregiving and secondary outcomes, compared with SAU only, will be evaluated by intention to treat analyses using linear regression models, mixed-model regression, or analysis of covariance.DiscussionIf proven effective, Carer eSupport has the potential to significantly improve ICs’ preparedness for caregiving and their wellbeing, thereby improving patient-perceived quality of care and patient wellbeing.Trial registrationClinicalTrials.gov; NCT06307418, registered 12.03.2024 (https://clinicaltrials.gov/search? term=NCT06307418).

Effects of routine repetitive transcranial magnetic stimulation on the sleep duration of patients with treatment-resistant depression: A prospective cohort study.

The aim of this study was to evaluate the short-term and long-term effects of routine repetitive transcranial magnetic stimulation (rTMS) on the sleep duration, depressive symptoms, and quality of life of patients with treatment-resistant depression (TRD). In this prospective cohort study, 25 participants with TRD were assessed using the Insomnia Severity Index (ISI) and four sleep duration components of the Pittsburgh Sleep Quality Index (PSQI). Depression severity was measured with Hamilton's Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI-II), and patient-perceived quality of life with the 36-Item Short-Form Survey (SF-36). All of these measures were evaluated at baseline (T0), and immediately (T1), 6 weeks (T2), and 12 weeks (T3) after the end of intervention. At T1 endpoint, HDRS, BDI, SF-36, ISI, and three PSQI items (time to wake up, time taken to fall asleep, and Real Sleep Time) significantly improved, though these gains were reduced at follow-up endpoints (T2 and T3). Adjusting for confounders (age, sex, occupational status, BMI, and hypnotic medication) revealed that only improvements in HDRS, BDI, and time taken to fall asleep at T1 remained statistically significant. Linear regression analyses showed no significant association between reduced time taken to fall asleep and depression symptoms, suggesting rTMS can independently enhance this parameter, irrespective of depression resolution. Routine rTMS therapy can potentially enhance sleep duration in TRD individuals, alongside improved depressive symptoms and quality of life. However, these benefits tend to decrease over long-term follow-up, emphasizing a more pronounced short-term efficacy of rTMS.

Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study

Background Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored. Objectives This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China. Methods Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders. Results Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308–0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275–0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276–0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051–4.825). Conclusion Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.

Single-Item Instruments to Measure Aspects of Whole Person Care for an Inpatient Palliative Care Chaplain's Clinical Note: An Examination of Tools

As members of the palliative care team, chaplains’ clinical notes in the electronic health record reflect their encounters with patients. Along with their specialized spiritual assessment included within these notes, chaplains document whole-person aspects of the patient attending to such matters as quality of life. This article examines the psychometric properties of single-item instruments that could measure specific whole-person care components to be documented within a palliative care chaplain's clinical note. A literature search discovered three single-item tools, one related to patient-perceived quality of care and two addressing quality of life. While continued work is needed developing single-item measures, the quality of care question, “Heard and Understood,” and the quality of life question, “How satisfied are you currently with your physical and emotional well-being?,” show promise for current use. Additional investigations are needed to develop single-item measures contributing to comprehensive palliative patient care.