Patients In Quality Improvement Research Articles

АНАЛИЗ РАБОТЫ С ОБРАЩЕНИЯМИ В СФЕРЕ ОХРАНЫ ЗДОРОВЬЯ ГРАЖДАН НА РЕГИОНАЛЬНОМ УРОВНЕ

Significance. Increasing involvement of patients in quality improvement of health care is a global trend. Appeals of the citizens to the state authorities are the easiest way to protect the rights of the citizens in the field of health care. The increased social activity of the citizens and transparency of the state authorities have determined the increase in the number of complaints and appeals of the citizens to the state authorities and medical organizations regarding provision of medical care. Handling appeals and complaints is a systemic problem of the Russian healthcare. Organization of monitoring over incoming information will make it possible to organize systematic work to protect the rights of the citizens in the field of health care, to improve health care quality and accessibility. The purpose of the study is to analyze organization of activities for handling appeals in public health protection at the regional level in order to develop proposals aimed at improving efficiency of appeals’ handling. Material and Methods. Material: official data of the Ministry of Health of the Chelyabinsk region. Research methods: mathematical and statistical; analytical (quantitative, structural, comparative). Results. A growth trend in the number of public appeals to the health executive authorities both at the federal and regional levels has been identified, including dynamics in the increase in the number of appeals related to the provision of medical care, financing and staff remuneration in medical organizations. Regional features of the structure of public appeals submitted to the Ministry of Health of the Chelyabinsk region have been determined. Results of the analysis of the appeal handling in medical chats in the Telegram messenger in 2022, as part of the “ZdravControl” project implementation have been presented. Conclusion. Results of the analysis of the public appeal handling in the field of public health protection at the regional level substantiate the need for developing a set of organizational measures to improve organization of care delivery in the region, and raising public awareness about their rights in the field of public health protection. Implementation of the “ZdravControl” project will make it possible to reduce the number of appeals submitted by the residents directly to the health executive authorities, as well as distribute the appeals by source and method of receipt.

Illuminating the importance of adding patient knowledge to continual improvement in healthcare

The importance of involving patients in quality improvement (QI) is becoming increasingly evident in healthcare.[1 2][1] To achieve this, various approaches, such as codesign[3][2] and coproduction,[4][3] are being introduced alongside...

Engaging Patients in the Veterans Health Administration's Lean Enterprise Transformation: A Qualitative Study.

Lean management is a strategy for improving health care experiences of patients. While best practices for engaging patients in quality improvement have solidified in recent years, few reports specifically address patient engagement in Lean activities. This study examines the benefits and challenges of incorporating patient engagement strategies into the Veterans Health Administration's (VA) Lean transformation. We conducted a multisite, mixed-methods evaluation of Lean deployment at 10 VA medical facilities, including 227 semistructured interviews with stakeholders, including patients. Interviewees noted that a patient-engaged Lean approach is mutually beneficial to patients and health care employees. Benefits included understanding the veteran's point of view, uncovering inefficient aspects of care processes, improved employee participation in Lean events, increased transparency, and improved reputation for the organization. Challenges included a need for focused time and resources to optimize veteran participation, difficulty recruiting a diverse group of veteran stakeholders, and a lack of specific instructions to encourage meaningful participation of veterans. As the first study to focus on patient engagement in Lean transformation efforts at the VA, this study highlights ways to effectively partner with patients in Lean-based improvement efforts. Lessons learned may also help optimize patient input into quality improvement more generally.

Partnering with patients in quality improvement: towards renewed practices for healthcare organization managers?

BackgroundAround the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices.MethodsIn-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers.ResultsOur findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its deployment and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement.ConclusionThis research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.

How is patient involvement measured in patient centeredness scales for health professionals? A systematic review of their measurement properties and content

BackgroundPatient centeredness is an important component of patient care and healthcare quality. Several scales exist to measure patient centeredness, and previous literature provides a critical appraisal of their measurement properties. However, limited knowledge exists regarding the content of the various scales in terms of what type of patient centeredness they represent and how they can be used for quality improvement. The aim of this study was to explore the measurement properties of patient centeredness scales and their content with a special focus on patient involvement, and assess whether and how they can be used for quality improvement.MethodsA systematic review of patient centeredness scales was conducted in Medline, CINAHL, Embase, and SCOPUS in April and May 2017. Inclusion criteria were limited to articles written in English published from 2005 to 2017. Eligible studies were critically appraised in terms of internal consistency and reliability, as well as their content, structural, and cross-cultural validity. Type of studies included were scale-development articles and validation studies of relevant scales, with healthcare personnel as respondents. We used directed content analysis to categorize the scales and items according to Tritter’s conceptual framework for patient and public involvement.ResultsEleven scales reported in 22 articles were included. Most scales represented individual, indirect, and reactive patient involvement. Most scales included items that did not reflect patient centeredness directly, but rather organizational preconditions for patient centered practices. None of the scales included items explicitly reflecting the use of patient experiences of quality improvement.ConclusionsThere is a lack of patient centeredness scales focusing on direct and proactive involvement of patients in quality improvement. It would be useful to develop such instruments to further study the role of patient involvement in quality improvement in healthcare. Furthermore, they could be used as important tools in quality improvement interventions.

Supporting Patient and Family Engagement for Healthcare Improvement: Reflections on "Engagement-Capable Environments" in Pan-Canadian Learning Collaboratives.

Although the involvement of patients in their care has been central to the concept of patient-centred care, patient engagement in the realms of health professional education, policy making, governance, research and healthcare improvement has been rapidly evolving in Canada in the past decade. The Canadian Foundation for Healthcare Improvement (CFHI) has supported healthcare organizations across Canada to meaningfully partner with patients in quality improvement and system redesign efforts. This article describes CFHI initiatives to enhance patient engagement efforts across Canada and the lessons learned in the context of "engagement-capable environments" and offers reflections for the future of patient engagement in Canada.

Exploring the phase for highest impact on radicality: a cross-sectional study of patient involvement in quality improvement in Swedish healthcare

ObjectivesInvolving patients in quality improvement is often suggested as a critical step for improving healthcare processes. However, this comes with challenges related to resources, tokenism, validity and competence. Therefore, to...

How to engage patients in research and quality improvement in community-based primary care settings: protocol for a participatory action research pilot study

Plain English summaryMaking primary care clinics more patient-centered is key to improving patients’ experience of care. If patients themselves were engaged in helping define priorities and suggesting quality improvements in the clinic, care would respond better to their needs. However, patient engagement is a new phenomenon, particularly in community based primary care clinics. How to engage patients in quality improvement in these clinics, or what effect this might have, is not well known. The involvement of patients needs to be adapted to the way these clinics function. The aim of this study is to create and evaluate a new model of patient engagement for quality improvement in community based primary care clinics. Patients, primary care professionals and researchers will create advisory councils in two primary care clinics in Quebec City (Canada). In each clinic, the advisory council will include 12 patients or caregivers registered at the clinic, a clinician and a clinic manager. The advisory council will meet every 6 weeks for a total of six meetings. Two patient-experts will facilitate meetings. During meetings, members of the council will list their needs in order of importance. Then they will suggest improvements in line with these needs. We will study if our advisory council model is well adapted to community based primary care settings and meets participants’ expectations. At the end of the study we will be able to offer guidance about engaging patients with health professionals in quality improvement in primary care clinics.BackgroundInvolvement of end-users, including patients, managers and clinicians, in identifying quality improvement and research priorities might improve the relevance of projects and increase their impact. Few patient engagement initiatives have taken place in community based primary care practices (CBPCPs) and best practices for engaging patients in such settings are not well defined. The aim of this pilot study is to develop and assess the feasibility of a new collaborative model of advisory council involving clinicians, managers, patients and caregivers in CBPCP to strengthen their capacity to conduct quality improvement and patient-oriented research projects.MethodsWe will conduct a participatory action research project in two non-academic CBPCPs in Quebec City (Canada). In each CBPCP, the advisory council will include 12 patients or caregivers, a clinician and a clinic manager. Patients or their caregivers will be identified by clinicians and contacted by patient-experts. They will be eligible if they are registered at the practice, motivated, and available to attend meetings. The council will meet every 6 weeks for a total of six meetings. Two patient-experts will guide council members to identify quality improvement priorities and patient-oriented research questions based on their experience in the clinic. They will then be supported to plan actions to target these priorities. Analysis of meetings will be based on feasibility criteria, notes by non-participant observers in log books, audio-recording of the meetings and questionnaires to evaluate council members’ perceptions and the likelihood they would engage in such councils.DiscussionThe results of this study will be a model of patient engagement and a discussion of factors to improve the model to fit the needs of primary care patients and professionals. This will lay the foundation for a sustainable structure for long-term patient engagement and contribute to the development of a patient-centered and quality-improvement culture in CBPCPs.

Patients’ expectations and solutions for improving primary diabetes care

PurposeThe purpose of this paper is to document health care needs expressed by people living with diabetes, describe the solutions they envisaged for improving the quality of primary care (PC) services and empower them to make better use of PC services.Design/methodology/approachA participatory research approach was used. Six workshops were organised to provide diabetes patients with knowledge on available services and to engage them in sharing their experience. Group discussions were recorded. Data were analysed using the thematic analysis method.FindingsIn total, 79 persons living with diabetes for a mean of 13 years participated. Needs expressed were grouped under seven themes: assurance of satisfactory follow-up by a family physician, continuous access to services adapted to evolving needs, motivation to adopt and maintain healthy behaviours, maintenance of knowledge about diabetes, psychological support, financial constraints, and collaboration with secondary-level services. Patients proposed solutions for improving services that were grouped under five themes: facilitating access to services, disseminating information about available services, centralising diabetes information on the internet, offering personalised services and improving interprofessional collaboration.Practical implicationsNeeds expressed by diabetic patients concern different aspects of care such as accessibility, organisation, coordination, and better dissemination and visibility of services. The solutions proposed by patients focussed on better access to information and interprofessional services.Originality/valueThe workshop format used in this study offers an original and interesting approach and tool for actively engaging patients in quality improvement of services.

Expanding patient engagement in quality improvement and health system redesign: Three Canadian case studies.

Healthcare organizations face growing pressures to increase patient-centred care and to involve patients more in organizational decisions. Yet many providers worry that such involvement requires additional time and resources and do not see patients as capable of contributing meaningfully to decisions. This article discusses three efforts in four organizations to engage patients in quality improvement efforts. McGill University Health Centre, Saskatoon Health Region, and Vancouver Coastal and Fraser Health Regions all engaged patients in quality improvement and system redesign initiatives that were successful in improving care processes, outcomes, and patient experience measures. Patient involvement in redesigning care may provide a way to demonstrate the value of patients' experiences and inputs into problem-solving, building support for their involvement in other areas. Further study of these cases and a broader survey of organizational experiences with patient involvement may help elucidate the factors that support greater patient engagement.

Patients' involvement in improvement initiatives: a qualitative systematic review.

Over the last 20 years, quality improvement in health has become an important strategy in health services in many countries. With the emphasis on quality health care, there has been a shift in social paradigms towards including service users in their own health on different levels. There is growing evidence in literature on the positive impact on health outcomes where patients are active participants in their personal care. There is however less information available on the broader influence of users on improvement in systems. The objective of this review was to identify the barriers and enablers to patients being involved in quality improvement efforts directed towards their own health care. This review considered studies that included adults and children of any age experiencing any health problem.The review considered studies that explored patient or user participation in quality improvement and the factors enabling and hindering this processThe qualitative component of this review considered studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Other texts such as opinion papers and reports were also considered. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The searches using all identified keywords and index terms included the databases PubMed, PsycINFO, Medline, Scopus, EBSCOhost and CINAHL.Qualitative, text and opinion papers were considered for inclusion in this review.Closely related concepts like community involvement, family involvement, patients' involvement in their own care (for example, in the case of shared decision making), and patient centeredness in the context of a consultation were excluded. Qualitative and textual papers selected for retrieval were assessed by two independent reviewers for authenticity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute. Qualitative and textual data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute. The above findings were pooled and through the identification of categories, a final meta-synthesis was formulated. Two synthesized findings were created from the included papers. Firstly, there are barriers to patients' participation in quality improvement in health and in spite of policy support for user involvement in quality improvement, it is a difficult strategy to implement. The second synthesized finding was that there are enablers to patients' involvement in quality improvement: when patients are involved in quality improvement efforts in health care, there are innovative, often unexpected, outcomes at different levels of the process, and sustaining these efforts is possible with ongoing individual or group support.Five categories which supported the synthesized findings were created through the meta-aggregative process. There are enablers and barriers to involving patients in quality improvement in health care that need to be considered when planning such interventions.Relationships and roles will need to be very clear from the outset. A developmental approach needs to be considered where support and training is part of the project. Where patients are truly engaged in service improvement, unexpected innovation occurs.There are many more reports and opinion papers published regarding this topic than there are rigorous research studies. This leaves the field open to the development of good methodological studies related to quality improvement and in particular to the participation of patients.

Support and Strategies for Change Among Small Patient-Centered Medical Home Practices

We aimed to determine the motivations and barriers facing small practices that seek to adopt the patient-centered medical home (PCMH) model, as well as the type of help and strategies they use. We surveyed lead physicians at practices with fewer than 5 physicians, stratified by state and level of National Committee for Quality Assurance PCMH recognition, using a Web-based survey with telephone, fax, and mail follow-up. The response rate was 59%, yielding a total sample of 249 practices from 23 states. Improving quality and patient experience were the strongest motivations for PCMH implementation; time and resources were the biggest barriers. Most practices participated in demonstration projects or received financial rewards for PCMH, and most received training or other kinds of help. Practices found training and help related to completing the PCMH application to be the most useful. Training for patients was both less common and less valued. The most commonly used strategies for practice transformation were staff training, systematizing processes of care, and quality measurement/goal setting. The least commonly endorsed strategy was involving patients in quality improvement. Practices with a higher level of PCMH recognition were more likely to have electronic health records, to report barriers, and to use measurement-based quality improvement strategies. To spread the adoption of the PCMH model among small practices, financial support, practical training, and other help are likely to continue to be important. Few practices involved patients in their implementation, so it would be helpful to test the impact of greater patient involvement in the PCMH.

Survey Shows That Fewer Than A Third Of Patient-Centered Medical Home Practices Engage Patients In Quality Improvement

Directly involving patients and families in care improvement increasingly is viewed as an important component of patient-centered care. To assess the extent to which practices actually involve patients, we surveyed 112 patient-centered medical home practices in twenty-two states. Nearly all of these practices sought patient feedback. However, only 29percent involved patients and families as advisers and sought feedback through surveys, and only 32percent involved patients in a continuing role in quality improvement. Interviews showed that practices that highly value patient involvement overcame barriers to ongoing patient participation. We argue that a cultural shift is needed in how practices view patients as partners, not just in areas such as personal responsibility and self-management, but also in quality improvement and governance. Practices must gain more experience and see more examples of the benefits of engaging patients, and they may need more incentives and support for engaging them.

Patients' involvement in their own care through quality improvement initiatives: a systematic review of qualitative and opinion evidence.

Review question/objective The objective of this review is to identify the barriers and enablers towards patients being involved in quality improvement efforts towards their own health care. The review question is: What difference does the involvement of patients in quality improvement projects and processes make to their own health? Inclusion criteria Types of participants The qualitative and textual components of this review will consider studies that include adults and children of all ages experiencing any health problem. Phenomena of interest The qualitative and textual components of this review will consider studies that evaluate the involvement of patients in quality improvement efforts/projects. in any health setting in all areas of health. Types of outcomes This review will consider studies that include amongst others, the following outcome measures: patient empowerment or satisfaction, clinical outcomes as appropriate to the QI e.g. blood levels, admissions and cost outcomes. Types of studies The qualitative and textual components of this review will consider studies that focus on qualitative data, including but not limited to designs such as phenomenology, grounded theory, ethnography, action research and feminist research.

Patientsʼ involvement in their own care through quality improvement initiatives: a systematic review of qualitative and opinion evidence

Review question/objective The objective of this review is to identify the barriers and enablers towards patients being involved in quality improvement efforts towards their own health care. The review question is: What difference does the involvement of patients in quality improvement projects and processes make to their own health? Inclusion criteria Types of participants The qualitative and textual components of this review will consider studies that include adults and children of all ages experiencing any health problem. Phenomena of interest The qualitative and textual components of this review will consider studies that evaluate the involvement of patients in quality improvement efforts/projects. in any health setting in all areas of health. Types of outcomes This review will consider studies that include amongst others, the following outcome measures: patient empowerment or satisfaction, clinical outcomes as appropriate to the QI e.g. blood levels, admissions and cost outcomes. Types of studies The qualitative and textual components of this review will consider studies that focus on qualitative data, including but not limited to designs such as phenomenology, grounded theory, ethnography, action research and feminist research.

Involving patients and users of services in quality improvement: what are the benefits?

The current interest in involving all members of the health care team in the evaluation and improvement of care has grown to include patients and recipients of care. Although much is written about how important it is to involve patients there is less information available about how this might be achieved. Even the term ‘involvement’ is itself open to various interpretations and this may result in involving patients in quality improvement remaining in the realms of rhetoric rather than reality. In this article we outline the benefits obtained from the active collaboration of patients with health care professionals in making decisions about their care. We examine ways in which patients’ views about the quality of the care that they receive can be heard and suggest that clinical guidelines might be one way of bridging the knowledge gap between health care professionals and patients so that joint decision‐making becomes more effective.