Quality Of Care Experience Research Articles

Dyadic coping strategies and quality of care experience: An original study of patients living with multiple sclerosis and their caregivers

Background and objectiveMultiple sclerosis has a major impact on the lives of patients and their caregivers. Measuring their experience is essential for improving the quality of care. Based on a sample of patient–informal caregiver dyads we examine whether coping strategies they implemented influenced their self-experience of quality of care. MethodsOne hundred and eighty three dyads were involved in this cross-sectional study. Self reported data included experience with the quality of care (Musicare) and coping strategies (Brief Cope) for patients and their caregivers. An actor–partner interdependence model (APIM) analysis was performed to assess the dyadic effects of coping strategies on experience of quality of care. ResultsPositive coping strategies were the most used by patients and caregivers alike. They were associated with a better experience of relationships with healthcare professionals, information about the disease and patient reception at the sites providing care. APIM analyses confirmed most of these results and identified one “partner” effect. ConclusionThe experience of the quality of the care of patients living with MS is related to the use of positive coping strategies.

Impact of triage by a rheumatologist on appropriateness of referrals from primary to secondary care: a cluster randomized trial

Objective The quality of referrals is often criticized, and the effectiveness of improvement efforts remains uncertain. We assessed the impact of a rheumatologist triaging patients in primary care on the appropriateness of referrals to secondary care, healthcare utilization, and patient experience and outcomes. Method A cluster randomized controlled trial was conducted with patients experiencing musculoskeletal complaints. Intervention practices deployed an experienced rheumatologist triaging patients through in-person review. Usual care was performed in control practices, where practitioners referred patients based on their own judgement. The primary outcome was the proportion of inflammatory rheumatic diseases (IRDs) diagnosed by rheumatologists in referred patients. Healthcare utilization (iMTA Medical Consumption Questionnaire), quality of life (EuroQol 5 Dimensions), and experience of care (Consumer Quality Index) were determined after 3 months of follow-up. Data were analysed according to the intention-to-treat principle. Results In total, 544 participants were included [mean age 51.4 (range 18–87) years; 24% were men]. Of all referred patients, 51% had an IRD in the intervention group versus 21% in the control group (p = 0.035). After 3 months of follow-up, patients from the triage intervention showed lower healthcare utilization (p = 0.006) and higher quality of life (p = 0.011), without a decline in experienced quality of care (p = 0.712), compared to controls. Conclusion Triage by a rheumatologist in primary care provides appropriate care and adequate experience of care, leading to a higher quality of life. Long-term evidence is needed to assess the value on cost-effectiveness before implementing this strategy nationwide.

Colorectal cancer caregivers demonstrate need for a one-stop comprehensive resource.

74 Background: Patients with colorectal cancer often require a caregiver’s assistance with daily activities, medical care, social needs, and navigating treatment options. In providing this assistance, caregivers may be at an increased risk for psychological distress. Direct support to manage a caregiver’s stress and maintain their well-being is essential. More research is needed to fully understand the challenges caregivers face and to provide solutions. Previous studies have found that caregivers experience high levels of depression and anxiety, and many lack access to resources despite the evidenced need for support. Methods: A survey was disseminated via the Colorectal Cancer Alliance’s Blue Hope Nation community for two weeks and by email. Forty caregivers of colorectal cancer patients of varying stages and diverse demographic backgrounds completed the survey. Results: Half of the respondents have been providing care for 1-3 years, and 63% indicated they were a patient’s spouse or partner. Most caregivers were in the 35-40 age group, and 30% were full-time caregivers. A majority reported experiencing anxiety/stress (97.5%), fatigue (80%), poor sleep (77.5%), depression (75%), and feelings of isolation (72.5%). Primary caregiver activities included providing moral support, completing household chores, and researching treatment options. Only 32.5% of caregivers received help or advice from their patient’s doctors or medical team on the tasks listed. The survey results suggest the need for a comprehensive resource with information on medications, side effects and treatments; a guide for medical discussions; organization for medical forms and documents; and a tool to connect with peer caregivers. Conclusions: Survey themes indicate that caregivers often feel unprepared to provide care, have inadequate knowledge, and receive little guidance from health care providers, so there is continued need to place both the patient and caregiver at the center of care. A comprehensive centralized resource given at diagnosis with vital information and a method for document organization would help reduce caregivers’ stress and allow them to share information easily. Such patient and caregiver-directed resources would enable a better quality of care experience, and potentially better mental health outcomes, for patients and their caregivers.

Text-Mining in Long-Term Care: Exploring the Usefulness of Computer-Aided Analyzing Methods

In nursing homes, narrative data are collected to evaluate quality of care as perceived by residents or their family members. This results in a large amount of textual data which exceeds the capability of humans to analyse it. This study aims to explore the usefulness of text-mining approaches regarding narrative data gathered in a nursing home setting. Data has been collected as part of the project ‘Connecting Conversations’: assessing experienced quality of care by conducting individual interviews (n=125) with residents of nursing homes, family members and care professionals. Several pre-processing steps were applied to the textual data. Finally, a variety of text-mining analyses were conducted: individual and bigram word frequencies, correlation analysis and sentiment analysis. A survey was conducted to establish a sentiment analysis model tailored to text collected in long-term care for older adults. Residents, family members and care professionals uttered respectively 285, 362 and 549 words per interview. Word frequency analysis showed that words that occurred most frequently in the interviews are often positive. Although there are some differences in wording such as the use of ‘mother’ and ‘breakfast’, correlation analysis displayed that similar words are used by all three groups to describe quality of care. The majority of interviews displayed a neutral sentiment. Care professionals are more diverse in their sentiment than residents and family members: while some express a more positive sentiment, others express more negativity. This study demonstrates the usefulness of text-mining to extend our knowledge regarding quality of care in a nursing home setting.

Quality of care experience in aged care: An Australia-Wide discrete choice experiment to elicit preference weights

The quality of aged care provided to older people is a concern for all countries globally. This study adopts a novel first-stage discrete choice experiment (DCE) and a second-stage quality rating task to empirically estimate the relative importance of six key aged care quality criteria from more than 10,000 Australian general population sample. The six attributes or characteristics (each with five levels) compose the new measure, Quality of Care Experience (QCE) in aged care that includes: ‘Respect & Dignity’, ‘Make Own Decisions’, ‘Skills & Training (of staff)’, ‘Health & Wellbeing’, ‘Social Relationships’, and ‘Lodging Complaints’. The online survey was conducted between September and October 2019. Preference heterogeneity was evident among respondents. The latent class analysis indicates that those more experienced respondents (i.e. have a better knowledge of Australia's current aged care system or they had a close family member who was receiving aged care services) valued more towards the outcomes of the aged care services whilst the inexperienced respondents valued highly towards the process of the aged care services. A preference weighted scoring algorithm was developed for the QCE measure (on a 0–1 scale whereby 0 = lowest quality and 1 = highest quality) and the corresponding quality thresholds for ‘Unacceptable/Poor’, ‘Satisfactory’ and ‘High/Very High’ quality of care were reported based on the second-stage quality rating questions following each DCE task. The impact of different QCE attributes on the quality ratings was non-linear when considering movements from ‘Unacceptable/Poor’ to ‘Satisfactory’, and from ‘Satisfactory’ to ‘High/Very High’. This study provides important insights into the general public's perceptions of the relative importance of key quality of care experience criteria in aged care.

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

BackgroundEnhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on available evidence. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review.MethodsWe included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). Following databases (1990 onwards) were searched: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two authors screened the citations, full-text articles, and extracted data. A narrative synthesis was provided. We constructed Evidence Profile (EP) tables for each component of the pathway, where appropriate information was available. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. GRADE system was used to classify confidence in cumulative evidence for each component of the pathway.ResultsWe identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We identified specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables where suitable. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components.ConclusionsWe identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS.Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery.

The needs of key-stakeholders for evaluating client\u2019s experienced quality of home care: a qualitative approach

BackgroundTo optimize home care, it is essential to determine how care recipients experience quality of care. Traditionally, quality of care is measured with normative quality indicators such as safety, efficiency, or prevalence rates such as falls. The growing interest for qualitative patient-reported experience measures in home care requires insight into the needs of care receivers, providers, and organizations as key-stakeholders. Each stakeholder has their own needs that are important to communicate and use to conduct thorough comparisons before implementing new experience measures. This study aims to understand the needs of clients, formal/informal caregivers, and managers/policy officers in measuring client’s experienced quality of care in home care.MethodsFour focus group interviews and 25 semi-structured interviews with key-stakeholders were conducted and analyzed by means of content analysis. The value-proposition canvas was used as a thematic framework to explore the purpose of experience quality of care measures and related pains and gains.ResultsThere were two main purposes for measuring experienced quality of care: first improving the primary care process of individual clients and second for learning and improving in home care team. Using experienced quality of care measures for external accountability and transparency on an organizational or national level were considered less relevant. Among others, participants described not having time and no clear procedure for conducting an evaluation as a pain of the current methods used to evaluate perceived quality of home care. As gains they put forward the ability to informally evaluate experiences during care delivery and to openly discuss complaints with a familiar caregiver.ConclusionsThis study advocates that home care organizations should be aware of the goal of quality of care measures. They should consider selecting experienced quality of care measures mainly for improving primary care processes of individual clients. The results also underline the relevance of adopting next to quantitative evaluations, more narrative evaluation methods which support communicating openly on care experiences, leading to concrete point-of-improvement. The findings of this study can serve as a guide for both the development or selection of adequate methods, from the perspectives of key-stakeholders, in assessing experienced quality in home care.

Prospective cohort study of patients with advanced cancer and their relatives on the experienced quality of care and life (eQuiPe study): a study protocol

BackgroundPalliative care is becoming increasingly important because the number of patients with an incurable disease is growing and their survival is improving. Previous research tells us that early palliative care has the potential to improve quality of life (QoL) in patients with advanced cancer and their relatives. According to limited research on palliative care in the Netherlands, patients with advanced cancer and their relatives find current palliative care suboptimal. The aim of the eQuiPe study is to understand the experienced quality of care (QoC) and QoL of patients with advanced cancer and their relatives to further improve palliative care.MethodsA prospective longitudinal observational cohort study is conducted among patients with advanced cancer and their relatives. Patients and relatives receive a questionnaire every 3 months regarding experienced QoC and QoL during the palliative trajectory. Bereaved relatives receive a final questionnaire 3 to 6 months after the patients’ death. Data from questionnaires are linked with detailed clinical data from the Netherlands Cancer Registry (NCR). By means of descriptive statistics we will examine the experienced QoC and QoL in our study population. Differences between subgroups and changes over time will be assessed while adjusting for confounding factors.DiscussionThis study will be the first to prospectively and longitudinally explore experienced QoC and QoL in patients with advanced cancer and their relatives simultaneously. This study will provide us with population-based information in patients with advanced cancer and their relatives including changes over time. Results from the study will inform us on how to further improve palliative care.Trial registrationTrial NL6408 (NTR6584). Registered in Netherlands Trial Register on June 30, 2017.

Limited multi-drug resistant organism related stigma in carriers exposed to isolation precautions: an exploratory quantitative questionnaire study

Isolation precautions are applied to control the risk of transmission of multi-drug resistant organisms (MDROs). These precautions have been associated with adverse effects, such as anxiety and depression. This study aimed to quantify stigma among MDRO carriers and its association with perceived mental health and experienced quality of care. A quantitative questionnaire study was performed in MDRO carriers exposed to ≥3 days of isolation precautions during hospitalization. Items derived from the Consumer Quality Index questionnaire (CQI) were used to assess perception of care. Stigma scores were calculated using the recently modified Berger Stigma Scale for meticillin-resistant Staphylococcus aureus (MRSA). Mental health was measured with the RAND Mental Health Inventory. The Spearman rank correlation test was used to assess the association between stigma score and RAND mental health score. Of the 41 included carriers, 31 (75.6%) completed both questionnaires. The experienced quality of care was 'good' according to CQI score. Twenty-four percent reported not to have received proper explanation about MDRO carriership from healthcare workers (HCWs). MDRO-associated stigma was reported in 1/31 (3.2%). Poor mental health was self-reported in 3/31 (9.7%). There was no correlation between stigma score and RAND mental health score (Spearman correlation coefficient: 0.347). In this study, MDRO carriers exposed to ≥3 days of isolation precautions did not report stigma. This contrasts with a recent study that investigated MRSA-associated stigma and may be explained by contact plus airborne isolation protocols in MRSA compared with contact isolation alone in most other MDROs. Also, the psychological impact may be of a different magnitude due to as yet unknown reasons.

Patients' perspectives on a new delivery model in primary care: A propensity score matched analysis of patient-reported outcomes in a Dutch cohort study.

Rationale, aims and objectivePrimary Care Plus (PC+) focuses on the substitution of hospital‐based medical care to the primary care setting without moving hospital facilities. The aim of this study was to examine whether population health and experience of care in PC+ could be maintained. Therefore, health‐related quality of life (HRQoL) and experienced quality of care from a patient perspective were compared between patients referred to PC+ and to hospital‐based outpatient care (HBOC).MethodsThis cohort study included patients from a Dutch region, visiting PC+ or HBOC between December 2014 and April 2018. With patient questionnaires (T0, T1 and T2), the HRQoL and experience of care were measured. One‐to‐two nearest neighbour calliper propensity score matching (PSM) was used to control for potential selection bias. Outcomes were compared using marginal linear models and Pearson chi‐square tests.ResultsOne thousand one hundred thirteen PC+ patients were matched to 606 HBOC patients with well‐balanced baseline characteristics (SMDs <0.1). Regarding HRQoL outcomes, no significant interaction terms between time and group were found (P > .05), indicating no difference in HRQoL development between the groups over time. Regarding experienced quality of care, no differences were found between PC+ and HBOC patients. Only travel time was significantly shorter in the HBOC group (P ≤ .001).ConclusionResults show equal effects on HRQoL outcomes over time between the groups. Regarding experienced quality of care, only differences in travel time were found. Taken as a whole, population health and quality of care were maintained with PC+ and future research should focus more on cost‐related outcomes.

Proposed pathway for patients undergoing enhanced recovery after spinal surgery: protocol for a systematic review

BackgroundThe best evidence-enhanced recovery care pathway is yet to be defined for patients undergoing spinal surgery. Minimally invasive surgery, multimodal analgesia, early mobilization, and early postoperative nutrition have been considered as critical components of enhanced recovery in spinal surgery (ERSS). The objective of this study will be to synthesize the evidence underpinning individual components of a proposed multidisciplinary enhanced recovery pathway for patients undergoing spinal surgery.MethodsThis is the study protocol for a systematic review of complex interventions. Our team identified 22 individual care components of a proposed pathway based on clinical practice guidelines and published reviews. We will include systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled trials, and observational studies in adults or pediatric patients evaluating any one of the pre-determined care components. Our primary outcomes will be all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). We will search the following databases (1990 onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The risk of bias for individual studies will be appraised using appropriate tools. A narrative synthesis will be provided with the information presented in the text and tables to summarize and explain the characteristics and findings of the included studies. Due to clinical and methodological heterogeneity, we do not anticipate to conduct meta-analyses. Confidence in cumulative evidence for each component of care will be classified according to the GRADE system.DiscussionThis systematic review will identify, evaluate, and integrate the evidence underpinning individual components of a pathway for patients undergoing spinal surgery. The formation of an evidence-based pathway will allow for the standardization of clinical care delivery within the context of enhanced recovery in spinal surgery.Systematic review registrationPROSPERO CRD42019135289

How to assess experienced quality of care in nursing homes from the client\u2019s perspective: results of a qualitative study

BackgroundThe culture shift in nursing homes from task-oriented to person-centered care has created a need to assess clients’ experienced quality of care (QoC), as this corresponds best with what matters to them. This study aimed to gain insight into how to assess experienced QoC in nursing homes from the client’s perspective.MethodA qualitative study was performed consisting of a focus group with client representatives (n = 10), a focus group with nursing home staff (n = 9) and a world café with client representatives and staff recruited from the Living Lab in Ageing & Long-Term Care (n = 24). Three questions about assessing experienced QoC from the client’s perspective were addressed during data collection: 1) What content needs to be assessed? 2) What assessment procedures are needed? and, 3) Who needs to be involved in the assessment? Semi-structured questions, photo elicitation and creative writing were used to answer these questions. Conventional content analysis was used to analyze the data.ResultsParticipants indicated that experienced QoC mostly occurs within the interactions between clients, family and staff, highlighting the impact of relationships. They suggested assessments should focus on three aspects: 1) knowledge about the client, 2) a responsive approach, and 3) a caring environment. These can be assessed by having conversations with clients, their families and staff, and additionally observing the clients in their living environments. Sufficient time and resources are prerequisites for this. Additionally, the person performing the quality assessments needs to possess certain communication and empathy skills.ConclusionIt is important to include the perspectives of the client, family and staff when assessing experienced QoC, in line with the principles underlying relationship-centered care. In order to be feasible, it is recommended to incorporate quality assessments into the nursing homes’ daily routines. Further research with clients, family and staff in nursing homes is needed to develop a feasible, reliable and valid method that assesses experienced QoC from the client’s perspective.

Measuring Regional Quality of Health Care Using Unsolicited Online Data: Text Analysis Study.

BackgroundRegional population management (PM) health initiatives require insight into experienced quality of care at the regional level. Unsolicited online provider ratings have shown potential for this use. This study explored the addition of comments accompanying unsolicited online ratings to regional analyses.ObjectiveThe goal was to create additional insight for each PM initiative as well as overall comparisons between these initiatives by attempting to determine the reasoning and rationale behind a rating.MethodsThe Dutch Zorgkaart database provided the unsolicited ratings from 2008 to 2017 for the analyses. All ratings included both quantitative ratings as well as qualitative text comments. Nine PM regions were used to aggregate ratings geographically. Sentiment analyses were performed by categorizing ratings into negative, neutral, and positive ratings. Per category, as well as per PM initiative, word frequencies (ie, unigrams and bigrams) were explored. Machine learning—naïve Bayes and random forest models—was applied to identify the most important predictors for rating overall sentiment and for identifying PM initiatives.ResultsA total of 449,263 unsolicited ratings were available in the Zorgkaart database: 303,930 positive ratings, 97,739 neutral ratings, and 47,592 negative ratings. Bigrams illustrated that feeling like not being “taken seriously” was the dominant bigram in negative ratings, while bigrams in positive ratings were mostly related to listening, explaining, and perceived knowledge. Comparing bigrams between PM initiatives showed a lot of overlap but several differences were identified. Machine learning was able to predict sentiments of comments but was unable to distinguish between specific PM initiatives.ConclusionsAdding information from text comments that accompany online ratings to regional evaluations provides insight for PM initiatives into the underlying reasons for ratings. Text comments provide useful overarching information for health care policy makers but due to a lot of overlap, they add little region-specific information. Specific outliers for some PM initiatives are insightful.

THE CARE RECIPIENT’S PERSPECTIVE ON QUALITY OF CARE: DIFFERENT APPROACHES IN NURSING HOMES

In long-term care, there has been an ongoing shift focused on person-centered care, positioning the care recipient at the core of good quality of care. This has resulted in more emphasis on care recipients’ preferences and experiences with the care they receive. In the Netherlands, Germany and the United States the need to focus on and assess quality from the care recipient’s perspective has emerged. This symposium presents four different approaches to quality of care from the care recipient’s perspective. The first speaker will focus on a narrative approach to assess experienced quality of care in nursing homes. The second speaker will present an observational method to assess the level of autonomy provided to people with dementia in nursing homes. The third speaker will present findings about the use of specialist health care in nursing homes as an indicator for quality of care. The last presentation will address the importance of preferences in quality of care. Defining, assessing and improving experienced quality of care from the care recipient’s perspective is an ongoing challenge, as each care recipient’s preferences and needs differ. It is important to assess in order to monitor that care is being tailored to the care recipient and to identify possible interventions that can enhance experienced quality of care.

FACILITATING CARE: A NARRATIVE APPROACH TO ASSESS EXPERIENCED QUALITY OF CARE

This study aimed to develop a method to assess experienced quality of care (QoC) in nursing homes from the resident’s perspective. A narrative approach “Facilitating Care” (FC) was developed based on the INDEXQUAL framework of experienced QoC and a needs assessment. FC assesses experienced QoC by training care professionals to perform individual conversations with residents, their family and their professional caregivers (triads) in another organization than where they are employed. FC consists of three phases: 1) training, 2) data collection and registration, and 3) analysis and reporting of the results. In 2018, 16 care professionals were trained and performed 148 conversations (47 residents, 44 family members, 57 professional caregivers) in 8 different nursing homes. Evaluation showed that FC teaches helpful conversation techniques and provides valuable insights into residents’ experienced QoC. Whilst the process was considered time consuming, all participants emphasized the added value of taking time for FC conversations.

What is the relationship between the quality of care experience and quality of life outcomes? Some evidence from long-term home care in England

Quality of care has multiple dimensions, including safety, experience and effectiveness. Understanding the relationship between these dimensions is important for policy and practice, since there may be both synergies and trade-offs that occur when attempting to maximise them. For long-term care effectiveness is understood as care that promotes a good quality of life (QoL). Here we investigate the relationship between care experience and QoL in long-term home care. Data from a cross-sectional survey conducted in 2008/09 were analysed using fractional response regression models to explore the relationship between experience, measured through items capturing perceptions of the care delivery process, and patient-reported QoL-outcomes, measured using ASCOT, controlling for relevant individual characteristics. The analysis included 14,172 people aged 65 and over using home care services from across England. After controlling for the confounding effect of individual characteristics, a ten percentage point increase in overall process quality is found to be associated on average with a 2.13 percentage point increase in ASCOT. Interpersonal aspects of care, such as the responsiveness and caring behaviour of staff, have a stronger relationship with ASCOT than those related to the organisation of care by the provider, such as timekeeping and continuity of care, with a ten percentage point increase in the former associated on average with a 1.9 percentage point increase in ASCOT and a ten percentage point increase in the latter associated on average with a 0.3 percentage point increase in ASCOT. Perceptions of care experience, particularly those related to the interpersonal care aspects, have an important association with QoL-outcomes. Measures of the experience of interpersonal aspects of care may therefore be useful indicators of QoL-outcomes for the routine monitoring of long-term home care services. Although associated, the two dimensions are distinctive and for policymakers there is value in assessing both care experience and QoL-outcomes.

The benefits of and barriers to using a social robot PARO in care settings: a scoping review

BackgroundGiven the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how.MethodsScientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO.ResultsA total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users’ needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation.ConclusionsMost interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits.

Reorganising dermatology care: predictors to substitute secondary care with primary care

Background: Substitution of healthcare is a way to control for rising healthcare costs. The intervention Primary Care Plus PC+ of the Dutch pioneer site ‘Blue Care’ aims to achieve this by facilitating consultations of medical specialists in the primary care setting. One of the specialisms involved is dermatology. Objective: This study focused on evaluating the referral decision after dermatology care in PC+, i.e. back to GP or referral to outpatient hospital care, and to evaluate the predictors. Methods: This retrospective study used monitoring data of patients visiting PC+ for dermatology care between January 2015 and March 2017. The referral decision after PC+ was the primary outcome. Stepwise logistic regression modelling was used to describe variations in referral decision, with patient’s age and gender, number of consultations in PC+, patient’s diagnosis and treating specialist as predicting factors. Results: 2,812 patients who visited PC+ for dermatology care were included in the analysis. Of those patients, 80.2% N=2,254 was referred back to the general practitioner GP and 19.8% N=558 was referred to outpatient hospital care. In the multivariable model, only treating specialist and patient’s diagnosis were independently influencing the referral decisions after PC+. Compared to specialist 1, patients treated by specialist 2 AOR = 1.88, 95% CI = 1.48–2.39, 3 AOR 1.97, 95% CI = 1.44–2.69 or another specialist AOR 1.80, 95% CI = 1.29–2.52 were more likely to be referred to outpatient hospital care after PC+. Compared to patients diagnosed with ‘Premaligne dermatosis’, patients with ‘Malignant dermatosis’ AOR 12.98, 95% CI = 7.96-21.17, ‘Inflammatory dermatoses’ AOR 2.12, 95% CI = 1.33-3.38 and an unknown diagnosis AOR 2.24, 95% CI = 1.45-3.45 were more likely to be referred to outpatient hospital care. Patient with ‘Eczema other’ AOR 0.36, 95% CI = 0.19-0.66, ‘Dermatoses by microorganism’ AOR 0.32, 95% CI = 0.16-0.66 and ‘Hair and nail disorders’ AOR 0.23, 95% CI = 0.09-0.59 were less likely to be referred to outpatient hospital care. The final model explained 19.3% of the variation in referral decisions. Discussion: In PC+, integrated care is stimulated through facilitating consultations of medical specialists in the primary care setting. The findings of this study can be used to discuss with GPs and dermatologist the optimisation of PC+ for dermatology care by learning from each other in order to achieve substitution by shifting specialised care to primary care. Conclusion: Looking at the referral decision after dermatology care in PC+, a majority of the patients were referred back to their GP. Treating specialist and patient’s diagnosis are independently influencing this referral decision. Lessons learned: Dermatology care seems to be suitable for PC+. However, not every specialist and diagnosis fit the profile of PC+. Limitations: The number of predictors included in this study was restricted. Follow-up data of patients visiting PC+ was not taken into account. Suggestions for future research: According to the Triple Aim, it is recommended to also look at the experienced quality of care, patient’s health and cost of care.

Gender differences in quality of care experiences during hospital stay: A contribution to patient-centered healthcare for both men and women

ObjectivesStudies demonstrate that there are important gender differences in perceptions of medicinal care. Our aim is to investigate whether there are also gender differences in patients’quality of care experiences during their hospital stay. MethodsIn a cross-sectional survey, patients who were admitted to a university hospital were invited to complete a questionnaire. Answers were compared between men and women of different ages, education levels, and health assessments, using the independent t-test. A linear regression model was performed to investigate the relationship between patient characteristics and hospital assessments Results4169 questionnaires were sent (41.8% returned). Women rated the hospital significantly (P=0.007) lower than men, especially higher educated women and women between the ages of 18 and 44 years. Behaviors of nurses were perceived to be unsatisfactory by significantly more female patients than male patients (P=0.016). One in six women wanted more privacy compared with one in ten men (P<0.001), and ten percent more women suffered from pain (P<0.001). ConclusionWomen, particularly those higher educated and between 45 and 64 years of age, assess hospital care significantly lower than men. Implications for practiceTo optimize patients’ assessments of hospital care, women require more gender-sensitive nursing care, more privacy, and better pain management than they receive at present.