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Measuring Patients’ Experience of Hospital Care. Angela Coulter Picker Institute Europe angela.coulter@pickereurope.ac.uk. Three Perspectives on Quality. Professional: technical competence, clinical outcomes Management: cost-effectiveness, risk management, service development

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Measuring patients experience of hospital care l.jpg

Measuring Patients’ Experience of Hospital Care

Angela Coulter

Picker Institute Europe

angela.coulter@pickereurope.ac.uk


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Three Perspectives on Quality

  • Professional: technical competence, clinical outcomes

  • Management: cost-effectiveness, risk management, service development

  • Patient: access, responsiveness, communication, symptom relief, health status, quality-of-life


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Why measure patients’ experience of health care?

  • To assist local quality improvement

  • For national performance assessment

  • For strategic policy-making

  • To build public confidence

  • To inform purchasers

  • To inform patients

  • To compare health systems


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Measuring patients’ experience

  • Focus on recent personal experience

  • Ask patients about what is important to them (focus groups and interviews)

  • Ask patients to report on what happened, NOT how satisfied they were (surveys)

  • Feed back actionable results



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Reporting Questions

  • A&E care disorganised38%

  • Reason for delay not explained6%

  • Staff gave conflicting information23%

  • Doctors talked as if I wasn’t there30%

  • Had to wait too long for pain medicine9%

  • Risks and benefits not discussed 24%

  • Not told when to resume activities60%


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Picker Surveys of Patients’ Experience

  • Access to care

  • Respect for patients’ preferences

  • Co-ordination of care

  • Information and education

  • Physical comfort

  • Emotional support

  • Involvement of family and friends

  • Continuity and transition


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Questionnaire Development

  • Define scope of survey

  • Review literature

  • Focus groups – professionals and patients

  • Cognitive interviews with patients

  • Two stage pilot testing

  • Validation tests and scale development


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Implementation

  • Random samples of patients

  • Detailed self completion questionnaires

  • Mailed 2 – 4 weeks after discharge

  • Two reminders to non-responders

  • Response rates of 60 - 70%

  • Problem scores and dimensions


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Patient Safety: AHRQ Guidelines

  • Active participation of patients

  • Information sharing

  • Allergies and adverse reactions to drugs

  • Understanding instructions

  • Cleanliness

  • Discharge information and treatment plan





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NHS Survey of Patients with Coronary Heart Disease

  • Sampled patients with diagnosis of CHD from hospital records

  • Names, addresses from 194 NHS Trusts in England

  • Sample size 112,000

  • Postal questionnaire

  • 84,300 completed questionnaires

  • Response rate 74%


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NHS Patients Survey (CHD):Information and Communication


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NHS Patients Survey (CHD):Coordination and Continuity


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NHS Patients Survey (CHD): Hospital Environment

  • 35% on mixed sex ward (5-76%)

  • 38% bothered by noise (26-54%)

  • 35% said toilets/bathrooms not clean (16-69%)

  • 36% said not enough nurses on duty (23-54%)


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Did not feel sufficiently involved in decisions about care

%

National Surveys of NHS Patients. Coronary Heart Disease 1999 (n=84,500)


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NHS Patients Survey (CHD): Discharge and Transition

  • 34% no written information about recovery (5-53%)

  • 39% no advice on prevention (10-55%)

  • 32% no advice on resuming normal activities (10-53%)

  • 31% said home circumstances not taken into account (18-45%)


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Patient Surveys Should Be:

  • Relevant to patients’ concerns

  • Relevant to policy goals

  • Actionable

  • Timely

  • Comparable

  • Methodologically sound

  • Accessible


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Local surveys

Locally ‘owned’

Locally relevant

Shorter time-scale

National surveys

Consistent methodology

Cost-effective

Independent of hospital

National vs. Local Surveys


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A Third Way: Locally-organised Surveys with National Standards

  • Core set of validated questions

  • Implementation standards and manual

  • Data analysis tool kit

  • National benchmarks

  • Flexibility to add local questions


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Conclusions Standards

  • Patient feedback is a key element of quality improvement

  • Surveys of patient experience are more useful than patient satisfaction

  • Patient surveys can help to improve safety standards

  • National benchmarks can stimulate improvements


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