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Quality of Patient-Centered Care

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (31 December 2017) | Viewed by 43269

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Prof. Dr. Flora Tzelepis

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School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
Interests: multiple health risk factors; smoking cessation; chronic disease prevention; priority populations
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Dear Colleagues,

Patient-centered care is responsive to patients’ values and needs and includes decision-making that is guided by patient preferences (Institute of Medicine 2001). The Institute of Medicine (IOM) has recommended improvements to patient-centered care to achieve high quality health care. The IOM endorsed six dimensions of patient-centered care which stated that care must be: 1) respectful to patients’ values, preferences, and expressed needs; 2) coordinated and integrated; 3) provide information, communication, and education; 4) ensure physical comfort; 5) provide emotional support—relieving fear and anxiety; and 6) involve family and friends (Institute of Medicine 2001). The Picker Institute and the International Association of Patients’ Organizations have also proposed similar frameworks of patient-centered care.

To examine patients’ experiences, reliable and valid measures that comprehensively assess patient-centered care are necessary. Patient-centered care measures identify areas where improvements are needed and inform quality improvement efforts. A systematic review of patient-reported measures assessing quality of patient-centered cancer care reported that the dimension of provision of information, communication and education was most commonly captured by measures while involvement of family and friends was least examined (Tzelepis et al 2014). This review also reported that the psychometric properties of patient-centered cancer care measures could be improved (Tzelepis et al 2014).

This Special Issue focuses on the quality of patient-centered care including the advantages, measures and provision of quality patient-centered care as well as interventions that aim to improve the delivery of patient-centered care. Submissions for this Special Issue on “Quality of Patient-Centered Care” are welcome.

References

Institute of Medicine. Crossing The Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press; 2001.

Tzelepis F, Rose SK, Sanson-Fisher RW, Clinton-McHarg T, Carey ML, Paul CL. Are we missing the Institute of Medicine’s mark? A systematic review of patient-reported outcome measures assessing quality of patient-centred cancer care. BMC Cancer. 2014;14:41.

Dr. Flora Tzelepis
Guest Editor

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Keywords

patient-centered care
quality of care
quality assessment
patient-reported measures
health care
patient experiences

Published Papers (7 papers)

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Research

10 pages, 302 KiB

Open AccessArticle

Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis

by Carmen S. Christian, Ulf-G. Gerdtham, Dumisani Hompashe, Anja Smith and Ronelle Burger

Int. J. Environ. Res. Public Health 2018, 15(4), 729; https://doi.org/10.3390/ijerph15040729 - 12 Apr 2018

Cited by 31 | Viewed by 8660

Abstract

This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management. Full article

(This article belongs to the Special Issue Quality of Patient-Centered Care)

16 pages, 326 KiB

Open AccessFeature PaperArticle

Quality of Patient-Centered Care Provided to Patients Attending Hematological Cancer Treatment Centers

by Flora Tzelepis, Tara Clinton-McHarg, Christine L Paul, Robert W Sanson-Fisher, Douglas Joshua and Mariko L Carey

Int. J. Environ. Res. Public Health 2018, 15(3), 549; https://doi.org/10.3390/ijerph15030549 - 19 Mar 2018

Cited by 8 | Viewed by 5133

Abstract

The Institute of Medicine has recommended that improvements are needed in patient-centered care. This study examined hematological cancer patients’ perceptions of which aspects of cancer care were being delivered well and areas that required improvement, and whether patient characteristics, or the treatment center they attended, were associated with quality of patient-centered care. Participants were recruited via three Australian hematological cancer treatment centers and completed a paper-and-pen survey assessing sociodemographic, disease, and psychological and treatment characteristics at recruitment. A second survey that contained the Quality of Patient-Centered Cancer Care measure was completed one month after recruitment (n = 215). The most frequently delivered feature of patient-centered cancer care was hospital staff showing respect for patients (91.0%). The area of care reported most commonly as not being delivered was hospital staff helping the patient find other cancer patients to talk to (29.8%). Patients without depression reported higher perceived quality of treatment decision-making, co-ordinated and integrated care, emotional support, follow-up care, respectful communication, and cancer information than patients with depression. The treatment center that was attended was associated only with the quality of cancer information patients received. Privacy issues may hinder staff connecting patients directly but this could be overcome via referrals to cancer organizations that offer peer support services. Full article

(This article belongs to the Special Issue Quality of Patient-Centered Care)

15 pages, 540 KiB

Open AccessArticle

Empathy Variation in General Practice: A Survey among General Practitioners in Denmark

by Justin A. Charles, Peder Ahnfeldt-Mollerup, Jens Søndergaard and Troels Kristensen

Int. J. Environ. Res. Public Health 2018, 15(3), 433; https://doi.org/10.3390/ijerph15030433 - 02 Mar 2018

Cited by 16 | Viewed by 9075

Abstract

Background: Previous studies have demonstrated that high levels of physician empathy may be correlated with improved patient health outcomes and high physician job satisfaction. Knowledge about variation in empathy and related general practitioner (GP) characteristics may allow for a more informed approach to improve empathy among GPs. Objective: Our objective is to measure and analyze variation in physician empathy and its association with GP demographic, professional, and job satisfaction characteristics. Methods: 464 Danish GPs responded to a survey containing the Danish version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP) and questions related to their demographic, professional and job satisfaction characteristics. Descriptive statistics and a quantile plot of the ordered empathy scores were used to describe empathy variation. In addition, random-effect logistic regression analysis was performed to explore the association between empathy levels and the included GP characteristics. Results: Empathy scores were negatively skewed with a mean score of 117.9 and a standard deviation of 10.1 within a range from 99 (p5) to 135 (p95). GPs aged 45–54 years and GPs who are not employed outside of their practice were less likely to have high empathy scores (≥120). Neither gender, nor length of time since specialization, length of time in current practice, practice type, practice location, or job satisfaction was associated with odds of having high physician empathy. However, odds of having a high empathy score were higher for GPs who stated that the physician-patient relationship and interaction with colleagues has a high contribution to job satisfaction compared to the reference groups (low and medium contribution of these factors). This was also the trend for GPs who stated a high contribution to job satisfaction from intellectual stimulation. In contrast, high contribution of economic profit and prestige did not contribute to increased odds of having a high empathy score. Conclusions: Albeit generally high, we observed substantial variation in physician empathy levels among this population of Danish GPs. This variation is positively associated with values of interpersonal relationships and interaction with colleagues, and negatively associated with middle age (45–54 years) and lack of outside employment. There is room to increase GP physician empathy via educational and organizational interventions, and consequently, to improve healthcare quality and outcomes. Full article

(This article belongs to the Special Issue Quality of Patient-Centered Care)

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16 pages, 348 KiB

Open AccessFeature PaperArticle

Patient-Centered Care in Breast Cancer Genetic Clinics

by Anne Brédart, Amélie Anota, Julia Dick, Violetta Kuboth, Olivier Lareyre, Antoine De Pauw, Alejandra Cano, Dominique Stoppa-Lyonnet, Rita Schmutzler, Sylvie Dolbeault and Jean-Luc Kop

Int. J. Environ. Res. Public Health 2018, 15(2), 319; https://doi.org/10.3390/ijerph15020319 - 12 Feb 2018

Cited by 7 | Viewed by 5204

Abstract

With advances in breast cancer (BC) gene panel testing, risk counseling has become increasingly complex, potentially leading to unmet psychosocial needs. We assessed psychosocial needs and correlates in women initiating testing for high genetic BC risk in clinics in France and Germany, and compared these results with data from a literature review. Among the 442 counselees consecutively approached, 212 (83%) in France and 180 (97%) in Germany, mostly BC patients (81% and 92%, respectively), returned the ‘Psychosocial Assessment in Hereditary Cancer’ questionnaire. Based on the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) BC risk estimation model, the mean BC lifetime risk estimates were 19% and 18% in France and Germany, respectively. In both countries, the most prevalent needs clustered around the “living with cancer” and “children-related issues” domains. In multivariate analyses, a higher number of psychosocial needs were significantly associated with younger age (b = −0.05), higher anxiety (b = 0.78), and having children (b = 1.51), but not with country, educational level, marital status, depression, or loss of a family member due to hereditary cancer. These results are in line with the literature review data. However, this review identified only seven studies that quantitatively addressed psychosocial needs in the BC genetic counseling setting. Current data lack understandings of how cancer risk counseling affects psychosocial needs, and improves patient-centered care in that setting. Full article

(This article belongs to the Special Issue Quality of Patient-Centered Care)

16 pages, 1858 KiB

Open AccessFeature PaperArticle

System-Wide and Group-Specific Health Service Improvements: Cross-Sectional Survey of Outpatient Improvement Preferences and Associations with Demographic Characteristics

by Elizabeth A. Fradgley, Christine L. Paul, Jamie Bryant, Alison Zucca and Christopher Oldmeadow

Int. J. Environ. Res. Public Health 2018, 15(2), 179; https://doi.org/10.3390/ijerph15020179 - 23 Jan 2018

Cited by 2 | Viewed by 4009

Abstract

Efficient patient-centred quality improvement requires an understanding of the system-wide areas of dissatisfaction along with evidence to identify the programs which can be strategically targeted according to specific patient characteristics and preferences. This cross-sectional study reports the proportion of chronic disease outpatients selecting 23 patient-centred improvement initiatives. Using univariate tests and multivariable logistic regressions, this multi-site study also identifies initiatives differentially selected by outpatients according to clinical and demographic characteristics. A total of 475 outpatients participated (49% response). Commonly selected initiatives included: reducing wait-times (22.3%); convenient appointment scheduling (16.0%); and receiving up-to-date treatment information (16.0%). Within univariate tests, preferences for information and service accessibility initiatives were not significantly associated with specific subgroups. However, seven initiatives were preferred according to age, gender, diagnosis status, and chronic disease type within multivariate models. For example, neurology outpatients were more likely to select assistance to manage psychological symptoms when compared to oncology outpatients (OR: 2.89). Study findings suggest that system-wide programs to enhance information provision are strategic approaches to improve experiences across patient characteristics. Furthermore, a few initiatives can be targeted to specific groups and emphasized the importance of detailed scoping analyses and tailored implementation plans when designing patient-centred quality improvement programs. Full article

(This article belongs to the Special Issue Quality of Patient-Centered Care)

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15 pages, 646 KiB

Open AccessArticle

Investigating Effect of Service Encounter, Value, and Satisfaction on Word of Mouth: An Outpatient Service Context

by Li-Chun Hsu

Int. J. Environ. Res. Public Health 2018, 15(1), 132; https://doi.org/10.3390/ijerph15010132 - 13 Jan 2018

Cited by 13 | Viewed by 6369

Abstract

This study investigates the relationships among service encounter, service value, patient satisfaction, and word-of-mouth (WOM) intention from the viewpoint of interactive marketing. Data were collected using a questionnaire survey. A total of 372 questionnaires were obtained and 350 of these questionnaires were valid (94.09%), and a structural equation model was used to analyze the data. This study proposed seven hypotheses, and five of the seven hypotheses were supported. Service encounters indirectly affect their patient WOM through service value and satisfaction. Therefore, service value and satisfaction play a crucial mediating role in linking service encounters and WOM. This study determined WOM intentions in an outpatient service context and provides crucial business implications for teaching hospitals to enable them to improve their service quality and achieve a sustainable operation. Full article

(This article belongs to the Special Issue Quality of Patient-Centered Care)

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343 KiB

Open AccessArticle

How Does Patient Safety Culture in the Surgical Departments Compare to the Rest of the County Hospitals in Xiaogan City of China?

by Manli Wang and Hongbing Tao

Int. J. Environ. Res. Public Health 2017, 14(10), 1123; https://doi.org/10.3390/ijerph14101123 - 26 Sep 2017

Cited by 25 | Viewed by 3948

Abstract

Objectives: Patient safety culture affects patient safety and the performance of hospitals. The Hospital Survey on Patient Safety Culture (HSOPSC) is generally used to assess the safety culture in hospitals and unit levels. However, only a few studies in China have measured surgical settings compared with other units in county hospitals using the HSOPSC. This study aims to assess the strengths and weaknesses of surgical departments compared with all other departments in county hospitals in China with HSOPSC. Design: This research is a cross-sectional study. Methods: In 2015, a Chinese translation of HSOPSC was administered to 1379 staff from sampled departments from 19 county hospitals in Xiaogan City (Hubei Province, China) using a simple random and cluster sampling method. Outcome Measures: The HSOPSC was completed by 1379 participants. The percent positive ratings (PPRs) of 12 dimensions (i.e., teamwork within units, organizational learning and continuous improvement, staffing, non-punitive response to errors, supervisor/ manager expectations and actions promoting patient safety, feedback and communication about errors, communication openness, hospital handoffs and transitions, teamwork across hospital units, hospital management support for patient safety, overall perception of safety, as well as frequency of events reported) and the positive proportion of outcome variables (patient safety grade and number of events reported) between surgical departments and other departments were compared with t-tests and X² tests, respectively. A multiple regression analysis was conducted, with the outcome dimensions serving as dependent variables and basic characteristics and other dimensions serving as independent variables. Similarly, ordinal logistic regression was used to explore the influencing factors of two categorical outcomes. Results: A total of 56.49% of respondents were from surgical departments. The PPRs for “teamwork within units” and “organizational learning and continuous improvement” were ≥75%, which denoted strengths, and the PPRs for “staffing” and “non-punitive response to errors” were ≤50%, which denoted weaknesses in surgical units and other units. Three dimensions for surgical departments were weaker than those for other departments (p < 0.05). The staff from surgical units reported more events compared with the other units, but only a few respondents in surgical settings evaluated patient safety grade as good/excellent. Four dimensions influenced patient safety grade, and three dimensions influenced event reporting in surgical units. Conclusions: Strategies including recruiting workers, using the reporting system, and building a non-punitive culture should be adopted in the surgical units of county hospitals in China to improve safety culture. Supervisors should also prioritise patient safety. Full article

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