Patient experience

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The patient experience describes an individual's experience of illness/injury and how healthcare treats them. Increasing focus on patient experience is part of a move towards patient-centered care. [1] [2] It is often operationalised through metrics, a trend related to consumerism and New Managerialism.

Contents

Patient experience (PX) is defined as the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. [3]

Patient experience has become a key Quality outcome for healthcare; measuring it is seen to support improvement in healthcare quality, governance, public accountability and, especially in the NHS in England, patient choice. [4] Measures of patient experience arose from work in the 1980s and is now there use is now widescale. However, their effectiveness has been questioned [5] and clinicians and managers may disagree about their use. [6] There is a general agreement in the literature that measuring patient experience can be accomplished using a quantitative, qualitative, or mixed-methods approach.

When patient experience is discussed in terms of experiences with health care services it is similar to patient satisfaction. However, patient experience is often reported in health research as also encompassing people's experiences of illness and injury outside of their experiences with health services, such as those experiences with family and friends, the influence of illness/injury over their capacity to engage in social activities or previously imagined futures, [7] and even their engagement with the development of the guidelines that will inform their treatment. [8] For example, researchers might report of the patient experience of living with heart failure [9] or other chronic illnesses. [10]

Metrics

Patient-reported experience measures (PREMs) are, akin to patient-reported outcome measures (PROMs), questionnaires completed by the patient to assess their experience. These include: [4]

Related Research Articles

A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care provider.

A clinical decision support system (CDSS) is a health information technology that provides clinicians, staff, patients, and other individuals with knowledge and person-specific information to help health and health care. CDSS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients, clinical guidelines, condition-specific order sets, focused patient data reports and summaries, documentation templates, diagnostic support, and contextually relevant reference information, among other tools. CDSSs constitute a major topic in artificial intelligence in medicine.

In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.

<span class="mw-page-title-main">Self-care</span> Taking care of ones own health

Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and actively manage illness when it occurs. Individuals engage in some form of self-care daily with food choices, exercise, sleep, and hygiene. Self-care is not only a solo activity, as the community—a group that supports the person performing self-care—overall plays a role in access to, implementation of, and success of self-care activities.

Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety with mobile health apps being a growing area of research.

Multimorbidity, also known as multiple long-term conditions (MLTC), means living with two or more chronic illnesses. For example, a person could have diabetes, heart disease and depression at the same time. Multimorbidity can have a significant impact on people's health and wellbeing. It also poses a complex challenge to healthcare systems which are traditionally focused on individual diseases. Multiple long-term conditions can affect people of any age, but they are more common in older age, affecting more than half of people over 65 years old.

End-of-life care (EOLC) is health care provided in the time leading up to a person's death. End-of-life care can be provided in the hours, days, or months before a person dies and encompasses care and support for a person's mental and emotional needs, physical comfort, spiritual needs, and practical tasks.

Unwarranted variation in health care service delivery refers to medical practice pattern variation that cannot be explained by illness, medical need, or the dictates of evidence-based medicine. It is one of the causes of low value care often ignored by health systems.

Graded exercise therapy (GET) is a programme of physical activity that starts very slowly and gradually increases over time, intended as a treatment for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Most public health bodies, including the CDC and NICE, consider it ineffective, and its safety is disputed. However, GET still enjoys support among a minority of clinicians and organizations.

Outcomes research is a branch of public health research which studies the end results of the structure and processes of the health care system on the health and well-being of patients and populations. According to one medical outcomes and guidelines source book - 1996, Outcomes research includes health services research that focuses on identifying variations in medical procedures and associated health outcomes. Though listed as a synonym for the National Library of Medicine MeSH term "Outcome Assessment ", outcomes research may refer to both health services research and healthcare outcomes assessment, which aims at health technology assessment, decision making, and policy analysis through systematic evaluation of quality of care, access, and effectiveness.

<span class="mw-page-title-main">Quality of life (healthcare)</span> Notion in healthcare

In general, quality of life is the perceived quality of an individual's daily life, that is, an assessment of their well-being or lack thereof. This includes all emotional, social and physical aspects of the individual's life. In health care, health-related quality of life (HRQoL) is an assessment of how the individual's well-being may be affected over time by a disease, disability or disorder.

Patient participation is a trend that arose in answer to medical paternalism. Informed consent is a process where patients make decisions informed by the advice of medical professionals.

Minimally disruptive medicine is an approach to patient care in chronic illness proposed by Carl R May, Victor Montori, and Frances Mair. In a 2009 article in the British Medical Journal they argued that the burden of illness has its counterpart in the burden of treatment. As medical responses to illness have become more sophisticated, the burden of treatment has grown, and includes increasingly complex techniques and health technologies that must be routinely incorporated in everyday life by their users. minimally disruptive medicine is an approach to designing patient care that seeks to consider the effects of treatment work, and in particular to prevent overburdening patients. Overburdening leads, May, Montori and Mair argued, to structurally induced non-compliance with treatment, in which it becomes progressively more difficult for patients – especially older patients with multiple long-term conditions – to meet the demands that therapeutic regimens place upon them. minimally disruptive medicine has a theoretical basis in Normalization Process Theory, which explains the processes by which treatment regimens and other ensembles of cognitive, behavioural and technical practices are routinely incorporated in everyday life.

Pediatric psychology is a multidisciplinary field of both scientific research and clinical practice which attempts to address the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting. Psychological issues are addressed in a developmental framework and emphasize the dynamic relationships which exist between children, their families, and the health delivery system as a whole.

The Patient Activation Measure (PAM) is a commercial product which assesses an individual's knowledge, skill, and confidence for managing one's health and healthcare. Individuals who measure high on this assessment typically understand the importance of taking a pro-active role in managing their health and have the skills and confidence to do so.

The Patient-Reported Outcomes Measurement Information System (PROMIS) provides clinicians and researchers access to reliable, valid, and flexible measures of health status that assess physical, mental, and social well–being from the patient perspective. PROMIS measures are standardized, allowing for assessment of many patient-reported outcome domains—including pain, fatigue, emotional distress, physical functioning and social role participation—based on common metrics that allow for comparisons across domains, across chronic diseases, and with the general population. Further, PROMIS tools allow for computer adaptive testing, efficiently achieving precise measurement of health status domains with few items. There are PROMIS measures for both adults and children. PROMIS was established in 2004 with funding from the National Institutes of Health (NIH) as one of the initiatives of the NIH Roadmap for Medical Research.

Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.

The Friends and Family Test was introduced into the English NHS in 2013. It was a single question survey which asked patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care.

Patient satisfaction is a measure of the extent to which a patient is content with the health care which they received from their health care provider.

Value-based health care (VBHC) is a framework for restructuring health care systems with the overarching goal of value for patients, with value defined as health outcomes per unit of costs. The concept was introduced in 2006 by Michael Porter and Elizabeth Olmsted Teisberg, though implementation efforts on aspects of value-based care began long before them in the 1990s. With patient value as the overarching goal, VBHC emphasizes systematic measurement of outcomes and costs, restructuring provider organizations, and transitioning toward bundled payments. Within this framework, cost reduction alone is not seen as proper strategy for healthcare systems: health outcomes have to improve to enhance value. Although value-based health care is seen as a priority in many health systems worldwide, a global assessment in 2016 found many countries are only beginning to align their health systems with VBHC-principles. Additionally, several studies report incoherent implementation efforts, and there seem to be various interpretations of VBHC, both within and across countries.

References

  1. ↑ Ahmed F, Burt J, Rowland M: Measuring patient experience: concepts and methods. In The Patient - Patient-Centered Outcomes Research. doi:10.1007/s40271-014-0060-5.
  2. ↑ Mirzaei, M., Aspin, C., Essue, B., Jeon, Y. H., Dugdale, P., Usherwood, T., & Leeder, S. (2013). A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness. BMC health services research, 13(1), 251.
  3. ↑ "Defining Patient Experience". Archived from the original on 2017-08-24. Retrieved 2017-08-24.
  4. 1 2 Benson T, Potts HWW (2014). A short generic patient experience measure: howRwe development and validation. BMC Health Services Research, 14, 499. doi:10.1186/s12913-014-0499-z
  5. ↑ Haugum M, Danielsen K, Iversen HH, Bjertnaes O: The use of data from national and other large-scale user experience surveys in local quality work: a systematic review.International J Qual Health Care 2014:1;14. doi:10.1093/intqhc/mzu077
  6. ↑ Rozenblum R, Lisby M, Hockey P, Levtzion-Korach O, Salzberg C, Efrati N, Lipsitz S, Bates D: The patient satisfaction chasm: the gap between hospital management and frontline clinicians. BMJ Qual Saf 2013, 22:242-250
  7. ↑ Bury, M. (1982). Chronic illness as biographical disruption. Sociology of health & illness, 4(2), 167-182.
  8. ↑ Khodyakov, Dmitry; Denger, Brian; Sean Grant DPhil; Armstrong, Courtney; Ann Martin; Peay, Holly; Coulter, Ian; Hazlewood, Glen (2019). "The RAND/PPMD Patient-Centeredness Method: a novel online approach to engaging patients and their representatives in guideline development". European Journal for Person Centered Healthcare. 7 (3): 470–475. doi:10.5750/ejpch.v7i3.1750 (inactive 1 November 2024). PMC   8281319 . PMID   34277012.{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)
  9. ↑ Jeon, Y. H., Kraus, S. G., Jowsey, T., & Glasgow, N. J. (2010). The experience of living with chronic heart failure: a narrative review of qualitative studies. BMC health services research, 10(1), 77.
  10. ↑ Jeon, Y. H., Jowsey, T., Yen, L., Glasgow, N. J., Essue, B., Kljakovic, M., ... & Kraus, S. G. (2010). Achieving a balanced life in the face of chronic illness. Australian Journal of Primary Health, 16(1), 66-74.
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