Improving Methods for Measuring Quality of Care A Patient-Centered Approach in Chronic Disease

Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Bedford, MA, USA.
Medical Care Research and Review (Impact Factor: 2.62). 04/2009; 66(2):147-66. DOI: 10.1177/1077558708327174
Source: PubMed


As health care systems seek to provide patient-centered care as a cornerstone of quality, how to measure this aspect of quality has become a concern. Previous development of quality indicators for treating individual chronic disease has rarely included patient perspectives on quality of care. Using epilepsy as an exemplar, the authors sought to develop an approach to measuring patient-centered quality of care. They conducted six focus groups with adults with epilepsy. Using qualitative methods, the authors initially identified 10 patient-generated quality indicators, 5 of which were subsequently rated, along with literature-based quality indicators, by an expert panel using a modified RAND appropriateness methodology. The authors discuss similarities and differences in aspects of care patients and providers value as essential for good quality. The process presented in this article may serve as a model for incorporating patient perceptions of quality into the future development of quality indicators for chronic diseases.

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Available from: Mary Jo Pugh, Sep 02, 2015
    • "Patient-centered care (PCC) is widely accepted as an essential component of high-quality health care (Institute of Medicine, 2001; National Health Services, 2005). It is broadly described as an approach that puts the patient at the center of the care process and that is sensitive, empathic, and responsive to patients' individual needs, preferences, and values (Bokhour et al., 2009). PCC is expected to contribute to beneficial outcomes for patients (e.g., increased satisfaction with care, improved adherence to treatment, and reduced symptom severity ), for healthcare providers (e.g., increased job satisfaction, reduction of malpractice complaints), and for the healthcare system (e.g., appropriate use of healthcare resources, decreased costs; Hudon, Fortin, Haggerty, & Poitras, 2011). "
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    ABSTRACT: Background Patient-centered care (PCC) is a vaguely defined element of high-quality care, which precludes its consistent and precise operationalization. A conceptualization of PCC was derived from the literature and guided the development of an instrument to assess implementation of PCC by healthcare providers. The items of the instrument capture specific activities that reflect three components of PCC: holistic, collaborative, and responsive care. This paper reports on the measure's content and construct validity and reliability.Methods Content validity was evaluated in a sample of 11 nurse practitioners who rated the relevance of each items’ content in reflecting the respective component of PCC. The content validity index (CVI) was estimated. Construct validity and internal consistency reliability were examined in a survey of 149 nurse practitioners employed in acute care institutions, using factor analysis and the KR-20 coefficient, respectively.ResultsThe CVIs were 100% for the three subscales assessing the holistic, collaborative, and responsive care components of PCC. The items in each subscale loaded on one factor. The KR-20 coefficients were .66, .70, and .42, respectively. Overall, the majority (>70%) of respondents indicated performance of the activities comprising the three components of PCC.Linking Evidence to ActionThe PCC measure demonstrated acceptable psychometric properties. The low variance in responses, which is anticipated for instruments assessing fidelity of intervention implementation, accounts for the low reliability coefficients. Additional testing of the measure's psychometric properties in different groups of healthcare providers is warranted. The measure can be used to monitor healthcare providers’ implementation of PCC in their usual practice.
    No preview · Article · Jul 2014 · Worldviews on Evidence-Based Nursing
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    • "Therefore, alternative strategies to incorporate patient perspectives may need to be considered. For example, Bokhour et al. used focus groups to generate patient-centered indicators and presented them to clinical experts for evaluation [28]. "
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    ABSTRACT: Background Consensus methodologies are often used to create evidence-based measures of healthcare quality because they incorporate both available evidence and expert opinion to fill gaps in the knowledge base. However, there are limited studies of the key domains that are considered during panel discussion when developing quality indicators. Methods We performed a qualitative content analysis of the discussions from a two-day international workshop of injury control and quality-of-care experts (19 panel members) convened to create a standardized set of quality indicators for injury care. The workshop utilized a modified RAND/UCLA Appropriateness method. Workshop proceedings were recorded and transcribed verbatim. We used constant comparative analysis to analyze the transcripts of the workshop to identify key themes. Results We identified four themes in the selection, development, and implementation of standardized quality indicators: specifying a clear purpose and goal(s) for the indicators to ensure relevant data elements were included, and that indicators could be used for system-wide benchmarking and improving patient outcomes; incorporating evidence, expertise, and patient perspectives to identify important clinical problems and potential measurement challenges; considering context and variations between centers in the health system that could influence either the relevance or application of an indicator; and contemplating data collection and management issues, including availability of existing data sources, quality of data, timeliness of data abstraction, and the potential role for primary data collection. Conclusion Our study provides a description of the key themes of discussion among a panel of clinical, managerial, and data experts developing quality indicators. Consideration of these themes could help shape deliberation of future panels convened to develop quality indicators.
    Full-text · Article · Apr 2013 · Implementation Science
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    • "The themes will be presented in the form of QIs (e.g. provider team should offer to meet with patient and/or family within 24 hours of admission to hospital) [27]. A modified version of the RAND/UCLA Appropriateness Method (RAM), a reproducible and valid nominal group technique used in health services research to gather feedback and information from relevant experts [54-57], will be utilized. "
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    ABSTRACT: Background Quality indicators (QI) are used in health care to measure quality of service and performance improvement. Health care professionals and organizations caring for patients with injuries need information regarding the quality of care provided and the outcomes experienced in order to target improvement efforts. However, very little is known about the quality of injury care provided to individual patients and populations and even less about patients’ perspectives on quality of care. The absence of QIs that incorporate patient or family preferences, needs or values has been identified as an important gap in the science and practice of injury quality improvement. The primary objective of this research protocol is to develop and evaluate the first set of patient and family-centred QIs of injury care for critically injured patients Methods/design This mixed methods study is comprised of three Sub-Studies. Sub-Study A will utilize focus group methodology to describe the preferences, needs and values of critically injured patients and their family members regarding the quality of health care delivered. Qualitative content analysis of the transcripts will begin after the first completed focus group and will draw on grounded theory using a process of open, axial and selective coding. A panel of stakeholders will be assembled during Sub-Study B to review the themes identified from the focus groups and develop a catalogue of potential patient and family-centred QIs of injury care using the RAND/UCLA Appropriateness Method (RAM). The QIs developed by the stakeholder panel will be pilot tested in Sub-Study C using surveys of patients and their family members to determine construct validity, intra-rater reliability and clinical sensibility. Discussion Measuring the quality of injury care is but a first step towards improving patient outcomes. This research will develop the first set of patient and family-centred QIs of injury care. To improve patient care, we need accessible, reliable indicators of quality that are important to patients, and that can then be used to establish quality of care benchmarks, to flag potential problems or successes, follow trends over time and identify disparities across organizations, communities, populations and regions.
    Full-text · Article · Jan 2013 · BMC Health Services Research
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