Meas easuring uring xperience of Care Patient Reported E in in Br Brit itish ish Co Colum lumbia bia Performance Anxiety: CHSPR 2014 - Health Policy Conference Vancouver February 25, 2014 Lena Cuthbertson, Co-chair, BC PREMS
Wh What are we at are we tryi trying ng to to acco accompl mplish? ish? In British Columbia: 1. …measurement of the quality of the health care system “through the patient’s eyes” 2. …translation of patient-centred data into information and information into action to improve BOTH experience and outcomes for patients and their families at the point of care AND at the level of the system
Wh What are we at are we tryi trying ng to to acco accompl mplis ish? h? Today at this conference: Dialogue about … the science of performance measurement – Share the learnings from a decade of patient-centred data collection and reporting in BC about the science of the measurement (and our evolving understanding) of patient satisfaction, patient experience, and patient-centred care, Dialogue about … best practices for reporting on performance – Share promising practices developed in BC for reporting quantitative and qualitative information about the quality of care and services from the perspective of those who have received care (patients and families)
Coordinated, province- wide surveying in BC… a look back
Patient, resident Individual values Timely and family and Safe Minimizes and centered choices effective pain Equitable 5 (1) In 2000 and 2001, the Institute of Medicine issued two reports, To Err is Human and Crossing the Quality Chasm, documenting a glaring divergence between the rush of progress in medical science and the deterioration of health care delivery.
Through the Patients Model for Patient Achieving an Excep- Eyes & Family Centred Care tional Care Experience (Picker Institute, 1986) (IPFCC, 1992) (IHI, 2012) (8 dimensions) (4 core concepts) (5 primary drivers) Respect for patient Respect and Dignity Respectful values & preferences Partnerships Information, Information Sharing Evidence Based Care Communication & Education Coordination of Care Collaboration Leadership Involvement of Family Participation Emotional Support Hearts & Minds Physical Comfort Preparation for Reliable Care Discharge /Continuity & Transitions in Care Access
Mandate of BC PREMS (BC Patient Reported Experience Measures Steering Committee) To develop a coordinated, cost-efficient, and scientifically rigourous provincial approach to the measurement of patient experience in order to: enhance 1. public accountability support 2. quality improvement
BC PREMS Guiding Principles: Promote a common, scientifically rigorous, province-wide approach to measurement of patient satisfaction and experience; Work towards evidence-based benchmarks that will enable objective comparisons and trending over time; Compliment existing national and/or provincial measurement strategies; Minimize data collection burden for Health Authorities; Provide satisfaction data that supports and promotes quality improvements efforts at the point of service; and supports the accountability of the health care system; Recognize that the strategy and process for a complex undertaking such as this will evolve over time Page 8
BC PREMS’ mandate Data Sharing Action Survey Data Reporting Design Collection Processing Results Planning • Selection of • Distributing • Processing • Production of • Dissemination of • Knowledge survey tools with surveys surveys reports results to all sharing strong • Collecting • Collating results • Quantitative and stakeholders • Promoting “mini psychometrics • Public Reporting completed • Case mix qualitative surveys or point • Development of responses/ of service QI • Graphic and adjustment; tools or custom surveys initiatives weighting for narrative questions • Secondary disproportional • Defining sampling, if analysis and methodology necessary promoting x-HA (survey design • Analyzing data collaboration and sampling • Recommending plan) targets for accountability & system level improvement
From data collection… To dissemination of results… To acting on results… REPEAT!
Self-report instruments (surveys, questionnaires) used to obtain patients’ appraisals of their experience and satisfaction with the quality of care and services. Typically address various composites/domains/dimensions • of patient-centred care Provide information from patients’ perspectives without • interpretation from a ‘middle man’ Provide quantitative and qualitative feedback to drive • service improvement at the local level or for system level improvement May or may not include patients’ self reports of the • outcome of the care experience or self-rated health status
Collected in a uniform manner • Asking the same questions in the same way so answers are influenced by the respondents' experiences, NOT due to how the questions are worded/asked Tells us what our patients and families “really think” • Collected so patients and family members feel no fear of retaliation (confidential and/or anonymous) Focuses on what is important to patients and their families (not providers) Provides a “snapshot” or baseline against which to compare progress with improvement efforts over time & against others Provides information that is representative of the whole population
satisfaction Results provide a global rating. “Overall, how satisfied were you with the quality of care and services you received?” experience Results provide a measure of acceptability. “Were you involved in decisions about your care as much as you wanted?” “outcome” Results provide a measure of self perceived health status and quality of life concerns. How would you rate your health? How would you rate your quality of life?
Patient SATISFACTION Patient Patient EXPERIENCE OUTCOMES Patient-reported Patient-reported Patient-centred experience outcome Clinical performance measures measures outcomes indicators (PREMs) (PROMs) To achieve a complete view of the quality of care, it is desirable to combine measures of experience with measures of outcome Lena Cuthbertson & Rick Sawatzky, Jan 31/2014
• Coordination of province-wide surveys in BC for 11 years • Feedback from more than 1million users of health care services across 13 sectors/subsectors and all age groups • Quantitative AND qualitative reporting and analysis • Practical support to make effective use of data for QI and for accountability • Public reporting of results
From whom have we heard? Outpatient Cancer Care Mental Health & Patients Substance Use (radiation, IV chemo, Acute Inpatients Clients non-IV) (medical, surgical, pediatrics, maternity, rehab) E mergency Department Patients Long-Term Care Long-Term Care Residents Families & Mental Health & Frequent Visitors Substance Use Families/ Supporters 16
Response Year Sector Methodology Timeframe Rate 2003 Mail; Random sample Point in time -- 3 months 37.6% July 1 st to September 30 th , 2003 103 facilities Point in time – 3 months As above 32.5% 2007 February 1 st – April 30 th , 2007 Emergency 111 facilities 2007 As above Continuous 31.1% to 2015 111 facilities May 1st, 2007 to March 31, 2015 RESIDENTS: Point in time -- Oct 2003 to March 2004 48.4% Interview; Census Long Term All residents and their most frequent 102 facilities visitor (who was sometimes a family Care 2004 FAMILY/FREQUENT VISITOR: 69.8% member, but not always) in directly Mail; Census funded and managed facilities 102 facilities Acute Inpts Point in time – 3 or 6 months 2005 Mail I) June 1 st to Nov 30 th , 2005 80 hospitals 42.2% Medical, Surgical, 2008 II) Oct 1 st to Dec 31 st , 2008 52.8% Maternity, Pediatrics III) Oct 1 st /11 to Mar 31 / 12 42.8% Freestanding Rehab 2011/12 Outpatient 2006 Mail Point in time -- 6 months I) Nov 15 th , 2005 to May 15 th , 2006 5 regional cancer centres and 45 60.2% Cancer Care 2012/13 community cancer hospitals/services II) June 15 to December 16, 2012 48.9% PATIENTS/CLIENTS: Point in time – 6 months 2010 70% MH Mental Health Oct 12 th /2010 to April 11 th /2011 Short stay Inpatient care 60% SU Handout with telephone follow up & Substance FAMILY/SUPPORTERS 2014 Focus groups, cognitive interviews, pilot TBD Use testing – in progress Development of Survey Tool 17
What have we learned?
D … The results from the surveys are VALUE
The Focus of BC PREMS… Survey results = The voice of our patients Results are meant to complement other sources of information about the quality of care at the point of care and at the system level
Recommend
More recommend
