Kimberly Fisher1,2, Kelly Smith3,4, Thomas Gallagher5, Laura Burns2, Crystal Morales3,4, Kathleen Mazor1,2. 1. Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA. 2. Meyers Primary Care Institute, Worcester, Massachusetts, USA. 3. MedStar Health Research Institute, Hyattsville, Maryland, USA. 4. MedStar Health, System Quality and Patient Safety, Columbia, Maryland, USA. 5. University of Washington, School of Medicine, Seattle, Washington, USA.
Abstract
BACKGROUND: There is increasing recognition that patients have critical insights into care experiences, including breakdowns in care. Harnessing patient perspectives for hospital improvement requires an in-depth understanding of the types of breakdowns patients identify and the impact of these events. METHODS: We interviewed a broad sample of patients during hospitalization and postdischarge to elicit patient perspectives on breakdowns in care. Through an iterative process, we developed a categorization of patient-perceived breakdowns called the Patient Experience Coding Tool. RESULTS: Of 979 interviewees, 386 (39.4%) believed they had experienced at least one breakdown in care. The most common reported breakdowns involved information exchange (n = 158, 16.1%), medications (n = 120, 12.3%), delays in admission (n = 90, 9.2%), team communication (n = 65, 6.6%), providers' manner (n = 62, 6.3%), and discharge (n = 56, 5.7%). Of the 386 interviewees who reported a breakdown, 140 (36.3%) perceived associated harm. Patient- perceived harms included physical (eg, pain), emotional (eg, distress, worry), damage to relationship with providers, need for additional care or prolonged hospital stay, and life disruption. We found higher rates of reporting breakdowns among younger ( <60 years old) patients (45.4% vs 34.5%, 𝑃 < 0.001), those with at least some college education (46.8% vs 32.7%, 𝑃 < 0.001), and those with another person (family or friend) present during the interview or interviewed in lieu of the patient (53.4% vs 37.8%, 𝑃 = 0.002). CONCLUSIONS: When asked directly, almost 4 out of 10 hospitalized patients reported a breakdown in their care. Patient- perceived breakdowns in care are frequently associated with perceived harm, illustrating the importance of detecting and addressing these events.
BACKGROUND: There is increasing recognition that patients have critical insights into care experiences, including breakdowns in care. Harnessing patient perspectives for hospital improvement requires an in-depth understanding of the types of breakdowns patients identify and the impact of these events. METHODS: We interviewed a broad sample of patients during hospitalization and postdischarge to elicit patient perspectives on breakdowns in care. Through an iterative process, we developed a categorization of patient-perceived breakdowns called the Patient Experience Coding Tool. RESULTS: Of 979 interviewees, 386 (39.4%) believed they had experienced at least one breakdown in care. The most common reported breakdowns involved information exchange (n = 158, 16.1%), medications (n = 120, 12.3%), delays in admission (n = 90, 9.2%), team communication (n = 65, 6.6%), providers' manner (n = 62, 6.3%), and discharge (n = 56, 5.7%). Of the 386 interviewees who reported a breakdown, 140 (36.3%) perceived associated harm. Patient- perceived harms included physical (eg, pain), emotional (eg, distress, worry), damage to relationship with providers, need for additional care or prolonged hospital stay, and life disruption. We found higher rates of reporting breakdowns among younger ( <60 years old) patients (45.4% vs 34.5%, 𝑃 < 0.001), those with at least some college education (46.8% vs 32.7%, 𝑃 < 0.001), and those with another person (family or friend) present during the interview or interviewed in lieu of the patient (53.4% vs 37.8%, 𝑃 = 0.002). CONCLUSIONS: When asked directly, almost 4 out of 10 hospitalized patients reported a breakdown in their care. Patient- perceived breakdowns in care are frequently associated with perceived harm, illustrating the importance of detecting and addressing these events.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Eric C Schneider; M Susan Ridgely; Denise D Quigley; Lauren E Hunter; Kristin J Leuschner; Saul N Weingart; Joel S Weissman; Karen P Zimmer; Robert C Giannini Journal: Rand Health Q Date: 2017-06-19
Authors: Saul N Weingart; Odelya Pagovich; Daniel Z Sands; Joseph M Li; Mark D Aronson; Roger B Davis; Russell S Phillips; David W Bates Journal: Int J Qual Health Care Date: 2005-11-10 Impact factor: 2.038
Authors: Anton J Kuzel; Steven H Woolf; Valerie J Gilchrist; John D Engel; Thomas A LaVeist; Charles Vincent; Richard M Frankel Journal: Ann Fam Med Date: 2004 Jul-Aug Impact factor: 5.166
Authors: Joel S Weissman; Eric C Schneider; Saul N Weingart; Arnold M Epstein; Joann David-Kasdan; Sandra Feibelmann; Catherine L Annas; Nancy Ridley; Leslie Kirle; Constantine Gatsonis Journal: Ann Intern Med Date: 2008-07-15 Impact factor: 25.391
Authors: Rebecca Lawton; Jane Kathryn O'Hara; Laura Sheard; Caroline Reynolds; Kim Cocks; Gerry Armitage; John Wright Journal: BMJ Qual Saf Date: 2015-04-10 Impact factor: 7.035
Authors: Kimberly A Fisher; Thomas H Gallagher; Kelly M Smith; Yanhua Zhou; Sybil Crawford; Azraa Amroze; Kathleen M Mazor Journal: BMJ Qual Saf Date: 2019-11-13 Impact factor: 7.035
Authors: Sigall K Bell; Stephanie D Roche; Ariel Mueller; Erica Dente; Kristin O'Reilly; Barbara Sarnoff Lee; Kenneth Sands; Daniel Talmor; Samuel M Brown Journal: BMJ Qual Saf Date: 2018-07-12 Impact factor: 7.035
Authors: Richard M Elias; Karen M Fischer; Mustaqeem A Siddiqui; Trevor Coons; Cindy A Meyerhofer; Holly J Pretzman; Hope E Greig; Sheila K Stevens; M Caroline Burton Journal: J Patient Exp Date: 2021-04-08