Implementation of a patient-collected audio recording audit & feedback quality improvement program to prevent contextual error: stakeholder perspective

BMC Health Services Research

Neil Jordan¹  Frances Weaver²  Alan Schwartz³  Bryan Gee⁴  Benjamin Kass⁵  Amy Binns-Calvey⁵  Brendan Kelly⁶  Gunjan Sharma⁶  Saul J. Weiner⁶  Meghana Frenchman⁷  Carolyn Chan⁸  Cecilia Scholcoff⁹  Jeffrey L. Jackson^1,10  Lisa Altman^1,11  Maria Wopat^1,12  Corinna Falck-Ytter^1,13  Soumya Subramaniam^1,14  Sherry L. Ball^1,14  Nasia Safdar^1,15 

[1] Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA;Department of Psychiatry and Behavioral Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA;Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA;Department of Medical Education, University of Illinois at Chicago, Chicago, USA;Department of Medicine, Edward Hines Jr VA Hospital, Hines, IL, USA;Department of Medicine, University of Illinois at Chicago, Chicago, USA;Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA;Department of Medicine, University of Illinois at Chicago, Chicago, USA;Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Chicago Health Care System, Chicago, IL, USA;Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA;Department of Medicine, Yale University School of Medicine, New Haven, CT, USA;General Medicine Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA;General Medicine Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA;Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA;Office of Healthcare Transformation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA;Pharmacy Services, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA;Primary Care, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA;Research Services, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA;Research Services, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA;

关键词: Patient-collected audio;    Performance improvement;    Quality improvement;    Contextualization of care;    Contextual error;   

DOI  :  10.1186/s12913-021-06921-3

来源: Springer

【 摘 要 】

BackgroundUsing patient audio recordings of medical visits to provide clinicians with feedback on their attention to patient life context in care planning can improve health care delivery and outcomes, and reduce costs. However, such an initiative can raise concerns across stakeholders about surveillance, intrusiveness and merit. This study examined the perspectives of patients, physicians and other clinical staff, and facility leaders over 3 years at six sites during the implementation of a patient-collected audio quality improvement program designed to improve patient-centered care in a non-threatening manner and with minimal effort required of patients and clinicians.MethodsPatients were invited during the first and third year to complete exit surveys when they returned their audio recorders following visits, and clinicians to complete surveys annually. Clinicians were invited to participate in focus groups in the first and third years. Facility leaders were interviewed individually during the last 6 months of the study.ResultsThere were a total of 12 focus groups with 89 participants, and 30 leadership interviews. Two hundred fourteen clinicians and 800 patients completed surveys. In a qualitative analysis of focus group data employing NVivo, clinicians initially expressed concerns that the program could be disruptive and/or burdensome, but these diminished with program exposure and were substantially replaced by an appreciation for the value of low stakes constructive feedback. They were also significantly more confident in the value of the intervention in the final year (p = .008), more likely to agree that leadership supports continuous improvement of patient care and gives feedback on outcomes (p = .02), and at a time that is convenient (p = .04). Patients who volunteered sometimes expressed concerns they were “spying” on their doctors, but most saw it as an opportunity to improve care. Leaders were supportive of the program but not yet prepared to commit to funding it exclusively with facility resources.ConclusionsA patient-collected audio program can be implemented when it is perceived as safe, not disruptive or burdensome, and as contributing to better health care.

【 授权许可】

CC BY