Key Points
Question
Can data from patient-collected audio recordings of their visits help clinicians improve their attention to patient life context when planning care, improve patient outcomes, and reduce health care costs?
Findings
In this quality improvement study, feedback was delivered to 666 clinicians based on analysis of 4496 audio-recorded visits. Attention to patient contextual factors increased from 67% to 72%, and contextualized care planning was associated with a greater likelihood of improved outcomes, resulting in an estimated cost savings of $25.2 million from avoided hospitalizations.
Meaning
These findings suggest that continuous feedback to clinicians about their attention to patient life context, based on audio recordings of their care, may substantially improve their performance, with measurable benefits for their patients and substantial cost savings.
Background
Using 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.
Methods
Patients 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.
Results
There 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.
Conclusions
A patient-collected audio program can be implemented when it is perceived as safe, not disruptive or burdensome, and as contributing to better health care.
This is the tale of a Haitian woman's attitudes towards acute febrile illness in post-earthquake Haiti and a medical student's insights into public health gained by viewing a data set within a narrative.KEY WORDS: global health, public health interventions, stories Data, we often forget, are just stories expressed with numbers. Scientists and physicians tend in their articles to forsake the complexity behind these stories for the pragmatic simplicity of charts, tables, and graphs. But in the conversion of life into data something immeasurable is lost, despite our best intentions. The statistic 71.2 percent of 52 Haitians respondents consider the high cost of medications a barrier to health care, for instance, highlights a problem that must be solved. However, it fails to convey the daily struggle to survive in Port-au-Prince; it misses the terrible dilemma of whether a visit to a doctor is worth the sacrifice of a meal. Though the traditional presentation of data as statistics is useful, it is not perfect-missing from charts and tables are unquantifiable details. To illustrate, here is the story of a Haitian woman.The summer after my first year of medical school, I spent 2 weeks in Haiti working with an acute medical mission team. My task was the collection of data for a pilot survey entitled "Haitian's socio-behavioral attitudes to undifferentiated acute febrile illness and healthcare delivery." The goal of the survey was to gain insight into local health-care attitudes to assist in creating community education intervention projects. A total of 52 surveys were collected in several locations, an internally displaced person's camp in Port-au-Prince, a local clinic in Gonaiives, and a clinic in Léogâne. Survey participants were selected by inviting the final person in the clinic line to participate, as surveys took approximately 1-h, and participants were brought to the front of the clinic line after completion. A local translator was used on-site to translate the survey and the respondent's answers directly on location. The information collected can be presented in numerous forms fit for academic journals, but offered here as an alternative viewpoint of the data as a personal commentary.
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