Providing a good patient experience is a key part of providing high-quality medical care. This paper explains why patient experience is important in its own right, and its relationship to other domains of quality. We describe methods of measuring patient experience, including issues relating to validity, reliability and response bias. Differences in reported patient experience may sometimes reflect differences in expectations of different population groups and we describe the arguments for and against adjusting patient experience data for population characteristics. As with other quality improvement strategies, feeding back patient experience data on its own is unlikely to improve quality: sustained and multiple interventions are usually required to deliver sustained improvements in care. Key Points for Decision MakersQuality is a multi-dimensional concept, and a single indicator does not (and should not) reflect quality in other domains. Patient experience is important in its own right.Patient experience is consistently and positively associated with other quality outcomes including patient safety and clinical effectiveness across a wide range of studies, and healthcare facilities providing high-quality clinical care tend to have better experiences reported by patients. However, these associations are frequently modest in size. Clinical quality and patient experience should be considered as distinct but inter-related aspects of quality.Differences in patient experience scores between population (e.g. ethnic) groups may in part reflect differences in expectations.Adjusting patient experience scores for population characteristics (e.g. ethnicity, deprivation) increases the acceptability of the results to healthcare providers. Case-mix adjustment in general makes only small differences to scores, though the greatest positive effect is on providers serving vulnerable populations.Significant quality improvement in general requires multiple strategies which are sustained over time. The same is probably true when using patient experience measures as a quality improvement tool. Simple feedback is unlikely to produce significant improvements in care.

IMPORTANCE Deprescribing of antihypertensive medications is recommended for some older patients with polypharmacy and multimorbidity when the benefits of continued treatment may not outweigh the harms.OBJECTIVE This study aimed to establish whether antihypertensive medication reduction is possible without significant changes in systolic blood pressure control or adverse events during 12-week follow-up. DESIGN, SETTING, AND PARTICIPANTSThe Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE) study was a randomized, unblinded, noninferiority trial conducted in 69 primary care sites in England. Participants, whose primary care physician considered them appropriate for medication reduction, were aged 80 years and older, had systolic blood pressure lower than 150 mm Hg, and were receiving at least 2 antihypertensive medications were included. Participants enrolled between April 2017 and September 2018 and underwent follow-up until January 2019.INTERVENTIONS Participants were randomized (1:1 ratio) to a strategy of antihypertensive medication reduction (removal of 1 drug [intervention], n = 282) or usual care (control, n = 287), in which no medication changes were mandated. MAIN OUTCOMES AND MEASURESThe primary outcome was systolic blood pressure lower than 150 mm Hg at 12-week follow-up. The prespecified noninferiority margin was a relative risk (RR) of 0.90. Secondary outcomes included the proportion of participants maintaining medication reduction and differences in blood pressure, frailty, quality of life, adverse effects, and serious adverse events. RESULTS Among 569 patients randomized (mean age, 84.8 years; 276 [48.5%] women; median of 2 antihypertensive medications prescribed at baseline), 534 (93.8%) completed the trial. Overall, 229 (86.4%) patients in the intervention group and 236 (87.7%) patients in the control group had a systolic blood pressure lower than 150 mm Hg at 12 weeks (adjusted RR, 0.98 [97.5% 1-sided CI, 0.92 to ϱ]). Of 7 prespecified secondary end points, 5 showed no significant difference. Medication reduction was sustained in 187 (66.3%) participants at 12 weeks. Mean change in systolic blood pressure was 3.4 mm Hg (95% CI, 1.1 to 5.8 mm Hg) higher in the intervention group compared with the control group. Twelve (4.3%) participants in the intervention group and 7 (2.4%) in the control group reported at least 1 serious adverse event (adjusted RR, 1.72 [95% CI, 0.7 to 4.3]).CONCLUSIONS AND RELEVANCE Among older patients treated with multiple antihypertensive medications, a strategy of medication reduction, compared with usual care, was noninferior with regard to systolic blood pressure control at 12 weeks. The findings suggest antihypertensive medication reduction in some older patients with hypertension is not associated with substantial change in blood pressure control, although further research is needed to understand long-term clinical outcomes.

BackgroundDespite widespread adoption of patient feedback surveys in international health‐care systems, including the English NHS, evidence of a demonstrable impact of surveys on service improvement is sparse.ObjectiveTo explore the views of primary care practice staff regarding the utility of patient experience surveys.DesignQualitative focus groups.Setting and participantsStaff from 14 English general practices.ResultsWhilst participants engaged with feedback from patient experience surveys, they routinely questioned its validity and reliability. Participants identified surveys as having a number of useful functions: for patients, as a potentially therapeutic way of getting their voice heard; for practice staff, as a way of identifying areas of improvement; and for GPs, as a source of evidence for professional development and appraisal. Areas of potential change stimulated by survey feedback included redesigning front‐line services, managing patient expectations and managing the performance of GPs. Despite this, practice staff struggled to identify and action changes based on survey feedback alone.DiscussionWhilst surveys may be used to endorse existing high‐quality service delivery, their use in informing changes in service delivery is more challenging for practice staff. Drawing on the Utility Index framework, we identified concerns relating to reliability and validity, cost and feasibility acceptability and educational impact, which combine to limit the utility of patient survey feedback.ConclusionsFeedback from patient experience surveys has great potential. However, without a specific and renewed focus on how to translate feedback into action, this potential will remain incompletely realized.

Background The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This study explores experience of care planning in patients with long term conditions in three areas in England. Methods We conducted semi-structured interviews with 23 predominantly elderly patients with multiple long term conditions. The interviews were designed to explore variations in and emergent experiences of care planning. Qualitative analysis of interview transcripts involved reflexively coding and re-coding data into categories and themes. Results No participants reported experiencing explicit care planning discussions or receiving written documentation setting out a negotiated care plan and they were unfamiliar with the term ‘care planning’. However, most described some components of care planning which occurred over a number of contacts with health care professionals which we term”reactive” care planning. Here, key elements of care planning including goal setting and action planning were rare. Additionally, poor continuity and coordination of care, lack of time in consultations, and patient concerns about what was legitimate to discuss with the doctor were described. Conclusions Amongst this population, elements of care planning were present in their accounts, but a structured, comprehensive process and consequent written record (as outlined in English Department of Health policy) was not evident. Further research needs to explore the advantages and disadvantages of different approaches to care planning for different patient groups.

There is some evidence that older people are less likely to be referred to, or to use, SPC. These findings require confirmation in studies using prospectively collected data which control for patient's need for SPC.

SPHEREx, the Spectro-Photometer for the History of the Universe, Epoch of Reionization, and Ices Explorer, is a proposed NASA MIDEX mission selected for Phase A study pointing to a downselect in early CY2019, leading to launch in CY2023. SPHEREx would carry out the first all-sky spectral survey at wavelengths between 0.75 and 2.42 µm [with spectral resolution R=41], 2.42 and 3.82 µm [with R=35], 3.82 and 4.42 µm [with R=110], and 4.42 and 5.00 µm [with R=130]. At the end of its two-year mission, SPHEREx would obtain 0.75-to-5µm spectra of every 6.2×6.2 arcsec pixel on the sky, with a 5-sigma sensitivity AB>19 per spectral/spatial resolution element. SPHEREx would obtain spectra of every sources in the 2MASS PSC (1.2µm, 1.6µm, 2.2µm) catalog to at least (40 σ, 60 σ, 150 σ) per spectral channel, and spectra with S/N ≥3 per frequency element of the faintest sources detected by WISE. More details concerning SPHEREx are available at http://spherex.caltech.edu. The SPHEREx team has proposed three specific science investigations to be carried out with this unique data set: cosmic inflation, interstellar and circumstellar ices, and the extra-galactic background light.Though these three scientific issues are undoubtedly compelling, they are far from exhausting the scientific output of SPHEREx. Indeed, as Table 1 shows, SPHEREx would create a unique all-sky spectral database including spectra of very large numbers of astronomical and solar system targets, including both extended and diffuse sources. These spectra would enable a wide variety of scientific investigations, and the SPHEREx team is dedicated to making the SPHEREx data available to the scientific community to facilitate these investigations, which we refer to as Legacy Science. To that end, we have sponsored two workshops for the general scientific community to identify the most interesting Legacy Science themes and to ensure that the SPHEREx data products are responsive to their needs. In February of 2016, some 50 scientists from all scientific fields met in Pasadena to develop these themes and to understand their implications for the SPHEREx mission. The results of this initial workshop are reported in Doré et al., 2016. Among other things, discussions at the 2016 workshop highlighted many synergies between SPHEREx Legacy Science and other contemporaneous astronomical missions, facilities, and databases. Consequently, in January 2018 we convened a second workshop at the Center for Astrophysics in Cambridge to focus specifically on these synergies. This white paper, which contains substantial contributions from the participants, presents some of the highlights of the 2018 SPHEREx workshop. 1

ObjectivesTo investigate initial reliability of the Global Consultation Rating Scale (GCRS: an instrument to assess the effectiveness of communication across an entire doctor–patient consultation, based on the Calgary-Cambridge guide to the medical interview), in simulated patient consultations.DesignMultiple ratings of simulated general practitioner (GP)–patient consultations by trained GP evaluators.SettingUK primary care.Participants21 GPs and six trained GP evaluators.Outcome measuresGCRS score.Methods6 GP raters used GCRS to rate randomly assigned video recordings of GP consultations with simulated patients. Each of the 42 consultations was rated separately by four raters. We considered whether a fixed difference between scores had the same meaning at all levels of performance. We then examined the reliability of GCRS using mixed linear regression models. We augmented our regression model to also examine whether there were systematic biases between the scores given by different raters and to look for possible order effects.ResultsAssessing the communication quality of individual consultations, GCRS achieved a reliability of 0.73 (95% CI 0.44 to 0.79) for two raters, 0.80 (0.54 to 0.85) for three and 0.85 (0.61 to 0.88) for four. We found an average difference of 1.65 (on a 0–10 scale) in the scores given by the least and most generous raters: adjusting for this evaluator bias increased reliability to 0.78 (0.53 to 0.83) for two raters; 0.85 (0.63 to 0.88) for three and 0.88 (0.69 to 0.91) for four. There were considerable order effects, with later consultations (after 15–20 ratings) receiving, on average, scores more than one point higher on a 0–10 scale.ConclusionsGCRS shows good reliability with three raters assessing each consultation. We are currently developing the scale further by assessing a large sample of real-world consultations.

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