Can Patient–Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review

Haverfield, Marie C.; Tierney, Aaron A.; Schwartz, Rachel; Bass, Michelle; Brown‐Johnson, Cati; Zionts, Dani; Safaeinili, Nadia; Fischer, Michael M. J.; Shaw, Jonathan G.; Thadaney, Sonoo; Piccininni, Gabriella; Lorenz, Karl; Asch, Steven M.; Verghese, Abraham; Zulman, Donna M.

doi:10.1007/s11606-019-05525-2

Cited by 69 publications

(67 citation statements)

References 89 publications

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“…Ultimately, most providers supported a hybrid model for telemedicine and in-office appointments; this would preserve the opportunity for face-to-face contact when needed for optimal decision-making and foster patient connection and flexibility, both of which influence physician burnout. 19 …”

Section: Discussionmentioning

confidence: 99%

Radiation Oncologist Perceptions of Telemedicine from Consultation to Treatment Planning: A Mixed-Methods Study

Zhang

Elaine

Lynch

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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Purpose Telemedicine was rapidly implemented for initial consultations and radiation treatment planning in the wake of the coronavirus disease 2019 (COVID-19) pandemic. In this study, we explore utilization of and physician perspectives on this approach in an attempt to identify patient populations that may benefit most from virtual care. Methods and Materials This is a mixed-methods study with a convergent design. Approximately 6 to 8 weeks after implementation of telemedicine, all radiation oncologists in a single academic radiation oncology department were invited to participate in either semistructured interviews with embedded survey questions or a concurrently administered survey only. Rapid qualitative analysis was used to identify common themes, and quantitative data was assessed using descriptive statistics and univariable analyses. Results At the apex of the pandemic, 92% of radiation oncology visits were conducted via telemedicine. In total, 51 of 61 radiation oncologists participated in the study (response rate 84%). Most (71%) reported no difference in ability to treat cancer appropriately via telemedicine, which was more common among specialized physicians ( P = .01) but not those with higher visit volume or years of experience. Over half (55%) perceived no difference or even improvement in overall visit quality with telemedicine. Virtual visits were deemed acceptable for a median of 70% to 96% of patients, which varied by disease site. Need for physical examination, and availability of an acceptable proxy, factored into telemedicine acceptability. Most (88%) found telemedicine better than expected, but opinions were split on how telemedicine would affect physician burnout. Almost all (96%) foresaw a role for telemedicine beyond the pandemic and would opt for a median of 50% (interquartile range 20%-66%) of visits conducted via telemedicine. Conclusions Among radiation oncologists in an academic setting, telemedicine was perceived to be highly appropriate and acceptable for most patients. Future studies should focus on identifying the 5% to 30% of patients whose care may be optimized with in-person visits, and if there is alignment with patient preferences.

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Section: Discussionmentioning

confidence: 99%

Radiation Oncologist Perceptions of Telemedicine from Consultation to Treatment Planning: A Mixed-Methods Study

Zhang

Elaine

Lynch

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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“…In doing so, the review revealed that interpersonal communication interventions with lower demands on provider time and effort were often as effective as those with higher demands. 22…”

Section: Resultsmentioning

confidence: 99%

“…21 The studies were a subset of articles from a systematic review that was conducted for a previous evidence synthesis project. 22 For this review, we focused on studies of physician communication skills interventions to facilitate comparison of implementation factors across similar types of interventions. For this proof-of-concept systematic review, our objective was to determine whether implementation factors could be reliably abstracted using the above guidelines.…”

Section: Systematic Review Methodsmentioning

confidence: 99%

“…Also, extracting this type of information may give researchers examples of how to effectively implement similar interventions and may aid in design and this information could be used to examine the association between intervention complexity and study outcomes. 22 Such information could also provide justification for certain implementation strategies or inspire innovations to address implementation barriers. Standardizing the practice of incorporating implementation information could also improve intervention design methods, resulting in greater uptake and implementation of interventions with proven efficacy on improving outcomes of interest.…”

Section: (100%) 79%mentioning

confidence: 99%

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Advancing Evidence Synthesis from Effectiveness to Implementation: Integration of Implementation Measures into Evidence Reviews

et al. 2019

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BACKGROUND: In order to close the gap between discoveries that could improve health, and widespread impact on routine health care practice, there is a need for greater attention to the factors that influence dissemination and implementation of evidence-based practices. Evidence synthesis projects (e.g., systematic reviews) could contribute to this effort by collecting and synthesizing data relevant to dissemination and implementation. Such an advance would facilitate the spread of high-value, effective, and sustainable interventions. OBJECTIVE: The objective of this paper is to evaluate the feasibility of extracting factors related to implementation during evidence synthesis in order to enhance the replicability of successes of studies of interventions in health care settings. DESIGN: Drawing on the implementation science literature, we suggest 10 established implementation measures that should be considered when conducting evidence synthesis projects. We describe opportunities to assess these constructs in current literature and illustrate these methods through an example of a systematic review. SUBJECTS: Twenty-nine studies of interventions aimed at improving clinician-patient communication in clinical settings. KEY RESULTS: We identified acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, intervention complexity, penetration, reach, and sustainability as factors that are feasible and appropriate to extract during an evidence synthesis project. CONCLUSIONS: To fully understand the potential value of a health care innovation, it is important to consider not only its effectiveness, but also the process, demands, and resource requirements involved in downstream implementation. While there is variation in the degree to which intervention studies currently report implementation factors, there is a growing demand for this information. Abstracting information about these factors may enhance the value of systematic reviews and other evidence synthesis efforts, improving the dissemination and adoption of interventions that are effective, feasible, and sustainable across different contexts.

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“…Speculatively, one well-designed and evidence-based intervention that was implemented uniformly in a health service would have a more signi cant impact than multiple interventions implemented in different departments. This study contributes to the body of literature on the e cacy of single versus multiple interventions (44,45), where the evidence on the e cacy is caveat by the context and nature of the intervention. Nevertheless, in the context of the Victorian public inpatient services, using one evidence-based intervention in the areas at the point of care mentioned above is associated with improvement in overall patient experience.…”

Section: Discussionmentioning

confidence: 96%

Victorian Healthcare Experience Survey 2016 – 2018; Evaluation of Interventions to Improve the Patient Experience.

Wong

Mavondo

Horvat³

et al. 2020

Preprint

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BackgroundPatient experience is recognised as a quality of care indicator and increasingly health services are working on achieving set targets and improving their performance. Interventions at the point of care targeting communication with patients, patient engagement in care processes and discharge planning are associated with better patient experience. However, their efficacy and application to different contexts are still unclear. The aims were to describe the interventions implemented by health services to improve patient experience, their impact on overall patient experiences and specific experiences in areas of communication, discharge planning, patient education on treatment/tests, the physical environment and access to care.MethodsSecondary data analysis of the Victorian Healthcare Experience inpatient surveys reported in September 2016 and 2018 and content analysis of interventions published in the Victorian Quality Account for 2017 from 59 public health services in Victoria, Australia. The interventions were categorised using an adapted taxonomy of professional interventions by the Cochrane EPOC Review Group. Univariate tests and confirmatory factor analysis were conducted to test measure invariance across the 2016 and 2018 groups and examine the association between each of the intervention categories on overall patient experience measure and specific outcome measures.ResultsThis study found that the overall patient experience was consistent (93%) between 2016 and 2018 samples. In comparing impact, a single intervention rather than none or multiple interventions in communication, respect and dignity and treatment and disease education areas were associated with a higher level of the overall patient experience. Interventions in waiting time, access to service, care continuity and emotional support categories were associated with a decrease in overall patient experience. ConclusionThis study found that to improve the overall patient experience, more focus is needed on evidence-based interventions in dignity and respect and emotional support. Furthermore, the choice of interventions should be guided by evidence of their efficacy and prioritising implementing one intervention well, provides more gains.

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Can Patient–Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review

Cited by 69 publications

References 89 publications

Radiation Oncologist Perceptions of Telemedicine from Consultation to Treatment Planning: A Mixed-Methods Study

Radiation Oncologist Perceptions of Telemedicine from Consultation to Treatment Planning: A Mixed-Methods Study

Advancing Evidence Synthesis from Effectiveness to Implementation: Integration of Implementation Measures into Evidence Reviews

Victorian Healthcare Experience Survey 2016 – 2018; Evaluation of Interventions to Improve the Patient Experience.

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