Changing Health-Related Behaviours 5: On Interventions to Change Physician Behaviours

Etchegary, Cheryl M.; Taylor, Lynn; Mahoney, Krista; Parfrey, Owen; Hall, Amanda

doi:10.1007/978-1-0716-1138-8_33

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…More generally, erosion related to physician behaviors and coaching95 is a specific instance of a general phenomenon, and has been found in other behavioral change interventions (eg, smoking cessation, alcohol use, anger management, weight loss programs). Engaging providers in the coaching process is critical96,97 but its program implementation also needs a “booster” component to sustain desired behaviors 95–99. Structural and environmental factors, which may have led to the need for the coaching in the first place, may also have been at least partly responsible for the erosion of improvement.…”

Section: Discussionmentioning

confidence: 96%

“…This may correspond to providers gradually slipping back into their previous habits of interacting with patients, as there is some evidence that clinician behavior lapses when feedback ends. 94 More generally, erosion related to physician behaviors and coaching 95 is a specific instance of a general phenomenon, and has been found in other behavioral change interventions (eg, smoking cessation, alcohol use, anger management, weight loss programs). Engaging providers in the coaching process is critical 96,97 but its program implementation also needs a "booster" component to sustain desired behaviors.…”

Section: Discussionmentioning

confidence: 99%

“…Engaging providers in the coaching process is critical 96,97 but its program implementation also needs a "booster" component to sustain desired behaviors. [95][96][97][98][99] Structural and environmental factors, which may have led to the need for the coaching in the first place, may also have been at least partly responsible for the erosion of improvement. Organizational structure may obstruct providers seeking to change their behaviors.…”

Section: Discussionmentioning

confidence: 99%

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Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later

et al. 2021

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Background: Health care organizations strive to improve patient care experiences. Some use one-on-one provider counseling (shadow coaching) to identify and target modifiable provider behaviors.Objective: We examined whether shadow coaching improves patient experience across 44 primary care practices in a large urban Federally Qualified Health Center.Research Design: Seventy-four providers with "medium" (ie, slightly below average) overall provider ratings received coaching and were compared with 246 uncoached providers. We fit mixedeffects regression models with random effects for provider (level of treatment assignment) and fixed effects for time (linear spline with a knot and "jump" at coaching date), patient characteristics and site indicators. By design, coached providers performed worse at selection; models account for the very small (0.2 point) regression-tothe-mean effects. We assessed differential effects by coach.Subjects: A total of 46,452 patients (from 320 providers) who completed the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) Visit Survey 2.0.Measures: CAHPS overall provider rating and provider communication composite (scaled 0−100).Results: Providers not chosen for coaching had a nonsignificant change in performance during the period when selected providers were coached. We observed a statistically significant 2-point (smallto-medium) jump among coached providers after coaching on the CAHPS overall provider rating and provider communication score. However, these gains disappeared after 2.5 years; effects differed by coach.Conclusions: Shadow coaching improved providers' overall performance and communication immediately after being coached. Regularly planned shadow coaching "booster" sessions might maintain or even increase the improvement gained in patient experience scores, but research examining additional coaching and optimal implementation is needed.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later

et al. 2021

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Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

et al. 2022

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INTRODUCTION: Shadow coaching improves providerpatient interactions, as measured by CG-CAHPS® overall provider rating (OPR) and provider communication (PC). However, these improvements erode over time. AIM: Examine whether a second coaching session (recoaching) improves and sustains patient experience. SETTING: Large, urban Federally Qualified Health Center PROGRAM: Trained providers observed patient care by colleagues and provided suggestions for improvement. Providers with OPRs<90 (0-100-point scale) were eligible. EVALUATION: We used stratified randomization based on provider type and OPR to assign half of the 40 eligible providers to re-coaching. For OPR and PC, we fit mixedeffects regression models with random-effects for provider (level of treatment assignment) and fixed-effects for time (linear spline with knots and possible "jump" at initial coaching and re-coaching), previous OPR, patient characteristics, and sites. We observed a statistically significant medium jump among re-coached providers after recoaching on OPR (3.7 points) and PC (3.5 points); differences of 1, 3, and ≥5-points for CAHPS measures are considered small, medium, and large. Improvements from re-coaching persisted for 12 months for OPR and 8 months for PC. DISCUSSION: Re-coaching improved patient experience more than initial coaching, suggesting the reactivation of knowledge from initial coaching. However, re-coaching gains also eroded. Coaching should occur every 6 to 12 months to maintain behaviors and scores.

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Understanding providers' perspectives using patient-reported outcomes in a pain management setting: a pilot study

Witkin,

Kasubhai,

Jiang

et al. 2024

Pain Management

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Aim: This pilot study evaluated an electronic patient-reported outcomes collection system in pain management to understand providers' experiences using the data, and how it affects their patient interaction and guides their clinical decision-making. Materials & methods: Using stratified convenience sampling, nine semi-structured interviews were conducted with consented pain physicians. The transcribed, de-identified interviews were coded and analyzed. Results: Although most physicians utilized patient reported outcomes (PROs), one-third reported no significant change in their practice since implementation and 56% stated it does not influence their treatment recommendations. Conclusion: Despite the importance of measuring the impact of chronic pain on quality of life, there are significant limitations to the real-world use of PRO that may limit the patient's assessment and care.

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Changing Health-Related Behaviours 5: On Interventions to Change Physician Behaviours

Cited by 3 publications

References 28 publications

Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later

Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later

Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

Understanding providers' perspectives using patient-reported outcomes in a pain management setting: a pilot study

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