Improving the quality of person-centred healthcare from the patient perspective: development of person-centred quality indicators

Abstract

ImportanceInternational efforts are being made towards a person-centred care (PCC) model, but there are currently no standardised mechanisms to measure and monitor PCC at a healthcare system level. The use of metrics to measure PCC can help to drive the changes needed to improve the quality of healthcare that is person centred.ObjectiveTo develop and validate person-centred care quality indicators (PC-QIs) measuring PCC at a healthcare system level through a synthesis of the evidence and a person-centred consensus approach to ensure the PC-QIs reflect what matters most to people in their care.MethodsExisting indicators were first identified through a scoping review of the literature and an international environmental scan. Focus group discussions with diverse patients and caregivers and interviews with clinicians and experts in quality improvement allowed us to identify gaps in current measurement of PCC and inform the development of new PC-QIs. A set of identified and newly developed PC-QIs were subsequently refined by Delphi consensus process using a modified RAND/UCLA Appropriateness Method. The international consensus panel consisted of patients, family members, community representatives, clinicians, researchers and healthcare quality experts.ResultsFrom an initial 39 unique evidence-based PC-QIs identified and developed, the consensus process yielded 26 final PC-QIs. These included 7 related to structure, 16 related to process, 2 related to outcome and 1 overall global PC-QI.ConclusionsThe final 26 evidence-based and person-informed PC-QIs can be used to measure and evaluate quality incorporating patient perspectives, empowering jurisdictions to monitor healthcare system performance and evaluate policy and practice related to PCC.

¿Cómo valorar la atención centrada en la persona según los profesionales? Un estudio Delphi

“…La complejidad de realizar y manejar la información de una técnica Delphi en pacientes hizo que el GI desaconsejara su realización. Para intentar complementar y contrastar la información obtenida en el Delphi, seguiremos las recomendaciones de Hudon 12 y, mediante una técnica de Grupos Focales al igual que en otros estudios similares, se recogerá la opinión de pacientes atendidos en AP 32 , 33 , 34 . Las conclusiones de nuestro estudio Delphi, junto con la información obtenida en los grupos focales y la revisión sistemática, nos permitirá una visión global de la ACP ayudándonos a seleccionar los aspectos más relevantes para elaborar un cuestionario autocumplimentado.…”

An Overview of Measurement Systems and Practices in Healthcare Systems Applied to Person-Centred Care Interventions

“…From a management perspective, what is not measured cannot be managed or improved and, consequently, linking cost to process improvements or outcomes is difficult [65]. Using metrics to measure PCC can help drive the changes needed to improve the quality of healthcare that is person-centred [69].…”

“…From a metrological point of view, there is a need to go beyond the traditional physical, chemical and biological quantities of clinical biomarkers to develop reference standards for novel kinds of quantities related to patient activity, participation and social well-being. Santana et al [69] also point out that international efforts are being made towards the PCC model, but there are no standard mechanisms at a healthcare system level to measure and monitor PCC. The main conclusion is that a measuring instrument can be the best in one context and not so good in another, and there is a continuous need to ensure that quality indicators (often called psychometric indicators) are the most appropriate for the specific case.…”

“…The ECHOs model (Economic, Clinical, and Humanistic Outcomes) focus on economic outcomes and their interrelationships with the clinical and humanistic outcomes [13]. Other studies identify tools that can be applied to different actors and dimensions [46,77] and quality indicators that can be used to measure PCC [67][68][69]. The explored framework from Santana et al [71], presented in the previous section, considers as outcomes PROMs, PREMs, and PRAOs.…”

“…For instance, Silva [77], from the UK's Health Foundation, reviewed measurement tools targeted to different actors (carers, patients, professionals) and categories (carer experience, communication, dignity/empathy, engagement, patient experience, person-centred care, self-management support, and shared decision-making). From a quality perspective, the Canadian Institutes of Health Research and the MSI Foundation identified person-centred quality indicators related to structure, process, and outcomes [68,69]. Using program theories (PTs), Lloyd et al [46] identified seven different types of evidence-based PTs that could shape health laboratories' design to implement PCC.…”