Patient’s perspective on improving the quality of acute medical care: determining patient reported outcomes

Abstract

RationaleThere is an increasing societal demand for quality assurance and transparency of medical care. The American National Academy of Medicine has determined patient centredness as a quality domain for improvement of healthcare. While many of the current quality indicators are disease specific, most emergency department (ED) patients present with undifferentiated complaints. Therefore, there is a need for generic outcome measures. Our objective was to determine relevant patient reported outcomes (PROs) for quality measurement of acute care.MethodsWe conducted semistructured interviews in patients ≥18 years presenting at the ED for internal medicine. Patients with a cognitive impairment or language barrier were excluded. Interviews were analysed using qualitative content analysis.ResultsThirty patients were interviewed. Patients reported outcomes as relevant in five domains: relief of symptoms, understanding the diagnosis, presence and understanding of the diagnostic and/or therapeutic plan, reassurance and patient experiences. Experiences were often mentioned as relevant to the perceived quality of care and appeared to influence the domain reassurance.ConclusionWe determined five domains of relevant PROs in acute care. These domains will be used for developing generic patient reported measures for acute care. The patients’ perspective will be incorporated in these measures with the ultimate aim of organising truly patient-centred care at the ED.

Quality of acute internal medicine: A patient-centered approach. Validation and usage of the Patient Reported Measure-acute care in the Netherlands

“…Face- and content validity was partly established in our previous study [ 9 ]. In this study, professionals in acute care recognised all domains and questions as relevant.…”

“…We examined the validity of the PRM-acute care following the COSMIN-criteria for a formative construct-model. Intensive previous research formed the basis of the PRM-acute care [ 9 ], including semi-structured interviews with both healthcare professionals and patients, which was followed by cognitive testing in this study. Therefore, we deem the face- and content validity as good.…”

“…The development of the PRM-acute care was based on the previously determined five relevant domains for patients presenting for internal medicine in the ED, namely relief of symptoms, understanding the diagnosis, understanding the therapeutic plan, reassurance, and patient experiences [ 9 ]. A concept questionnaire was developed and presented in three focus groups to 16 different experts in the field of acute medicine by a trained interviewer (MK) to explore the face- and content validity.…”

“…Since the patient population in the ED is heterogeneous and often lacks a diagnosis, many disease and patient specific PROMs are not suitable for use in this setting [ 8 ]. In particular, patients presenting for internal medicine often suffer from multiple chronic conditions and present with non-specific complaints, which may explain why commonly used indicators do not reflect relevant outcomes for this specific group of patients [ 9 ]. In a previous study, we determined the PROs relevant to internal medicine patients in an acute setting.…”

“…In a previous study, we determined the PROs relevant to internal medicine patients in an acute setting. Five core domains were identified, namely relief of symptoms, understanding the diagnosis, understanding the treatment plan, reassurance and patient experiences [ 9 ]. Experiences were determined as a relevant domain, because in the patients’ perception of quality of care, both outcomes and experiences play an important role.…”