TY - JOUR
T1 - Implementation of a patient-collected audio recording audit & feedback quality improvement program to prevent contextual error
T2 - stakeholder perspective
AU - Ball, Sherry L.
AU - Weiner, Saul J.
AU - Schwartz, Alan
AU - Altman, Lisa
AU - Binns-Calvey, Amy
AU - Chan, Carolyn
AU - Falck-Ytter, Corinna
AU - Frenchman, Meghana
AU - Gee, Bryan
AU - Jackson, Jeffrey L.
AU - Jordan, Neil
AU - Kass, Benjamin
AU - Kelly, Brendan
AU - Safdar, Nasia
AU - Scholcoff, Cecilia
AU - Sharma, Gunjan
AU - Subramaniam, Soumya
AU - Weaver, Frances
AU - Wopat, Maria
N1 - Funding Information:
The research described was funded by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development (IIR 15–452), and the quality improvement program received funds from VISN 12.
Funding Information:
We would like to acknowledge the following research and project assistants who recruited patients, provided technical support, and/or assisted with logistics: Adrienne Krol; John W Merriman, LaShawnta S. Jackson DrPH, MPH, Tammy Voth, Christine Wurm, Daniel Finlay, and Kelsey Baubie. The views expressed in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Using patient audio recordings of medical visits to provide clinicians with feedback on their attention to patient life context in care planning can improve health care delivery and outcomes, and reduce costs. However, such an initiative can raise concerns across stakeholders about surveillance, intrusiveness and merit. This study examined the perspectives of patients, physicians and other clinical staff, and facility leaders over 3 years at six sites during the implementation of a patient-collected audio quality improvement program designed to improve patient-centered care in a non-threatening manner and with minimal effort required of patients and clinicians. Methods: Patients were invited during the first and third year to complete exit surveys when they returned their audio recorders following visits, and clinicians to complete surveys annually. Clinicians were invited to participate in focus groups in the first and third years. Facility leaders were interviewed individually during the last 6 months of the study. Results: There were a total of 12 focus groups with 89 participants, and 30 leadership interviews. Two hundred fourteen clinicians and 800 patients completed surveys. In a qualitative analysis of focus group data employing NVivo, clinicians initially expressed concerns that the program could be disruptive and/or burdensome, but these diminished with program exposure and were substantially replaced by an appreciation for the value of low stakes constructive feedback. They were also significantly more confident in the value of the intervention in the final year (p =.008), more likely to agree that leadership supports continuous improvement of patient care and gives feedback on outcomes (p =.02), and at a time that is convenient (p =.04). Patients who volunteered sometimes expressed concerns they were “spying” on their doctors, but most saw it as an opportunity to improve care. Leaders were supportive of the program but not yet prepared to commit to funding it exclusively with facility resources. Conclusions: A patient-collected audio program can be implemented when it is perceived as safe, not disruptive or burdensome, and as contributing to better health care.
AB - Background: Using patient audio recordings of medical visits to provide clinicians with feedback on their attention to patient life context in care planning can improve health care delivery and outcomes, and reduce costs. However, such an initiative can raise concerns across stakeholders about surveillance, intrusiveness and merit. This study examined the perspectives of patients, physicians and other clinical staff, and facility leaders over 3 years at six sites during the implementation of a patient-collected audio quality improvement program designed to improve patient-centered care in a non-threatening manner and with minimal effort required of patients and clinicians. Methods: Patients were invited during the first and third year to complete exit surveys when they returned their audio recorders following visits, and clinicians to complete surveys annually. Clinicians were invited to participate in focus groups in the first and third years. Facility leaders were interviewed individually during the last 6 months of the study. Results: There were a total of 12 focus groups with 89 participants, and 30 leadership interviews. Two hundred fourteen clinicians and 800 patients completed surveys. In a qualitative analysis of focus group data employing NVivo, clinicians initially expressed concerns that the program could be disruptive and/or burdensome, but these diminished with program exposure and were substantially replaced by an appreciation for the value of low stakes constructive feedback. They were also significantly more confident in the value of the intervention in the final year (p =.008), more likely to agree that leadership supports continuous improvement of patient care and gives feedback on outcomes (p =.02), and at a time that is convenient (p =.04). Patients who volunteered sometimes expressed concerns they were “spying” on their doctors, but most saw it as an opportunity to improve care. Leaders were supportive of the program but not yet prepared to commit to funding it exclusively with facility resources. Conclusions: A patient-collected audio program can be implemented when it is perceived as safe, not disruptive or burdensome, and as contributing to better health care.
KW - Contextual error
KW - Contextualization of care
KW - Patient-collected audio
KW - Performance improvement
KW - Quality improvement
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U2 - 10.1186/s12913-021-06921-3
DO - 10.1186/s12913-021-06921-3
M3 - Article
C2 - 34461903
AN - SCOPUS:85113747144
VL - 21
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 891
ER -