Patient surveys: (how) do they improve healthcare? Patientenbefragungen im Rahmen der sektorübergreifenden Qualitätssicherung Prof. Dr. Michel Wensing Radboud University Medical Centre Nijmegen, Niederlande Seite 1
Outline Potential applications of patient surveys How can patient surveys improve healthcare? Do patient surveys improve healthcare? Conclusions and discussion Seite 2
Potential applications of patient surveys 1. Educational feedback to help healthcare providers to improve their performance and outcomes 2. Provide information that is required for contracts or additional payments of healthcare providers 3. Provide information that help users and payers of healthcare providers to chose between healthcare providers 4. Show authorities/inspection that (minimum) standards are met Seite 3
How can feedback based on patient surveys improve healthcare? Identify areas with suboptimal performance from patients perspectives, which are then addressed by healthcare providers For instance: Patients report lack of continuity of care improve cooperation of healthcare providers Patients report insufficiently improved quality of life analyze clinical procedures and implement evidence-based practice Patients reports adverse events analyze incidents systematically and plan improvements of patient safety Seite 4
How do patient surveys improve healthcare? possible additional mechanisms Reminder: improvements in organisation and performance may be made, before the first questionnaire is sent to patients Priority setting: survey help to prioritize/ create time for known problems in the performance Perceived urgency: Comments by individual patients (including adverse events) often get much response Confirmation: discussion of findings with colleagues or in a patient care team may be crucial for impact of patient surveys Seite 5
Do patient surveys improve healthcare? What do we know from published research? Seite 6
Intermezzo: what is effectiveness? Best motivated and capable participants Intervention group +80 +40 Control group Other participants +40 0 Average improvement +60 +20 Improvement project: + 80 Effectiveness: + 20 (=60 20) Seite 7
Audit and feedback is effective Printed educational material (Farmer 2008) Educational meetings (Forsetlund 2009) Educational outreach visits (O Brien 2007) Audit and feedback (Jamtvedt 2006) N trials ES 23 +4% 56 +6% 34 +5% 118 +5% Seite 8
Evidence on feedback on patient surveys No Cochrane review available. Cheraghi-Sohi S, Bower P. Can the feedback of patient assessments, brief training, or their combination, improve the interpersonal skills of primary care physicians? A systematic review. BMC Health Serv Res 2008;8:179. N=9 cluster randomized trials Sample sizes varied from 19 to 210 physicians All but one had methodological limitations, such as: -no adequate allocation concealment (n=8) -clustering not taking into account (n=2) -no power calculation (n=4) Seite 9
A high-quality cluster randomized trial of patient survey feedback in primary care Randomized trial in primary care: feedback versus no feedback (n=60 physicians and 3500 adult patients) Perceived as useful by general practitioners; they mentioned specific improvements in their practice No effect on standard measures of patient evaluations, practice management or doctor-patient communication Vingerhoets E, Wensing M, Grol R. Educational feedback on patients' evaluations of care: a randomised trial. Qual Health Care 2001;10:224-228. Seite 10
Notes on other applications of patient surveys Public reporting: few individual users of data, as yet (Faber 2009) Patient reported adverse events: many events are reported, little overlap with other patient safety data (Gaal 2008) Patient reported outcomes (PROM): under development Seite 11
Conclusions and discussion Patients assess many aspects of healthcare; for some aspects of healthcare nobody is in a better position for assessment Validated questionnaires and rigorous sampling procedures are necessary, but not sufficient conditions for improvement Direct, convincing evidence on effectiveness of patient survey feedback is lacking and insight into mechanisms is limited It is only useful and ethical to ask patients time for patient surveys, if they result in improvements in the quality of healthcare Seite 12