Janet Sansoni

Question Prompt Lists in health consultations: A review

OBJECTIVES This review examines the use and effectiveness of Question Prompt Lists (QPL) as communication aids to enhance patient question asking, information provision to patients and patient participation in health and medical consultations. METHODS A systematic search was undertaken to identify relevant literature concerning QPLs including academic databases, Google-based and snowball searching. Forty-two relevant studies reporting 50 interventions were identified. RESULTS Although findings varied there was some evidence that a QPL endorsed by the physician increased total question asking. Using a QPL increased question asking concerning specific content areas (e.g. prognosis). There was some evidence that physicians provided more information during consultations. There were no consistent findings concerning effects on patient knowledge recall, anxiety and satisfaction or consultation time. Some interventions that increased question asking had longer consultation times. CONCLUSION There is evidence that an appropriate QPL, endorsed by the physician and provided immediately before the consultation, may increase patient question asking and lead to more information being provided by the physician. PRACTICE IMPLICATIONS There is increasing evidence to support QPL use in routine practice. Further trials might address the issues identified including an assessment of QPL optimal length and QPL adaptation for cultural and special needs groups.

Measuring patient satisfaction with health care treatment using the Short Assessment of Patient Satisfaction measure delivered superior and robust satisfaction estimates.

OBJECTIVES Reviews of patient satisfaction suggest seven dimensions, each of which should be assessed. This study reports development of a short generic patient satisfaction measure for use in routine clinical practice. STUDY DESIGN AND SETTINGS Participants were randomly recruited from two Australian incontinence clinics. Participants completed a follow-up questionnaire including patient satisfaction items. Iterative Mokken and Rasch analyses derived the Short Assessment of Patient Satisfaction (SAPS) scale from the item bank. RESULTS The SAPS psychometric properties illustrated the following features, namely its descriptive system covers all seven patient satisfaction dimensions, there were no misfitting items, and the scale exceeded the Loevinger H criteria for a strong unidimensional scale. The reliability of the SAPS was Cronbach α=0.86. When discriminatory function was examined, the SAPS scale was more sensitive than two other generic patient satisfaction instruments. CONCLUSION The SAPS scale is based on a firm theoretical model of patient satisfaction and its descriptive system covers the known dimensions contributing to patient satisfaction. Its internal psychometric properties exceeded standard psychometric standards, and it discriminated at least as well as other longer patient satisfaction measures. Although it needs further validation, the study results suggest that it may be useful for assessing patient satisfaction with health care.

The revised faecal incontinence scale: a clinical validation of a new, short measure for assessment and outcomes evaluation.

BACKGROUND: The patient perspective on fecal incontinence can only be captured through the use of participant-reported measures. There are few psychometric evaluations of such measures, and these evaluations have reported some problems with existing measures. OBJECTIVE: This study clinically evaluated the new Revised Faecal Incontinence Scale which was developed to provide a short, psychometrically sound measure for epidemiological and evaluative research. DESIGN: A sample of consecutive patients was recruited and administered a questionnaire pre and posttreatment (Continence Advising, Physiotherapy and Surgery). SETTINGS: The study was conducted at 6 incontinence clinics across Australia. PATIENTS: The sample included 61 people with fecal incontinence at baseline and 38 at follow-up. MAIN OUTCOME MEASURES: Measures included the Revised Faecal Incontinence Scale, the Wexner Continence Scale, and the St Mark’s Incontinence Score. Additionally, patient and clinician ratings of severity and improvement were collected. RESULTS: The internal reliability of the Revised Faecal Incontinence Scale had a Cronbach’s &agr; = 0.78 compared with 0.65 for both the Wexner and St Mark’s scales. Test-retest reliabilities were 0.80, 0.74, and 0.68. All 3 instruments were similarly responsive to change at follow-up. Correlations with other fecal incontinence measures were high and significant. LIMITATIONS: The small sample size, particularly at posttreatment, provides limitations concerning generalizability and subanalyses that could be undertaken. CONCLUSIONS: The Revised Faecal Incontinence Scale possessed evaluative discrimination between different levels of incontinence severity. In this sample it had superior internal consistency and test-retest reliability to the Wexner and St Marks Incontinence Scales. It was at least as responsive as the Wexner and St Mark’s in detecting change in incontinence status following treatment. Although ongoing clinical validation is required, these findings suggest it is a short, reliable, and valid scale that could be considered for use by researchers, epidemiologists, and clinicians.

Younger Onset Dementia: A Review of the Literature to Inform Service Development

This literature review focused on the experience, care, and service requirements of people with younger onset dementia. Systematic searches of 10 relevant bibliographic databases and a rigorous examination of the literature from nonacademic sources were undertaken. Searches identified 304 articles assessed for relevance and level of evidence, of which 74% were academic literature. The review identified the need for (1) more timely and accurate diagnosis and increased support immediately following diagnosis; (2) more individually tailored services addressing life cycle issues; (3) examination of the service needs of those living alone; (4) more systematic evaluation of services and programs; (5) further examination of service utilization, costs of illness, and cost effectiveness; and (6) current Australian clinical surveys to estimate prevalence, incidence, and survival rates. Although previous research has identified important service issues, there is a need for further studies with stronger research designs and consideration of the control of potentially confounding factors.

A Delphi study to develop indicators of cancer patient experience for quality improvement

PurposeThe purpose of this study was to develop prioritised indicators to measure cancer patient experience and thus guide quality improvement in the delivery of patient care.MethodsA Delphi study, consisting of two surveys and three workshops, was employed to gather expert opinions on the most important indicators to measure. Survey participants were 149 health professionals, academics/technical experts and consumers. The first survey was based on a literature review which identified 105 elements of care within 14 domains of patient experience. These were rated on a 7-point Likert scale, with ‘1’ representing high importance. Elements with mean ratings between 1.0 and 2.0 were retained for the second survey. The 43 least-important elements were omitted, four elements were revised and nine new elements added. Consensus was defined as at least 70% of participants rating an element ‘1’ or ‘2’. Multivariate and cluster analyses were used to develop 20 draft indicators, which were presented to 51 experts to refine and prioritise at the three workshops.ResultsAll elements in the second survey were rated ‘1’ or ‘2’ by 81% of participants. Workshop participants agreed strongly on the four most important indicators: coordinated care, access to care, timeliness of the first treatment, and communication. Other indicators considered highly important were follow-up care for survivors; timeliness of diagnosis; information relating to side effects, pain and medication; comprehensibility of information provided to patients; and needs assessment.ConclusionsExperts identified priorities with a high level of consensus, providing a rigorous foundation for developing prioritised indicators of quality in cancer patient experience.

Is it possible to incorporate quality into hospital pricing systems

Australia has recently implemented an activity - based funding system for public hospitals. Policymakers and providers are keen to ensure that the price paid for health care services stimulates improvements in quality and safety , but some remain scept ical that this can be achieved through pricing mechanisms. There are four main ways of linking quality and safety to hospital pricing in the context of activity based funding: Best-practice pricing This involves making evidenced - based decisions on what constitutes ‘best-practice’ for the treatment of a particular condition, then paying health services a set price when they provide best-practice care. Normative pricing This involves using price to influence the delivery of care (for example, providing incentives to deliver more care in the home for certain conditions or to provide day surgery options where appropriate). Structural models of pricing quality This involves linking funding to meeting accreditation standards or participating in benchmarking activities or clinical quality registries. Payment for Performance (P4P) or quality pricing This involves using financial incentives and/or disincentives to encourage providers to behave in certain ways that will improve quality and safety. This paper briefly examines the strength of the evidence for each of these pricing models. It considers both peer-reviewed research as well as non peer-reviewed material, such as program evaluations and government reports.

Some highlights of the Australian Dementia Outcomes Measurement Suite (DOMS) project: Social isolation

available on Alzheimer’s disease, and no investigation has been carried out in France on this subject. Methods: We will rely on a quantitative survey conducted by phone with a representative sample of 2013 people over 18 years. Knowledge is assessed by three questions about the signs of Alzheimer’s disease, the difficulties encountered in early disease and preventive factors for Alzheimer’s disease; scores of knowledge were constructed from these three items. A question explores the level of information collected on several health problems including Alzheimer’s disease. Descriptive and inferential analysis were conducted to establish socio-economic profiles and analyze the relationship between knowledge, the level of information and the proximity to the disease. Results: Six out of ten (62%) feel well informed about the disease, which is low compared to the level of information on other diseases such as AIDS, cancer or cardiovascular disease. The older people with higher incomes, regular family caregivers are significantly more likely to feel well informed about the disease. The signs, preventive factors and the main difficulties encountered in early disease are identified by a majority of respondents. The score of knowledge on the signs is significantly higher among older persons having the highest incomes, the more graduates. Only income and diploma influence knowledge of the factors preventing the disease. The scores are equal among not concerned people as among caregivers. Conclusions: While family caregivers feel well informed about the disease, their knowledge scores are not higher than in general population. Specific information actions should be considered with this target.