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PURPOSE: Near real-time patient experience feedback (NRTPEF) can enable a patient-centric, immediate service recovery but has not been widely used in inpatient rehabilitation. We 1) assess the utility, feasibility, and acceptability of implementing a new NRTPEF, perceived by patients and providers; and 2) understand how the NRTPEF became embedded into routine provider practices. MATERIALS AND METHODS: Mixed methods process evaluation of the 8-month implementation of an innovative NRTPEF in an inpatient rehabilitation unit, using interviews and focus groups with all the service-unit leaders and interviews with a randomised sample of patients. Beyond descriptive statistics and content analysis, the Normalisation Process Theory (NPT) informed a framework analysis. RESULTS: Patients and service-unit leaders perceived high utility in the NRTPEF (median: 9 for both; 0-10 scale) and qualitative comments emphasised the value of providing/obtaining timely feedback. The system was found feasible and acceptable for patients (median: 9.5), but with an improvement margin for providers (median: 7.3). Suggestions include strengthening the data-relay format. Even in the pilot form, providers found the NRTPEF became embedded into practice (median 10; average: 8.6). The analysis based on the NPT shows how providers saw differential value, engaged with, and used the patient feedback into reconfigured practices. CONCLUSION: An innovative NRTPEF was found useful, feasible and acceptable, but with refinement opportunities before scale-up.
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Near Real-Time Feedback (NRTF) on the patient's experience with care, coupled with data relay to providers, can inform quality-of-care improvements, including at the point of care. The objective is to systematically review contemporary literature on the impact of the use of NRTF and data relay to providers on standardized patient experience measures. Six scientific databases and five specialty journals were searched supplemented by snowballing search strategies, according to the registered study protocol. Eligibility included studies in English (2015-2023) assessing the impact of NRTF and data relay on standardized patient-reported experience measures as a primary outcome. Eligibility and quality appraisals were performed by two independent reviewers. An expert former patient (Patient and Family Advisory Council and communication sciences background) helped interpret the results. Eight papers met review eligibility criteria, including three randomized controlled trials (RCTs) and one non-randomized study. Three of these studies involved in-person NRTF prior to data relay (patient-level data for immediate corrective action or aggregated and peer-compared) and led to significantly better results in all or some of the experience measures. In turn, a kiosk-based NRTF achieved no better experience results. The remaining studies were pre-post designs with mixed or neutral results and greater risks of bias. In-person NRTF on the patient experience followed by rapid data relay to their providers, either patient-level or provider-level as peer-compared, can improve the patient experience of care. Reviewed kiosk-based or self-reported approaches combined with data relay were not effective. Further research should determine which approach (e.g. who conducts the in-person NRTF) will provide better, more efficient improvements and under which circumstances.
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Retroalimentação , Satisfação do Paciente , Humanos , Melhoria de Qualidade , Qualidade da Assistência à SaúdeRESUMO
AIM: To synthesize the impact of improvement interventions related to care coordination, discharge support and care transitions on patient experience measures. METHOD: Systematic review. Searches were completed in six scientific databases, five specialty journals, and through snowballing. Eligibility included studies published in English (2015-2023) focused on improving care coordination, discharge support, or transitional care assessed by standardized patient experience measures as a primary outcome. Two independent reviewers made eligibility decisions and performed quality appraisals. RESULTS: Of 1240 papers initially screened, 16 were included. Seven studies focused on care coordination activities, including three randomized controlled trials [RCTs]. These studies used enhanced supports such as improvement coaching or tailoring for vulnerable populations within Patient-Centered Medical Homes or other primary care sites. Intervention effectiveness was mixed or neutral relative to standard or models of care or simpler supports (e.g., improvement tool). Eight studies, including three RCTs, focused on enhanced discharge support, including patient education (e.g., teach back) and telephone follow-up; mixed or neutral results on the patient experience were also found and with more substantive risks of bias. One pragmatic trial on a transitional care intervention, using a navigator support, found significant changes only for the subset of uninsured patients and in one patient experience outcome, and had challenges with implementation fidelity. CONCLUSION: Enhanced supports for improving care coordination, discharge education, and post-discharge follow-up had mixed or neutral effectiveness for improving the patient experience with care, compared to standard care or simpler improvement approaches. There is a need to advance the body of evidence on how to improve the patient experience with discharge support and transitional approaches.
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Alta do Paciente , Humanos , Cuidado Transicional , Assistência Centrada no Paciente , Satisfação do Paciente , Continuidade da Assistência ao Paciente , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To understand whether lower limb asymmetry in chronic stroke is related to paretic motor impairment or impaired interlimb coordination. METHODS: Stroke and control participants performed conventional, unilateral, and bilateral uncoupled pedaling. During uncoupled pedaling, the pedals were mechanically disconnected. Paretic mechanical work was measured during conventional pedaling. Pedaling velocity and muscle activity were compared across conditions and groups. Relative limb phasing was examined during uncoupled pedaling. RESULTS: During conventional pedaling, EMG and mechanical work were lower in the paretic than the non-paretic limb (asymmetry). During unilateral pedaling with the paretic limb, muscle activity was larger, but velocity was slower and more variable than during conventional pedaling (evidence of paretic motor impairment). During uncoupled pedaling, muscle activity increased further, but velocity was slower and more variable than in other conditions (evidence of impaired interlimb coordination). Relative limb phasing was impaired in stroke participants. Regression analysis suggested that interlimb coordination may be a stronger predictor of asymmetry than paretic motor impairment. CONCLUSIONS: Paretic motor impairment and impaired interlimb coordination may contribute to asymmetry during pedaling after stroke. SIGNIFICANCE: Rehabilitation that addresses paretic motor impairment and impaired interlimb coordination may improve symmetry and maximize improvement.