We Want to Know: Eliciting Hospitalized Patients' Perspectives on Breakdowns in Care

被引:17
作者
Fisher, Kimberly A. [1 ,2 ]
Smith, Kelly M. [3 ,4 ]
Gallagher, Thomas H. [5 ]
Burns, Laura [2 ]
Morales, Crystal [3 ,4 ]
Mazor, Kathleen M. [1 ,2 ]
机构
[1] Univ Massachusetts, Sch Med, Dept Med, Worcester, MA USA
[2] Meyers Primary Care Inst, 630 Plantat St, Worcester, MA 01605 USA
[3] MedStar Hlth Res Inst, Hyattsville, MD USA
[4] MedStar Hlth Syst Qual & Patient Safety, Columbia, MD USA
[5] Univ Maryland, Sch Med, Seattle, WA USA
基金
美国医疗保健研究与质量局;
关键词
PATIENTS TELL US; ADVERSE EVENTS; HARM;
D O I
10.12788/jhm.2783
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: There is increasing recognition that patients have critical insights into care experiences, including breakdowns in care. Harnessing patient perspectives for hospital improvement requires an in-depth understanding of the types of breakdowns patients identify and the impact of these events. METHODS: We interviewed a broad sample of patients during hospitalization and postdischarge to elicit patient perspectives on breakdowns in care. Through an iterative process, we developed a categorization of patient-perceived breakdowns called the Patient Experience Coding Tool. RESULTS: Of 979 interviewees, 386 (39.4%) believed they had experienced at least one breakdown in care. The most common reported breakdowns involved information exchange (n = 158, 16.1%), medications (n = 120, 12.3%), delays in admission (n = 90, 9.2%), team communication (n = 65, 6.6%), providers' manner (n = 62, 6.3%), and discharge (n = 56, 5.7%). Of the 386 interviewees who reported a breakdown, 140 (36.3%) perceived associated harm. Patient-perceived harms included physical (eg, pain), emotional (eg, distress, worry), damage to relationship with providers, need for additional care or prolonged hospital stay, and life disruption. We found higher rates of reporting breakdowns among younger (<60 years old) patients (45.4% vs 34.5%, P < 0.001), those with at least some college education (46.8% vs 32.7%, P < 0.001), and those with another person (family or friend) present during the interview or interviewed in lieu of the patient (53.4% vs 37.8%, P = 0.002). CONCLUSIONS: When asked directly, almost 4 out of 10 hospitalized patients reported a breakdown in their care. Patient-perceived breakdowns in care are frequently associated with perceived harm, illustrating the importance of detecting and addressing these events. (C) 2017 Society of Hospital Medicine
引用
收藏
页码:603 / 609
页数:7
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