3. BACKGROUND
Growing interest in the measurement of patient experience -
service quality improvement
Patients in rehab care - medically complex & many care
providers across system
Their condition and treatment may produce differences in their
conceptualization of an optimal experience while receiving care.
Difficulty identifying SYSTEM level psychometrically tested
patient experience survey tools
3
6. SYSTEMATIC LITERATURE
REVIEW
6
PubMed
(n=2061)
CINAHL
(n=230)
Articles identified
for title review
(n=2442)
Duplicates removed
(n=30)
Articles retrieved for
abstract review
(n=262)
Articles excluded
based on title
(n=2180)
Articles retrieved for
full review
(n=38)
Articles excluded
based on abstract
(n=224)
Articles included in
critical review
(n=33)
Articles excluded
based on full text
review
(n=10)
PsychInfo
(n=181)
Articles identified
from hand search of
selected journals
(n=5)
7. SOME NUMBERS…
33 articles
15 countries
50% of papers published since 2010
Setting
20 (60%) outpatient care
8 inpatient rehab
4 inpatient acute care i.e. post-stroke
1 cross continuum
25 discrete measurement tools
20 studies involved patients in survey development
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8. SURVEY INSTRUMENTS WITH
REHAB PATIENT EXPERIENCE
QUESTIONS INCLUDED…
CCRQ Client Centred Rehabilitation Questionnaire
CQI: ConsumerQuality Hip KneeQuestionnaire
CRPF-R: RevisedCardiac Rehabilitation Preference
Form
MISS-21: Medical Interview Satisfaction Scale
MRPS: MedRiskInstrument forMeasuring Patient
SatisfactionWith PhysicalTherapy Care
NREQ: Neurorehabilitation Experience
Questionnaire
OAKHQOL: Osteo-Arthritis KneeandHip Quality of
Life
OPEQ: Outpatient ExperienceQuestionnaire
PEQ: Patient Experience Questionnaire
POPS: Physiotherapy Outpatient Survey
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PPTO: Patients’ Perception ofTreatmentOutcomes
P-QPD: Patients’Questionnaireon Participation in
Discharge Planning
PSQ or PTPSQ: Patient SatisfactionQuestionnaire or
PhysicalTherapy Patient Satisfaction Questionnaire
PTOPS: PhysicalTherapyOutpatients Satisfaction
Questionnaire
QCS: Quality of Care Scale
QUOTE:Quality of CareThrough thePatient’s Eyes
QUOTE-HIV:Quality ofCareThrough thePatient’s Eyes- HIV
Re-PEQ: Rehabilitation Patient Experiences Questionnaire
SAPHORA
SASC orC-SASC: Satisfaction with StrokeCare orCaregivers
Satisfaction with StrokeCare
SERVQUAL
4 unnamedinstruments
9. QUALITATIVE ANALYSIS
Theme Key focus
Group Identities (I) Factors that mediatethe patient experience related to
identity as individual or with groups i.e. gender, age,
ethnicity
Patient & Healthcare Provider
Relationship (R)
Nature of interaction between patient andprovider i.e.
Respect, trust, listening skills, understands problems
Client & Informal Caregiver
Engagement (C)
Education andinformation sharingto engage patient
(andwhere appropriate thecaregiver) in decision
making & improve coping
Rehabilitative Care Ecosystem
(E)
Organizational /provider processes, policy andfacilities
i.e. wait times, appointment length, privacy, staff
training
Body Function (F) Interplay between activity, andlimitations and
impairments i.e. pain management, support fordaily
routines, safety
General Experience (G) Universal experience impressions of
organization/provider
Qualitative (Q) Granular feedback throughopen-ended questions 9
10. KEY LEARNINGS FROM
LITERATURE REVIEW
Measures of patient experience are universal
Different sectors, settings, diseases or conditions change which
measures are relevant
There are currently no psychometrically tested SYSTEM
measures for patient experience in rehabilitative care
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11. KEY INFORMANT INTERVIEW
HIGHLIGHTS
2 representatives from CIHI performance measurement, AB
consultant, BC MOH
None of the key informants were aware of any tools being used
to specifically measure rehabilitative care patients’ experience.
Won’t recommend measures that are not empirically and
psychometric tested
Continuity and transition are most important
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12. ANALYSISOF SECONDARY
ETHNOGRAPHIC DATA
Data source: InfoRehab: Better Information for Better MSK Health
and Quality of Life for Older Persons
Focus on transitional care for rehabilitative care patients across
the care continuum -WWLHIN
Interviews with providers, patients & informal care providers: 16
Waterloo patient and caregiver interviews analyzed for this
report
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13. FOCUSSED IN-DEPTH
INTERVIEWS
2 female & 1 male
Recruited from the SHARP network
Personal or family experience with each of the four streams of
care within the WWHLIN including cardiopulmonary, frail elderly,
stroke and MSK (hip replacement, knee replacement and back
problems)
Critical event method & review of ethnography “themes”
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14. FEEDBACK
Unanimous Agreement on:
All majorthemes
Identified as particularly important
Familyengagement
Group identifiers
Concerns were incorporated into
“treating with kindness” implies feeling sorry – focus on
empathy
“understanding capacity to provide care” – families won’t
know until lived experience
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15. WE MAPPEDTHE LIT REVIEW &
ETHNOGRAPHY THEMES
Triangulation of
literature review,
interviews, and
secondary data analysis
15
16. 16
KNOWLEDGE MOBILIZATION
• Two academic peer reviewed publications
– McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P.
Measuring patients’ experience of rehabilitation services across
the care continuum. Part I: A systematic review of the
literature. Arch Phys Med Rehabil. 2016;(97):104–20.
– McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P.
Measuring patients’ experience of rehabilitation services across
the care continuum. Part II: Key dimensions. Arch Phys Med
Rehabil. 2015;(97):121–30.
• Request for instrument use inAustralian study of
OP rehab patient experience
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20. PATIENT INCLUSION CRITERIA
A minimum of 250 participants will be recruited to
participate in this study. Inclusion criteria include:
Representative sample of patients rehabilitation clinics;
Male and female adults(over the age of 18 years old) whomeet
thediagnostic criteria to receive theservices in the
participating clinics;
Currently admittedin the participating rehab clinic;
Within two weeks fromtheir expected dischargefromthe
program;
Capable of reading English or have a caregiver to assistwith
this
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21. COGNITION & ELIGIBILITY
Staff will determine the eligibility of the patient to complete the
questionnaire:
Patients are eligible if staff can answer ‘yes’ to the following two
questions:
Can this person read written material on his/her own?
Is this person able to comprehend the written material on his/her
own?
If yes, but a client requires assistance transcribing their
responses onto the questionnaire, they are eligible and may use
an assistant:
An assistant is anyone who is not an owner, employee or volunteer
at the clinic
The assistant transcribes the patient’s responses “verbatim”
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22. PROTOCOL
Create drop box, print copies of customized, anonymized survey &
introductory letter – place in envelope
Identify eligible clients and ask them to participate within 2 weeks of
discharge from amb rehab care
Hand patient survey to be completed in clinic, returned to envelope,
sealed and placed in dropbox
Caregiver may assist non-English-speakers, physical or mild
cognitive deficits – must not be a member of staff or volunteer
Sites batch and periodically mail completed surveys in sealed
envelopes to RCA
22
23. RISKS AND BENEFITS
There are no expected risks or benefits for study participants:
Participation in this study is completely voluntary and participants
can choose to withdraw from the study or refuse to answer any
questions at any time;
The care received by patients will not be affected by choosing to
participate in this study in any way.
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25. WHAT’S IN IT FORYOU?
Beta testing of newest patient experience tool - input
Rapid turn around of data at the end of the study
Descriptive individual data by clinic
Aggregated, anonymous comparator data from other study
sites – as long as they can not be indirectly identified
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26. UPDATES FOLLOWING OUR
JANUARY 20TH WEBINAR
Without impacting legibility we have fit the 10 scale questions
onto one page
Patients are prompted to turn the page for final questions
Gender: “other” option – “please specify” removed
If respondent indicates they completed the survey “with
assistance” they will be asked to state their relationship with the
patient
If patient is receiving care other than rehabilitative care through
your clinic, please administer the survey within two weeks of
their completion of the rehab treatment
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27. THANKYOU
Please contact Dr. Josephine McMurray jmcmurray@wlu.ca
with any questions or comments.
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