Gianna Melillo

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Results of a longitudinal survey study offer new insights on how patient-reported data could be collected and used in hospital quality improvement. 

, also open the debate about the use of real-time focused data when capturing vulnerable 

“Patient-reported data (satisfaction, preferences, outcomes and experience) have been increasingly studied with the aim of providing excellent patient-centered care,” researchers wrote. “In particular, the collection of patient experience data is emerging as an increasingly key component in assessing the quality of delivered health services.”

Patient experience data collected throughout different points in a patient’s stay at a hospital (i.e. patient journey) could help discern whether there are discontinuities within units and between different units. In the absence of a complete view of the whole process, inter- and cross-organizational gaps like obstructed data flow and lack of service synchronization can occur, authors explained.

In order to explore which data collected from patients could be useful in improving the patient journey and to analyze whether gathering timely patient experience data can capture areas for improvement, patients in the orthopedics department at a 250-bed Italian university hospital participated in a longitudinal survey study.

As the unit of analysis was the patient’s journey from first outpatient visit to hospital discharge, all individuals who underwent major or minor orthopedic surgery between January and February 2019 were considered for inclusion. Participants received two different questionnaires assessing patient-reported outcomes, patient-reported experience, patient-reported satisfaction, and patient-reported preferences at two different stages of the hospital patient journey: at the time of admission before surgery and at discharge.

A total of 254 participants completed the pencil and paper questionnaires, and more than 80% were older than 50 years. Knee replacement and hip replacement were the most common major surgical operations completed.

Overall, analyses of the patient-reported data showed “greater or less negative satisfaction may not reveal pathology-related needs, but patient experience data can detect important areas of improvement along the hospital journey,” authors wrote.

“As clinical conditions and the context of care change rapidly within a single hospital stay for surgery, collecting data at two different moments of the patient journey enables researchers to capture areas of potential improvement in the patient journey that are linked to the context, clinical conditions and emotions experienced by the patient,” they added.

Results revealed the five most important aspects for a good hospital journal experience, including:

Receive the best treatment for the related health conditions

Have clear instructions on how to prepare for surgery (therapy, fasting, surgery aids)

Have clear instructions on how to check in at the hospital

Have clear indications on the treatment pathway I will also have to take

Receive explanations from staff in case of waiting

In comparison, the least important aspects included:

Have explanations and understand everything that happens to me

Be involved in all decisions concerning my care

Feel comfortable in the environments where I have to be

Wait as little time as possible for a visit or for assistance

Have a room where I am not disturbed and with hotel services (TV, landline, etc.)

“By timely and simultaneously gathering preferences, satisfaction, outcomes and experience data, it is possible to have a complete picture of the hospital patient journey,” researchers wrote. Furthermore, results show how “at the beginning of the journey, patients might consider an issue as not critical, but while living the hospital experience, it becomes important.”

Authors concluded results emphasize that personalized medicine should not only refer to targeted therapy but requires management teams to be able to customize the patient’s journey and identify different patient profiles.

As the study was conducted at a single center, results cannot be generalized, marking a limitation to the study. Because the orthopedic surgical journey is relatively shorted compared with the oncological one, for example, this aspect could have influenced the results and methodology should be tested on difference clinical pathways. Futures studies should also explore the impact of the patient-health care staff relationship in the hospital journey experience.

Articles

Responses collected from longitudinal surveys show how patient-reported data can help improve hospital quality. 

Real-Time Patient-Reported Data Help Assess Hospital Quality 

, researchers outlined both the benefits and potential risks and harms of inpatient units for children. Although there will always be a need for some inpatient beds, for many children and young people intensive community interventions may yield better outcomes, be more cost-effective, and improve 

According to authors, children may require inpatient care for one of three reasons. These patients may present with high risk due to mental health difficulties and cannot be managed safely at home or in social care placement, or these patients require an intervention not available elsewhere. “Rarely, a third reason can be the requirement for an intensive assessment involving 24-hr observation by a specialist team, when a community assessment is not possible,” researchers noted.

However, these criteria may be subject to interpretation and not be consistently utilized across the board, leaving open the question as to whether young people who meet these criteria could be better served through an intensive community-based intervention. Hospital admission among this cohort is often chosen because it is the only option in the absence of sufficiently resourced community services, authors explained, as opposed to the best option.

Overall, research indicates inpatient admission is effective, but comes at the cost for some and holds the potential to cause harm, including:

Separation from family and friends, with a risk of dependence and ‘institutionalization’

Adverse influences from peers, including risk of increased self-harm

Exposure to an environment with high levels of disturbance causing distress and com- pounding difficulties

Families and young people feeling disconnected, deskilled and disempowered

Inpatient treatments are expensive using resources which might be better deployed to intensive community interventions

Children and young people are over five times more likely to be physically restrained than their adult counterparts in the same trust

“There is a range of functions that community services need to provide in order to offer a comprehensive alternative to admission, and/or reduce lengths of stay” which can be provided together or separately, researchers wrote.

Functions include crisis assessment and management for those in acute crisis, intensive outreach services that are designed to encourage early discharge and reduce length of stay or transition to other services, and planned home treatment services for those who need long-term treatment. Specialist treatment services for young people with eating disorders or severe self-harm will also be beneficial when patients’ needs exceed the capacity of regular community services. According to authors, these solutions could be delivered in the patient’s home, a clinic or day hospital.

“Randomized controlled trials when alternatives to admission are compared with admission, evidence of reduced admission rates in localities that have access to high-quality alternatives to admission and data mapping service provision around the country [England] provide further evidence to support the case for developing comprehensive alternatives to admission,” authors said.

Previous research has revealed well-designed community services can reduce admission rates, lengths of stay, result in fewer harms, cost less to provide, and improve patient experience overall.

However, researchers caution against immediate reduction of inpatient beds before suitable alternatives are available. Using England as an example, they note the way National health Service (NHS) funds are distributed for young people’s mental health services has hindered progress in this area. “Highly specialized services such as inpatient care currently have a separate funding stream from regular community services,” they said. “In many places, this has resulted in a funding gap for services that should sit between regular community services and inpatient care.”

Temporarily increasing funding to admission alternatives may provide a simple solution to this roadblock, as once services are established, money will be recouped by reducing beds. Vision and commitment are needed by those in control of funding for a significant acceleration in this progress to take place, researchers concluded.

Researchers weight the benefits and risks of inpatient units for children and young patients. 

Researchers Propose an Alternative to Inpatient Units for Children

 show researchers validated two five-item tools that can be used to measure 

 of physician and nurse compassion in inpatient settings and can be used in conjunction with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

“In health care, empathy is a feeling the clinician has, as opposed to compassion, which encompasses positive behaviors which patients can perceive,” authors explained. Clinician compassion is considered a vital element of high-quality care.

Defined as “the emotional response to another’s pain or suffering involving an authentic desire to help,” not only has research shown compassion is associated with better clinical outcomes across conditions, but it may have a financial impact on organizations. A lack of compassion has been linked with increased resource utilization and health care spending.

As evidence points to a suboptimal level of compassion in health care worldwide, researchers set out to psychometrically validate the five-item compassion measure when administered with the HCAHPS survey for inpatient hospital care. The current study also assessed if the compassion measure is valid and reliable when it comes to quantifying physician and nurse compassion for hospitalized patients.

A total of 91 community hospitals within 16 states participated in the study which took place between July 1 and July 31, 2020. All participants were aged 18 or older, had at least one overnight stay in a hospital as an inpatient, and completed the HCAHPS survey. “Each of the five items of the original measurement tool were modified to specifically elicit separate responses for interactions with physicians and nurses,” researchers said.

Of the 24,600 HCAHPS surveys delivered, a total of 4,756 patient responses were assessed. Analyses revealed:

Confirmatory factor analysis found all five items loaded well on separate single constructs for both the physician and the nurse measures.

Both models had a good fit to the observed data.

Internal reliability was excellent for both the physician and nursing five-item compassion measures (Cronbach’s alpha = 0.96 and 0.95, respectively).

The physician five-item compassion measure had only a moderate correlation with the nurse five-item compassion measure (i.e., while they trend in the same direction, they are discrete and not redundant) (r = 0.68, 

Both measures demonstrated good convergent validity.

“Mediation testing found that while there were important associations between compassion, communication, and overall hospital rating, the physician and nurse five-item compassion measures allow for specific assessments of compassion, which are distinct from, and add additional information to, the HCAHPS questions,” researchers explained.

The two compassion measures are novel in that they are completed by patients as opposed to third parties or self-assessments, they are brief, and allow for distinct assessments as opposed to an overall measure of clinician compassion.

According to authors, being compassionate can be taught and a validated measurement tool can allow for rigorous testing of interventions aimed at increasing this trait among clinicians.

Future research is needed to better understand the relationship between compassion and communication among patients and clinicians. In addition, future studies should also “examine the impact of patient-clinician concordance/discordance in gender, race, and age on patient perception of compassionate care, as well as to validate the five-item compassion measure in other languages,” authors said.

Low response rates and a majority non-Hispanic white study population mark limitations.

Researches have validated a five-item assessment tool that can be used to measure clinicians' compassion. 

Patient Assessment Tool Helps Measure Physician, Nurse Compassion in Hospitals 

Microsoft will acquire Nuance Communications, Inc. in an effort to deliver new cloud and artificial intelligence (AI) capabilities across the healthcare industry. The all-cash transaction—which took place on April 9—is valued at about 

 and $19.7 billion with debt. The deal is expected to close this calendar year and comes after the two companies announced a partnership in 

Mark Benjamin will remain CEO of the cloud and AI software company and will report to Scott Guthrie, executive vice president of Cloud and AI at Microsoft. The decision comes after the introduction of 

, announced in 2020, which set out to manage health data at scale to help organizations improve patient experience, coordinate care, and drive efficiency.

"Nuance provides the AI layer at the health care point of delivery and is a pioneer in the real-world application of enterprise AI," 

“AI is technology's most important priority, and healthcare is its most urgent application. Together, with our partner ecosystem, we will put advanced AI solutions into the hands of professionals everywhere to drive better decision-making and create more meaningful connections, as we accelerate growth of Microsoft Cloud for Healthcare and Nuance."

The company provides conversational AI and cloud-based ambient clinical intelligence for providers with products including the Dragon Ambient eXperience and Dragon Medical One and PowerScribe One for radiology reporting. These solutions work with core health care systems, including electronic health records, to help ease clinical documentation. Currently they are used by over half of the nation’s physicians and 75% radiologists, in addition to 77% of U.S. hospitals. Nuance also provides solutions across interactive voice response, virtual assistants and digital and biometric solutions.

The company’s health care cloud revenue saw a 37% year-over-year growth in its 2020 fiscal year, which ended in September 2020. The acquisition marks a doubling of Microsoft’s total addressable market in the health care provider space, raising it to nearly $500 billion.

"Over the past three years, Nuance has streamlined its portfolio to focus on the health care and enterprise AI segments, where there has been accelerated demand for advanced conversational AI and ambient solutions," Benjamin said.

"To seize this opportunity, we need the right platform to bring focus and global scale to our customers and partners to enable more personal, affordable and effective connections to people and care. The path forward is clearly with Microsoft—who brings intelligent cloud-based services at scale and who shares our passion for the ways technology can make a difference. At the same time, this combination offers a critical opportunity to deliver meaningful and certain value to our shareholders who have driven and supported us on this journey."

Microsoft will acquire Nuance Communications, Inc. for around $16 billion. 

Gianna Melillo

Articles

Real-Time Patient-Reported Data Help Assess Hospital Quality

Researchers Propose an Alternative to Inpatient Units for Children

Patient Assessment Tool Helps Measure Physician, Nurse Compassion in Hospitals

Microsoft Acquires Voice Recognition Company Nuance Communications