Listening to the “patient voice” can drive improvements in hospital care for patients undergoing heart surgery

Analysis of patient experience surveys in Alberta, Canada reported findings around areas that could be the subject of future patient-centered quality improvements, while also revealing areas that are highly rated by patients, reports the Canadian Journal of Cardiology


Philadelphia, August 22, 2019

Patient-reported experiences have potential for driving improvements in the quality of hospital care, according to a new study in the Canadian Journal of Cardiology, published by Elsevier. Investigators report on an analysis of the Canadian Patient Experience Survey responses obtained from cardiac patients in Alberta, which revealed areas that are highly rated by patients, but also reported findings around areas that could be the subject of future patient-centered quality improvements.

The term “patient-centered care” is gaining currency as it places the patient first, rather than reducing them to the sum of their symptoms or medical condition. Providing patients’ first-hand reports of their care is important to help reinforce or confirm areas in which care is working well (from the patient perspective), as well as to guide quality improvement experts to where impactful improvements can be made. Patient-centered care is often measured through surveys, specifically those that measure the patient experience. Despite the proliferation of such surveys, there is limited research in this area.

Using records from the Canadian Patient Experiences Survey – Inpatient Care (CPES-IC), investigators analyzed the experiences of over 1,000 patients in Alberta who underwent coronary artery bypass graft (CABG) and/or valve replacement from April 2014 to March 2018.

“To our knowledge, this is the first study of its kind in Canada – one that uses linkage of patient experience surveys with routinely-collected administrative data to examine the comprehensive hospital experience of a particular clinical group,” explained lead investigator Kyle A. Kemp, a PhD candidate working in the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. “Examining the comprehensive experience of patients who have undergone cardiac procedures such as CABG and valve replacement may provide tremendous value, given the labor-intensive and costly nature of these procedures.”

CPES-IC surveys are administered across 93 hospitals in Alberta using a standard script and responses to frequently asked questions. A random sample of 10 percent of eligible discharges is obtained from each hospital, resulting in approximately 25,000 completed surveys each year. Participants complete a 56-question telephone survey after being discharged from hospital. Questions assess many aspects of care, including communication with doctors and nurses, medications, patient/family involvement in care, pain control, the physical environment, coordination of care, and discharge planning.

The results were rated on a scale from 0 (worst) to 10 (best) and overall were quite positive. More than 73 percent of the 1,082 respondents rated their overall hospital care as a 9 or 10. Top performing questions pertained to discussing help needed after discharge (96.6 percent responding “yes”) and receiving written discharge information (93.2 percent responding “yes”). The responses also identified areas that could be targeted in quality improvement efforts. For example, less than 40 percent of respondents reported that the space around their room was always quiet at night, and only about 45 percent reported that hospital staff had always described the potential side effects of any new medications that patients were given.

“These findings are important because historically, many efforts to improve hospital care have been driven by administrators or clinicians – largely in absence of the ‘patient voice’,” commented Mr. Kemp. “Being the first Canadian study of its kind, there is an opportunity for it to serve as a baseline when examining future data from this survey, both in Alberta and from other Canadian provinces. The study methodology can be also replicated elsewhere in Canada and throughout the world to examine the experience of other clinical populations such as joint replacement patients, labor and delivery patients, and seniors living with chronic diseases.”

“The study by Kemp and colleagues is a step in the right direction and is in essence the first rung on the ladder towards meeting the much sought-after triple aim (better health, improved experiences of care, and lower costs for the system) of healthcare in Canada,” commented Michelle M. Graham, MD, and Colleen M. Norris, PhD, GNP, both from the University of Alberta and the Mazankowski Alberta Heart Institute, Edmonton, AB, Canada, in an accompanying editorial. “The investigators have in fact provided a methodology for building a Pan-Canadian patient-centered database required to drive improvement in various demographic, regional, and clinical cohorts in the Canadian health care system. Patients have been given a new way to speak; we just have to listen. Providing truly relevant, patient-centered care is dependent on it.”

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Notes for editors
The articles are “Patient-Reported Experiences With Coronary Artery Bypass Grafting and Valve Replacement,” by Kyle A. Kemp, MSc; Hude Quan, PhD; Merril L. Knudtson, MD, FRCSC; Elizabeth Oddone Paolucci, PhD; and Maria J. Santana, PhD, MPharm, MRPharmS (https://doi.org/10.1016/j.cjca.2019.05.008) and “Editorial: A New Way to Listen to Patients: Heeding Patient Reported Experiences to Improve Quality of Care,” by Michelle M. Graham, MD; and Colleen M. Norris, PhD, GNP (https://doi.org/10.1016/j.cjca.2019.05.026). They appear in the Canadian Journal of Cardiology published by Elsevier.

The study was funded by the Canadian Institutes of Health Research (CIHR).

Full text of the articles is available to credentialed journalists upon request. Contact Eileen Leahy at +1 732 238 3628 or cjcmedia@elsevier.com to obtain copies. Journalists wishing to speak to the authors of the study should contact Kelly Johnston, Senior Communications Specialist; Cumming School of Medicine, University of Calgary, at +1 403 220 5012 or kjohnston2@ucalgary.ca. To reach the editorial’s authors for comment contact Michelle M. Graham at mmg2@ualberta.ca.

About the Canadian Journal of Cardiology
The Canadian Journal of Cardiology is the official journal of the Canadian Cardiovascular Society. It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as a major venue for the results of Canadian cardiovascular research and Society guidelines. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, review articles, case reports, and papers on health outcomes, policy research, ethics, medical history, and political issues affecting practice. www.onlinecjc.ca

About the Editor-in-Chief
Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

Media contact
Eileen Leahy
Elsevier
+1 732 238 3628
cjcmedia@elsevier.com