Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1033 — Evaluation of Changes in Patient-Provider Communication in Evidence-Based Quality Improvement Sites Using a Non-randomized Stepped Wedge Design

Lead/Presenter: Alexis Huynh, COIN - Los Angeles
All Authors: Huynh AK (Veterans Health Administration) Lee ML (Veterans Health Administration) Rose DE (Veterans Health Administration) Stockdale SE (Veterans Health Administration) Wang MM (Veterans Health Administration) Rubenstein LV (Veterans Health Administration)

Objectives:
Patient-provider communication is a major determinant of overall patient experience with care. A variety of interventions can improve provider communication skills. Yet few have been tested as part of primary care quality improvement intervention (QII). We evaluate whether QII would accelerate improvement in patient-provider communication.

Methods:
We introduced evidence-based quality improvement (EBQI-PACT) at four different time points in 6 primary care practices in one region from 2010 to 2012, during early Veterans Health Administration (VHA) primary care transformation to Patient Aligned Care Teams (PACT). We compared EBQI-PACT sites to PACT only sites using a non-randomized stepped wedge model. In EBQI-PACT, we used local practice data feedback, including VHA Survey of Health Experiences of Patients (SHEP) patient survey data, to sites and engaged patient participants in QI. Frontline QI teams proposed and implemented diverse projects. Five practices implemented projects on patient-provider communication. We analyzed 5 years (July 2009 - March 2015) of monthly SHEP data on patients from 10 sites (6 EQBI-PACT, 4 PACT only; n = 34,193) on provider communication. Responses assessed whether the provider explained information; listened carefully; showed respect; and spent enough time ("always" or "usually" to "never"). We used 3-level repeated cross-sectional hierarchical linear model based on treatment status, quarterly time trend, and duration of EBQI-PACT participation with respondents clustered within time within sites adjusting for respondent and site characteristics.

Results:
Patient-provider communication improved over time for all sites. Respondents reported a 2.4% increase in the odds of improvement for providers always explaining things in an easy way to understand; a 2.3% increase for providers listening carefully; a 2.7% increase for providers showing respect; and a 2.1% increase for providers spending enough time. For each additional quarter that EBQI-PACT sites participated, these sites showed a 1.6% increase in the odds of improvement for listening carefully, showing respect, and spending time compared to PACT only.

Implications:
Patient-provider communication improved over time after the introduction of team-based care through PACT. EBQI-PACT accelerated communication improvement.

Impacts:
Engaging primary care practices in EBQI has the potential to improve patient-provider communication, either as a result of communication-related QI projects or as an indirect effect of improved QI culture.