Providing Veteran-centered care is a high priority for the VHA and efforts are underway to improve Veterans' experience through the development of personalized, proactive, and patient-driven care. In addition, VA increasingly is focused on providing measurement based care. It is therefore important to be able to systematically measure experiences of care to assess the extent to which current approaches to healthcare delivery are Veteran-centered. The VA currently asks Veterans how satisfied they are with their access to care at the time of their appointment. This project will extend point-of-care assessment to understand a critical aspect of Veterans' experience - provider communication.
The objective is to examine the impact of audit-feedback using a brief measure of patient-centered communication, the CollaboRATE, at the point-of care in VA primary care settings.
Aims: 1) Assess the feasibility of collecting a brief survey of patient experience of communication with providers at the point-of-care in primary care settings; 2) Describe the variability in collaboRATE scores and proportion of top-scoring patients across providers and clinics; and 3) Assess clinician, clinic leadership, and hospital leadership perspectives on the acceptability and integration of this feedback for guiding patient-centered care quality improvement.
Patients were invited to fill out a brief survey immediately following their primary care appointment. We calculated response rate to the survey; examined the distribution of scores, and the proportion of top-scoring patients by provider and by clinic; and examined the association between communication scores and satisfaction with care and self-reported health status. We presented feedback to providers and leaders, including average overall scores benchmarked against other providers and overall score at the clinic level. We conducted qualitative interviews with providers, clinic leaders, and medical center leaders to understand how they view the value, validity, and practicality of this feedback for improving patient-centered care.
Across the full sample, the average rating for 'needs met' was 4.70/5 and for satisfaction was 5.76/6. Compared to those who did not give 'top scores', patients who gave 'top scores' to their clinician for patient-centered communication (CollaboRATE) were 10.8 times more likely to report their needs had been 'completely' met (p<.001) and 13.3 times more likely to report they were 'very satisfied' with their care (p<.001). The proportion of patients giving CollaboRATE 'top scores' ranged from 41%-92% for the 16 clinicians who had at least 25 completed surveys (N=464 patients). Interviewees found clinician-specific feedback useful; concerns included the challenge of prioritizing this data when other measures are already in use for evaluation of clinicians' performance. Interviewees also cited challenges beyond their control, such as those imposed by exam room layout or by clinic policies that permit frequent phone interruption. Clinicians requested additional information to inform improvements. Recommendations for follow-up interventions included peer-to-peer education and mentoring by top-scoring clinicians.
Making feedback on patient perceptions of communication available to providers and leadership in real-time may offer an opportunity to conduct quality improvement to improve communication. This is critical to reaching the VA goal of providing personalized, proactive, patient-driven care to all Veterans. The findings will be useful to our operational partners as they seek to measure patient-centered care. It will set the foundation for future studies of the impact of interventions to improve patient-centered care in VHA.
External Links for this Project
Grant Number: I21HX002412-01A1
- Dryden EM, Hyde JK, Wormwood JB, Wu J, Calloway R, Cutrona SL, Elwyn G, Fix GM, Orner MB, Shimada SL, Bokhour BG. Assessing Patients' Perceptions of Clinician Communication: Acceptability of Brief Point-of-Care Surveys in Primary Care. Journal of general internal medicine. 2020 Oct 1; 35(10):2990-2999. [view]