"Nothing Is More Powerful than Words:" How Patient Experience Narratives Enable Improvement.

Background And Objectives: Patient experience narratives (narratives) are an increasingly important element of both measurement approaches and improvement efforts in healthcare. Prior studies show that narratives are considered by both clinicians and staff to be an appealing, meaningful, and credible form of evidence on performance. They also suggest that making concrete use of narratives within organizational settings to improve care can be complex and challenging.

Leveraging Patients' Creative Ideas for Innovation in Health Care.

Unlabelled: Policy Points Patients' creative ideas may inform learning and innovation that improve patient-centered care. Routinely collected patient experience surveys provide an opportunity to invite patients to share their creative ideas for improvement. We develop and assess a methodological strategy that validates question wording designed to elicit creative ideas from patients.

Learning from patients: The impact of using patients' narratives on patient experience scores.

Background: Enthusiasm has grown about using patients' narratives-stories about care experiences in patients' own words-to advance organizations' learning about the care that they deliver and how to improve it, but studies confirming association have not been published.

Purpose: We assessed whether primary care clinics that frequently share patients' narratives with their staff have higher patient experience survey scores.

Approach: We conducted a 1-year study of 5,545 adult patients and 276 staff affiliated with nine clinics in one health system.

Assessing an innovative method to promote learning from patient narratives: Findings from a field experiment in ambulatory care.

Objective: To assess whether an online interactive report designed to facilitate interpretation of patients' narrative feedback produces change in ambulatory staff learning, behavior at the individual staff and practice level, and patient experience survey scores.

Data Sources And Setting: We studied 22 ambulatory practice sites within an academic medical center using three primary data sources: 333 staff surveys; 20 in-depth interviews with practice leaders and staff; and 9551 modified CG-CAHPS patient experience surveys augmented by open-ended narrative elicitation questions.

Study Design: We conducted a cluster quasi-experimental study, comparing 12 intervention and 10 control sites.

Summary of the 2020 AHRQ research meeting on 'advancing methods of implementing and evaluating patient experience improvement using consumer assessment of healthcare providers and systems (CAHPS®) surveys'.

Background: The Agency for Healthcare Research and Quality held a research meeting on using Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data for quality improvement (QI) and evaluating such efforts.

Topics Covered.: Meeting addressed: 1)What has been learned about organizational factors/environment needed to improve patient experience? 2)How have organizations used data to improve patient experience? 3)What can evaluations using CAHPS data teach us about implementing successful programs to improve patient experience?

Key Themes: Providers and stakeholders need to be engaged early and often, standardize QI processes, complement CAHPS data with other data, and compile dashboards of CAHPS scores to identify and track improvement.

What Words Convey: The Potential for Patient Narratives to Inform Quality Improvement.

Unlabelled: Policy Points Narratives about patients' experiences with outpatient care are essential for quality improvement because they convey ample actionable information that both elaborates on existing domains within patient experience surveys and describes multiple additional domains that are important to patients. The content of narrative feedback from patients can potentially be translated to improved quality in multiple ways: clinicians can learn from their own patients, groups of clinicians can learn from the experience of their peers' patients, and health system administrators can identify and respond to patterns in patients' accounts that reflect systemic challenges to quality. Consistent investment by payers and providers is required to ensure that patient narratives are rigorously collected, analyzed fully, and effectively used for quality improvement.

Americans' Growing Exposure To Clinician Quality Information: Insights And Implications.

For two decades, various initiatives have encouraged Americans to consider quality when choosing clinicians, both to enhance informed choice and to reduce disparities in access to high-quality providers. The literature portrays these efforts as largely ineffective. But this depiction overlooks two factors: the dramatic expansion since 2010 in the availability of patients' narratives about care and the growth of information seeking among consumers.

Improving Patients' Choice of Clinician by Including Roll-up Measures in Public Healthcare Quality Reports: an Online Experiment.

Background: Public reports on healthcare quality typically include complex data. To lower the cognitive burden of interpreting these data, some report designers create summary, or roll-up, measures combining multiple indicators of quality into one score. Little is known about how the availability of roll-ups affects clinician choice.

A Rigorous Approach to Large-Scale Elicitation and Analysis of Patient Narratives.

Patient narratives have emerged as promising vehicles for making health care more responsive by helping clinicians to better understand their patients' expectations, perceptions, or concerns and encouraging consumers to engage with information about quality. A growing number of websites incorporate patients' comments. But existing comments have fragmentary content, fail to represent less vocal patients, and can be manipulated to "manage" providers' reputations.

Choosing Doctors Wisely: Can Assisted Choice Enhance Patients' Selection of Clinicians?

We conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants ( = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator. Introducing patient comments enhanced engagement with the quality information but led to a decline in decision quality, particularly the consistency of choices with consumers' stated preferences. Labeling comments helped erase the decline in decision quality, although the highest percentage of preference-congruent choices was seen in the navigator arm.

Using "roll-up" measures in healthcare quality reports: perspectives of report sponsors and national alliances.

Objectives: To understand the views of prominent organizations in the field of healthcare quality on the topic of reporting roll-up measures that combine indicators of multiple, often disparate, dimensions of care to consumers.

Study Design: This study used a semi-structured, qualitative interview design.

Methods: We conducted 30- to 60-minute semi-structured telephone interviews with representatives of 10 organizations that sponsor public healthcare quality reports and 3 national alliances representing multiple stakeholder groups.

CAHPS and Comments: How Closed-Ended Survey Questions and Narrative Accounts Interact in the Assessment of Patient Experience.

Objectives: To investigate whether content from patient narratives explains variation in patients' primary care provider (PCP) ratings beyond information from the closed-ended questions of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey and whether the relative placement of closed- and open-ended survey questions affects either the content of narratives or the CAHPS composite scores.

Methods: Members of a standing Internet panel (N = 332) were randomly assigned to complete a CAHPS survey that was either preceded or followed by a set of open-ended questions about how well their PCP meets their expectations and how they relate to their PCP.

Results: Narrative content from healthier patients explained only an additional 2% beyond the variation in provider ratings explained by CAHPS composite measures.

Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives.

Objective: To design a methodology for rigorously eliciting narratives about patients' experiences with clinical care that is potentially useful for public reporting and quality improvement.

Data Sources/study Setting: Two rounds of experimental data (N = 48 each) collected in 2013-2014, using a nationally representative Internet panel.

Study Design: Our study (1) articulates and operationalizes criteria for assessing narrative elicitation protocols; (2) establishes a "gold standard" for assessment of such protocols; and (3) creates and tests a protocol for narratives about outpatient treatment experiences.

Using Patient-Reported Information to Improve Clinical Practice.

Objective: To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives.

Data Sources/study Setting: Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries.

Study Design/data Collection: We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians.

How Patient Comments Affect Consumers' Use of Physician Performance Measures.

Background: Patients' comments about doctors are increasingly available on the internet. The effects of these anecdotal accounts on consumers' engagement with reports on doctor quality, use of more statistically reliable performance measures, and ability to choose doctors wisely are unknown.

Objective: To examine the effects of providing patient comments along with standardized performance information in a web-based public report.

Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior.

Health care consumers often make choices that are imperfectly informed and inconsistent with their expressed preferences. Past research suggests that these shortcomings become more pronounced as choices become more complex, through either additional options or more performance metrics. But it is unclear why this is true: Consumer choice remains a "black box" that research has scarcely illuminated.

Context-based strategies for engaging consumers with public reports about health care providers.

Efforts to engage consumers in the use of public reports on health care provider performance have met with limited success. Fostering greater engagement will require new approaches that provide consumers with relevant content at the time and in the context they need to make a decision of consequence. To this end, we identify three key factors influencing consumer engagement and show how they manifest in different ways and combinations for four particular choice contexts that appear to offer realistic opportunities for engagement.

Improving organizational climate for quality and quality of care: does membership in a collaborative help?

Background: The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown.

Consumer response to patient experience measures in complex information environments.

Background: As indicators of clinician quality proliferate, public reports increasingly include multiple metrics. This approach provides more complete performance information than did earlier reports but may challenge consumers' ability to understand and use complicated reports.

Objectives: To assess the effects of report complexity on consumers' understanding and use of patient experience measures derived from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.

A randomized trial comparing mail versus in-office distribution of the CAHPS Clinician and Group Survey.

Objective: To assess the effect of survey distribution protocol (mail versus handout) on data quality and measurement of patient care experiences.

Data Sources/study Setting: Multisite randomized trial of survey distribution protocols. Analytic sample included 2,477 patients of 15 clinicians at three practice sites in New York State.

Analysis & commentary. Measuring patient experience as a strategy for improving primary care.

Patients value the interpersonal aspects of their health care experiences. However, faced with multiple resource demands, primary care practices may question the value of collecting and acting upon survey data that measure patients' experiences of care. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) suite of surveys and quality improvement tools supports the systematic collection of data on patient experience.

From patient education to patient engagement: implications for the field of patient education.

Objective: Advances in health care require that individuals participate knowledgeably and actively in their health care to realize its full benefit. Implications of these changes for the behavior of individuals and for the practice of patient education are described.

Methods: An "engagement behavior framework" (EBF) was compiled from literature reviews and key informant interviews.

Evaluating the use of a modified CAHPS survey to support improvements in patient-centred care: lessons from a quality improvement collaborative.

Objectives: To evaluate the use of a modified Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to support quality improvement in a collaborative focused on patient-centred care, assess subsequent changes in patient experiences, and identify factors that promoted or impeded data use.

Background: Healthcare systems are increasingly using surveys to assess patients' experiences of care but little is established about how to use these data in quality improvement.

Design: Process evaluation of a quality improvement collaborative.