J. Med. Internet Res. - Consumer participation in quality improvements for chronic disease care: development and evaluation of an interactive patient-centered survey to identify preferred service initiatives.

Tópicos

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Resumo

CKGROUND: With increasing attention given to the quality of chronic disease care, a measurement approach that empowers consumers to participate in improving quality of care and enables health services to systematically introduce patient-centered initiatives is needed. A Web-based survey with complex adaptive questioning and interactive survey items would allow consumers to easily identify and prioritize detailed service initiatives.OBJECTIVE: The aim was to develop and test a Web-based survey capable of identifying and prioritizing patient-centered initiatives in chronic disease outpatient services. Testing included (1) test-retest reliability, (2) patient-perceived acceptability of the survey content and delivery mode, and (3) average completion time, completion rates, and Flesch-Kincaid reading score.METHODS: In Phase I, the Web-based Consumer Preferences Survey was developed based on a structured literature review and iterative feedback from expert groups of service providers and consumers. The touchscreen survey contained 23 general initiatives, 110 specific initiatives available through adaptive questioning, and a relative prioritization exercise. In Phase II, a pilot study was conducted within 4 outpatient clinics to evaluate the reliability properties, patient-perceived acceptability, and feasibility of the survey. Eligible participants were approached to complete the survey while waiting for an appointment or receiving intravenous therapy. The age and gender of nonconsenters was estimated to ascertain consent bias. Participants with a subsequent appointment within 14 days were asked to complete the survey for a second time.RESULTS: A total of 741 of 1042 individuals consented to participate (71.11% consent), 529 of 741 completed all survey content (78.9% completion), and 39 of 68 completed the test-retest component. Substantial or moderate reliability (Cohen's kappa>0.4) was reported for 16 of 20 general initiatives with observed percentage agreement ranging from 82.1%-100.0%. The majority of participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again.CONCLUSIONS: The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care.

Resumo Limpo

ckground increas attent given qualiti chronic diseas care measur approach empow consum particip improv qualiti care enabl health servic systemat introduc patientcent initi need webbas survey complex adapt question interact survey item allow consum easili identifi priorit detail servic initiativesobject aim develop test webbas survey capabl identifi priorit patientcent initi chronic diseas outpati servic test includ testretest reliabl patientperceiv accept survey content deliveri mode averag complet time complet rate fleschkincaid read scoremethod phase webbas consum prefer survey develop base structur literatur review iter feedback expert group servic provid consum touchscreen survey contain general initi specif initi avail adapt question relat priorit exercis phase ii pilot studi conduct within outpati clinic evalu reliabl properti patientperceiv accept feasibl survey elig particip approach complet survey wait appoint receiv intraven therapi age gender nonconsent estim ascertain consent bias particip subsequ appoint within day ask complet survey second timeresult total individu consent particip consent complet survey content complet complet testretest compon substanti moder reliabl cohen kappa report general initi observ percentag agreement rang major particip indic webbas survey easi complet comprehens particip also report interact relat priorit exercis easi complet help decid initi import averag complet time minut sd fleschkincaid read level overal particip indic willing complet similar survey againconclus webbas consum prefer survey suffici reliabl high accept patient base complet time read level tool integr routin clinic practic allow consum easili particip qualiti evalu result provid comprehens list patientpriorit initi patient major chronic condit deliv practicereadi evid guid improv patientcent care

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