Healthc (Amst) - Use of patient ethnography to support quality improvement in benign prostatic hyperplasia.

Tópicos

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Resumo

CKGROUND: Patient-centeredness is a primary aim of quality improvement (QI) but optimal strategies to achieve that goal remain elusive. Benign prostatic hyperplasia (BPH) is one of the commonest urologic diagnoses and significantly affects quality of life. Patient ethnography is an emerging qualitative method of observation and dynamic interviews to understand the context through which the patient experiences care. We implemented patient ethnography to support our QI infrastructure and improve patient-centeredness in BPH.PROBLEM: Little is known about how to measure whether processes of care are patient-centered. We did not know whether the care processes our patients experienced provided value from their perspective.GOALS: We sought to discover previously unrecognized components of care that patients perceived to be of low value. Our primary goal was to develop QI initiatives that targeted low-value themes identified in the ethnography. Our secondary goal was a rapid rollout of three targeted initiatives.STRATEGY: We used a 4-step patient ethnography: (1) created detailed process maps to define phases of care, (2) interviewed patients, (3) synthesized transcript data in focus groups using the Crawford Slip method, and (4) targeted undesirable components of care for QI. Semi-structured interviews with seven representative patients identified low-value themes. Focus groups, comprised of primary care physicians, case coordinators, nurses, and urologists, evaluated the interview transcripts and generated improvement opportunities prioritized based on feasibility, patient value, scalability, and innovation. We used affinity mapping and priority matrix techniques to prioritize QI opportunities.RESULTS: We identified five low-value themes from the patient interviews and developed corresponding QI opportunities. These included issues surrounding the referral and consultation process as well as postoperative care, especially home urinary catheter maintenance. Six months after completing the ethnography three of five targeted improvement opportunities had been implemented.

Resumo Limpo

ckground patientcentered primari aim qualiti improv qi optim strategi achiev goal remain elus benign prostat hyperplasia bph one commonest urolog diagnos signific affect qualiti life patient ethnographi emerg qualit method observ dynam interview understand context patient experi care implement patient ethnographi support qi infrastructur improv patientcentered bphproblem littl known measur whether process care patientcent know whether care process patient experienc provid valu perspectivego sought discov previous unrecogn compon care patient perceiv low valu primari goal develop qi initi target lowvalu theme identifi ethnographi secondari goal rapid rollout three target initiativesstrategi use step patient ethnographi creat detail process map defin phase care interview patient synthes transcript data focus group use crawford slip method target undesir compon care qi semistructur interview seven repres patient identifi lowvalu theme focus group compris primari care physician case coordin nurs urologist evalu interview transcript generat improv opportun priorit base feasibl patient valu scalabl innov use affin map prioriti matrix techniqu priorit qi opportunitiesresult identifi five lowvalu theme patient interview develop correspond qi opportun includ issu surround referr consult process well postop care especi home urinari cathet mainten six month complet ethnographi three five target improv opportun implement

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