Shaller Consulting Group, Stillwater, Minnesota, USA.
Health Care Management Department, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Health Serv Res. 2024 Apr;59(2):e14245. doi: 10.1111/1475-6773.14245. Epub 2023 Oct 16.
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.
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.
We conducted a cluster quasi-experimental study, comparing 12 intervention and 10 control sites. At control sites, narratives were delivered free-form to site administrators via email; at intervention sites, narratives were delivered online with interactive tools for interpretation, accompanied by user training. We assessed control-versus-intervention site differences in learning, behavior, and patient experience scores.
Staff surveys and interviews were completed at intervention and control sites, 9 months after intervention launch. Patient surveys were collected beginning 4 months pre-launch through 9 months post-launch. We used control-versus-intervention and difference-in-difference analyses for survey data and thematic analysis for interview data.
Interviews suggested that the interface facilitated narrative interpretation and use for improvement. Staff survey analyses indicated enhanced learning from narratives at intervention sites (29% over control sites' mean of 3.19 out of 5 across eight domains, p < 0.001) and greater behavior change at staff and practice levels (31% and 21% over control sites' means of 3.35 and 3.39, p < 0.001, respectively). Patient experience scores for interactions with office staff and wait time information increased significantly at intervention sites, compared to control sites (3.7% and 8.2%, respectively); however, provider listening scores declined 3.3%.
Patient narratives presented through structured feedback reporting methods can catalyze positive changes in staff learning, promote behavior change, and increase patient experience scores in domains of non-clinical interaction.
评估旨在促进解读患者叙事反馈的在线互动报告是否会改变门诊员工的学习、个人员工和实践层面的行为，以及患者体验调查评分。
我们使用三种主要数据源研究了学术医疗中心内的 22 个门诊实践场所：333 名员工调查；20 次与实践负责人和员工的深入访谈；以及 9551 份经修改的 CG-CAHPS 患者体验调查，其中增加了开放式叙事引出问题。
我们进行了一项群组准实验研究，比较了 12 个干预组和 10 个对照组。在对照组中，叙事通过电子邮件以自由格式传递给现场管理员；在干预组中，叙事在线提供，带有用于解释的互动工具，并提供用户培训。我们评估了学习、行为和患者体验评分的控制与干预组之间的差异。
员工调查和访谈在干预和对照组进行，在干预启动后 9 个月完成。患者调查从启动前 4 个月开始收集，直到启动后 9 个月结束。我们使用控制与干预以及差异分析对调查数据进行分析，对访谈数据进行主题分析。
访谈表明，该界面促进了叙事的解释和利用，以实现改进。员工调查分析表明，干预组的叙事学习能力得到了提高（干预组的平均得分为 8 个领域中的 3.19 分，比对照组的平均得分为 3.19 分高出 29%，p<0.001），员工和实践层面的行为变化更大（干预组的平均得分为 3.35 分和 3.39 分，比对照组的平均得分为 3.35 分高出 31%和 21%，p<0.001）。与对照组相比，干预组的门诊工作人员互动和等待时间信息的患者体验评分显著增加（分别为 3.7%和 8.2%）；然而，医生倾听评分下降了 3.3%。
通过结构化反馈报告方法呈现的患者叙事可以促进员工学习的积极变化，促进行为变化，并在非临床互动领域提高患者体验评分。
