Using qualitative methods for generating patient reported outcome measures and patient reported experience measures for pre-hospital care of stroke and heart attack

Togher, Fiona and Davy, Zowie and Siriwardena, A. Niroshan (2012) Using qualitative methods for generating patient reported outcome measures and patient reported experience measures for pre-hospital care of stroke and heart attack. In: SAPC 41st Annual Scientific Meeting, 3-4 October 2012, Scottish Exhibition and Conference Centre, Glasgow, UK. (Unpublished)

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Using qualitative methods for generating patient reported outcome measures and patient reported experience measures for pre-hospital care of stroke and heart attack
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Abstract

The problem: Current health policy emphasises patient experience, together with effectiveness and safety, as key components of quality of care. As a consequence, Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) are increasingly being seen as important, whether by providers, commissioners, regulators or service users themselves for assessing quality of care; by researchers for evaluating the outcomes of specific interventions; and also by clinicians for assessment and decision support.
Patients with suspected acute myocardial infarction (AMI) or stroke commonly present first to the ambulance service rather than general practice. Little is known about outcomes and experiences of pre-hospital care which are important for measuring the quality of services for patients with AMI or stroke.
There are few validated PROMs in use within prehospital care including for conditions such as AMI or stroke
The approach: Guidance around the development of PROMs suggests that items for inclusion within the questionnaires can be generated from stakeholders including service users. We decided to utilise a qualitative research design to explore the experiences of patients and ambulance service clinicians for emergency care of stroke or heart attack in the pre-hospital setting.
Thirty four semi-structured interviews (22 with patients, 12 with clinicians) and one focus group (5 clinicians) were conducted using a predetermined interview schedule designed to elicit participants’ views on clinical outcome and patient experience elements of prehospital care.
Data were analysed using a thematic network approach supported by Nvivo 8 software. A coding frame was initially developed based on the questions included within the interview schedule. This was then modified following thorough immersion in the text to produce the final themes. The thematic networks were discussed and refined by all three authors. The analyses of clinician and patient data were untaken together as one data set to facilitate the comparison, connections and disjuncture of experiences.
Findings: Patients, regardless of their medical condition, often considered the same factors as essential to a good pre-hospital experience. They focused on both personal and technical skills of the clinician emphasising effective communication and the clinician-patient relationship. The most important themes that emerged from the patient perspective were; communication, holistic care and professionalism. The remaining themes of treatment of condition and transitions were more regularly discussed by clinicians.
Consequences: Within the evaluation and improvement of health care services the development of PROMs and PREMs will continue to be important and the methods used in this study within the context of prehospital care may be transferrable to other health care settings such as primary and acute care. Utilising a qualitative research design enabled us to obtain a more informed understanding of the outcomes and experiences that patients attach greatest importance to as well as understanding how these corresponded with the views of clinicians.

Item Type:Conference or Workshop Item (Presentation)
Additional Information:The problem: Current health policy emphasises patient experience, together with effectiveness and safety, as key components of quality of care. As a consequence, Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) are increasingly being seen as important, whether by providers, commissioners, regulators or service users themselves for assessing quality of care; by researchers for evaluating the outcomes of specific interventions; and also by clinicians for assessment and decision support. Patients with suspected acute myocardial infarction (AMI) or stroke commonly present first to the ambulance service rather than general practice. Little is known about outcomes and experiences of pre-hospital care which are important for measuring the quality of services for patients with AMI or stroke. There are few validated PROMs in use within prehospital care including for conditions such as AMI or stroke The approach: Guidance around the development of PROMs suggests that items for inclusion within the questionnaires can be generated from stakeholders including service users. We decided to utilise a qualitative research design to explore the experiences of patients and ambulance service clinicians for emergency care of stroke or heart attack in the pre-hospital setting. Thirty four semi-structured interviews (22 with patients, 12 with clinicians) and one focus group (5 clinicians) were conducted using a predetermined interview schedule designed to elicit participants’ views on clinical outcome and patient experience elements of prehospital care. Data were analysed using a thematic network approach supported by Nvivo 8 software. A coding frame was initially developed based on the questions included within the interview schedule. This was then modified following thorough immersion in the text to produce the final themes. The thematic networks were discussed and refined by all three authors. The analyses of clinician and patient data were untaken together as one data set to facilitate the comparison, connections and disjuncture of experiences. Findings: Patients, regardless of their medical condition, often considered the same factors as essential to a good pre-hospital experience. They focused on both personal and technical skills of the clinician emphasising effective communication and the clinician-patient relationship. The most important themes that emerged from the patient perspective were; communication, holistic care and professionalism. The remaining themes of treatment of condition and transitions were more regularly discussed by clinicians. Consequences: Within the evaluation and improvement of health care services the development of PROMs and PREMs will continue to be important and the methods used in this study within the context of prehospital care may be transferrable to other health care settings such as primary and acute care. Utilising a qualitative research design enabled us to obtain a more informed understanding of the outcomes and experiences that patients attach greatest importance to as well as understanding how these corresponded with the views of clinicians.
Keywords:patient reported outcome measures, patient reported experience measures, Emergency Medical Services, prehospital care, ambulance services, qualitative research, patient views, practitioners views
Subjects:B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
B Subjects allied to Medicine > B780 Paramedical Nursing
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Social Science > School of Health & Social Care
ID Code:6572
Deposited By: Niro Siriwardena
Deposited On:13 Oct 2012 12:13
Last Modified:13 Mar 2013 09:16

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