Evaluation of a protocol for eliciting narrative accounts of pediatric inpatient experiences of care

Abstract

Objective To evaluate the measurement properties of a set of six items designed to elicit narrative accounts of pediatric inpatient experience. Data Sources Data came from 163 participants recruited from a probability‐based online panel of U.S. adults. Participants were family members of a child who had an overnight hospital stay in the past 12 months. Study Design Cross‐sectional survey with follow‐up phone interviews. Data Collection/Extraction Methods Participants completed an online (n = 129) or phone (n = 34) survey about their child's hospitalization experience. The survey contained closed‐ended items from the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey, followed by the six narrative items. Approximately 2 weeks after completing the survey, 47 participants additionally completed a one‐hour, semi‐structured phone interview, the results of which served as a “gold standard” for evaluating the fidelity of narrative responses. Qualitative content analysis was used to code narrative and interview responses for domains of patient experience and actionability. Principal Findings The average narrative was 248 words (SD = 319). Seventy‐nine percent of narratives mentioned a topic included in the Child HCAHPS survey; 89% mentioned a topic not covered by that survey; and 75% included at least one detailed description of an actionable event. Overall, there was 66% correspondence between narrative and interview responses. Correspondence was higher on the phone than in the online condition (75% vs. 59%). Conclusions Narratives elicited from rigorously designed multi‐item sets can provide detailed, substantive information about pediatric inpatient experiences that hospitals could use to improve child and family experiences during pediatric hospitalization. They add context to closed‐ended survey item responses and provide information about experiences of care important to children and families that are not included in quantitative surveys.

“Nothing Is More Powerful than Words:” How Patient Experience Narratives Enable Improvement

“…This study was conducted in a large urban health system that serves a diverse patient population: 35% are not native English speakers, 56% are Medicaid beneficiaries, and approximately 75% are racialized minorities identifying with different groups. All clinics in this system use the Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) Narrative Item Set (NIS), a validated tool to elicit rich narratives 14,26,27 alongside standardized CG-CAHPS survey scores. The Office of Patient Experience (PX Office) for this system is actively engaged as an educational and training resource for these clinics, sharing the narrative comments collected with the NIS along with the standardized CG-CAHPS survey scores each week and meeting monthly with clinic staff and leaders to discuss insights from both sources of data, as well as improvement ideas.…”

“…While scores have become broadly accepted measures, long-standing reservations about the scientific value of qualitative data or “stories”5 have resulted in slower uptake of narratives as a tool for measurement and improvement. Evidence is now growing, however, that narratives can be a key complement to PE scores because they can provide details needed to guide improvement efforts and contain actionable insights and creative ideas—especially when systematically collected as part of standardized PE surveys 6-14…”

Evaluating the Efficiency of Survey Collection Methods to Trauma Patients

“…13 Several studies describe implementing different surveys in trauma and other care settings using 1 or more delivery methods. [14][15][16][17][18] No studies have assessed the resiliency of inpatient trauma patients using the CD-RISC-10 and which delivery method is most efficient to collect survey data. Therefore, this study aimed to determine the most efficient delivery method of the CD-RISC-10 to trauma patients.…”

“…Feasibility studies measure the acceptability or quality of data collection procedures, survey items, tools, and data management strategies essential to improve population and patient outcomes 13. Several studies describe implementing different surveys in trauma and other care settings using 1 or more delivery methods 14-18. No studies have assessed the resiliency of inpatient trauma patients using the CD-RISC-10 and which delivery method is most efficient to collect survey data.…”