Patient experience with a large-scale integrated behavioral health and primary care initiative: A qualitative study.

Abstract

Introduction:Patient engagement in research can improve a health system's responsiveness to patient need, but patient experience with integrated care is not well understood. This qualitative study explores patient experience and provider perceptions of patient experience with the Behavioral Health Integration and Complex Care Initiative (BHICCI), which is a large-scale system redesign that delivers integrated care to persons with complex needs. Methods: We conducted 8 patient focus groups (n ϭ 54 patients) and n ϭ 32 interviews with BHICCI providers at five community health settings participating in the BHICCI during which patients and providers described how patient experience with care had changed under the initiative. Results: Patient experience and provider perception of patient experience aligned under 2 themes: (a) care coordination is essential for positive patient experience; and (b) the BHICCI strengthened patient provider relationships. Perspectives diverged under theme (c) patient experience with programmatic "growing pains." Discussion: This study highlights the importance of seeking outpatient feedback and incorporating these experiences into the redesign of integrated care systems. Formal mechanisms, such as patient advisory boards, are needed to ensure that health care quality improvement initiatives are patient centered. Public Significance StatementThis qualitative study highlights the importance of seeking out patient feedback and incorporating these experiences into the redesign of health systems delivering integrated behavioral health care. Additionally, it suggests a need to share patient experience with a system's providers when implementing new programs.

Patient and healthcare provider perceptions on using patient-reported experience measures (PREMs) in routine clinical care: a systematic review of qualitative studies

“…This review supports the positive impact of care coordination on patients’ experience and found that patients considered PREMs a critical feedback tool to assess and improve the quality of care across various clinical settings and between staff within a healthcare team [ 24 , 32 ]. Arguably, for some health conditions such as chronic wounds, disease specific PREMs may be useful to assess condition-specific aspects of care coordination, interdisciplinary communication, and shared decision-making [ 24 , 32 ].…”

“…Table 1 provides a summary of the 20 included studies. Five studies (25%) were conducted in primary care settings [ 4 , 21 – 24 ], nine (45%) in hospitals [ 8 , 25 – 32 ], and the rest either in psychological therapy services [ 33 ], a disability care organization [ 34 ] or other healthcare settings such as Veterans Health Administration [ 35 ] or National Health Service (NHS) [ 36 ]. Studies were conducted in the UK (N = 9; 45%), the USA (N = 8; 40%), Ireland (N = 1; 5%), Brazil (N = 1; 5%) and the Netherlands (N = 1; 5%).…”

“…Three studies exploring patients’ perspectives on using PREMs routinely in practice reported the biggest challenge patients faced in providing feedback was the fear of being questioned about their treatment process and asked for an opinion about it while they were receiving treatment [ 24 , 31 , 32 ]. Patients stated that PREMs data have potential to improve overall care coordination and provided a unique opportunity to produce timely feedback on measurable processes and outcomes so that healthcare teams could use PREM data to improve their overall performance [ 24 , 32 ]. Patients also reported an implementation challenge to be addressed by hospitals was to identify competent staff to help sustain the quality improvement program [ 24 , 32 ].…”

“…Patients stated that PREMs data have potential to improve overall care coordination and provided a unique opportunity to produce timely feedback on measurable processes and outcomes so that healthcare teams could use PREM data to improve their overall performance [ 24 , 32 ]. Patients also reported an implementation challenge to be addressed by hospitals was to identify competent staff to help sustain the quality improvement program [ 24 , 32 ].…”

‘I Accelerate’ model: A grounded theory on conceptual framework of patient experience with nursing care in China

“…Insights from patients can highlight intrinsically valuable and meaningful aspects of health care related to patient experience, enabling a better understanding of current problems with health care delivery, pushing continuous improvement, redesigning the delivery of services and helping professionals reflect on practice. Therefore, qualitative researches have been widely used to explore patient experience with health care services (Davis et al., 2018; Siantz et al., 2020). In October 2011, the English National Health Service (NHS) published patient experience framework, outlining 8 elements that were critical to the patient experience of NHS Service: (i) respect for patient‐centred values, preferences and expressed needs; (ii) coordination and integration of care; (iii) information, communication and education; (iv) physical comfort; (v) emotional support; (vi) welcoming the involvement of family and friends; (vii) transition and continuity; and (viii) access to care (Department of Health, 2011).…”