Patient‐reported experience measures are essential to improving quality of care for chronic wounds: An international qualitative study

Abstract

Traditional quality measures for chronic wounds have focused on objective outcomes that are challenging to risk adjust, lack patient input, and have limited ability to inform quality improvement interventions. Patient‐reported experience measures (PREMs) provide information from the patient perspective regarding health care quality and have potential to improve patient‐centredness, increase care efficiency, and generate actionable data for quality improvement. The purpose of this study was to understand patient experiences and health care processes that impact quality of care among patients with chronic wounds. Sixty patients at least 18 years of age with various wound aetiologies were recruited from Canada, Denmark, The Netherlands, and the United States as part of a larger phase 1 qualitative study to develop a patient‐reported outcome measure for chronic wounds (WOUND‐Q). All patients had a chronic wound for at least 3 months, were fluent in their native speaking language, and able to participate in a one‐on‐one semi‐structured interview. Interviews were digitally recorded and transcribed verbatim. Interpretive description was used to identify recurrent themes relating to patient experience and quality of care. We identified five domains (care coordination, establishing/obtaining care, information delivery, patient‐provider interaction, and treatment delivery) and 21 sub‐domains (access to patient information, interdisciplinary communication, encounter efficiency, provider availability, specialist referral, staff professionalism, travel/convenience, modality, reciprocity, understandability/consistency, accountability, continuity, credentials, rapport, appropriateness, complication management, continuity, environment/setting, equipment and supply needs, expectation, and patient‐centred) as potential opportunities to measure and improve quality of care in the chronic wound population. PREMs for chronic wounds represent an important opportunity to engage patients and longitudinally assess quality across clinical settings and providers. Future research should focus on developing PREMs to complement traditional objective and patient‐reported outcome measures for chronic wounds.

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 ].…”

Single-Use Negative Pressure Wound Therapy for Chronic Wounds

“…Chronic wounds present a challenge for patients, clinicians, and health systems. [1][2][3][4][5] Characterized by impaired and delayed healing, chronic wounds can include a variety of ulcerative wounds, 1 as well as nonhealing surgical, traumatic, and other wounds. 6 Both wound care treatment and innovation have advanced over the past several decades.…”