2020
Transfer of results
The qualitative and quantitative studies on interviewing patients and decision-makers in health care organizations in the city of Cologne on their understanding of patient-centered care have been completed. Based on the results, three factsheets on the topics of patient orientation, organisational culture and process orientation have recently been prepared. These factsheets provide an overview of the three topics mentioned above, show relevant findings of the quantitative survey in this respect and offer suggestions for improvement. The factsheets are available for download on the CoRe-Net homepage.
At the International Health Care Quality Conference in Cape Town in October 2019, hosted by the International Society for Quality in Health Care (ISQua), further results from the quantitative survey of decision-makers were presented in a short lecture. In the lecture, the connection between an open communication atmosphere and the implementation of patient orientation was reported. The contents are currently being prepared for publication in a scientific journal.
In addition, the question was examined as to what extent care organizations of different types are burdened by influences in the organizational environment – especially scarce personnel resources. Following a presentation on this topic at the 18th German Congress for Health Services Research in October 2019, the results are now also being prepared for publication in a scientific journal.
In the course of the event “Health Services Research in Cologne: CoRe-Net invites”, together with the other CoRe-Net projects LYOL-C and MenDis-CHD, comprehensive results from OrgValue could be discussed with a broad specialist audience. Core results were prepared for the perspective of doctors, nurses and patients and reflected by representatives of the target group. One core result was that general practitioners and specialists in private practice, in comparison to other health care organisations, do not review patient satisfaction in a structured way at least once a year – despite a very high value in private practices. In addition, the patient interviews produced a new element of the concept of “patient orientation” in which patients can contribute to a certain extent to patient-centered care through their own initiative. Often patients are confronted with the problem that they do not know exactly what they can do themselves, have not received comprehensible information or do not find their way in the health system. From the perspective of the nursing staff, it was reported that continuity of care was identified as a central component of patient-centred care. However, implementation often fails in nursing facilities due to staff qualification, planning and staff shortages. To ensure continuity, therefore, healthy and qualified personnel are needed, among other things.
Under the heading Publications you can find further results in the form of research reports, congress contributions and journal articles from the OrgValue project.
Feasibility Study
The interviews with decision-makers from different health care organizations in the city of Cologne were conducted in order to better understand the individual organizational processes. The OrgValue research team received a good insight into the recording of costs, revenues, the service portfolio as well as quality based on company key figures. Based on these new insights, a set of key figures is now being developed for each of the areas, which can be used to inquire about the above-mentioned dimensions on an organisation type-specific basis. In addition, it will continue to be analysed whether it is possible to develop a survey instrument that can be used in all types of organisations. In a next step, this survey instrument could be used to identify organisational characteristics that could possibly have an influence on patient- and resource-oriented care.
2019
Qualitative Study with Patients on Determinants of Patient-Centered Care
The evaluation of the qualitative interviews with patients to understand patient-centered care and its determinants has been completed. A scientific article was submitted for publication in an international journal and is currently in review. The evaluation of the results showed, among other things, that patients attach great importance to all persons involved in the care of patients. Overall, a well-rehearsed care team is important for the patients. In addition, many patients would like to play an active role in coping with their diseases, but often lack reliable, understandable and easily accessible information.
Quantitative survey of decision-makers in care organisations in the city of Cologne
The quantitative survey on the status of patient- and resource-oriented care in care organisations in the city of Cologne has been completed. The results were prepared for the results report and a separate individual report for each participant. The results report is now also available online on our website. The results report and individual results were sent to the participating organisations by post in September. The reports have been prepared accordingly in order to enable comparability of the organisation types. The report provides a basis for organisational learning.
At the same time, the data will be analysed and prepared for publication. The questions are, for example, which organizational factors are associated with the implementation of patient-oriented care in different types of care organizations; to what extent care organizations of different types are burdened by influences in the organizational environment – especially limited personnel resources; and what importance process orientation has in the different types of care organizations.
Excerpts of the results will be presented in October at the International Health Care Quality Conference in Cape Town, hosted by the International Society for Quality in Health Care (ISQua).
18th German Congress for Health Services Research (DKVF)
The following contributions will be presented by OrgValue project members at the 18th German Congress for Health Services Research (www.dkvf2019.de) in Berlin between 9 and 11 October:
- Implementation of patient-oriented care – Determinants and differences between types of care facilities
- From outpatient care to maximum care hospitals – differences between types of care organisations in the management of human resources
- Pay for Performance (P4P) in inpatient care – systematic literature research and discussion of selected approaches
- Comparison of patient and relative assessments of patient centering in the care of patients with coronary heart disease
- Patient-centered care in the last year of life: Adaptation and validation of a PACIC short version for close relatives
Feasibility study
Interviews are currently being conducted with decision-makers from various care organisations in the city of Cologne as part of a “feasibility study”. The aim of these interviews is to gain insight into the recording of costs, proceeds, the service portfolio and quality on the basis of key company figures. In addition, a set of key figures is to be developed for each of the areas. On that basis, the above-mentioned dimensions can be asked for specific organisation types. This will be used as a basis for analysing whether it is possible to develop a survey document that can be used in all types of organisations.
Qualitative Study with Patients on Determinants of Patient-Centered Care
The evaluation of the qualitative interviews with patients to understand patient-centered care and its determinants has been completed. A scientific article will be published in an international journal soon. The evaluation of the results showed, that patients attach great importance to all persons involved in the care of patients. Overall, a well-coordinated care team is important for the patients. In addition, many patients would like to play an active role in coping with their illnesses, but there is often a lack of reliable, understandable and easily accessible information.
Feasibility study
A “feasibility study” is currently being prepared which will analyse the recording of costs, proceeds, the service portfolio as well as quality on the basis of key company figures in hospitals and doctors’ practices. For this purpose, decision-makers in the various organisations will be interviewed. The aim is to develop a set of indicators for each of the areas, on the basis of which the described dimensions can be asked for specific organisation types. On this base, it will also be analysed if it is possible to develop a survey document that can be used in all organisation types.
Quantitative survey of decision-makers in health service organisations in the city of Cologne
The quantitative survey on the status of patient- and resource-oriented care in health service organisations in the city of Cologne has been completed. In January, a total of 1790 decision-makers from health care institutions were invited to participate by post.
With a response rate of 13%, n=236 decision-makers from n=19 stationary care facilities and hospices (8.1%), n=14 hospitals (5.9%), n=6 rehabilitation facilities (2.5%), n=79 GP and specialised medical practices (33.5%), n=22 ambulatory care and hospice services (9.3%) and n=96 psychotherapeutic facilities (40.7%) took part in the survey. This enabled us to make a donation to the association “wir für pänz e.V.” (www.wir-fuer-paenz.de) at a value of 236 €.
Actually, the results are being prepared for the report, which will be sent to all participants. The evaluations are presented in such a way that the organisation types can be compared with each other. In addition, each organisation receives its individual results in a separate supplementary sheet. The report thus facilitates organisational learning.
At the same time, the data are analysed and prepared for publication in order to investigate various issues. The questions are, for example, which organizational factors are associated with the implementation of patient-oriented care in different types of care organizations; to what extent care organizations of different types are burdened by influences in the organizational environment – especially scarce human resources; and what significance process orientation has in the different types of care organizations.
Excerpts of the results will be presented in October at the International Health Care Quality Conference in Cape Town, hosted by the International Society for Quality in Health Care (ISQua). (https://www.isqua.org/events/ct2019.html)
The despatch of the questionnaires and study information started in January. A total of approximately 1,400 health-care providers from general and specialized practices, mobile nursing services, nursing homes, hospitals, inpatient and outpatient rehabilitation facilities, and psychotherapeutic practices will be invited to participate by post. OrgValue donates 1€ to the association wir für pänz e. V. (www.wir-fuer-paenz.de) for each questionnaire returned. The goal of the association is to encourage and enable families and children to cope with difficult situations increasingly independently. After the survey the participants will have the opportunity to compare their answers with those of other health-care organizations.
2018
Analysis of qualitative data from decision-makers and patients regarding patient-centred care
The analysis of the qualitative interviews with decision-makers concerning the understanding of patient-centred care and its determinants has been completed. The results have been presented at congresses.
The results were analysed regarding communication-based aspects of patient-centred care for the “International Conference on Communication in Healthcare (ICCH)”, which took place from 1st to 4th September in Porto, Portugal, and was organized by the Association for Communication in Healthcare (EACH). For this purpose, a poster was created. It depicts four areas of communication that surround patients in health care and hinder or foster patient-centred care. This poster was translated into German and presented at the joint annual meeting of the German Society for Medical Psychology and the Germen Society for Medical Sociology, which took place from 26th to 28th September 2018 at the University of Leipzig.
Moreover, the interviews were analysed regarding determinants of implementation using the “Consolidated Framework for Implementation Research (CFIR)” (Darmshroder et al., 2009). The results were presented at the German Congress for Health Services Research during the session “Patient-centred care and patient preferences”. A scientific paper summarizing the results is being prepared and will be submitted to an international journal for publication soon.
The analysis of the qualitative interviews with patients regarding the understanding of patient-centred care and its determinants has been completed. The interviews show that the patients’ ideas overlap with existing models of patient-centred care in many aspects (e.g. Scholl et al., 2014).
The results were also analysed regarding communication-based aspects of patient-centred care for a poster for the “International Conference on Communication in Healthcare (ICCH)” from 1st to 4th September in Porto, Portugal, which was organized by the Association for Communication in Healthcare (EACH). The poster visualizes statements of patients concerning communication-based features that foster or hinder the implementation of patient-centred care at three levels (micro, meso and macro level).
The results of a more comprehensive analysis regarding the features of patient-centred care were presented at the German Congress for Health Services Research in the session “Patient-centred care and patient preferences”. A scientific paper presenting the results of the patient interviews is being prepared at the moment.
Quantitative survey of decision-makers in health-care organizations in Cologne
Currently, a questionnaire is being developed based on the results of the qualitative interviews with decision-makers in Cologne health-care organizations and scientific publications and concepts concerning this topic. The questionnaire will be used within the next project step – a quantitative survey of decision-makers of health-care organizations in Cologne. The procedure of the survey and the measuring instruments of the questionnaire were examined through the use of pretests with the target group within the range of the various health-care organizations with regard to practicability and comprehensibility. The resulting revisions were completed so that the survey can start shortly.
Literature:
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., and Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1):50–65.
Scholl, I., Zill, J. M., Härter, M., and Dirmaier, J. (2014). An integrative model of patient-centeredness – A systematic review and concept analysis. PLOS ONE, https://doi.org/10.1371/journal.pone.0107828
OrgValue examines the perspective of decision-makers in health care organizations and the perspective of patients in Cologne regarding patient-centered care. Also, determinants of patient-centered care are inquired.
The aims and the methodical approach in OrgValue were published in the journal BMJ Open as part of the study protocol, so we reached one of our first major milestones.
Characteristics and determinants of patient-centered care from health care organizations’ perspective
As a first step, semi-structured interviews were conducted with decision-makers (n=20) from care institutions in Cologne (hospitals, rehabilitation clinics, nursing homes, inpatient care settings, general practices and specialized practices). Within these interviews, the understanding of patient-centered care and its determinants were identified. The interviews were analyzed with MAXQDA, by using the approach of content analysis.
The interviewees expressed a comprehensive understanding regarding patient-centeredness. For example, employee welfare, process orientation and continuity in health care were identified as key determinants of patient-centered care.
The interview results will be finalized within an article. Also, they are part of the basis for developing the questionnaire for a subsequent survey. A literature research was also necessary for the choice of the right survey instruments. Pretest-interviews are planned for August/September 2018.
Patient-centered care from patients’ perspective
As a second step, OrgValue examines the patient-centeredness perceived by patients with chronic illnesses. The patients were requested to express positive and negative experiences with health care. The interviews were analyzed with MAXQDA, by using the approach of content analysis. Categories were built deductively and inductively.
Existing concepts regarding patient-centered care contain several aspects that were considered as important in the interviews. However, the concepts must be expanded by the roles of different players, for example, self-help groups and health insurance funds. The interview results provide many concrete suggestions for the further development of health care regarding patient-centeredness, especially regarding the dissemination of therapy offered and contact points for health problems.
Presentation of project results
OrgValue was presented at the event “A coffee with science” on 10th July 2018. The relevance of research goals and some project results were shown to a broad audience, by presenting quotations from the interviews.
OrgValue will be represented at scientific congresses. We will present interview results at the International Conference on Communication in Healthcare (ICCH), organized by EACH (International Association for Communication in Healthcare). Furthermore, we will present some results at the Congress on Health Care Research and at the Joint Congress of the German Society for Medical Psychology (DGMP) and the German Society of Medical Sociology (DGMS).
Value-based health and social care imply patient-centeredness and, simultaneously, resource-orientation. The OrgValue project aims to examine how Health and Social Care Organizations (HSCOs) in Cologne perceive and implement the compatibility of patient-centeredness and resource-orientation. In a first step, we conducted 17 out of around 20 interviews with decision-makers from various HSCOs. The interview partners were representatives of hospitals, practices, ambulant care and nursing homes, hospices and rehabilitation clinics. We recruited these interview partners with the support of our practice partners. In a joint meeting held in summer 2017, these interview partners gave us valuable information about the approach and the recruitment. At the moment, we are looking for interview partners from outpatient psychotherapy practices and cardiology practices. Simultaneously, we are preparing exciting results for a publication. We want to identify barriers and facilitators determining the implementation of patient-centeredness and value-based care. Also, the interview results are the basis for developing the questionnaire for the subsequent questionnaire survey. In addition, OrgValue wants to examine patient-centeredness in health and social care from the perspective of chronically ill patients. We are currently recruiting practice participants for conducting interviews.
The first milestone was the study approval by the Ethics Commission of University Hospital Cologne. The next milestone will be the publication of a study protocol at the beginning of 2018.
