The Association between Clinical Outcomes and Experienced Quality of Outpatient Care among Patients Treated for Atrial Fibrillation

Document Type : Original Article

Authors

1 Netherlands Heart Network, Veldhoven, the Netherlands.

2 Catharina Hospital, Eindhoven, the Netherlands.

3 Máxima Medical Center, Veldhoven, the Netherlands.

4 St. Anna Hospital, Geldrop, the Netherlands.

5 Elkerliek Hospital, Helmond, the Netherlands.

6 GP Organization ELAN, Helmond, the Netherlands.

7 GP Organization PoZoB, Veldhoven, the Netherlands.

8 Diagnostics for You, Eindhoven, the Netherlands.

9 Department of Electrical Engineering, Technical University, Eindhoven, the Netherlands.

Abstract

Introduction: Patient-Reported Experience Measures (PREMs) are commonly used to indicate patients’ experiences in atrial fibrillation (AF) care. As outcomes are the primary goal in Value-Based Health Care, questions are raised regarding whether those experiences represent AF patients’ relevant outcomes. Therefore, this study aims to assess whether a questionnaire concerning AF patients’ experienced quality of care is correlated with AF patients’ clinical outcomes.
Materials and Methods: Data of the present study originated from a prospective cohort study performed among outpatient AF patients in the Netherlands. In October 2015, all patients were asked to complete the Consumer Quality Index (CQI) to assess their experiences with the outpatient AF clinic. Analyses are performed to assess the association between patients’ experiences and clinical outcomes of AF patients (i.e. EHRA score) after three and six months of follow-up.
Results: A total of 242 AF patients (68.7 years) met the inclusion criteria. Regarding the eight domains of the CQI, only provided information (B=3.10; p=0.01) and the physicians’ communication (B=-3.13; p=0.03) were associated with improved EHRA scores at three months. After six months, EHRA score improvements were associated with only one out of eight CQI indicators, namely the information AF patients received from other healthcare providers (B=-5.15; p<0.01).
Conclusion: An inconsistent correlation between AF patients’ clinical outcomes and AF patients’ PREMs was found. Although PREMs are relevant in healthcare, they cannot replace outcomes as a measure of medical care quality. For healthcare organizations, it is crucial to identify the required strategy for assessing the various aspects of the quality of services provided.

Keywords

Main Subjects

References

  1. Kannel WB, Benjamin EJ. Status of the epidemiology of atrial fibrillation. Med Clin North Am, 2008. 92(1): p. 17-40, ix.
  2. Hendriks JM, de Wit R, Crijns HJ, Vrijhoef HJ, Prins MH, Pisters R, et al., (2012). Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation. Eur Heart J, 33(21), 2692-2699.
  3. Nieuwlaat R, Capucci A, Camm AJ, Olsson SB, Andresen D, Davies DW, et al., (2005). Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J, 26(22), 2422-2434.
  4. Hendriks JM, de Wit R, Vrijhoef HJ, Tieleman RG, Crijns HJ. (2010). An integrated chronic care program for patients with atrial fibrillation: study protocol and methodology for an ongoing prospective randomised controlled trial. Int J Nurs Stud, 47(10), 1310-1316.
  5. Gleeson H, Calderon A, Swami V, Deighton J, Wolpert M, Edbrooke-Childs J. (2016). Systematic review of approaches to using patient experience data for quality improvement in healthcare settings. BMJ open, 6(8), e011907.
  6. Beattie M, Lauder W, Atherton I, Murphy DJ. (2014). Instruments to measure patient experience of health care quality in hospitals: a systematic review protocol. Systematic reviews, 3(1), 4.
  7. Porter ME, Lee TH. (2013). The strategy that will fix health care. Harvard Bus Rev, 91(10), 1-19.
  8. Porter ME. (2009). A strategy for health care reform-toward a value-based system. New Engl J Med, 361(2), 109-112.
  9. Parker J, Nester CJ, Long AF, Barrie J. (2003). The problem with measuring patient perceptions of outcome with existing outcome measures in foot and ankle surgery. Foot Ankle Int, 24(1), 56-60.
  10. Delnoij DM, Rademakers JJ, Groenewegen PP. (2010). The Dutch consumer quality index: an example of stakeholder involvement in indicator development. BMC Health Serv Res, 10(1), 88.
  11. Stubbe JH, Brouwer W, Delnoij DM. (2007). Patients' experiences with quality of hospital care: the Consumer Quality Index Cataract Questionnaire. BMC Ophthalmol,7(1), 14.
  12. Triemstra M, Winters S, Kool RB, Wiegers TA. (2010). Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care. BMC Health Serv Res, 10(1), 95.
  13. Zuidgeest M. (2011). Measuring and improving the quality of care from the healthcare user perspective: the Consumer Quality Index. Tilburg University
  14. Bos N, Sturms LM, Schrijvers AJ, van Stel HF. (2012). The consumer quality index (CQ-index) in an accident and emergency department: development and first evaluation. BMC Health Serv Res, 12(1), 284.
  15. Stubbe JH, Gelsema T, Delnoij DM. Psychometric properties of a survey measuring patients' experience with quality of care after a total hip or knee arthroplasty. BMC Health Serv Res, 2007; 7:14
  16. Porter ME, Teisberg EO. (2006). Redefining health care: creating value-based competition on results. Harvard Business Press.
  17. Black N, Varaganum M, Hutchings A. (2014). Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Qual Saf, bmjqs-2013.
  18. Wynn GJ, Todd DM, Webber M, Bonnett L, McShane J, Kirchhof P, Gupta D. (2014). The European Heart Rhythm Association symptom classification for atrial fibrillation: validation and improvement through a simple modification. Europace, 16(7), 965-972.
  19. Kirchhof P, Benussi S, Kotecha D, Ahlsson, A, Atar D, Casadei B, et al., (2016). 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J, 37(38), 2893-2962.
  20. Cremers HP, van Veghel HPA, Theunissen LJHJ, Dekker LRC. Nederlands Hart Netwerk, voorbeeld van toekomstige zorg? Een bypass over de 1e, 2e en 3e lijn [Netherlands Heart Network, example of future healthcare? A bypass over the primary, secondary, and tertiary care]. Kwaliteit in Zorg, 2017, 5. 
  21. Camm AJ, Kirchhof P, Lip GY, et al., Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace, 2010. 12(10): p. 1360-420.
  22. Benjamin EJ, Blaha MJ, Chiuve SE., et al., Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation, 2017. 135(10): p. e146-e603.
  23. Thygesen K, Alpert JS, Jaffe AS, et al., Third universal definition of myocardial infarction. Eur Heart J, 2012. 33(20): p. 2551-67.
  24. Cannon CP, Battler A, Brindis RG, et al. American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes. J Am Coll Cardiol 2001; 38: p. 2114-30.
  25. Ponikowski P, Voors AA., Anker SD., et al., 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016. 37(27): p. 2129-200.
  26. American Diabetes Association, Diagnosis and classification of diabetes mellitus. Diabetes Care, 2013. 36 Suppl 1: p. S67-74.
  27. Rydén L, Grant PJ, Anker SD, et al., ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J, 2013. 34(39): p. 3035-87. NIVEL: CQ-index (2018). URL: https:// www. nivel.nl/nl/cq-index
  28. ARGO, Vragenlijst Poliklinische Ziekenhuiszorg, versie 2.1 Basisvragenlijst [Questionnaire Outpatient Hospital Care, version 2.1 basic questionnaire] 
  29. Zorginzicht (2013). Werkinstructie voor de CQI Poliklinisch Zorg, versie 1.2 [Workinstruction for the CQI Outpatient Care, version 1.2] 
  30. Street Jr RL, Makoul G, Arora NK, Epstein, RM. (2009). How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns, 74(3), 295-301.
  31. Stewart MA. (1995). Effective physician-patient communication and health outcomes: a review. Can Med Assoc J, 152(9), 1423.
  32. Maxwell RJ. (1984). Quality assessment in health. British medical journal (Clinical research ed.), 288(6428), 1470.
  33. Gleeson H, Calderon A, Swami V, Deighton J, Wolpert M, Edbrooke-Childs J. (2016). Systematic review of approaches to using patient experience data for quality improvement in healthcare settings. BMJ open, 6(8), e011907.
  34. Siriwardena AN, Gillam S. (2014). Patient perspectives on quality. Quality in Primary Care, 22(1).
  35. Boyce MB, Browne JP, Greenhalgh J. (2014). The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ Qual saf, 23(6), 508-518.
  36. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM  de Vet HC. (2007). Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol, 60(1), 34-42.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Journal of Patient Safety & Quality Improvement
Volume 7, Issue 3
July 2019
Pages 95-104

Files

Share

How to cite

Statistics