A sense of being rejected: Patients' lived experiences of cancelled knee or hip replacement surgery.

BACKGROUND: Growing care queues, reduced access to care and cancelled surgery are realities for some patients being treated with total hip or knee replacement surgery in Sweden. Most of the patients on the waiting lists have experienced pain and limited motion for a varying period of time, with a negative effect on their everyday lives. Overbooked surgical schedules are already contributing to the lengthy waiting times, but, with the addition of cancellations, longer waiting times will increase still further and may affect patients' well-being. METHODS: In the present study, we aimed to illuminate the experience of having planned surgery cancelled, based on narratives from 10 participants. The interview transcriptions were analysed using a phenomenological hermeneutic approach. RESULTS: The comprehensive analyses revealed that the participants described the agony of being deselected and the additional impression of being excluded. Metaphors of being damaged and feeling physical pain were used and the interpretations referred to the cancellations as unpleasant. Additionally, the important relationship and the trust between the health workers and the patient were negatively affected by the cancellation. CONCLUSION: After the cancellation, the participants expressed being vulnerable and from their perspective the cancelled surgery affected them deeply; in fact, much more than the healthcare workers appeared to understand. Therefore, information around the cancellation must be given respectfully and with dignity, in a dialogue between the patient and the healthcare workers. Taken together, to enable an opportunity to be involved in the continued care. The cancellations should be seen as an interruption, in which the patients' chance of living a pain-free, active life is postponed.

Economic evaluation of a person-centred care intervention in head and neck oncology: results from a randomized controlled trial.

PURPOSE: Head and neck cancer and its treatment deteriorate quality of life, but symptoms improve with person-centred care. We examined the cost-effectiveness of a person-centred care intervention versus standard medical care. METHODS: In this randomized clinical trial of a person-centred intervention, patients were planned for outpatient oncology treatment in a Swedish university hospital between 2012 and 2014 and were followed during 1 year. Annual healthcare costs were identified from medical records and administrative register data. Productivity costs were calculated from reported sick leave. Health-related quality of life was collected using the EuroQol Group's five-dimension health state questionnaire. RESULTS: Characteristics were similar between 53 patients in the intervention group and 39 control patients. The average total cost was Euro (EUR) 55,544 (95% confidence interval: EUR 48,474-62,614) in the intervention group and EUR 57,443 (EUR 48,607-66,279) among controls, with similar health-related quality of life. CONCLUSIONS: This person-centred intervention did not result in increased costs and dominated the standard medical care. TRIAL REGISTRATION: ClinicalTrials.gov (registration number: NCT02982746).

Impact of a person-centered intervention for patients with head and neck cancer: a qualitative exploration.

BACKGROUND: People affected by head and neck cancer (HNC) experience a variety of multifaceted health-related problems during the treatment process, based on both the disease and side effects, several years after the treatment is complete. This study investigated a person-centred intervention using transition theory as a framework. AIM: Thus, the aim of the present study was to explore patients' experience of the transition and person centred care from diagnosis to the end of the treatment period. METHODS: Interviews were conducted with 12 persons included in the person-centred intervention group. The patients were recruited from a randomised controlled study. We used a directed deductive content analysis as an analysis method. RESULTS: There was a distinct transition between being a healthy person to being diagnosed with a serious disease. The majority of the participants felt that the diagnosis had put their lives in the balance; they felt both healthy and sick at the same time, and all participants described that their symptoms and side effects were the worst possible and totally unexpected. Of great importance was the health-care plan, comprising self-management goals which were formed in partnership between the patient and the nurse. The participants experienced that their interaction and engagement with lay persons and healthcare professionals supported a gradual acceptance of the situation and a sense of relief with a kind of awareness of the disease. CONCLUSION: The intervention played a significant role in promoting a healthy transition. Person-centredness and transition theory can help healthcare professionals to be more confident and resourceful in supporting people affected by HNC.

Can a person-centred-care intervention improve health-related quality of life in patients with head and neck cancer? A randomized, controlled study.

BACKGROUND: The incidence of head and neck cancer is increasing slightly. Head and neck cancer but also it's necessary and often successful treatment may affect general domains of health-related quality of life and provoke a variety of adverse symptoms and side effects, both during and after treatment. The objective of this study was to compare a person-centred care intervention in terms of health-related quality of life, disease-specific symptoms or problems, with traditional care as a control group for patients with head and neck cancer. METHODS: In this randomized controlled trial, person-centred-care intervention and traditional care (control) groups comprised 54 and 42 patients, respectively. Outcome measures used were: the EORTC QLQ-C30 and the EORTC QLQ-C35. Both groups answered the questionnaires at baseline and after 4, 10, 18 and 52 weeks from start of treatment. The questionnaires' scores were compared between groups by using independent samples test and non-parametric test for continuous variables. For categorical data, Fisher's exact test was used. Longitudinal data were analysed using generalized linear models for normally distributed repeated measures data. RESULTS: At baseline, the intervention and control groups were comparable in terms of medical and sociodemographic variables, clinical characteristics, health-related quality of life and disease-specific symptoms or problems. At all the follow-up points, even during the worst period for the patients, the person-centred-care group consistently reported better scores than the control group. The differences were numerically but not always statistically significant. When testing longitudinal data, statistically significant results were found for head and neck cancer-specific problems, swallowing (p = 0.014), social eating (p = 0.048) and feeling ill (p = 0.021). CONCLUSIONS: The results from this study suggest that adopting the person-centred-care concept practiced here could be a way to improve function and wellbeing in patients with head and neck cancer. TRIAL REGISTRATION: The study was retrospectively registered in 2016-12-05 in Clinical Trials gov. "Can a Person-centred-care Intervention Improve Health-related Quality of Life in Patients With Head and Neck Cancer" registration number: NCT02982746.

The unannounced patient in the corridor: trust, friction and person-centered care.

In this study, a Swedish cancer clinic was studied where three to four unscheduled patients sought support from the hospital on a daily basis for pain and nutrition problems. The clinic was neither staffed nor had a budget to handle such return visits. In order to offer the patients a better service and decrease the workload of the staff in addition to their everyday activities, a multidisciplinary team was established to address the unscheduled return visits. The team was supposed to involve the patient, build trust, decrease the friction, and contribute to a successful rehabilitation process. Data were collected from the patients and the staff. Patients who encountered the team (intervention) and patients who encountered the regular ad hoc type of organization (control) answered a questionnaire measuring trust and friction. Nurses in the control group spent 35% of their full-time employment, and the intervention group staffed with nurses spent 30% of their full-time employment in addressing the needs of these return patients. The patients perceived that trust between them and the staff was high. In summary, it was measured as being 4.48 [standard deviation (SD) = 0.82] in the intervention group and 4.41 (SD = 0.79) in the control group using the 5-point Likert scale. The data indicate that using a multidisciplinary team is a promising way to handle the problems of unannounced visits from patients. Having a team made it cost effective for the clinic and provided a better service than the traditional ad hoc organization. Copyright © 2015 John Wiley & Sons, Ltd.

Evaluation of person-centred care after hip replacement-a controlled before and after study on the effects of fear of movement and self-efficacy compared to standard care.

BACKGROUND: The goal of total hip arthroplasty (THA) is optimal pain relief and a normalized health-related quality of life. Anxious patients describe more pain and more difficulties than non-anxious patients during rehabilitation after THA. The aims of the present study were twofold: (1) to identify vulnerable patients using the general self-efficacy scale (GSES) and the Tampa scale for Kinesiophobia (TSK), and (2) to evaluate if person-centred care including the responses of the instruments made rehabilitation more effective in terms of shortening hospital length of stay. METHODS: The design of the study was quasi-experimental. Patients scheduled for THA, a control group (n = 138) and an intervention group (n = 128) were consecutively recruited. The intervention was the provision of person-centred care which was designed to reduce the negative effects of low self-efficacy and high levels of pain-related fear of movement. RESULTS: Patients with low GSES in the intervention group had shorter length of stay (LoS) by 1.6 days (95 % CI 0.16-3.15) p-value 0.03. Patients with high TSK in the intervention group had shorter LoS by 2.43 days (95 % CI 0.76-4.12) p-value 0.005. For patients who had both, the reduction of LoS was 2.15 days (95 % CI 0.24-4.04) p-value 0.028. CONCLUSIONS: The GSES and the TSK instrument were found useful as tools to provide information to support patients which reduced the LoS by 1.67 days in the whole intervention group (95 % CI 0.72-2.62) p-value 0.001. More importantly, vulnerable patients such as ASA group 3 probably gained the most from the extra support, they had a reduction with 6.78 days (95 % CI 2.94-10.62) p-value 0.001.

Use of the PREPARE (PREhabilitation, Physical Activity and exeRcisE) program to improve outcomes after lumbar fusion surgery for severe low back pain: a study protocol of a person-centred randomised controlled trial.

BACKGROUND: Following lumbar fusion surgery, a successful outcome is empirically linked to effective rehabilitation. While rehabilitation is typically postoperative, the phase before surgery - termed prehabilitation - is reportedly an ideal time to prepare the patient. There are presently no guidelines for prehabilitation before lumbar fusion surgery. Physical activity has well-known health benefits, and staying physically active despite pain is a major principle in non-pharmacological chronic low back pain treatment. Psychological factors such as fear of movement, pain catastrophizing and low self-efficacy are known to be barriers to staying active. No studies have investigated prehabilitation protocols that promote physical activity and target psychological risk factors before lumbar fusion surgery. The aim of our proposed randomised controlled trial is to investigate whether patients who undergo lumbar fusion surgery for degenerative disc disease experience better functioning with a physiotherapeutic prehabilitation program (PREPARE) based on a cognitive behavioural approach compared to conventional care. METHODS/DESIGN: We will recruit 110 patients between 18-70 years of age with degenerative disc disease who are waiting for lumbar fusion surgery. These patients will be randomly assigned to receive either PREPARE or conventional care. PREPARE uses a person-centred perspective and focuses on promoting physical activity and targeting psychological risk factors before surgery. The primary outcome will be disability measured using the Oswestry Disability Index 2.0. Secondary outcomes will include functioning (patient-reported and performance-based), physical activity (accelerometer), health-related quality of life, back and leg pain intensity, pain catastrophizing, kinesiophobia, self-efficacy, depression, anxiety, satisfaction with treatment results and health economic factors. Data will be collected at baseline (preoperatively) after the intervention (preoperatively), 3 and 8 weeks, 3, 6, 12, 24 and 60 months postoperatively. DISCUSSION: We hypothesise that the focus on promoting physical activity and targeting psychological risk factors before surgery will decrease disability and help the patients to be more active despite pain both before and after surgery. We will use a combination of outcome measures both patient-reported and performance-based, as well as accelerometer data. This will provide a more comprehensive picture of the patient's functioning than just patient-reported outcomes alone. TRIAL REGISTRATION: Current Controlled Trials ISCRTN17115599 , Retrospectively Registered 18 May 2015.

Person-centred care for patients with chronic heart failure - a cost-utility analysis.

BACKGROUND: Costs of care for patients with chronic heart failure have been estimated at between 1% and 2% of the total health care expenditure in Europe and North America. Two-thirds are for inpatient care. Person-centred care (PCC) asserts that patients are persons and should not be reduced to their diseases alone. AIMS: The aim of this study was to estimate the cost-utility of PCC when compared with conventional care in patients hospitalized for worsening chronic heart failure. METHODS AND RESULTS: Data for the cost-utility analysis were collected alongside a prospective clinical intervention study with a controlled before and after design from 2008 to 2010. Patient-specific resources used and preference-based health status data were collected at an individual level.Only 63% received PCC as intended illustrating the difficulties of introducing new methods in established organizations. The group intended to have PCC yielded higher costs in comparison with the conventional care group. The incremental cost was estimated as €98. The costs for those who actually received PCC, per protocol (PP) (63%) were significantly (p=0.026) lower than for those in the conventional care group, with an incremental cost-saving of €863. For the first three months, patients in the conventional care group showed decreasing health-related quality of life, with a corresponding improvement in the PCC(PP) group. CONCLUSION: It must be emphasized, however, that these positive effects, both cheaper and somewhat better, were obtained only among those receiving the PCC intervention in its intended form, PCC(PP).

Person-centred care - An approach that improves the discharge process.

BACKGROUND: Discharge planning is important to bridge the gap between hospital and home. Many patients with chronic heart failure are often fragile elderly with co-morbidities and functional decline due to increased symptom burden. A structured Gothenburg person-centred care (gPCC) approach may promote better discharge-planning. AIMS: To evaluate whether proactive care-planning based on the gPCC model leads to improved efficiency in discharge procedures compared with usual care in patients hospitalized for worsening chronic heart failure. METHODS: In a controlled before-and-after design, patients hospitalized for worsening chronic heart failure were assigned to either a usual care group or a gPCC intervention group. The patients' social situation, their discharge destination and the number of days until the discharge were recorded. The time interval (in days) between notification and start of coordination of care was recorded. RESULTS: In total, 248 patients were included, 123 in the usual care group and 125 in the gPCC intervention. During hospitalization, notifications to the community home help service and/or round-the-clock home nursing care services were more frequent in the gPCC-group (33.8%) compared with patients in the usual care group (12.1%). A confirmed discharge planning conference started within the first five days in the gPCC group whereas the usual care group ranged from one to 28 days. Compared with the usual care group, the gPCC group had fewer days in hospital (11 versus 35) ready for discharge. CONCLUSION: gPCC improves discharge processes because patients are viewed as competent to be involved in planning their subsequent care.

Person-centred care compared with standardized care for patients undergoing total hip arthroplasty--a quasi-experimental study.

BACKGROUND: A common approach to decrease length of stay has been to standardize patient care, for example, by implementing clinical care pathways or creating fast-track organizations. In a recent national report, it was found that Sweden's healthcare system often fails to anticipate and respond to patients as individuals with particular needs, values and preferences. We compared a standardized care approach to one of person-centred care for patients undergoing total hip replacement surgery. METHODS: A control group (n =138) was consecutively recruited between 20th September 2010 and 1st March 2011 and an intervention group (n =128) between 12th December 2011 and 12th November 2012, both scheduled for total hip replacement. The primary outcome measures were length of stay and physical function at both discharge and 3 months later. RESULTS: The mean length of stay in the control group was 7 days (SD 5.0) compared to 5.3 days in the intervention group (SD 2.2). Physical functional performance, as assessed using activities of daily living, was similar at baseline for both groups. At discharge, 84% in the control group had regained activities of daily living level A vs. 72% in the intervention group. At 3 months after surgery, 88% in the control group had regained their independence vs. 92.5% in the person-centred care group. CONCLUSIONS: Focusing attention on patients as people and including them as partners in healthcare decision-making can result in shorter length of stay. The present study shows that the patients should be the focus and they should be involved as partners.

Experiences of person-centred care - patients' perceptions: qualitative study.

BACKGROUND: Patient care models have been implemented and documented worldwide. Many studies have focused on features that hinder and facilitate the shift to such models, including the implementation process, staff involvement, resistance to new models and cultural dimensions. However, few studies have identified the potential effects of such new care models from a patient perspective. The aim of the present study was to investigate whether patients did in fact perceive the intentions of partnership in the new care model 1 year after its implementation. METHODS: Sixteen participants were interviewed, selected from two wards in a medical department where a new care model had been implemented 1 year earlier. A directed deductive content analysis was selected. The aim of the directed approach to content analysis was to investigate to what extent the new care model had been implemented, using patients' perspectives to describe the level of implementation. A coding framework was developed based on a theoretical paper that described the key features of the new care model. RESULTS: The implementation of person-centred care had clearly occurred to a large degree, even if some patients appeared not to have been exposed to the model at all. Aspects of the newly implemented care model were obvious; however, it was also clear that implementation was not complete. The analysis showed that patients felt listened to and that their own perception of the situation had been noted. Patients spontaneously expressed that they felt that the staff saw them as persons and did not solely focus on their disease. It was also stated that not every ailment or aspect of a patient's illness needed to be addressed or resolved for open listening to be perceived as a positive experience. CONCLUSIONS: The findings indicate that even though some patients were not interested in participating and playing an active role in their own care, this might relate to a lack of understanding on how to invite them to do so and to increase their confidence. To change healthcare from a paternalistic system to care where patients are seen as partners may require pedagogical skills.

The association between subcultures and resistance to change--in a Swedish hospital clinic.

PURPOSE: The purpose of this paper is to explore the different subcultures and the employees' preparedness for change at an orthopaedic clinic in a university hospital in Sweden. DESIGN/METHODOLOGY/APPROACH: Surveys were sent out to 179 nurses and physicians. The survey included the two instruments Organisational Values Questionnaire and resistance to change (RTC) Scale. FINDINGS: The results suggest a dominance of a human relations culture, i.e. flexibility, cohesion and trust, in the orthopaedic clinic. These characteristics seemed to decrease RTC. Opposite to this, planning, routines and goal setting appeared to increase change-resistant behaviour. PRACTICAL IMPLICATIONS: By predicting potential obstacles in a certain context prior to a change process, resources can be used in a more optimal way. An instrument that pinpoints the culture of a particular healthcare setting may be a useful tool in order to anticipate the possible outcome of change. ORIGINALITY/VALUE: The rational goal/internal processes dimension exerted a stronger association with RTC than in earlier studies. Deeply rooted standards and routinised care models, governed by work schedules, could be an obstacle to introducing a care model based on the individual needs of the patient. There was, however, a surprisingly low RTC. The results are contrary to the accepted understanding of public organisations known to be slow to change.

Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases.

BACKGROUND: The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery. METHODS: The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once. RESULTS: Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations. CONCLUSIONS: In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process.

The impact of organizational culture on the outcome of hospital care: after the implementation of person-centred care.

AIMS: To measure the effect of organizational culture on health outcomes of patients 3 months after discharge. METHODS: a quantitative study using Organizational Values Questionnaire (OVQ) and a health-related quality of life instrument (EQ-5D). A total of 117 nurses, 69% response rate, and 220 patients answered the OVQ and EQ-5D, respectively. RESULTS: The regression analysis showed that; 16% (R(2) = 0.02) of a decreased health status, 22% (R(2) = 0.05) of pain/discomfort and 13% (R(2) = 0.02) of mobility problems could be attributed to the combination of open system (OS) and Human Relations (HR) cultural dimensions, i.e., an organizational culture being dominated by flexibility. CONCLUSIONS: The results from the present study tentatively indicated an association between an organizational culture and patients' health related quality of life 3 months after discharge. Even if the current understanding of organizational culture, which is dominated by flexibility, is considered favourable when implementing a new health care model, our results showed that it could be hindering instead of helping the new health care model in achieving its objectives.

Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care.

BACKGROUND: Many patients with chronic heart failure (CHF) experience uncertainty regarding the treatment and characteristics of their illness. Person-centred care (PCC) emphasizes patient involvement in care. We have previously shown that PCC improved outcomes such as length of hospital stay and activities of daily living in patients with CHF. The impact of PCC on self-reported uncertainty in illness among patients hospitalized for CHF is still unknown. AIM: To evaluate whether PCC is associated with less self-reported uncertainty in illness compared with usual care in patients hospitalized for worsening CHF. METHODS: Using a controlled before-and-after design, eligible CHF patients were assigned to either a usual care group or a PCC intervention group. Patient-reported uncertainty in illness was assessed at hospital discharge with the Cardiovascular Population Scale (CPS). The CPS consists of two domains: 1) Ambiguity (about illness severity); and 2) Complexity (of treatment and system of care). RESULTS: Two hundred and forty-eight patients were included in the study; 123 in the usual care group and 125 in the PCC intervention. The PCC group had better scores than the usual care group in the CPS domains complexity (M=15.2, SD=4.7 vs. M=16.8, SD=4.7; p=0.020) and ambiguity (M=27.8, SD=6.6 vs. M=29.8, SD=6.9; p=0.041). CONCLUSION: Patients with CHF were less uncertain in their illness after PCC, which may help to equip and empower patients to manage their illness. Together with earlier findings of shortened hospital stay and improved activities of daily living, this indicates that PCC should be a standard approach for hospital care of patients with worsening CHF.

Efficacy of person-centred care as an intervention in controlled trials - a systematic review.

AIMS AND OBJECTIVES: To identify person-centred care as an intervention in controlled trials, where patients had been involved as a partner, and to describe the outcomes of these studies. BACKGROUND: The notion of person-centred care asserts that patients are persons and partners in care and should not be reduced to their disease alone. DESIGN: A systematic literature review. METHOD: Searches were undertaken in the databases PUBMED and CINAHL. The inclusion criteria were that person-centred care as an intervention was described as a partnership between the caregiver and the patient, and that the studies were randomised controlled trials or quasi-experimental designs. The studies were analysed based on methodology, context and type of intervention, outcomes and effects of the interventions. Eleven trials fulfilled the inclusion criteria. RESULTS: The studies were carried out in a variety of contexts with diverse outcomes. Person-centred care as an intervention was shown to be successful in eight of the studies. The internal and external validity in the studies were generally good. However, as regards the precision of the studies there was a wide variation. CONCLUSIONS: The value and efficacy of person-centred care as an intervention have only been studied to a limited extent. Methodological problems in trial design and execution could account for the general lack of research on person-centred care. Evidence that person-centred care is effective is insufficient, more stringent studies are needed. RELEVANCE TO CLINICAL PRACTICE: The results suggest that person-centred care may lead to significant improvements, but the implementation and relevant effects needs to be assessed in more studies.

Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care.

Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding.

Impacts of patient characteristics on hospital care experience in 34,000 Swedish patients.

BACKGROUND: Standardized patient surveys are widely used for assessing quality of healthcare from the patient perspective. An important purpose of such surveys is to identify disparities in care among different patient groups. The purpose of this study was to 1.) evaluate aspects of the validity of the adapted Swedish version of the Picker Patient Care Experience -15 (PPE-15) survey and 2.) examine the explanatory value of various socio-demographic and health characteristics in predicting patients' care experiences. METHODS: A retrospective cross-sectional study design was used. Patients discharged from internal medicine wards at regional and university hospitals in different parts of Sweden during 2010 were invited to participate in the regularly administered national care-experience survey for hospital care. The internal validity of the PPE-15 was assessed with Cronbach's alpha and item-scale correlations. Pearson product-moment correlation coefficients were used to compare PPE-15 total scores with overall care satisfaction ratings and Spearman correlation coefficients were used to compare PPE-15 total scores with various patient characteristics. Multiple linear regression analysis was performed to examine the influence of various patient characteristics on PPE-15 scores. RESULTS: The response rate was 66% (n = 34 603). Cronbach's alpha was 0.87. The correlation between the PPE-15 total score and overall care satisfaction was high (0.62, p < 0.0001). Good self-rated health (SRH) and having Swedish as native language were associated with better care experiences and poorer experiences with greater healthcare utilization, higher age, functional impairment and being female. All examined characteristics, except language, were significant predictors in the regression model and SRH was the strongest predictor; however, the model explained only 7% of the total variance. Vulnerable patients (i.e. poor SRH and functional impairment) reported significantly less positive care experiences than did non-vulnerable patients (mean PPE-15 score 75 vs 85; p < 0.0001). CONCLUSIONS: Our results supported the internal validity of the Swedish adapted version of the PPE-15. The explanatory value of the examined patient socio-demographic and health characteristics was low, suggesting the need for exploring other patient-related determinants of care experiences. Our findings also suggest a care paradox: patients in greatest need of hospital care are least satisfied with the quality of the care they receive.

Effects of person-centred care in patients with chronic heart failure: the PCC-HF study.

AIMS: Person-centred care (PCC) emphasizes a partnership in care between patients and healthcare professionals and is advocated by WHO as a key component of quality health care. We evaluated outcomes of PCC in hospitalized patients with chronic heart failure (CHF) with respect to the length of hospital stay (LOS), activities of daily living (ADL), health-related quality of life (HRQL) and 6-month readmission rate. METHODS AND RESULTS: During 2008-2010, 248 consecutive patients hospitalized for symptoms of worsening CHF were enrolled in a controlled before and after designed study. A Usual care group (n= 123) was recruited according to pre-defined criteria to map usual CHF care and assess outcomes at five designated hospital wards. Based on the mapping, a panel of in-house clinicians and researchers developed measures aimed at aligning usual care with basic PCC principles. These measures were incorporated into a study protocol to guide care procedures at the same five wards. Person-centred care was then implemented at these wards and evaluated in 125 patients. Both length of hospital stay and 6-month readmission were extracted from patient records. Activities of daily living were evaluated at baseline and discharge and HRQL was evaluated at baseline and after 3 months. In the analysis of all patients, the LOS was reduced by 1 day (P = 0.16) while retaining ADL (P = 0.07). When PCC was fully implemented (per protocol analysis), LOS was reduced by 2.5 days (P = 0.01) and the ADL-level better preserved (P = 0.04). Health-related quality of life and time-to-first readmission did not differ. CONCLUSION: In this proof-of-concept study, our findings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalized for worsening CHF, without increasing risk for readmission or jeopardizing patients' HRQL.

Person-centered care--ready for prime time.

Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.