Capturing the experience of the hospital-stay journey from admission to discharge using diaries completed by patients in their own words: a qualitative study.

OBJECTIVE: To capture and better understand patients' experience during their healthcare journey from hospital admission to discharge, and to identify patient suggestions for improvement. DESIGN: Prospective, exploratory, qualitative study. Patients were asked to complete an unstructured written diary expressed in their own words, recording negative and positive experiences or anything else they considered noteworthy. PARTICIPANTS AND SETTING: Patients undergoing vascular surgery in a metropolitan hospital. PRIMARY OUTCOME MEASURES: Complete diary transcripts underwent a general inductive thematic analysis, and opportunities to improve the experience of care were identified and collated. RESULTS: We recruited 113 patients in order to collect 80 completed diaries from 78 participants (a participant response rate of 69%), recording patients' experiences of their hospital-stay journey. Participating patients were a median (range) age of 69 (21-99) years and diaries contained a median (range) of 197 (26-1672) words each. Study participants with a tertiary education wrote more in their diaries than those without-a median (range) of 353.5 (48-1672) vs 163 (26-1599) words, respectively (Mann-Whitney U test, p=0.001). Three primary and eight secondary themes emerged from analysis of diary transcripts-primary themes being: (1) communication as central to care; (2) importance of feeling cared for and (3) environmental factors shaping experiences. In the great majority, participants reported positive experiences on the hospital ward. However, a set of 12 patient suggestions for improvement were identified, the majority of which could be addressed with little cost but result in substantial improvements in patient experience. Half of the 12 suggestions for improvement fell into primary theme 1, concerning opportunities to improve communication between healthcare providers and patients. CONCLUSIONS: Unstructured diaries completed in a patient's own words appear to be an effective and simple approach to capture the hospital-stay experience from the patient's own perspective, and to identify opportunities for improvement.

Obstructive sleep apnea in New Zealand adults: prevalence and risk factors among Maori and non-Maori.

STUDY OBJECTIVES: Examine the distribution of symptoms and risk factors, and estimate the prevalence of obstructive sleep apnea (OSA) among Maori and non-Maori New Zealanders. DESIGN: Mail-out survey to a stratified random sample from the electoral roll of 10,000 people aged 30-59 y, and overnight MESAM IV monitoring during sleep of a similarly aged stratified random sample of 364 people from the Wellington electoral roll. SETTING: Nationwide survey of OSA symptoms (71% response rate) and regional home-based measurement of respiratory disturbance index (RDI, 4% oxygen desaturations/h of sleep, plus bursts of snoring or > or = 10/min increase in heart rate). PARTICIPANTS: Sample designs aimed for equal numbers of Maori and non-Maori participants, men and women, and participants in each decade of age. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Maori were more likely than non-Maori to report OSAS risk factors and symptoms. After controlling for sex and age, Maori were 4.3 times more likely to have RDI > or = 15 (95% CI = 1.3-13.9). Ethnicity was not an independent risk factor after controlling for body mass index (BMI) and neck circumference. The prevalence of OSAS (RDI > or = 5 and ESS > 10) was conservatively estimated to be 4.4% for Maori men, 4.1% for non-Maori men, 2.0% for Maori women, and 0.7% for non-Maori women. CONCLUSIONS: The national survey and the regional monitoring study indicate a higher prevalence of OSA among Maori and among men. The higher prevalence among Maori appears to be attributable to recognized risk factors, notably body habitus. In addition to increased prevention and treatment services, strategies are needed to reduce ethnic disparities in OSAS prevalence.