Immigrant and ethnic minority patients` reported experiences in psychiatric care in Europe - a scoping review.

BACKGROUND: There is little evidence on experiences in psychiatric care treatment among patients with immigrant or ethnic minority background. Knowledge about their experiences is crucial in the development of equal and high-quality services and is needed to validate instruments applied in national patient experience surveys in Norway. The aim of this scoping review is to assess and summarize current evidence on immigrant and ethnic minorities` experiences in psychiatric care treatment in Europe. METHODS: Guidelines from the Joanna Briggs Institute were followed and the research process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The literature search was carried out in Medline, Cinahl, Web of Science, Cochrane database of systematic reviews, Embase, and APA PsychInfo, up to Dec 2022, for articles on immigrant patients` experiences in psychiatric care. Reference lists of included articles were screened for additional relevant articles. Titles and abstracts were screened, and potentially relevant articles read in full-text, by two researchers. Evidence was extracted using an a priori extraction form and summarized in tables and text. Any disagreement between the reviewers regarding inclusion of articles or extracted information details were resolved through discussion between authors. RESULTS: We included eight studies in the scoping review. Immigrant and ethnic minority background patients did not differ from the general population in quantitative satisfaction questionnaires. However, qualitative studies showed that they experience a lack of understanding and respect of own culture and related needs, and difficulties in communication, which do not seem to be captured in questionnaire-based studies. CONCLUSION: Raising awareness about the importance of respect and understanding for patients` cultural background and communication needs for treatment satisfaction should be addressed in future quality improvement work.

A methodology for identifying high-need, high-cost patient personas for international comparisons.

OBJECTIVE: To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. DATA SOURCES: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. STUDY DESIGN: We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care-hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. DATA COLLECTION/EXTRACTION METHODS: Data collected by ICCONIC partners. PRINCIPAL FINDINGS: Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. CONCLUSION: Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.

Are parents' geographical origin associated with their evaluation of child and adolescent mental health services? Results from a national survey in Norway.

The objective was to assess the association between parents' geographical origin and their evaluation of outpatient child and adolescent mental health services (CAMHS). Data were collected in a national parent's experience survey of all outpatient CAMHS in Norway in 2017. Following exclusions, 16,143 parents were part of the study, of which 5932 responded (36.1%). Diagnosis and global psychosocial functional level were collected from the National Patient Register. Multilevel regression was used to assess the association between parents' geographical origin and parent evaluation of the outpatient CAMHS on ten indicators. Sentiment and content analysis was conducted on open-ended comments from parents. The estimated regression coefficients showed that parents born in Eastern Europe scored the services significantly poorer than parents born in Norway on outcome of treatment (- 7.73, p < 0.01), general satisfaction (- 5.53, p < 0.05), ease of getting in contact with health personnel outside of scheduled appointments (- 17.04, p < 0.001), and knowledge of the services that the child has received at the service (- 10.63, p < 0.001). Parents born in Asia/Africa/South America scored the services similar as Norwegian parents on eight of ten indicators, better on one (waiting time) and poorer on one (ease of getting in contact). Sentiment analysis showed that 54% of the comments from parents born in Eastern Europe were negative, compared to 42% for the Norwegian group and 36% for Asia/Africa/South America. The parents' evaluation of the outpatient CAMHS were partly associated with their geographical origin, with parents born in Eastern Europe reporting poorer experiences than parents born in Norway.

The association between patient-reported incidents in hospitals and estimated rates of patient harm.

OBJECTIVE: The aim of this study was to test the association between the rates of patient-reported incidents and patient harm documented in the patient record. DESIGN: The study was a secondary analysis of two national hospital assessments conducted in 2011. SETTING: Hospital services in Norway. PARTICIPANTS: The patient survey was a standard national patient-experience survey conducted at the hospital level for all 63 hospitals in Norway. The medical record review was performed by 47 Global Trigger Tools (GTTs) in all 19 hospital trusts and 4 private hospitals. The two data sets were matched at the unit level, yielding comparable patient experiences and GTT data for 7 departments, 16 hospitals and 11 hospital trusts. INTERVENTION: No intervention. MAIN OUTCOME MEASURES: The correlation at the unit level between the patient-reported incident in hospital instrument (PRIH-I) and estimated rates of patient harm from the GTT. RESULTS: The PRIH-I index was significantly correlated with all patient-reported experience indicators at the individual level, with estimates for all patient harm events (Categories E-I) at the unit level (r = 0.62, P < 0.01), and with estimates of more serious harm events in Categories F-I (r = 0.42, P < 0.05). CONCLUSIONS: Patient-reported incidents in hospitals, as measured by the PRIH-I, are strongly correlated with patient harm rates based on the GTT. This indicates that patient-reported incidents are related to patient safety, but more research is needed to confirm the usefulness of patient reporting in the evaluation of patient safety.

Patient evaluation of hospital outcomes: an analysis of open-ended comments from extreme clusters in a national survey.

OBJECTIVES: A recent study identified patients in six distinct response groups based on their evaluations of outcomes related to overall satisfaction, malpractice and benefit of treatment. This study validates the response clusters by analysing and comparing open-ended comments from the extreme positive and extreme negative response groups. DESIGN: Qualitative content analysis. SETTING: Data from open-ended comment fields provided by patients who completed a national patient-experience survey carried out in Norway in 2011. 10 514 patients responded to the questionnaire and 3233 provided comments. A random sample of 50 open-ended comments from respondents representing cluster 1 ('excellent services'), cluster 5 ('services have clear improvement needs') and outliers ('very poor services') was reviewed. RESULTS: 3 distinct patient profiles were identified. More than half of the comments in cluster 1 included descriptions of positive healthcare experiences, one addressed patient safety issues. Only 1 of the comments in cluster 5 was positive, and 12 were related to safety. All comments from the outliers were negative, and more than three-quarters reported experiences related to malpractice or adverse events. Recurring themes did not differ significantly between the three respondent groups, but significant differences were found for the descriptions and severity of the experiences. CONCLUSIONS: Patients in negative response groups had distinct and much poorer healthcare descriptions than those in the extreme positive group, supporting the interpretation of quality differences between these groups. Further research should assess ways of combining statistical cluster information and qualitative comments, which could be used for local quality improvement and public reporting.

The Patient-Reported Incident in Hospital Instrument (PRIH-I): assessments of data quality, test-retest reliability and hospital-level reliability.

BACKGROUND: The objective of this study was to test the data quality, test-retest reliability and hospital-level reliability of the Patient-Reported Incident in Hospital Instrument (PRIH-I). METHODS: 13 incident questions were included in a national patient-experience survey in Norway during the spring of 2011. All questions and a composite incident index were assessed by calculating missing-item rates, test-retest reliability and hospital-level reliability. A multivariate linear regression on a global item regarding incorrect treatment was used to assess the main sources of variation in patient-perceived incorrect treatment at hospitals. RESULTS: Five of the 13 patient-incident questions had a missing-item rate of >20%. Only one item met the criterion of 0.7 for test-retest reliability (wrong or delayed diagnosis), seven items had a score of >0.5, while the remainder had a reliability score of <0.5. However, the reliability was >0.7 for six of 10 items tested at the hospital level, and >0.6 for the remaining four items. A patient-incident index based on 12 of the incident items had no missing data, the test-retest reliability was 0.6 and the hospital-level reliability was 0.85. CONCLUSIONS: The PRIH-I comprises 13 questions about patient-perceived incidents in hospitals, and can be easily and cost-effectively included in national patient-experience surveys with an acceptable increase in respondent burden. Although the missing-item rate and test-retest reliability were poor for several items, the hospital-level reliability was satisfactory for most of the items. The incident items contribute to a patient-reported incident index, with excellent data quality and hospital-level reliability.

Classification of patients based on their evaluation of hospital outcomes: cluster analysis following a national survey in Norway.

BACKGROUND: A general trend towards positive patient-reported evaluations of hospitals could be taken as a sign that most patients form a homogeneous, reasonably pleased group, and consequently that there is little need for quality improvement. The objective of this study was to explore this assumption by identifying and statistically validating clusters of patients based on their evaluation of outcomes related to overall satisfaction, malpractice and benefit of treatment. METHODS: Data were collected using a national patient-experience survey of 61 hospitals in the 4 health regions in Norway during spring 2011. Postal questionnaires were mailed to 23,420 patients after their discharge from hospital. Cluster analysis was performed to identify response clusters of patients, based on their responses to single items about overall patient satisfaction, benefit of treatment and perception of malpractice. RESULTS: Cluster analysis identified six response groups, including one cluster with systematically poorer evaluation across outcomes (18.5% of patients) and one small outlier group (5.3%) with very poor scores across all outcomes. One-Way ANOVA with post-hoc tests showed that most differences between the six response groups on the three outcome items were significant. The response groups were significantly associated with nine patient-experience indicators (p < 0.001), and all groups were significantly different from each of the other groups on a majority of the patient-experience indicators. Clusters were significantly associated with age, education, self-perceived health, gender, and the degree to write open comments in the questionnaire. CONCLUSIONS: The study identified five response clusters with distinct patient-reported outcome scores, in addition to a heterogeneous outlier group with very poor scores across all outcomes. The outlier group and the cluster with systematically poorer evaluation across outcomes comprised almost one-quarter of all patients, clearly demonstrating the need to tailor quality initiatives and improve patient-perceived quality in hospitals. More research on patient clustering in patient evaluation is needed, as well as standardization of methodology to increase comparability across studies.

The Nordic Patient Experiences Questionnaire (NORPEQ): cross-national comparison of data quality, internal consistency and validity in four Nordic countries.

OBJECTIVES: To evaluate the Nordic Patient Experiences Questionnaire (NORPEQ) for data quality, reliability and validity following surveys of patients in Finland, Norway, Sweden and the Faroe Islands. DESIGN, METHODS AND PARTICIPANTS: The NORPEQ was mailed to 500 patients randomly selected after receiving inpatient treatment in Finland, Norway and Sweden. The NORPEQ was also included in a national survey in Norway and in the Faroe Islands. Dimensionality was assessed using principal component analysis and internal consistency by item-total correlation and Cronbach's α. Construct validity was assessed by correlating NORPEQ scores with variables known to be related to patient experiences. SETTING: Somatic hospitals in Finland, Faroe Islands, Norway and Sweden. PRIMARY AND SECONDARY OUTCOME MEASURES: Item missing, internal consistency reliability and construct validity. RESULTS: Response rates ranged from 45.8% in Norway to 84% for Sweden. Levels of missing data were low for all items across the surveys. Principal component analysis identified one component with six experiences items. Mean NORPEQ scores ranged from 74 to 79 on the 0-100 scale, where 100 represents the best possible experiences. Cronbach's α ranged from 0.84 in Finland to 0.88 in Sweden. CONCLUSIONS: The NORPEQ is a brief measure of patient experiences that covers important aspects of the healthcare encounter. It shows good evidence of reliability and validity. PRACTICE IMPLICATIONS: The NORPEQ instrument is recommended for cross-national comparisons of healthcare experiences for the four Nordic countries.