Evaluating patient care communication in integrated care settings: application of a mixed method approach in cerebral palsy programs.

OBJECTIVE: In this study, we evaluated patient care communication in the integrated care setting of children with cerebral palsy in three Dutch regions in order to identify relevant communication gaps experienced by both parents and involved professionals. DESIGN: A three-step mixed method approach was used starting with a questionnaire to identify communication links in which parents experienced gaps. In subsequent in-depth interviews with parents and focus group meetings with professionals underlying factors were evaluated. RESULTS: In total, 197 parents completed the questionnaire (response 67%); 6% scored negative on parent-professional communication, whereas 17% scored negative on inter-professional communication, especially between the rehabilitation physician and primary care physiotherapy (16%) and (special) education/day care (15%). In-depth interviews among a subset of 20 parents revealed various sources of dissatisfaction such as lack of cooperation and patient centeredness, inappropriate amount of information exchange and professional use of parents as messenger of information. Focus group meetings revealed that professionals recognized these gaps. They attributed them to capacity problems, lack of interdisciplinary guidelines and clear definition of roles, but also a certain hesitance for contact due to unfamiliarity with involved professionals in the care network. CONCLUSIONS: Parents particularly identified gaps in inter-professional communication between (rehabilitation) hospitals and primary care settings. Involved professionals recognized these gaps and primarily attributed them to organizational factors. Improvement initiatives should focus on these factors as well as facilitation of low-threshold contact across the patient's care network.

Evaluating quality of patient care communication in integrated care settings: a mixed method approach.

BACKGROUND: Owing to the involvement of multiple professionals from various institutions, integrated care settings are prone to suboptimal patient care communication. To assure continuity, communication gaps should be identified for targeted improvement initiatives. However, available assessment methods are often one-sided evaluations not appropriate for integrated care settings. OBJECTIVE: We developed an evaluation approach that takes into account the multiple communication links and evaluation perspectives inherent to these settings. In this study, we describe this approach, using the integrated care setting of Cerebral Palsy as illustration. RESULTS: The approach follows a three-step mixed design in which the results of each step are used to mark out the subsequent step's focus. The first step patient questionnaire aims to identify quality gaps experienced by patients, comparing their expectancies and experiences with respect to patient-professional and inter-professional communication. Resulting gaps form the input of in-depth interviews with a subset of patients to evaluate underlying factors of ineffective communication. Resulting factors form the input of the final step's focus group meetings with professionals to corroborate and complete the findings. CONCLUSIONS: By combining methods, the presented approach aims to minimize limitations inherent to the application of single methods. The comprehensiveness of the approach enables its applicability in various integrated care settings. Its sequential design allows for in-depth evaluation of relevant quality gaps. Further research is needed to evaluate the approach's feasibility in practice. In our subsequent study, we present the results of the approach in the integrated care setting of children with Cerebral Palsy in three Dutch care regions.

The effect of prototype-based versus attribute-based presentation forms on the acquisition of a medical concept.

The purpose of this study was to determine the differential effect of two presentation-forms on the acquisition of the concept of shock. It is hypothesized that presenting a prototype facilitates learning and retention of the concept shock compared with verbally enumerating the attributes of the same concept. A group of 106 students from nursing education participated in the experiment. A matched group design guided the assigning of students to different instructional conditions. The instructional program consisted of expository texts, different types of questions and feedback. In the experimental condition eight videotaped typical cases of shock were incorporated in the program. Data-analysis resulted in confirmation of the hypotheses (p less than 0.01), i.e. new instances of shock were identified more frequently by students of the experimental group, while these students were also more able to list commonalities and differences between different cases of shock. This finding supports the prototype-paradigm in concept learning and implies the recommendation to organize lessons in clinical reasoning or diagnostic behavior around typical cases of concepts.