Validation of the Intermountain patient perception of quality (PPQ) survey among survivors of an intensive care unit admission: a retrospective validation study.

BACKGROUND: Patients' perceptions of the quality of their hospitalization have become important to the American healthcare system. Standard surveys of perceived quality of healthcare do not focus on the Intensive Care Unit (ICU) portion of the stay. Our objective was to evaluate the construct validity and internal consistency of the Intermountain Patient Perception of Quality (PPQ) survey among patients discharged from the ICU. METHODS: We analyzed prospectively collected results from the ICU PPQ survey of all inpatients at Intermountain Medical Center whose hospitalization included an ICU stay. We employed principal components analysis to determine the constructs present in the PPQ survey, and Cronbach's alpha to evaluate the internal consistency (reliability) of the items representing each construct. RESULTS: We identified 5,680 patients who had completed the PPQ survey. There were three basic domains measured: nursing care, physician care, and overall perception of quality. Most of the variability was explained with the first two principal components. Constructs did not vary by type of respondent. CONCLUSIONS: The Intermountain ICU PPQ survey demonstrated excellent construct validity across three distinct constructs. This, in addition to its previously established content validity, suggests the utility of the PPQ survey as an assay of the perceived quality of the ICU experience.

Storytelling, behavior planning, and language evolution in context.

An attempt is made to specify the structure of the hominin bands that began steps to language. Storytelling could evolve without need for language yet be strongly subject to natural selection and could provide a major feedback process in evolving language. A storytelling model is examined, including its effects on the evolution of consciousness and the possible timing of language evolution. Behavior planning is presented as a model of language evolution from storytelling. The behavior programming mechanism in both directions provide a model of creating and understanding behavior and language. Culture began with societies, then family evolution, family life in troops, but storytelling created a culture of experiences, a final step in the long process of achieving experienced adults by natural selection. Most language evolution occurred in conversations where evolving non-verbal feedback ensured mutual agreements on understanding. Natural language evolved in conversations with feedback providing understanding of changes.

Pediatric hospitalists and primary care providers: a communication needs assessment.

BACKGROUND/OBJECTIVE: Existing research on hospitalist-primary care provider (PCP) communication focuses mainly on adult hospitalist models with little known about the quality of current pediatric hospitalist-PCP communication. Our objective was to perform a needs assessment by exploring important issues around communication between pediatric hospitalists and PCPs. METHODS: Six previously identified issues around hospitalist-PCP communication from the adult hospitalist literature were abstracted and incorporated into an open-ended and closed-ended questionnaire. The questionnaire was pretested, revised, and administered by phone to 10 pediatric hospitalists and 12 pediatric PCPs residing in our 5-state catchment area. Interviews were transcribed and openly coded, and themes compared using qualitative methods. RESULTS: The 6 identified issues were: quality of communication, barriers to communication, methods of information sharing, key data element requirements, critical timing, and perceived benefits. Hospitalists and PCPs rated overall quality of communication from "poor" to "very good." Both groups acknowledge that significant barriers to optimal communication currently exist, yet the barriers differ for each group. Hospitalists and PCPs agree on what information is important to transmit (diagnoses, medications, follow-up needs, and pending laboratory test results) and critical times for communication during the hospitalization (at discharge, admission, and during major clinical changes). Both groups also agree that optimal communication could improve many aspects of patient care. CONCLUSIONS: Identifying and addressing barriers to these 6 issues may help both hospitalists and PCPs implement targeted interventions aimed at improving communication. Future studies will need to demonstrate the link between improved hospitalist-PCP communication and improved patient care and outcomes.