Research from the Field

Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs outlines best practices in the provision of sexual and reproductive health services, with a focus on continuous quality improvement (CQI), of which a critical component is the patient experience. The patient perspective is an essential dimension of health care quality that has been linked to improved service utilization and treatment adherence. By collecting patient experience data, family planning providers can target improvement efforts, and, in turn, enhance their service delivery and expand utilization. Because of the New York State Department of Health family planning provider network’s upcoming focus on using patient experience data for CQI, the NYS COE decided to highlight some seminal article on the topic of patient experience in this quarter’s Research Corner:

Manary M, Boulding W, Staelin R, and Glickman S. The Patient Experience and Health Outcomes. New England Journal of Medicine. 2013; 368(3):201-203.
Manary, et al., examine components of the patient experience that contribute to overall satisfaction with care using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Several drivers of patient satisfaction were identified such as communication with clinical staff, timeliness of assistance, explanation of medication administered, and site cleanliness. These indicators represent an aspect of quality that is otherwise difficult to measure objectively. According to research findings, satisfaction with care (higher HCAHPS scores) is positively correlated with adherence to treatment, impacting health care utilization and outcomes. Thus, patient experience data can be used to inform approaches to improve quality of care, health outcomes, and utilization of services. To access this full article, please go to: http://www.nejm.org/doi/full/10.1056/NEJMp1211775.

Weech-Maldonado R, Hall A, Bryant T, Jenkins K, and Elliott M. The Relationship between Perceived Discrimination and Patient Experiences with Health Care. Medical Care. 2012; 50(9): 62-68.
In this article, Weech-Maldonado, et al., assess the relationship between perceived discrimination and the patient experience among Medicaid beneficiaries in health care settings. Using Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, the authors examine the relationship between reports of provider discrimination and overall health care experience. To assess perceived discrimination, additional questions were added to the CAHPS survey tool. The adapted tool captures six domains: patient-provider communication, respect for patient preferences/shared decision making, experiences leading to trust or distrust, health literacy strategies, access to language services, and experiences of discrimination. Overall, 14% of respondents perceived discrimination based on Medicaid insurance, 9% perceived discrimination based on race/ethnicity, and 6% reported both types of discrimination. Reported discrimination was highest among black (12.2%) and Hispanic (8.6%) patients, as compared to white patients (5.9%). Those reporting discrimination based on race/ethnicity had lower CAHPS scores across dimensions of care, ranging from 15 to 6 points lower compared with those who never experienced discrimination. To access the full article, go to: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726249/.

Kossler K, Kuroki L, Allsworth J, Secura G, Roehl K, and Peipert J. Perceived racial, socioeconomic and gender discrimination and its impact on contraceptive choice. Contraception. 2011; 84:273-279.
Kossler, et al., analyze the association between experiences of discrimination and contraceptive use. Discrimination was measured by using items from the Experiences of Discrimination (EOD) scale. Overall, 57% of women reported a history of discrimination. EOD scores were highest among black women, with 19% of black women reporting experiencing discrimination when obtaining medical care and 4% specifically when obtaining contraception. In adjusted analysis-, gender, race-, or socioeconomic status-based discrimination was associated with increased current use of less effective contraceptive methods (e.g., barrier methods, natural family planning, withdrawal). Furthermore, perceived discrimination was associated with more negative attitudes towards contraception. Additional studies show that over half of black women report race-based discrimination when obtaining family planning services, especially those women with stronger black identity, younger age, and lower incomes. Combined, these factors influence method selection and use. To access this full article, please go to: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539813/

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Additionally, to support CQI efforts related to the patient experience, the Family Planning National Training Center has developed strategies, videos, and a toolkit. For more information, visit the Family Planning National Training Center: http://fpntc.org/training-and-resources/the-family-planning-patient-experience-skills-to-improve-every-visit