Objective: To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design: Systematic review. Setting: A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants: A wide range of demographic groups and age groups. Primary and secondary outcome measures: A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results: This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions: The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.

https://bmjopen.bmj.com/content/bmjopen/3/1/e001570.full.pdf

A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

Background Patient satisfaction is a widely used health care quality metric. However, the relationship between patient satisfaction and health care utilization, expenditures, and outcomes remains ill defined. Methods We conducted a prospective cohort study of adult respondents (N = 51 946) to the 2000 through 2007 national Medical Expenditure Panel Survey, including 2 years of panel data for each patient and mortality follow-up data through December 31, 2006, for the 2000 through 2005 subsample (n = 36 428). Year 1 patient satisfaction was assessed using 5 items from the Consumer Assessment of Health Plans Survey. We estimated the adjusted associations between year 1 patient satisfaction and year 2 health care utilization (any emergency department visits and any inpatient admissions), year 2 health care expenditures (total and for prescription drugs), and mortality during a mean follow-up duration of 3.9 years. Results Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53). Conclusion In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/1108766/iiq120001_405_411.pdf

The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality

People have a basic need to maintain the integrity of the self, a global sense of personal adequacy. Events that threaten self-integrity arouse stress and self-protective defenses that can hamper performance and growth. However, an intervention known as self-affirmation can curb these negative outcomes. Self-affirmation interventions typically have people write about core personal values. The interventions bring about a more expansive view of the self and its resources, weakening the implications of a threat for personal integrity. Timely affirmations have been shown to improve education, health, and relationship outcomes, with benefits that sometimes persist for months and years. Like other interventions and experiences, self-affirmations can have lasting benefits when they touch off a cycle of adaptive potential, a positive feedback loop between the self-system and the social system that propagates adaptive outcomes over time. The present review highlights both connections with other disciplines and lessons for a social psychological understanding of intervention and change.

/pdf/the-psychology-of-change-self-affirmation-and-social-1vx3ldnbx4.pdf

The psychology of change: Self-affirmation and social psychological intervention.

The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12266

Impact of weight bias and stigma on quality of care and outcomes for patients with obesity

https://ir.library.oregonstate.edu/downloads/bv73c226n

National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2.

Background:Numerous empirical studies from various populations and settings link patient treatment adherence to physician-patient communication. Meta-analysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians

/pdf/physician-communication-and-patient-adherence-to-treatment-a-1ydyr3dial.pdf

Physician Communication and Patient Adherence to Treatment: A Meta-analysis

Background: Numerous empirical studies from various populations and settings link patient treatment adherence to physician-patient communication. Meta-analysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians’ communication skills. Objectives: Calculation and analysis of “r effect sizes” and moderators of the relationship between physician’s communication and patient adherence, and the effects of communication training on adherence to treatment regimens for varying medical conditions. Methods: Thorough search of published literature (1949 –August 2008) producing separate effects from 106 correlational studies and 21 experimental interventions. Determination of random effects model statistics and the detailed examination of study variability using moderator analyses. Results: Physician communication is significantly positively correlated with patient adherence; there is a 19% higher risk of nonadherence among patients whose physician communicates poorly than among patients whose physician communicates well. Training physicians in communication skills results in substantial and significant improvements in patient adherence such that with physician communication training, the odds of patient adherence are 1.62 times higher than when a physician receives no training. Conclusion: Communication in medical care is highly correlated with better patient adherence, and training physicians to communicate better enhances their patients’ adherence. Findings can contribute to medical education and to interventions to improve adherence, supporting arguments that communication is important and resources devoted to improving it are worth investing in. Communication is thus an important factor over which physicians have some control in helping their patients to adhere.

/pdf/physician-communication-and-patient-adherence-to-treatment-8hcl8ect5b.pdf

Physician Communication and Patient Adherence to Treatment

An examination of psychosocial factors associated with malicious online trolling behaviors

The purpose of this study was the development of a rating instrument to assess the use of humor in physician- patient interactions, and to compare humor use as a function of patients' socioeconomic status. The 46-item Physician-Patient Humor Rating Scale (PPHRS) was used to rate 246 audiotaped primary care interactions. Four subscales were reliable and valid, demonstrating correlations with patient satisfaction and reports of physician humor, with physician satisfaction and with separate affective communication ratings. There was a significant difference in use of humor as a function of patient socioeconomic status, such that there was greater mutual trust between physicians and high versus low income patients.

Kelly B. Haskard Zolnierek

Papers

Physician Communication and Patient Adherence to Treatment: A Meta-analysis

Physician Communication and Patient Adherence to Treatment

An examination of psychosocial factors associated with malicious online trolling behaviors

Development and Validation of the Physician—Patient Humor Rating Scale: