Patient and Caregiver Perspectives During Transitions of Surgical Care

PATIENT AND CAREGIVER

PERSPECTIVES DURING

TRANSITIONS OF SURGICAL

CAREBenjamin S. Brooke MD, PhD1; Stacey L. Slager, MS2;

Charlene R. Weir, PhD, RN2

Departments of Surgery & Biomedical Informatics, University of

Utah School of Medicine, Salt Lake City, UT USA

11th Annual Utah Health Services Research Conference

Surgeon Perspective

Patient & Caregiver Perspective

Transitions of Surgical Care

Community

Access

PCP

Hospital

Acute Surgical Care

Services

Surgeon

Community

Follow-up

PCP

Utah Intermountain-West Partnership to Improve

Surgical Care Transitions (U-IMPACT) http://www.uimpactsurgery.com/

Goals:

• 1) To gain a better understanding of the factors that commonly influence the experience and expectations of surgical patients and their caregivers during transitions of care.

• 2) Identify areas for quality improvement & comparative effectiveness research

http://www.uimpactsurgery.com/

Surgical Patient & Caregiver Focus

Groups

• Eight focus group sessions

conducted among surgical

patients and caregivers located

in different geographic regions

within Utah and the surrounding

Intermountain West

• Discussions were conducted by

moderator using a semi-

structured schedule, recorded,

and transcribed

Methods – Content Analysis

• Content analysis of focus group transcripts used to

understand the main factors perceived by patients and

caregivers to influence their experience and expectations

of care coordination during transitions before, during and

after surgery.

• Deductive (a priori) and inductive (emerging) themes were

coded from transcripts & analyzed using Atlas.ti software.

• Five-rounds of iterative review involving three co-

investigators used to identify, refine and build consensus

around themes.

Results – 5 Themes

Results – Theme 1

1) The relationship between surgeon and patient is

guided by an unique and unwritten social contract.

Results – Theme 2

1) The relationship between surgeon and patient is guided

by an unique and unwritten social contract.

2) Surgery is a team process and patients expect that all

healthcare providers are on the same page.

Results – Theme 3





3) Patients are frightened to have surgery whether they

let on or not.

Results – Theme 4





3) Patients are frightened to have surgery whether they let

on or not.

4) Surgery is very disruptive and patients need to have

accurate expectations of their care plan.

Results – Theme 5





3) Patients are frightened to have surgery whether they let

on or not.

4) Surgery is very disruptive and patients need to have

accurate expectations of their care plan.

5) Surgery is a skilled function and patients expect that

surgeons and the surgical team are competence,

experienced, and knowledgeable.

Translation

• Patient and caregivers experience during

transitions of surgical care is dependent upon:

• Feeling that they could trust their surgeon

• Being able to communicate with the surgical team

• Knowing what to expect during the episode of care

• Feeling that their care is being effectively coordinated.

How do we use this information?

U-IMPACT Patient & Caregiver Advisory

Group

• Meet Quarterly

• Discuss ideas for

quality improvement

and comparative

effectiveness research

(CER) related to

surgical care

coordination

Potential Areas for Patient-Centered

Comparative Effectiveness Research

• Surgical care navigators

• Enhanced discharge planning

• Customizing health information resources

• Providing risk data to surgical patients

Future Directions for U-IMPACT

• Applying for Continued funding through PCORI

Tier III P2P Contract

• Targeting PCORI ‘Improving Healthcare

Systems’ Grant – Cycle 3, 2016

• Continue to build partnerships with patients &

caregivers along with healthcare and

community stakeholders

Thank You

Website: http://www.uimpactsurgery.com/

Email: [email protected]

Twitter: @BenjaminSBrooke

mailto:[email protected]