Patient Centered Measurement: The Acute Inpatient Survey 2016/17

Description

The Acute Inpatient 2016/17 Survey asked patients about their health-related quality of life and their experiences with the quality of care and services received as an inpatient in one of 78 acute care hospitals and two freestanding rehabilitation hospitals in British Columbia.

The survey was coordinated by the BC Office of Patient-Centred Measurement (PCM) on behalf of the BC PCM Working Group, a group that includes representation from the BC Ministry of Health and the seven Health Authorities.

The Survey included items from the following Patient Experience Reported Measures (PREMs) and Patient Outcome Reported Measures (PROMs).

View a video presentation on these data below:

PREMs

• Canadian Patient Experience Survey – Inpatient Care (CPES-IC)
• BC’s Continuity Across Transitions in Care Module
• BC’s Patient Safety Module
• 4 modules administered to patients when applicable:
  • BC’s Maternity Module
  • BC’s Surgical Module
  • BC’s Pediatrics Module
  • BC’s Rehabilitation Module

PROMs

• Veteran’s Rand 12 (VR-12) Item Health Survey
  • Includes 8 principles of health domains: general health perceptions, physical functioning, role limitations due to physical problems, role limitations due to emotional problems, bodily pain, energy-fatigue, social functioning, and mental health.

Inclusions

• The Acute Inpatient survey uses mostly four-point response scales without a neutral category (e.g., neither agree or disagree), with a mix of dichotomous questions and 11-point rating scales for global rating questions. Responses categories and the number of scale points for the CPES-IC survey were determined using rigorous testing by Canadian Institute for Health Information and Statistics Canada and validation processes, including cognitive interview and pilot studies that examined the scale reliability and validity of responses.
• In addition to the close-ended questions, patients were asked to provide narrative comments at the end of the questionnaire in response to the question, “What is the most important change we could make on this hospital unit? We welcome your additional comments.” For the purposes of the Acute Inpatient 2016/17 survey, open-text comments were transcribed verbatim if the survey was completed over the phone and are written exactly as entered if the survey was completed online. All comments appear verbatim in the data set, with no corrections for grammar or content, although any personal identifiers are masked (XXXX). The survey vendor reviewed all comments to remove identifiers that could reveal the identity of the patient, doctors, nurses, or other staff. Also, comments that were insensitive to specific racial or ethnic groups were adjusted so that the group was no longer identifiable.  Narrative comments are included at the record level. The survey vendor then coded each comment into 6 predefined themes (General, Treatment, Communication, Staff, Procedures, and Miscellaneous) and 38 individual themes. For each theme, valence codes were assigned depending on whether the theme-specific comment was positive, negative, neutral, or positive and negative.

Exclusions

All fields from the survey are available for researcher request apart from identifiable information and data collected using the EQ-5D-5L measure. The BC PCM Working Group was given permission by the EuroQol Group to use the EQ-5D-5L as part of a side-by-side study with the VR-12 to inform decisions about a generic PROM instrument for use in the province of BC. The data collected using this instrument cannot be made available to researchers at this time.

Quality/accuracy of information/field coding source

• The Acute 2016/17 Survey was a mixed mode survey. Patients completed the questionnaire over the phone or online (or both) instead of by mail. In total, 50% of respondents completed the questionnaire by phone and 30% completed it online. Approximately 20% of respondents completed the questionnaire using both survey modes over multiple sessions. The overall response rate for the survey was 46.9%. Provincially, the survey had a ±0.5% margin of error at the 95% confidence level. The margin of error at the health authority level ranges from ±1.0% to ±2.7%.
• Further information on the response rate and margin of error are available in the Acute Inpatient Survey 2016-17 Healthideas Toolkit for Data Users.

Important additional information

• Since 2003, the BC Patient-Centred Working Group (PCMWG) has led BC's strategy for patient-centred measurement, using scientifically rigorous survey instruments that give people who use BC's health care services the opportunity to assess the quality and safety of the health care system from their perspective. Patients’ self-reports of their experiences (and more recently, since 2016, their health related quality of life/health care outcomes) are solicited using PREMS (patient reported experience measures) and PROMS (patient reported outcome measures).
• To date, province-wide coordinated sector surveys have been conducted in the Emergency Department sector, Long Term Care sector, Acute (inpatient) sector, Outpatient Cancer Care sector, and Mental Health and Substance Use sector. The results of past surveys are publicly available. These are large scale surveys with all locations where services are provided in BC included.
• The release of the Acute Inpatient 2016/17 survey is the first time researchers will have access to the results of the PCM surveys conducted between 2003 and 2018. The "raw" survey data will be available via Population Data BC to conduct secondary analyses and inform patient-oriented research. Data from the Acute IP 2016/17 survey has been released first, followed by data from the Emergency Department 2018 survey. The release of data from each sector will occur in conjunction with the availability of support materials.
• The Office of PCM wants to support researchers who are interested in exploring and using the PCM data. Researchers may contact Ben Chou at: bchou@providencehealth.bc.ca with questions, or if interested in receiving more information.

Data collection process

For the Acute Inpatient 2016/17 survey, data was collected via the following process:

• Data submission: Every 2 weeks, the hospitals securely sent the survey vendor records of patients discharged from each hospital unit. The survey vendor generated a random sample of patients from the eligible patient records submitted.
• Patient notification: Prior to being contacted, patients were notified by mail within two weeks of discharge that they had been selected to receive a survey. The cover letter also provided a unique access code and URL for those who preferred to complete the survey online
• Survey administration: The surveys were then conducted by phone as an interview or self-completed online. All phone based surveys were completed using computer-assisted telephone interview (CATI), were available in multiple languages (English, French, Chinese, Punjabi, Korean, Spanish, German, and Vietnamese), and used standardized interview scripts and prompts.

The survey vendor was required to demonstrate compliance with the BC Freedom of Information and Protection Privacy Act and continues to be subject to the independent oversight of the BC Information and Privacy Commissioner. A Privacy Impact Assessment for the project was completed and approved by the Health Information and Privacy Operations Committee of BC on August 12th, 2016.

Further information on the data collection process is available in the Acute Inpatient Survey 2016-17 Healthideas Toolkit for Data Users.