DTA

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Tesi etd-09202017-170902

Thesis type
Perfezionamento
Author
KUMAH, EMMANUEL
URN
etd-09202017-170902
Title
Improving Healthcare Quality through Patient-Focused Strategies: A Focus on Self-Management and Care Experience
Scientific disciplinary sector
SECS-P/08
Corso di studi
SCIENZE ECONOMICHE E MANAGERIALI - Management
Commissione
relatore Prof.ssa NUTI, SABINA
Presidente Prof. PICCALUGA, ANDREA MARIO CUORE
Membro Dott.ssa MURANTE, ANNA MARIA
Membro Prof. RIZZI, FRANCESCO
Membro Prof. DI MININ, ALBERTO
Parole chiave
  • health care
  • patient experience
  • patient-centered care
  • patient-focused strategies
  • Quality improvement
  • self-management
Data inizio appello
;
Disponibilità
parziale
Riassunto analitico
Health care challenges, such as high prevalence of chronic illness, increasing costs, decreasing resources, rising patient expectations and more complex care episodes, have exposed the inadequacy of the traditional paternalistic approach to quality improvement. Policy makers increasingly believe that the ability to improve the quality of care and control costs will require an effective partnership with informed and engaged patients. Thus, current health systems are shifting toward consumer-centric quality improvement approach, by empowering patients to play a more active role in the planning and delivery of health services. <br><br>The aim of this thesis is to provide knowledge about how to improve the quality of health care through patient focused strategies. Patient-focused strategies consider the care user as the center for change, or contributing to change into the desired outcome. Strategies to encourage patients to play a more active role in their health care are classified by interventions designed to improve: health literacy, shared decision-making, self-management/self-care, patient safety, access to medical advice, and patient experience of care. This thesis focuses, specifically, on interventions designed to improve self-management and patient experience of care.<br><br>The thesis contains four study components: 1) a systematic literature review determining the possible influence of patients’ care providers on the outcomes of self-management education programs; 2) a secondary analysis of quantitative data examining the relationship between patient experience and patient satisfaction with a health care system; 3) a multivariate analysis of the determinants of inpatient experience of nursing care in medical, surgical, and maternal hospital units; and 4) a 12-year trend analysis of the impact of tracking trends in patients’ hospital experiences. <br><br>The first study provides evidence that the effectiveness of self-management intervention could be influenced by the different types of patients’ care providers. Clinicians and health care managers therefore need to consider the influence of care providers during the design and implementation of such educational programs. It is also imperative for researchers, evaluating the effectiveness of self-management interventions to take into account the possible influence of patients’ care providers on the outcomes and effects of these interventions. <br><br>The second study demonstrates that patient experience and patient satisfaction are not marginally related. The two concepts overlap significantly. The paper suggests that, in order to improve patients’ experiences and overall satisfaction with health services, health care managers need to direct more efforts towards those aspects of care experiences related to patient-professional interaction, such as: care provider’s effective communication, responsiveness of hospital staff and pain management. <br><br> The third study found factors related to patient characteristics, hospitalization process, care delivery variables, and institutional characteristics as the determinants of inpatients&#39; reported experience of nursing care. These factors may differ by the type of unit or ward to which patients are admitted. Health care managers therefore need to consider influencing factors in each hospital unit/ward separately. <br><br>The final study could not establish an upward trend in patients’ reported positive experiences of hospital care, an indication that organizations may not be fully using patient experience data in local quality improvement initiatives. The paper proposes two policy-level actions for stimulating the use of patient feedback data at the local level: 1) making the use of patient experience data in quality improvement mandatory, and 2) rewarding organizations that achieve sustained improvements in patient&#39;s reported experiences.<br><br>This thesis is relevant in the current health care management systems, as the four papers presented raise a number of implications for policy, practice and future research. The work contributes to the emerging science of improvement in health care. <br>
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