CONCEPT ANALYSIS
An evolutionary view of patient experience in primary care: A concept analysis
Jeana M. Holt DNP, MSN, RN, FNP-BC,
Corresponding Author
Jeana M. Holt DNP, MSN, RN, FNP-BC
University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin
Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Correspondence Jeana M. Holt, DNP, MSN, RN, FNP-BC, University of Wisconsin-Milwaukee, College of Nursing, 2901 E. Hartford Ave, Milwaukee 53201, WI. Email: [email protected]; [email protected]
Search for more papers by this authorJeana M. Holt DNP, MSN, RN, FNP-BC,
Corresponding Author
Jeana M. Holt DNP, MSN, RN, FNP-BC
University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin
Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Correspondence Jeana M. Holt, DNP, MSN, RN, FNP-BC, University of Wisconsin-Milwaukee, College of Nursing, 2901 E. Hartford Ave, Milwaukee 53201, WI. Email: [email protected]; [email protected]
Search for more papers by this authorAbstract
Aim
This concept analysis explores “patient experience” in the context of primary care.
Background
In the 21st century, person-centered care became the manner to address the healthcare quality needs of the United States. This study led to using measures of patient experience as an evaluation of patient-centered care.
Design
Concept analysis.
Data sources
CINAHL, Cochrane Review, PUBMED Central, PsycINFO, Web of Science, and Scopus were queried using “patient experience” and “primary care.” All peer-reviewed US-based articles were included from January 2000 to October 2017 (n = 59).
Review methods
Rodgers’ evolutionary view of concept analysis guided this inquiry.
Results
Patient experience is any process discernible by patients, including subjective experiences, objective experiences, and observations of provider or staff behavior. Patient experience reports are mediated and moderated by many variables and reflect care experiences that directly measure patient-centeredness from the patient’s viewpoint. Consequences of patient experience may lead to adherence to shared plans of care, patient engagement, and appropriate use of healthcare services.
Conclusion
Conceptual clarity of patient experience adds to the understanding of how patients experience healthcare quality. If healthcare aspires to deliver patient-centered care, understanding quality from the viewpoint of the patient is essential.
REFERENCES
- 1 National Academy of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: National Academies Press; 2001.
- 2Browne K, Roseman D, Shaller D, Edgman-Levitan S. Analysis & commentary: measuring patient experience as a strategy for improving primary care. Health Aff. 2010; 29(5): 921-925. https://doi.org/10.1377/hlthaff.2010.0238
- 3Martsolf GR, Alexander JA, Shi Y, et al. The patient-centered medical home and patient experience. Health Serv Res. 2012; 47(6): 2273-2295. https://doi.org/10.1111/j.14756773.2012.01429.x
- 4Anderson RT, Weisman CS, Camacho F, Scholle SH, Henderson JT, Farmer DF. Women’s satisfaction with their on-going primary health care services: a consideration of visit-specific and period assessments. Health Serv Res. 2007; 42(2): 663-681. https://doi.org/10.1111/j.1475-6773.2006.00620.x
- 5Sofaer S, Firminger K. Patient perceptions of the quality of health services. Annu Rev Public Health. 2005; 26(1): 513-559. https://doi.org/10.1146/annurev.publhealth.25.050503.153958
- 6Berkowitz B. The patient experience and patient satisfaction: measurement of a complex dynamic. Online J Issues Nurs. 2016; 21(1): 1. https://doi.org/10.3912/OJIN.Vol21No01Man01
- 7Kern L, Dhopeshwarker R, Edwards A, Kaushal R. Patient experience at the time of practice transformation into patient-centered medical homes. Eur J Person Centered Healthcare. 2013a; 1(2): 290-297.
10.5750/ejpch.v1i2.662 Google Scholar
- 8Cleary PD. Evolving concepts of patient-centered care and the assessment of patient care experiences: optimism and opposition. (Bringing the social sciences to health policy: An appreciation of David Mechanic). J Health Polit Policy Law. 2016; 41(4): 675-696.
- 9Norman J. Americans rate healthcare providers high on honesty, ethics. GALLUP News. 2016. Retrieved from http://news.gallup.com/poll/200057/americans-rate healthcare-providers-high-honesty-ethics.aspx
- 10 National Quality Forum. (2011). Nurse leaders’ top concerns: patient experience, quality care. Health Leaders Media. Retrieved from http://www.qualityforum.org/Topics/News/Nurse_Leaders__Top_Concerns__Patient_Experience,_Quality_Care.aspx
- 11Anhang Price R, Elliott MN, Zaslavsky AM, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev. 2014; 71(5): 522-554. https://doi.org/10.1177/1077558714541480
- 12Ryan P, Sawin KJ. The individual and family self-management theory: background and perspectives on context, process, and outcomes. Nurs Outlook. 2009; 57(4): 217-225. https://doi.org/10.1016/j.outlook.2008.10.004
- 13Rodgers BL. Concepts, analysis and the development of nursing knowledge: the evolutionary cycle. J Adv Nurs. 1989; 14(4): 330-335.
- 14Rodgers BL. Concept analysis: An evolutionary view. In: BL Rodgers, KA Knafl eds. Concept Development in Nursing: Foundations, Techniques, and Applications. (2nd ed.). Philadelphia: W. B. Saunders; 2000: pp. 77-102.
- 15Toulmin SE. Human Understanding. Princeton, NJ: Princeton University Press; 1972.
- 16Turris SA. Unpacking the concept of patient satisfaction: a feminist analysis. J Adv Nurs. 2005; 50: 293-298. https://doi.org/10.1111/j.1365-2648.2005.03392.x
- 17Balasubramanian BA, Cohen DJ, Jetelina KK, et al. Outcomes of integrated behavioral health with primary care. J Am Board Fam Med. 2017; 30(2): 130-139. https://doi.org/10.3122/jabfm.2017.02.160234
- 18Bauer AM, Parker MM, Schillinger D, et al. Associations between antidepressant adherence and shared decision-making, patient-provider trust, and communication among adults with diabetes: diabetes study of Northern California (distance). J Gen Intern Med. 2014; 29(8): 1139-1147. https://doi.org/10.1007/s11606-014-2845-6
- 19Beal A, Hernandez S, Doty M. Latino access to the patient-centered medical home. J Gen Intern Med. 2009; 24(3): S514-S520. https://doi.org/10.1007/s11606-009-1119 1
- 20Behl-Chadha B, Savageau JA, Bharel M, Gagnon M, Lei PP, Hillerns C. Comparison of patient experience between a practice for homeless patients and other practices engaged in a patient-centered medical home initiative. J Health Care Poor Underserved. 2017; 28(3): 1151-1164.
- 21Carvajal DN, Blank AE, Lechuga C, Schechter C, McKee MD. Do primary care patient experiences vary by teaching versus nonteaching facility? J Am Board Fam Med. 2014; 27(2): 239-248. https://doi.org/10.3122/jabfm.2014.02.130222
- 22Cook N, Hollar TL, Zunker C, Peterson M, Phillips T, De Lucca M. Supporting medical home transformation through evaluation of patient experience in a large culturally diverse primary care safety net. J Public Health Manage Pract. 2016; 22(3): 265-274. https://doi.org/10.1097/PHH.0000000000000263
- 23Dale SB, Ghosh A, Peikes DN, et al. Two-year costs and quality in the comprehensive primary care initiative. N Engl J Med. 2016; 374(24): 2345-2356. https://doi.org/10.1056/NEJMsa1414953
- 24Di Capua P, Clarke R, Tseng CH, et al. The effect of implementing a care coordination program on team dynamics and the patient experience. Am J Manag Care. 2017; 23(8): 494-500.
- 25Donahue KE, Reid A, Lefebvre A, Stanek M, Newton WP. Tackling the triple aim in primary care residencies: the I3 POP collaborative. Fam Med. 2015; 47(2): 91-97.
- 26Drain M. Quality improvement in primary care and the importance of patient perceptions. J Ambul Care Manage. 2001; 24(2): 30-46.
- 27Fan J, McCoy RG, Ziegenfuss JY, et al. Evaluating the structure of the patient assessment of chronic illness care (PACIC) survey from the patient’s perspective. Ann Behav Med. 2015; 49(1): 104-111. https://doi.org/10.1007/s12160-014-9638-3
- 28Fiscella K, Meldrum S, Franks P, et al. Patient trust: Is it related to patient-centered behavior of primary care physicians? Med Care. 2004; 42(11): 1049-1055.
- 29Grantham S, Goldberg DG, Infeld DL. Dual eligibles’ experience of care with North Carolina’s patient-centered medical home. Popul Health Manag. 2017; 20(4): 287-293. https://doi.org/10.1089/pop.2016.0060
- 30Hung D, Chung S, Martinez M, Tai-Seale M. Effect of organizational culture on patient access, care continuity, and experience of primary care. J Ambul Care Manage. 2016; 39(3): 242-252. https://doi.org/10.1097/JAC.0000000000000116
- 31Jones AL, Mor MK, Cashy JP, et al. Racial/ethnic differences in primary care experiences in patient-centered medical homes among veterans with mental health and substance use disorders. J Gen Intern Med. 2016; 31(12): 1435-1443. https://doi.org/10.1007/s11606-016 3776-1
- 32Jones AL, Hausmann LRM, Haas GL, et al. A national evaluation of homeless and non-homeless veterans’ experiences with primary care. Psychol Serv. 2017; 14(2): 174-183. https://doi.org/10.1037/ser0000116
- 33Kern LM, Dhopeshwarkar RV, Edwards A, Kaushal R. Patient experience over time in patient-centered medical homes. Am J Manag Care. 2013b; 19(5): 403-410.
- 34Kertesz SG, Holt CL, Steward JL, et al. Comparing homeless persons’ care experiences in tailored versus non-tailored primary care programs. Am J Public Health. 2013; 103: S331-S339. https://doi.org/10.2105/AJPH.2013.301481
- 35Ko JM, Rodriguez HP, Fairchild DG, Rodday AMC, Safran DG. Paying for enhanced service: comparing patients’ experiences in a concierge and general medicine practice. Patient. 2009; 2(2): 95-103. https://doi.org/10.2165/01312067-200902020-00005
- 36Luxford K, Safran DG, Delbanco T. Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. Int J Qual Health Care. 2011; 23(5): 510-515.
- 37Makoul G, Krupat E, Chang CH. Measuring patient views of physician communication skills: development and testing of the Communication Assessment Tool. Patient Educ Couns. 2007; 67(3): 333-342. https://doi.org/10.1016/j.pec.2007.05.005
- 38Martino SC, Shaller D, Schlesinger M, et al. CAHPS and comments: How closed-ended survey questions and narrative accounts interact in the assessment of patient experience. J Patient Exp. 2017; 4(1): 37-45. https://doi.org/10.1177/2374373516685940
- 39Misra-Hebert AD, Rabovsky A, Yan C, Hu B, Rothberg MB. A team-based model of primary care delivery and physician-patient interaction. Am J Med. 2015; 128(9): 1025-1028. https://doi.org/10.1016/j.amjmed.2015.03.035
- 40Murphy J, Chang H, Montgomery JE, Rogers WH, Safran DG. The quality of physician-patient relationships. Patients’ experiences 1996-1999. J Fam Pract. 2001; 50(2): 123-129.
- 41Nembhard IM, Yuan CT, Shabanova V, Cleary PD. The relationship between voice climate and patients’ experience of timely care in primary care clinics. Health Care Manage Rev. 2015; 40(2): 104-115. https://doi.org/10.1097/hmr.0000000000000017
- 42O’brien M, Shea J. Disparities in patient satisfaction among Hispanics: the role of language preference. J Immigr Minor Health. 2011; 13(2): 408-412. https://doi.org/10.1007/s10903-009-9275-2
- 43Otani K, Kurz RS, Harris LE, Byrne FD. Managing primary care using patient satisfaction measures. J Healthc Manag. 2005; 50(5): 311-324. discussion 324-5
- 44Panattoni L, Tai-Seale M. PS1-26: The impact of relational dynamics in primary care departments on patient satisfaction with clinic performance. Clin Med Res. 2014; 12(1-2): 98. https://doi.org/10.3121/cmr.2014.1250.ps1-26.
10.3121/cmr.2014.1250.ps1-26 Google Scholar
- 45Pincavage AT, Lee WW, Beiting KJ, Arora VM. What do patients think about year-end resident continuity clinic handoffs? A qualitative study. J Gen Intern Med. 2013; 28(8): 999-1007. https://doi.org/10.1007/s11606-013-2395-3
- 46Quigley DD, Palimaru AI, Chen AY, Hays RD. Implementation of practice transformation: patient experience according to practice leaders. Qual Manag Health Care. 2017; 26(3): 140-151. https://doi.org/10.1097/QMH.0000000000000141
- 47Ratanawongsa N, Karter AJ, Parker MM, et al. Communication and medication adherence: the diabetes study of Northern California. JAMA Intern Med. 2013; 173(3): 210-218. https://doi.org/10.1001/jamainternmed.2013.1216
- 48Rodriguez HP, Rogers WH, Marshall RE, Safran DG. Multidisciplinary primary care teams: effects on the quality of clinician-patient interactions and organizational features of care. Med Care. 2007a; 45(1): 19-27. https://doi.org/10.1097/01.mlr.0000241041.53804.29
- 49Rodriguez HP, Rogers WH, Marshall RE, Safran DG. The effects of primary care physician visit continuity on patients’ experiences with care. J Gen Intern Med. 2007b; 22(6): 787-793. https://doi.org/10.1007/s11606-007-0182-8
- 50Rodriguez HP, Rodday AMC, Marshall RE, Nelson KL, Rogers WH, Safran DG. Relation of patients’ experiences with individual physicians to malpractice risk. Int J Qual Health Care. 2008; 20(1): 5-12. https://doi.org/10.1093/intqhc/mzm065
- 51Ross TR, Reid RJ, Fishman P, Yu O, Tufano JT, Larson EB. C-B2-03: Patient and clinician experience in a patient-centered medical home demonstration. Clin Med Res. 2010; 8(1). 44-b. https://doi.org/0070044b
10.3121/cmr.8.1.44-b Google Scholar
- 52Rossom RC, Solberg LI, Vazquez-Benitez G, et al. The effects of patient-centered depression care on patient satisfaction and depression remission. Fam Pract. 2016; 33(6): 649-655. https://doi.org/10.1093/fampra/cmw068
- 53Safran DG. Defining the future of primary care: What can we learn from patients? Ann Intern Med. 2003; 138(3): 248-255. https://doi.org/10.7326/0003-4819-138-3200302040-00033
- 54Safran DG, Karp M, Coltin K, et al. Measuring patients’ experiences with individual primary care physicians: results of a statewide demonstration project. J Gen Intern Med. 2006; 21(1): 13-21. https://doi.org/10.1111/j.1525-1497.2005.00311.x
- 55Schiller KC, Weech-Maldonado R, Hall AG. Patient assessments of care and utilization in Medicaid managed care: PCCMs vs. PSOs. J Health Care Finance. 2010; 36(3): 13-23.
- 56Schillinger D, Bindman A, Wang F, Stewart A, Piette J. Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns. 2004; 52(3): 315-323. https://doi.org/10.1016/S0738-3991(03)00107-1
- 57Shi L, Lebrun-Harris LA, Parasuraman SR, Zhu J, Ngo-Metzger Q. The quality of primary care experienced by health center patients. J Am Board Fam Med. 2013; 26(6): 768-777. https://doi.org/10.3122/jabfm.2013.06.130062
- 58Simmons L, Wolever RQ, Bechard EM, Snyderman R. Patient engagement as a risk factor in personalized health care: a systematic review of the literature on chronic disease. Genome Med. 2014; 6(2): 1-21. https://doi.org/10.1186/gm533
- 59Stults CD, McCuistion MH, Frosch DL, Hung DY, Cheng PH, Tai-Seale M. Shared medical appointments: a promising innovation to improve patient engagement and ease the primary care provider shortage. Popul Health Manag. 2016; 19(1): 11-16. https://doi.org/10.1089/pop.2015.0008
- 60Swankoski KE, Peikes DN, Dale SB, et al. Patient experience midway through a large primary care practice transformation initiative. Am J Manag Care. 2017; 23(3): 178-184.
- 61Tai-Seale M, Elwyn G, Wilson CJ, et al. Enhancing shared decision making through carefully designed interventions that target patient and provider behavior. Health Aff. 2016; 35(4): 605-612. https://doi.org/10.1377/hlthaff.2015.1398
- 62Theis RP, Stanford JC, Goodman JR, Duke LL, Shenkman EA. Defining ‘quality’ from the patient’s perspective: findings from focus groups with Medicaid beneficiaries and implications for public reporting. Health Expect. 2017; 20(3): 395-406. https://doi.org/10.1111/hex.12466
- 63Timbie JW, Setodji CM, Kress A, et al. Implementation of medical homes in federally qualified health centers. N Engl J Med. 2017; 377(3): 246-256. https://doi.org/10.1056/NEJMsa1616041
- 64Wald JS, Grant RW, Schnipper JL, et al. (2009). Survey analysis of patient experience using a practice-linked PHR for type 2 diabetes mellitus. AMIA Annual Symposium Proceedings, 2009: 678-682. doi: amia-f2009-678
- 65Walker KO, Stewart AL, Grumbach K. Development of a survey instrument to measure patient experience of integrated care. BMC Health Serv Res. 2016; 16: 16. https://doi.org/10.1186/s12913-016-1437-z.
- 66Ward CE, Morella L, Ashburner JM, Atlas SJ. An interactive, all-payer, multi-domain primary care performance dashboard. J Ambul Care Manage. 2014; 37(4): 339-348. https://doi.org/10.1097/JAC.0000000000000044
- 67Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in Medicaid managed care. Health Serv Res. 2003; 38(3): 789-808. https://doi.org/10.1111/1475-6773.00147
- 68Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Br Med J. 2015; 349(g7647): g7647-g7647. 1 25. https://doi.org/10.1136/bmj.g7647
10.1136/bmj.g7647 Google Scholar
- 69Donabedian A. Evaluating the quality of medical care. Milbank Q Rev. 1966; 44(3): 166-203. 2005
- 70Lipsitz LA. Understanding health care as a complex system: the foundation for unintended consequences. JAMA. 2012; 308(3): 243-244. https://doi.org/10.1001/jama.2012.7551
- 71Morgan S, Yoder LH. A concept analysis of person-centered care. J Holist Nurs. 2012; 30(1): 6-15. https://doi.org/10.1177/0898010111412189
- 72Schwind JK, Beanlands H, Lapum J, et al. Fostering person-centered care among nursing students: creative pedagogical approaches to developing personal knowing. J Nurs Educ. 2014; 53(6): 343-347. https://doi.org/10.3928/01484834-20140520-01
- 73Baron R, Kenny D, Reis Harry T. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51(6): 1173-1182.
- 74Fairchild AJ, MacKinnon DP. A general model for testing mediation and moderation effects. Prev Sci. 2009; 10(2): 87-99. https://doi.org/10.1007/s11121-008-0109-6
- 75Agency for Healthcare Research and Quality. About CAHPS [homepage on the Internet]. c2011 [updated 2018 April; cited 2018 May 28]. Available from http://www.ahrq.gov/cahps/about-cahps/index.html
- 76Adams AS, Parker MM, Moffet HH, et al. Communication barriers and the clinical recognition of diabetic peripheral neuropathy in a diverse cohort of adults: The DISTANCE study. J Health Commun. 2016: 1-10.
- 77Chao Y-S, Wu H-T, Scutari M, et al. A network perspective on patient experiences and health status: The Medical Expenditure Panel Survey 2004 to 2011. BMC Health Serv Res. 2017; 17(1).
- 78Rodgers BL. Developing Nursing Knowledge: Philosophical Traditions and Influences. New York, NY: Lippincott Williams & Wilkins; 2005.
