Skip to main content
Erschienen in: The Patient - Patient-Centered Outcomes Research 2/2017

01.04.2017 | Original Research Article

The Rest of the Story: A Qualitative Study of Complementing Standardized Assessment Data with Informal Interviews with Older Patients and Families

verfasst von: Claire Lafortune, Jacobi Elliott, Mary Y. Egan, Paul Stolee

Erschienen in: The Patient - Patient-Centered Outcomes Research | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

While standardized health assessments capture valuable information on patients’ demographic and diagnostic characteristics, health conditions, and physical and mental functioning, they may not capture information of most relevance to individual patients and their families. Given that patients and their informal caregivers are the experts on that patient’s unique context, it is important to ensure they are able to convey all relevant personal information to formal healthcare providers so that high-quality, patient-centered care may be delivered. This study aims to identify information that older patients and families consider important but that might not be included in standardized assessments.

Methods

Transcripts were analyzed from 29 interviews relating to eight patients with hip fractures from three sites (large urban, smaller urban, rural) in two provinces in Canada. These interviews were conducted as part of a larger ethnographic study. Each transcript was analyzed by two researchers using content analysis. Results were reviewed in two focus group interviews with older adults and family caregivers. Identified themes were compared with items from two standardized assessments used in healthcare settings.

Results

Three broad themes emerged from the qualitative analysis that were not covered in the standardized assessments: informal caregiver and family considerations, insider healthcare knowledge, and patients’ healthcare attitudes and experiences. The importance of these themes was confirmed through focus group interviews. Focus group participants also emphasized the importance of conducting assessments in a patient-centered way and the importance of open-ended questions.

Conclusions

A less structured interview approach may yield information that would otherwise be missed in standardized assessments. Combining both sources could yield better-informed healthcare planning and quality-improvement efforts.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Wells J, Seabrook J, Stolee P, Borrie M, Knoefel F. State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment. Arch Phys Med Rehab. 2003;84:890–7. Wells J, Seabrook J, Stolee P, Borrie M, Knoefel F. State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment. Arch Phys Med Rehab. 2003;84:890–7.
2.
Zurück zum Zitat Hjar E, Cafiero A, Hanlon J. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:345–51.CrossRef Hjar E, Cafiero A, Hanlon J. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:345–51.CrossRef
3.
Zurück zum Zitat Stuck A, Aronow H, Steiner A, Alessi C, Bula C, Gold M, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. New Engl J Med. 1995;333:1184–9.CrossRefPubMed Stuck A, Aronow H, Steiner A, Alessi C, Bula C, Gold M, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. New Engl J Med. 1995;333:1184–9.CrossRefPubMed
4.
Zurück zum Zitat Gray L, Berg K, Fries BE, Henrard JC, Hirdes JP, Steel K, et al. Sharing clinical information across care settings: the birth of an integrated assessment system. BMC Health Serv Res. 2009;. doi:10.1186/1472-6963-9-71. Gray L, Berg K, Fries BE, Henrard JC, Hirdes JP, Steel K, et al. Sharing clinical information across care settings: the birth of an integrated assessment system. BMC Health Serv Res. 2009;. doi:10.​1186/​1472-6963-9-71.
5.
Zurück zum Zitat Stuck A, Siu A, Wieland G, Adams J, Rubenstein L. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342:1032–6.CrossRefPubMed Stuck A, Siu A, Wieland G, Adams J, Rubenstein L. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342:1032–6.CrossRefPubMed
6.
Zurück zum Zitat Filipovych R, Resnick S, Davatzikos C. Understanding heterogeneity in normal older adult populations via clustering of longitudinal data. In: Proc IEEE Int Symp Biomed Imaging; 2011. pp. 1101–4. Filipovych R, Resnick S, Davatzikos C. Understanding heterogeneity in normal older adult populations via clustering of longitudinal data. In: Proc IEEE Int Symp Biomed Imaging; 2011. pp. 1101–4.
7.
Zurück zum Zitat Lauver DR, Gross J, Ruff C, Wells TJ. Patient-centered interventions: implications for incontinence. Nurs Res. 2004;53(6):S30–5.CrossRefPubMed Lauver DR, Gross J, Ruff C, Wells TJ. Patient-centered interventions: implications for incontinence. Nurs Res. 2004;53(6):S30–5.CrossRefPubMed
9.
Zurück zum Zitat Kidd D, Stewart G, Baldry J, Johnson J, Rossiter D, Petruckevitch A, et al. The functional independence measure: a comparative validity and reliability study. Disabil Rehabil. 1995;17:10–4.CrossRefPubMed Kidd D, Stewart G, Baldry J, Johnson J, Rossiter D, Petruckevitch A, et al. The functional independence measure: a comparative validity and reliability study. Disabil Rehabil. 1995;17:10–4.CrossRefPubMed
10.
Zurück zum Zitat Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil. 1996;77:1226–32.CrossRefPubMed Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil. 1996;77:1226–32.CrossRefPubMed
11.
Zurück zum Zitat Granger CV, Hamilton BB, Linacre JM, Heinemann AW, Wright BD. Performance profiles of the functional independence measure. Am J Phys Med Rehabil. 1993;72:84–9.CrossRefPubMed Granger CV, Hamilton BB, Linacre JM, Heinemann AW, Wright BD. Performance profiles of the functional independence measure. Am J Phys Med Rehabil. 1993;72:84–9.CrossRefPubMed
12.
Zurück zum Zitat Paolinelli C, Gonzalez P, Doniez ME, Donoso T, Salinas V. Instrument for the functional evaluation of disability rehabilitation: study on the reliability and clinical experience with the use of functional independence measure. Rev Med Chil. 2001;129:23–31.CrossRefPubMed Paolinelli C, Gonzalez P, Doniez ME, Donoso T, Salinas V. Instrument for the functional evaluation of disability rehabilitation: study on the reliability and clinical experience with the use of functional independence measure. Rev Med Chil. 2001;129:23–31.CrossRefPubMed
13.
Zurück zum Zitat Corrigan JD, Smith-Knapp K, Granger CV. Validity of the functional independence measure for persons with traumatic brain injury. Arch Phys Med Rehabil. 1997;78:828–34.CrossRefPubMed Corrigan JD, Smith-Knapp K, Granger CV. Validity of the functional independence measure for persons with traumatic brain injury. Arch Phys Med Rehabil. 1997;78:828–34.CrossRefPubMed
14.
Zurück zum Zitat Hamilton BB, Laughlin JA, Fielder RC, Granger CV. Inter-rater reliability of the 7-level functional independence measure (FIM). Scand J Rehabil Med. 1994;26:115–9.PubMed Hamilton BB, Laughlin JA, Fielder RC, Granger CV. Inter-rater reliability of the 7-level functional independence measure (FIM). Scand J Rehabil Med. 1994;26:115–9.PubMed
15.
Zurück zum Zitat Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger CV. Relationships between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil. 1993;74:566–73.CrossRefPubMed Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger CV. Relationships between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil. 1993;74:566–73.CrossRefPubMed
16.
Zurück zum Zitat Morris JN, Fries BE, Steel K, Ikegami N, Bernabei R, Carpenter GI, et al. Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc. 1997;45(8):1017–24.CrossRefPubMed Morris JN, Fries BE, Steel K, Ikegami N, Bernabei R, Carpenter GI, et al. Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc. 1997;45(8):1017–24.CrossRefPubMed
17.
Zurück zum Zitat Hirdes J, Ljunggren G, Morris J, Frijters D, Soveri HF, Gray L, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8:277.CrossRefPubMedPubMedCentral Hirdes J, Ljunggren G, Morris J, Frijters D, Soveri HF, Gray L, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8:277.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Hirdes JP, Fries BE, Morris J, Steel K, Mor V, Frijters DH, et al. Integrated health information systems based on the RAI/MDS series of instruments. Healthc Manage Forum. 1999;12:30–40.CrossRefPubMed Hirdes JP, Fries BE, Morris J, Steel K, Mor V, Frijters DH, et al. Integrated health information systems based on the RAI/MDS series of instruments. Healthc Manage Forum. 1999;12:30–40.CrossRefPubMed
19.
Zurück zum Zitat Morris JN, Fries BE, Bernabei R, Steel RK, Ikegami N, Carpenter GI, et al. RAI—Home Care (RAI-HC) assessment manual for version 2.0. Boston, MA: interRAI; 1999. Morris JN, Fries BE, Bernabei R, Steel RK, Ikegami N, Carpenter GI, et al. RAI—Home Care (RAI-HC) assessment manual for version 2.0. Boston, MA: interRAI; 1999.
21.
Zurück zum Zitat Toscan J, Mairs K, Hinton S, Stolee P. Integrated transitional care: patient, informal caregiver and health care provider perspectives on care transitions for older persons with hip fracture. Int J Integr Care. 2012;12:e13.CrossRefPubMedPubMedCentral Toscan J, Mairs K, Hinton S, Stolee P. Integrated transitional care: patient, informal caregiver and health care provider perspectives on care transitions for older persons with hip fracture. Int J Integr Care. 2012;12:e13.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Toscan J, Manderson B, Santi S, Stolee P. “Just another fish in the pond”: the transitional care experience of a hip fracture patient. Int J Integr Care. 2013;13:e023.CrossRefPubMedPubMedCentral Toscan J, Manderson B, Santi S, Stolee P. “Just another fish in the pond”: the transitional care experience of a hip fracture patient. Int J Integr Care. 2013;13:e023.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Johnson H, Forbes D, Egan M, Elliott J, Stolee P, Chesworth BM, the InfoRehab Team. Hip fracture care in rural Southwestern Ontario: an ethnographic study of patient transitions and physiotherapy handoffs. Physiother Can. 2013;65:266–75. Johnson H, Forbes D, Egan M, Elliott J, Stolee P, Chesworth BM, the InfoRehab Team. Hip fracture care in rural Southwestern Ontario: an ethnographic study of patient transitions and physiotherapy handoffs. Physiother Can. 2013;65:266–75.
24.
Zurück zum Zitat Sims-Gould J, Byrne K, Hicks E, Khan K, Stolee P. Examining, “success” in post-hip fracture care transitions: a strengths based approach. J Interprof Care. 2012;26:205–11.CrossRefPubMed Sims-Gould J, Byrne K, Hicks E, Khan K, Stolee P. Examining, “success” in post-hip fracture care transitions: a strengths based approach. J Interprof Care. 2012;26:205–11.CrossRefPubMed
25.
Zurück zum Zitat Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.CrossRefPubMed Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.CrossRefPubMed
26.
Zurück zum Zitat Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;65:105–12.CrossRef Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;65:105–12.CrossRef
27.
Zurück zum Zitat Harris M. Evaluating public and community health programs. San Francisco: Jossey-Bass; 2010. Harris M. Evaluating public and community health programs. San Francisco: Jossey-Bass; 2010.
28.
Zurück zum Zitat Glenny C, Stolee P. Comparing the Functional Independence Measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature. BMC Geriatr. 2009;9:52.CrossRefPubMedPubMedCentral Glenny C, Stolee P. Comparing the Functional Independence Measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature. BMC Geriatr. 2009;9:52.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Wellens NS, Deschodt M, Flamaing J, Moons P, Boonen S, Boman X, et al. First-generation versus third-generation comprehensive geriatric assessment instruments in the acute hospital setting a comparison of the Minimum Geriatric Screening Tools (MGST) and the interRAI Acute Care (interRAI AC). J Nutr Health Aging. 2011;15:638–44.CrossRefPubMed Wellens NS, Deschodt M, Flamaing J, Moons P, Boonen S, Boman X, et al. First-generation versus third-generation comprehensive geriatric assessment instruments in the acute hospital setting a comparison of the Minimum Geriatric Screening Tools (MGST) and the interRAI Acute Care (interRAI AC). J Nutr Health Aging. 2011;15:638–44.CrossRefPubMed
32.
Zurück zum Zitat Berg K, Finne-Soveri H, Teare G, Gray L, Henrard JC, Hirdes J, et al. Relationship between interRAI HC and the ICF: opportunity for operationalizing the ICF. BMC Health Serv Res. 2009;9:47.CrossRefPubMedPubMedCentral Berg K, Finne-Soveri H, Teare G, Gray L, Henrard JC, Hirdes J, et al. Relationship between interRAI HC and the ICF: opportunity for operationalizing the ICF. BMC Health Serv Res. 2009;9:47.CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Cagle JG, Munn JC. Long-distance caregiving: a systematic review of the literature. J Gerontol Soc Work. 2012;55:682–707.CrossRefPubMed Cagle JG, Munn JC. Long-distance caregiving: a systematic review of the literature. J Gerontol Soc Work. 2012;55:682–707.CrossRefPubMed
34.
Zurück zum Zitat Demiris G, Oliver DR, Hensel B, Dickey G, Rantz M, Skubic M. Use of videophones for distant caregiving: an enriching experience for families and residents in long-term care. J Geontol Nurs. 2008;34:50–5.CrossRef Demiris G, Oliver DR, Hensel B, Dickey G, Rantz M, Skubic M. Use of videophones for distant caregiving: an enriching experience for families and residents in long-term care. J Geontol Nurs. 2008;34:50–5.CrossRef
37.
Zurück zum Zitat Elliott J, Forbes D, Chesworth BM, Ceci D, Stolee P. Information sharing with rural family caregivers during care transitions of hip fracture patients. Int J Integr Care. 2014;14:16. Elliott J, Forbes D, Chesworth BM, Ceci D, Stolee P. Information sharing with rural family caregivers during care transitions of hip fracture patients. Int J Integr Care. 2014;14:16.
38.
Zurück zum Zitat McNeil H, Elliott J, Stolee P, Heckman G, Boscart V. Integration through engagement: a movement towards older adults’ involvement in health care research, planning and decision making. Int J Integr Care. 2014; Annual Conf Suppl: URN:NBN:NL:UI:10-1-116167. McNeil H, Elliott J, Stolee P, Heckman G, Boscart V. Integration through engagement: a movement towards older adults’ involvement in health care research, planning and decision making. Int J Integr Care. 2014; Annual Conf Suppl: URN:NBN:NL:UI:10-1-116167.
39.
Zurück zum Zitat Elliott J, McNeil H, Stolee P. Engaging older adults in health care decision-making: key findings and recommendations from the CHOICE knowledge synthesis project. Int J Integr Care. 2014; WCIC Conf Suppl: URN:NBN:NL:UI:10-1-116616. Elliott J, McNeil H, Stolee P. Engaging older adults in health care decision-making: key findings and recommendations from the CHOICE knowledge synthesis project. Int J Integr Care. 2014; WCIC Conf Suppl: URN:NBN:NL:UI:10-1-116616.
40.
Zurück zum Zitat Jin J, Skylar GE. Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: a review from the patient’s perspective. Ther Clin Risk Manag. 2008;4:269–86.CrossRefPubMedPubMedCentral Jin J, Skylar GE. Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: a review from the patient’s perspective. Ther Clin Risk Manag. 2008;4:269–86.CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Wellens NIH, Flamain J, Moons P, Deschodt M, Boonen S, Milisen K. Translation and adaptation of the interRAI suite to local requirements in Belgian hospitals. BMC Geriatr. 2012;12:53.CrossRefPubMedPubMedCentral Wellens NIH, Flamain J, Moons P, Deschodt M, Boonen S, Milisen K. Translation and adaptation of the interRAI suite to local requirements in Belgian hospitals. BMC Geriatr. 2012;12:53.CrossRefPubMedPubMedCentral
43.
Zurück zum Zitat Lundgren-Nilsson Å, Grimby G, Ring H, Tesio L, Lawton G, Slade A, et al. Cross-cultural validity of functional independence measure items in stroke: a study using Rasch analysis. J Rehabil Med. 2005;37:23–31.CrossRefPubMed Lundgren-Nilsson Å, Grimby G, Ring H, Tesio L, Lawton G, Slade A, et al. Cross-cultural validity of functional independence measure items in stroke: a study using Rasch analysis. J Rehabil Med. 2005;37:23–31.CrossRefPubMed
44.
Zurück zum Zitat Lawton G, Lundgren-Nilsson Å, Biering-Sørensen Tesio L, Slade A, Penta M, et al. Cross-cultural validity of FIM in spinal cord injury. Spinal Cord. 2015;44:746–52.CrossRef Lawton G, Lundgren-Nilsson Å, Biering-Sørensen Tesio L, Slade A, Penta M, et al. Cross-cultural validity of FIM in spinal cord injury. Spinal Cord. 2015;44:746–52.CrossRef
45.
Zurück zum Zitat Ceci C. ‘What she says she needs doesn’t make a lot of sense’: seeing and knowing in a field study of home-care case management. Nurs Philos. 2006;7(2):90–9.CrossRefPubMed Ceci C. ‘What she says she needs doesn’t make a lot of sense’: seeing and knowing in a field study of home-care case management. Nurs Philos. 2006;7(2):90–9.CrossRefPubMed
46.
Zurück zum Zitat Deshpande P, Rajan S, Sudeepthi BL. Abdul Nazir CP. Patient reported outcomes: a new era in clinical medicine. Perspect. Clin Res. 2011;2:137–44. Deshpande P, Rajan S, Sudeepthi BL. Abdul Nazir CP. Patient reported outcomes: a new era in clinical medicine. Perspect. Clin Res. 2011;2:137–44.
Metadaten
Titel
The Rest of the Story: A Qualitative Study of Complementing Standardized Assessment Data with Informal Interviews with Older Patients and Families
verfasst von
Claire Lafortune
Jacobi Elliott
Mary Y. Egan
Paul Stolee
Publikationsdatum
01.04.2017
Verlag
Springer International Publishing
Erschienen in
The Patient - Patient-Centered Outcomes Research / Ausgabe 2/2017
Print ISSN: 1178-1653
Elektronische ISSN: 1178-1661
DOI
https://doi.org/10.1007/s40271-016-0193-9

Weitere Artikel der Ausgabe 2/2017

The Patient - Patient-Centered Outcomes Research 2/2017 Zur Ausgabe