Continuity of care lacking for maternity patients
June 1, 1998 4 minutes read
Continuity of care lacking for maternity patients
Surveys of patient experience reveal weaknesses
When women leave the hospital after having a baby, they often feel uneasy about how to care for themselves or their babies at home, according to the preliminary findings of two major patient surveys in Massachusetts and New Hampshire.
While that fact alone may not be surprising, it points up a weakness in continuity and coordination of care among different types of health care providers. And it highlights the importance of patient surveys that reflect on the continuum of care, says Gina Rogers, executive director of the Massachusetts Health Quality Partnership in Boston.
The partnership used a patient survey developed by the Picker Institute in Boston that goes far beyond traditional satisfaction questionnaires. The partnership and Foundation for Healthy Communities, a similar coalition based in Concord, NH, wanted patient experiences to guide quality improvement projects.
Among other questions, the survey asks patients if they knew what side effects their medication might have, what danger signals to look for before calling the doctor, and when to resume normal activities. Results from the surveys will be released later this year.
"One of our big priorities is to get consistent information to the patient over time," says Rogers, whose organization includes the state's hospital association, medical society, and major health plans. "What the nurse is telling you about breast-feeding may not bear any relation to what you heard back at the [doctor's] office."
Typically, satisfaction surveys ask patients to rate the technical skill of their provider, the friendliness of the staff, or their overall feeling about the practice. Because most patients are satisfied with these areas, it may not be clear what the practice should do to improve care or service.
"It's very difficult to take that [patient satisfaction] information and make it useful for physicians," says J. Lee Hargraves, PhD, senior survey scientist at The Picker Institute. "Patients can be very satisfied with poor quality care and dissatisfied with very high quality care.
"Certainly we want someone's assessment with their experience," he says. "But what's more important is descriptions of what occurred or didn't occur in the experience."
With that goal in mind, both the Massachusetts and New Hampshire maternity projects are linking survey results to a care map of processes that occur prenatally, in the hospital, and post-partum.
In Massachusetts, at least 200 surveys were mailed to a sample of maternity patients at each hospital. In a massive data collection effort, the Foundation for Healthy Communities offered a survey to every maternity patient in the state and at some hospitals in Massachusetts and Vermont. More than 8,000 of the 16,000 maternity patients in the region have responded to the questionnaires, says executive vice president Rachel Rowe, RN, MS.
Although at eight pages the surveys are lengthy, the response rate has been above 50%, she says. "Once patients see the questionnaire, they recognize that this survey is different because it asks questions about trust and confidence and much more detailed information about their experiences," she says. "They feel they are giving much more meaningful input."
Transition and continuity of care are particularly important issues in childbirth as hospitals and doctors have less time to spend with the patient due to managed care, says Hargraves.
For example, one question on the survey asks, "How confident were you that you could care for your baby?" (See sample survey, p. 71.)
"With mothers doing this for the first time, the confidence level is not there," he says. "As the mother spends less time in the hospital, the education has to occur more quickly. That was one of the reasons why we expanded the survey [from an inpatient version to include] what happened after patients left."
Although both the Massachusetts and New Hampshire projects will involve some public reporting, the surveys are geared toward internal performance improvement. Hospitals will receive results and share those with physicians. In New Hampshire, the large sample size will enable medical groups or individual physicians to look at their data.
Already, hospitals are focusing on continuity of care and transition to home, as well as other improvement projects, says Rogers.
"Every hospital is doing something to motivate for change," she says. "It's been a vehicle for hospitals to realize how important it is to listen to the patient."
Physicians also are looking forward to receiving their results, says Barry Smith, MD, chairman of obstetrics and gynecology at Dartmouth Medical School in Hanover, NH. For example, if obstetricians feel they are talking to all their patients about the dangers of alcohol and other substance abuse, but only 60% of the survey respondents recall hearing such advice, then doctors will know they're not communicating effectively, he says.
"There's going to be a whole host of quality improvement projects that are going to be obvious based on what the patients say we are or aren't doing for them," he says.
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