Patient Safety and Quality
Background: Understanding and incorporating patient perspectives is an under-explored aspect of quality improvement (QI). Little is known about patient perceptions related to QI efforts despite the recognition that the patient is a critical stakeholder. We thus designed a survey to assess the baseline knowledge and attitudes of emergency department (ED) patients related to QI and test whether these were modified by underlying levels of health literacy and activation.
Methods: A 35 question survey with fixed-choice responses was developed, piloted, and iteratively refined. To test for health literacy and levels of patient activation, the survey included the validated Rapid Estimate of Adult Literacy Medicine-Short Form (REALM-SF) and the Patient Activation Measure (PAM), along with demographic information. A study coordinator then surveyed a convenience sample of English-speaking, low acuity (triage score > 2), adult (>18 years old) patients at the University of Michigan ED between June – August 2016. Descriptive statistics and regression modeling were used for analysis.
Results: A total of 191 patients were approached with 110 completing the survey. Median age of respondents was 47 (range 18-80) with a predominance of women (62%), white (73%), and higher levels of health literacy (95% at REALM-SF = 7) and activation (69% in top half of PAM scale). Only 27% were familiar with goals of QI, 30% had participated in QI, and 23% correctly answered all questions for baseline knowledge of QI principles. After learning about QI, 95% said their hospital should use QI, 81% said their health data should be shared for QI efforts, and 60% expressed strong interest in QI participation. After accounting for baseline characteristics, REALM-RF was not independently predictive of QI engagement. In contrast, PAM was independently predictive of familiarity with QI (adjusted odds ratio [OR] 1.86, 95% confidence interval [CI] 1.23-2.81), but not of participating in hospital QI efforts (OR 0.82, 95% CI 0.55-1.24).
Conclusion: We found low levels of familiarity with QI definitions and limited baseline exposure. However, patient’s expressed great interest in engaging in these efforts regardless of underlying levels of health literacy or activation.