We Want to Know-A Mixed Methods Evaluation of a Comprehensive Program Designed to Detect and Address Patient-Reported Breakdowns in Care

摘要

Background: Patients have important insights into care experiences, including breakdowns, but are often reluctant tospeak up. The We Want to Know ( WW TK) program was designed to make it easy for hospitalized patients to speak upabout breakdowns in care and receive a response.Methods: The WWTK program was implemented from June 2014 through May 2017 at a large, community hospital inBaltimore. Core program features include (1) multiple channels for patients to report breakdowns, (2) campaign materials toincrease patient awareness of the WWTK program, and (3) a specialist to facilitate resolution of breakdowns. This programwas evaluated using mixed methods to assess the frequency and type of reported breakdowns, patient awareness of theprogram, and stakeholder perspectives.Results: WWTK specialists interviewed 4,676 patients; 822 (17.6%) reported a breakdown in care. Of these, 313 (38.1%)had not spoken with anyone at the hospital about the breakdown, and 547 (66.5%) described associated harm. There werealso 55 patient-initiated reports to WWTK; 41 (74.5%) of these reported a care breakdown. Patients had not spoken withanyone at the hospital in 12 (29.3%) patient-initiated cases; 38 (92.7%) described associated harm. Hospital stakeholdersfound the level of detail and timeliness of reports to be helpful.Conclusion: Active outreach to hospitalized patients detects substantially more breakdowns in care than patient-initiatedreporting. Both approaches identify breakdowns that are consequential to patients and provide opportunities to respond toindividual patients.