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A feasibility study of an automated practice-based survey

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1 A feasibility study of an automated practice-based survey
Sharon Johnston, Sabrina Wong, Fred Burge, William Hogg North American Primary Care Research Group Annual Conference Montreal, QC November 18, 2017 MEASURING AND IMPROVING THE PERFORMANCE OF PRIMARY HEALTH CARE IN CANADA

2 Challenge: sustainable patient experience data collection
Study objective: demonstrate the feasibility and acceptability of an automated patient survey system (adopted from an existing automated appointment reminder system)

3 Methods Setting: Three Canadian health regions in BC, ON, & NS
Recruitment: Patients completing paper-based waiting room survey at their practices (n=87 practices) Automated survey 5 questions administered within 72 hours of patient visit Offered in English/French and phone/ formats Outcomes Response rates: mode, age group, gender, & income Concordance between paper and APS survey responses

4 Automated Survey Questions
How good was your family doctor or nurse at giving you enough time? How good was your family doctor or nurse at explaining tests and treatments? Does your family doctor or nurse tell you about side effects you might get from a medicine? Were there times when the person you were seeing did not know about changes in your treatment plan that another person recommended? Were there times when the person you were seeing did not have access to your recent tests or exam results?

5 APS Respondents & Mode Preference
Eligible to participate 1929 Number of who consented 871 (56%) Mode preference: 606 (69.6%) Phone 265 (30.4%) Response rate (55.6%) Completion rate* (% of those who responded to APS survey) 470 (97.1%) Note: *surveys were complete if participants answered 5/5 questions APS Respondents Mode Preference n (%) n(%) Phone Eligible to participate 1929 Consented to participate 871 606 (69.6%) 265 (30.4%) Response rate 484 (55.6%) Completion rate* (% of those who agreed to APS survey) 470 (97.1%) 369 (60.9%) 101 (38.1%)

6 APS Respondents & Mode Preference
Phone n (%) n (%) 18-24 years 3 (10.3%) 26 (89.7%) 25-64 years 133 (24.1%) 420 (75.9%) 65-74 years 78 (42.2%) 107 (57.8%) 75+ years 45 (53.6%) 39 (46.4%) Male 101 (38.5%) 161 (61.5%) Female 154 (26.5%) 427 (73.5%) Transgender -- Income < $20K 50 (44.2%) 63 (55.8%) Income $20K - $40K 64 (38.8%) 101 (61.2%) Income $40K - $60K 47 (29.0%) 115 (71.0%) Income $60K - $100K 43 (20.9%) 163 (79.1%) Income $100K + 23 (16.9%) 113 (83.1%) 0 or 1 chronic conditions 43 (17.8%) 199 (82.2%) 2 chronic conditions 42 (33.3%) 84 (66.7%) 3 or more chronic conditions 170 (35.8%) 305 (64.2%) Respondents significantly preferred over phone for all age groups, except for those aged 75+

7 APS Completion Rates Significantly better completion rates among responders for: Age groups years and 75+ years Sexes For most income groups For all chronic conditions Completed APS Phone n (%) Overall 101 (38.1%) 369 (60.9%) 18-24 years 0 (0%) 11 (42.3%) 25-64 years 50 (37.6%) 263 (62.6%) 65-74 years 35 (44.9%) 62 (57.9%) 75+ years 12 (26.7%) 25 (64.1%) Male 28 (27.7%) 97 (60.2%) Female 68 (44.2%) 262 (61.4%) Transgender - < $20K 23 (46%) 29 (46%) $20K - $40K 23 (35.9%) 58 (57.4%) $40K - $60K 18 (38.3%) 74 (64.3%) $60K - $100K 16 (37.2%) 108 (66.3%) $100K + 10 (43.5%) 73 (64.6%) 0-1 chronic conditions 12 (27.9%) 115 (57.8%) 2 chronic conditions 14 (33.3%) 48 (57.1%) 3+ chronic conditions 71 (41.8%) 197 (64.6%)

8 Agreement between paper and APS responses
Question % Concordant Weighted Kappa (quadratic) Given enough time 75.8% 0.52 Explained tests and treatments 72.8% 0.45 Told about potential side effects from medications 72.5% 0.53 Times when provider didn’t have access to recent tests or exam results 57.1% 0.12 Times when provider did not know about changes in treatment plan that another person recommended 61.8% 0.16 For 3 questions, moderate concordance was seen between the waiting room paper survey and the APS Two questions saw slight agreement

9 Directionality of agreement between paper and APS
Phone More -ve % Concordant More +ve Given enough time 10.0% 64.6% 25.0% 12.0% 78.8% 9.2% Explained tests and treatments NS Told about potential side effects from medications Times when provider didn’t have access to recent tests or exam results Times when provider did not know about changes in treatment plan that another person recommended 44.2% 45.3% 10.5% 28.3% 66.1% 5.6% Mode of phone yielded more positive responses for enough time More negative responses for knowing about changes in treatment plan

10 Lessons learned Automated survey is feasible
Language preference easy to incorporate response rates appear significantly better than phone Age and income differences in vs phone preference as well as response rates Potential mode effects

11 Future directions: Direct from EMR
Deploy survey directly from EMR like appointment reminder systems or from patient registries: Deployed by preset parameters at specified times and intervals, e.g.: All or random random selection within age group If not seen in two years or missing recommended screening After visit for PHE APS linked to routine automated patient outreach: Appointment reminders Preventive care reminders

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