Biomedical subjects

Carol Edwards

Publications and source records attributed to Carol Edwards.

6 recordsLinked to original sources

PubMed2005

Patterns of unit and item nonresponse in the CAHPS Hospital Survey.

OBJECTIVE: To examine the predictors of unit and item nonresponse, the magnitude of nonresponse bias, and the need for nonresponse weights in the Consumer Assessment of Health Care Providers and Systems (CAHPS) Hospital Survey. METHODS: A common set of 11 administrative variables (41 degrees of freedom) was used to predict unit nonresponse and the rate of item nonresponse in multivariate models. Descriptive statistics were used to examine the impact of nonresponse on CAHPS Hospital Survey ratings and reports. RESULTS: Unit nonresponse was highest for younger patients and patients other than non-Hispanic whites (p<.001); item nonresponse increased steadily with age (p<.001). Fourteen of 20 reports of ratings of care had significant (p<.05) but small negative correlations with nonresponse weights (median -0.06; maximum -0.09). Nonresponse weights do not improve overall precision below sample sizes of 300-1,000, and are unlikely to improve the precision of hospital comparisons. In some contexts, case-mix adjustment eliminates most observed nonresponse bias. CONCLUSIONS: Nonresponse weights should not be used for between-hospital comparisons of the CAHPS Hospital Survey, but may make small contributions to overall estimates or demographic comparisons, especially in the absence of case-mix adjustment.

Adolescent↗

PubMed2004

Investigation of the ways in which patients' reports of their satisfaction with healthcare are constructed.

A characteristic feature of patient satisfaction research is the consistently high level of satisfaction recorded. More reliable and relevant inquiry tools are constantly being developed, but underlying psychological and social pressures that could promote such a consistent and undiscriminating response have been little investigated. Williams et al. (1998) explored the phenomenon and concluded that, by considering issues of duty and culpability, patients could make allowances for poor care, and avoid evaluating it negatively. Their study was in community mental health. This study follows up their work within elective orthopaedic surgery, and investigates the pressures promoting such apparent transformation of opinion. Using a longitudinal design, and in-depth qualitative interviews, the patient's process of reflection was explored. Three psycho-social pressures were identified that appear to work together to make the transformation of opinion almost the default process. They are: the relative dependency of patients within the healthcare system; their need to maintain constructive working relationships with those providing their care; and their general preference for holding a positive outlook. It is suggested that, while it is the patient's prerogative to re-interpret the quality of their care positively, it is not the prerogative of the inquirer to accept this re-interpretation as representative of the patient's experience. Methods of inquiry are needed which access something of patients' development of opinion, and thereby something of their initial, often more negative, untransformed responses to their healthcare experiences.

Adult↗

PubMed2003

Research into patients' perspectives: relevance and usefulness of phenomenological sociology.

BACKGROUND: The dominant epistemology underpinning much inquiry in the field of patient evaluation of health care is positivist, with categorization and quantification being high priorities, despite the highly personal and dynamic nature of people's responses to their health care experiences. The mis-match between underpinning theoretical assumptions and the nature of the subject under investigation has led to ineffectiveness in much current inquiry into patients' perspectives. More needs to be learnt about patients' processes of evaluation prior to any summary assessment of the quality of their care. AIMS: This paper documents the search for a close fit between a study's research questions and a theoretical perspective with which to underpin the research. It describes the benefits of identifying a specifically relevant perspective, in this case phenomenological sociology, and discusses the potential of that particular perspective to underpin research within health care. METHODS: Research questions relating to patients' processes of evaluation were established. The possible contribution of a range of interpretative methodologies was considered. While all were relevant to some degree, phenomenological sociology was identified as having considerable specific potential to illuminate the patient's process of evaluation. FINDINGS: The particular strengths of phenomenological sociology relevant to the investigation of patients' processes of reflection are in highlighting the importance of subjectivity; its insistence on a clear link from theoretical development right back to the raw data; its wealth of evocative ideas and concepts that support the investigation of the development of interpretation; and the relatively accessible language and style of its texts. CONCLUSION: Time spent evaluating the potential contribution of different theoretical perspectives to a study is worthwhile, as a good choice can not only support but also enhance the quality of the research. Phenomenological sociology has much potential to underpin research into patient evaluation of health care and in nursing research more widely.

Attitude to Health↗

PubMed2002

A proposal that patients be considered honorary members of the healthcare team.

Most research on cross-boundary issues in healthcare focuses on boundaries between groups of healthcare professionals, or between different healthcare settings. This paper considers the boundary between healthcare professionals and their patients, as complementary providers of care to the individual. Following major surgery, patients now spend the vast majority of their rehabilitation period in their own homes. This raises questions about where to draw the boundary around a healthcare intervention, and how to allocate and support responsibility for care once the patient is home. This paper reports the findings of a study within orthopaedic surgery that followed patients from a few weeks before their surgery to 3 months afterwards, recording their interpretations of their healthcare experiences. Most patients were keen to take responsibility for playing their part in trying to optimize the outcome of their surgery, but many were frustrated by lack of information and support to allow them to fulfil this role to their satisfaction. Reconceptualization of patients as honorary members of the healthcare team may facilitate the development of a framework within which the potential contribution of patients to their own care could be valued and supported more effectively. This would contribute towards optimizing patient outcomes and increasing patient satisfaction with care.

Adolescent↗

PubMed2000

Accessing the user's perspective.

Pressure is increasing on health care providers in the UK to demonstrate that they incorporate the views of users when planning and evaluating services. Most recently this has been seen in the commissioning of the National Patients' Experiences Survey. It is timely therefore to review the progress that has been made in trying to access the user's perspective. The aim of this paper is to assist individual service providers in planning their own strategy of user involvement and evaluation, based on an awareness of the current state of knowledge in this area. It reviews the results of research in the field of patient satisfaction over the last 20 years; summarises the main problems in the area, and suggests ways forward. Three main points emerge: the importance of developing and substantiating theory in this field to support study design; the need to exercise care if using quantitative methods and global satisfaction scores, until the process of evaluation is better understood, and the need to consider how a sensitive user-led agenda can be developed. The paper calls for a pause for reflection on the reason for our inquiry into user opinion, and for careful consideration of how we might best design studies to obtain information to fulfil this inquiry.

Journal Article↗

PubMedDate not supplied

The reflective patient: intrapersonal care.

AIM: To consider the relevance and potential role of patient reflection in their overall healthcare experience. METHOD: In-depth, unstructured, qualitative interviews were conducted with 19 patients due to have elective orthopaedic surgery. A longitudinal study design was used, covering the period from a few weeks before to approximately three months after surgery. Forty five interviews were conducted in total. RESULTS: The degree to which participants expressed evidence of reflection and the nature of their reflections varied. Much reflection focused on remaining unknowns and lingering queries. Participants seemed to be trying to work towards an acceptable interpretation of their experiences. This interpretation then fed into their experience of, and responses to, their care. CONCLUSION: Intrapersonal care is suggested as a way of conceptualizing the patient's process of reflection. This complements interpersonal care given by nurses. Intrapersonal care must be well supported to realise its potential therapeutic effect.

Attitude to Health↗