Presentation ESHRE Leuven 7-2-13. How to measure patientcentredness, how to benchark patientcentredness and how to improve patientcentredness.

1. Trustworthy national benchmarking for
patient-centeredness in infertility care
Prof dr Jan A.M. Kremer, gynaecologist
Radboud University Nijmegen Medical Centre
Twitter: @JKNL #ESHREinnovations
Email: j.kremer@obgyn.umcn.nl
Leuven, February 7th, 2013

2. Course objectives
• Know the definition, dimensions and importance of
patient-centred care
• Know the tools that can be used for measuring and
improving patientcentredness
• Get inspired to work in measuring and improving
patientcentredness in your own clinic

3. Don Berwick

4. Heyendael Castle, 2001

5. Paradigm shift
• Not the system should be dominant, but the patient as a
person should be dominant
• Don Berwick: ‘we should behave with
patients not as hosts in the care system
but as guests in their lives’
• Patientcentredness

6. What is patientcentredness?
• Patient-centred ART ≠ Patient-friendly ART
• False attractiveness: too positive, ART and infertility is not friendly at all
• No clear definition: could be used for any less invasive form of ART
• Commercial incentives: can be used to prevent drop-outs and to increase
the turnover of cycles and medication
• More than just being nice to patients
• Patient centeredness ≠ patient satisfaction

7. What is patientcentredness?
• Focus on patient’s experiences and needs
• Institute of Medicine, 2001:
Being respectful of (and responsive to) individual patient
preferences, needs and values; and ensuring that patient
values guide all clinical decisions.

8. Dimension of quality of care
1. Safety
2. Effectiveness
3. Timeliness
4. Efficiency
5. Equity of access
6. Patient centeredness
Bengoa (WHO), 2006 and Corrigan (IOM), 2001

9. Dimensions of patient centeredness
1. Access to care
2. Respect for patient's values, preferences, needs
3. Coordination and integration of care
4. Information, communication and education
5. Physical comfort
6. Emotional support and alleviation of fear and anxiety
7. Involvement of family and friends
8. Transition and continuity

10. How to measure patientcentredness?
• If you can not measure it, you can not improve it
• Not easy, because of the fuzzy concept
• Focus groups, interviews, qualitative studies (e.g.
storytellers) and questionnaires
• Measure experiences and not satisfaction
• Focus on the eight dimensions of PCM

11. A. Group interviews

12. B. PCQ Infertility
• A national measurement instrument
• Validation study van Empel et al., Hum Reprod. 2010
• Available in Dutch and English
• Online available:
• http://humrep.oxfordjournals.org
• http://www.umcn.nl/PCQInfertility

13. Examples of questions (n=46)

14. Examples of feedback

15. PCQ scores (NL)
* Range 0 – 3

16. Quality Improvement scores
QI = Importance x (3 – Experience) * Range 0 – 9

17. C. Improvement of patientcentredness
• Quiss study (Dana Huppelschoten)
• Multifaceted approach:
1. Feedback report
(QI-scores)
2. Educational outreach visits
(team, patient, quality expert, researcher)
3. Patient-mediated interventions
(focus groups, online communities, …)

18. Cluster-randomized trial (n=32; n=1620)

19. Results of PCQ 0 (n=32)

20. Educational outreach visits (n=16)
• 82 actions: 3-7 per hospital, based on their scores
36 actions completed (May 2011)

21. Examples of improvement actions
• Patients receive a card with the name of key doctor
• Each patient will get a standard evaluation visit after
three IUI cycles
• Patients receive a scheme of the time schedule of the
treatment
• Emotional aspects will be discussed during each
evaluation consultation

22. Results will follow in 2013
• …………….
• …………….
• …………….
• …………….

23. National benchmarking
Dutch Society of Reproductive Medicine (Annemijn Aarts)
• Adopted the PCQ as indicator for patient-centredness
• Acknowledges patient-centredness as equal to other
quality measures, such as effectiveness (pregnancy
rates) and safety (twin births)
• Annual measurement of Dutch fertility clinics to
monitor and improve patientcentredness

24. www.patientervaringen-fertiliteit.nl
Clinic invites their
patients to the
questionnaire

25. Benchmark and feedback
Website generates feedback reports
• Anonymously benchmark of PCQ dimensions
• Insight on individual care scores of your own clinic
• DSRM has insight in national scores, not in individual scores

26. We want children, …how static & top-down.
but most of all we As modern care
want patient- consumers, we want more
centred care… than just being treated!