Integrated care seen through the eyes of patients: PREM integrated care
Healthcare needs to become more sustainable. We can achieve this by organizing health care according to the Triple Aim and Value Based Health Care principles, in other words: value-based care.
If we want to bring this into practice, we need a clear picture of the current fragmentation of health care and of what the bottlenecks are. This means we need to follow the people that are directly involved in healthcare: the patient. Validated questionnaires, so-called PREMs, are very suitable for this.
Value based care, Triple Aim and the Rainbow model
Healthcare will need to change drastically in the coming years. Populations across the globe are aging, which leads to more complex health care demands and higher costs. Value based care is a good way to take on these challenges. The central focus is the Triple Aim: better experienced care, better health and lower costs. Value based care aims to fulfil these three objectives.
To achieve this, we need to gain insight into all the levels of care and the cooperations between them, also called coordinated care or integrated care. The Rainbow model gives an overview of what is needed to achieve value based care. All levels that affect the quality, health and cost outcomes are integrated.
The micro level presents the level of care for one individual. The meso level reflects the coordination of care between professionals and/or organizations. The macro level relates to laws and regulations around the health care system.
The Rainbow Model provides a theory which underpins how integrated care efforts (clinical, professional, organizational and system) act at different levels (micro, meso and macro) and can be perceived from multiple stakeholder perspectives (patients, professionals, managers and policymakers) in order to achieve the Triple Aim.
Fragmentation of healthcare
If we look at healthcare, it is highly fragmented. Health care providers are stuck in their own niche or specialism. Cooperation with other professionals, industries or organizations are generally non-existent.
This is especially apparent for patients that need multiple specialists due to multiple complex chronic diseases. They have to endure unnecessary examinations and different specialists sometimes perform the same exams. The consequences: double treatments, unnecessarily high healthcare costs and even more importantly: negative patient experiences.
To achieve value-based healthcare, we need to fight this fragmentation. For that, we need the help of patients and healthcare providers.
Through the patients eyes
Patients can point out the bottlenecks and areas of improvement within the healthcare sector. They are the only ones who are present during every step of their (dis)connected journey through the healthcare system, giving them a unique perspective. They are considered the best judges of whether they receive an integrated care trajectory.
Patient experience measures should be derived from validated survey questionnaires, which are also called ‘patient-reported experience measures’ (PREM). At the same time, a thorough evaluation of an integrated care approach should also take into account all levels and stakeholder perspectives, as described by the Rainbow Model.
The experience of patients is considered the key to improving quality of care
Available health system performance assessment tools, unfortunately, do not contain representative integrated care indicators. Consequently, having standardized, validated instruments that measure patients’ as well as providers’ perceptions of integrated care are increasingly recognized as essential quality assessment efforts.
For example, assessing integrated care through the patients’ and healthcare providers’ eyes can provide powerful insight into the strengths and weaknesses of a clinic, while providing valuable insights about the performance of more comprehensive efforts to align services provided within a network. It also provides opportunities to fill wide gaps in knowledge about the extent of integration between clinics, networks and countries for benchmarking purposes.
The difference between PROMs and PREMs
Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are measures that provide a patient-centric view of healthcare.
Patients Reported Outcome Measures (PROMs) are tools used to measure so-called patient-reported outcomes (PROs). PROMs are standardized, validated questionnaires that are completed by patients to ascertain perceptions of their health status and health-related quality of life. PROMs are a means of measuring clinical effectiveness and safety.
Patient-reported experience measures (PREMs) are tools used to measure patients’ views of their experience whilst receiving care. PREMs are standardized, validated questionnaires that focus on the aspects of the care that matter to the patient. PREMs are a means of measuring the quality of care.
To sum, PROMs provide insight into the impact of an intervention on the patient, whilst PREMs provide insight into the quality of care during the intervention. The two are often used in parallel to present the patients’ perceptions of both the process and outcome of their care.
To measure is to know
Integrated care research is criticised for its methodological problems relating to its measurement. A review of 379 validation studies showed that only a few tools were reliable and valid. Moreover, it was noted that none of the proposed methods capture all domains as described by the Rainbow Model. As a result, extensive international research has been conducted to develop a validated measurement tool for assessing integrated care based on the Rainbow Model. A literature review and two international Delphi studies were conducted to develop a validated measurement tool for assessing integrated care based on the Rainbow Model, known as the Rainbow Model Measurement Tool (RMIC-MT).
The Rainbow Model patient and provider survey questionnaires have been developed as generic instruments to assess integrated care. Both instruments, which were launched in 2017, are available in 16 different languages and benefit from validation in a study representing a statistically representative survey sample of over 60,000 patient and healthcare providers. The instruments were validated in 24 countries and have shown to be valid and reliable measures to assess the degree of care integration.
The patient survey (PREM Integrated Care)
The patient survey allows the assessment of care integration experiences, including shared-decision making, patient-physician relationship, multidisciplinary collaboration, and coordination of care.
The care provider survey
The provider survey asks care providers questions about how they perceive their clinics’ ability to deliver integrated care, including needs assessment, population screening, personal care plan, referral management, multidisciplinary teamwork, interoperable medical records, and collaborative culture.
The patients’ and care providers’ scores are shown graphically in an interactive online dashboard. This allows for comparison of strengths and weaknesses at a glance.
Our study data provides a unique insight into the patients’ as well as providers’ perceptions of integration and provides solid foundations for subsequent comparative studies between clinics, organizations and countries. This provides a unique opportunity to contribute independent assessments of the performance of integrated care initiatives, and to benchmark it internationally.
Practical applicability of the PREM
For health care providers and executives in healthcare the instrument is the ultimate tool to gain insight into the way in which they experience health care in their organization. An interactive online dashboard shows the patient’s scores in a graphical way. It gives you a quick overview of all the strong and weak points in the health care process. This way you can review and compare the scores based on the practice, region and/or (partial) population. This gives some insight and concrete tools for improvement.
Want to know more?
Do you want to map out patient experience for your own health care organization? We are happy to help you employ our measuring tools. Contact us for more information. Or download our brochure about the healthcare providers’ and patients’ reported experience measure (PREM) for integrated care.