USING QUALITATIVE AND QUANTITATIVE PATIENT SATISFACTION DATA TO IMPROVE THE QUALITY OF CARDIAC CARE

Background: In early 1993 leaders within the Hitchcock Clinic and card iac services section at Dartmouth-Hitchcock Medical Center (Lebanon, N H) formed the Cardiac Services Improvement Group (CSIG) as a pilot pro gram for patient-centered quality improvement (QI) at the sectional le vel. CSIG program: For open heart surgery (OHS) and percutaneous trans luminal coronary angioplasty (PTCA), a flowchart was constructed of se quential patient experiences. Content analysis of focus group discussi ons resulted in six key patient-defined quality characteristics: comfo rt, caring, certainty, convenience, communication, and cost. Linking o f patient comments to points on the patient experience flowchart made it possible to determine where particular quality characteristics were most relevant A patient satisfaction survey with questions that were specific to a patient experience and to a quality characteristic was m ailed to 100 consecutively discharged OHS and PTCA patients; 35 of the 50 patients in each group responded. Evaluating success: Analysis of the survey results led to the formation of two QI teams. One team bega n work on development of a critical pathway for discharge preparation and identified marker questions to track and monitor pathway success i n subsequent surveys. Another team began the development of protocols for more effective pain management during and after the PTCA procedure . A repeat patient satisfaction survey that took place from November 1 994 to March 1995 suggested a global improvement in patient satisfacti on for all patient experiences and all key quality characteristics. Co nclusion: The CSIG pilot program of patient-based quality measurement and management at the sectional level has been successful in fostering QI team formation and has been associated with a positive deflection in patient-based quality measures. Additional sections of the medical center have initiated similar projects, beginning with process definit ion and focus groups.