REFINEMENT AND PILOT TESTING OF A HIGHLY INNOVATIVE PROVIDER COACHING AND FEEDBACK INTERVENTION TO IMPROVE THE PATIENT HIV CARE EXPERIENCE

Baylor College Of Medicine, Houston TX

Investigators

Linked publications & trials

Abstract

Project Summary The goal of this R21 is to refine and pilot a provider coaching and feedback intervention to improve the patient care experience and ultimately retention in HIV care. HIV infects over 1.2 million people in the US. Yet, only 46% who know their status get regular HIV care. Patients who are not retained in HIV care, particularly in the first year, have more HIV-related complications and higher mortality. Few effective interventions to improve retention in care exist. Most involve frequent visits with case managers and interventionists to address unmet needs and teach skills training. The intensity in time and resources of these interventions and the need to repeat them with each new patient, make it hard to replicate outside the research setting. An urgent need exists to identify new targets for interventions that are feasible, low cost, and scalable. Our proposal uses the business model of customer satisfaction and retention as a strategic framework for improving patient experiences and retention in care. Patient experience is defined as a patient's evaluation of his or her experiences in receiving health care in a specific delivery setting. Studies show that patients with better care experiences are more likely to keep their appointments, take their medicines and have better health outcomes. Providers are a compelling target for a patient experience intervention. Patients' evaluation of their provider correlates the strongest with their overall care experience. Thus, an intervention targeting providers with even modest effects can have a large impact given the importance of the provider experience for an individual patient and the large number of patients one provider follows. A provider coaching and feedback intervention is a novel approach to improving the patient care experience. Most large firms use coaching and feedback to increase individual and organizational performance. Medicine, however, is unique in that once a provider completes training, no one directly observes his or her work or provides feedback on his or her interactions with patients. Studies on feedback in health care show that feedback, when timely, task-specific and actionable, can improve practice behavior and the quality of care. In analyzing over 130 hours of interviews with patients new to HIV care, we have identified five explicit, clearly defined communication behaviors that have the potential to greatly improve the patient care experience, and ultimately, retention in HIV care. Herein, we propose to target these five specific communication behaviors in a provider coaching and feedback intervention. Our Specific Aims are to: 1) refine and evaluate content of the intervention, using an Intervention Mapping approach, and 2) pilot test the intervention using a two-group staggered pre- post- intervention design to assess patient and provider acceptability and feasibility. This study explores a new patient-centered care- delivery model that has the potential to improve patient experiences and retention in a highly vulnerable population. An intervention to improve patient experience and outcomes has broad implications and may inform translation to other conditions that require long-term therapy and high level adherence.