Measuring what matters: A proposal for reframing how we evaluate and improve experience in healthcare

The conversation on measuring experience has been a long and thoughtful one. It has reflected a dynamic tension between measures used as a lever for action in some health systems and as a mechanism to determine reimbursable dollars in others. Yet underlying all the conversation, the question of what we measure, to what end we measure and what truly matters to those who experience care remains. Through a series of conversations over the last two years senior experience leaders across healthcare organizations determined it is time to assess the current landscape of patient experience measurement, to acknowledge what the existing system of measurement has inspired in effort and outcomes and to look forward to what could really make a difference in providing actionable insight and sustainable improvement in the future. While there are policy requirements for what organizations measure and report along with financial implications, this need not be the universal means by which patient feedback is captured and issues are addressed. This is paralleled by a global call for a clear, simple, comparable and actionable system of measurement to both understand and improve experience efforts in healthcare. This article reflects those conversations and frames the opportunity we have. It acknowledges all that the current system of measurement has helped us do, offers a new view on what measurement can be and presents a call to action to convene a diverse range of voices to shape experience measurement for the future. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Examination of Protein Quantity and Protein Distribution across the Day on Ad Libitum Carbohydrate and Fat Intake in Overweight Women

BACKGROUND: The effects of meal-specific protein quantity and protein distribution throughout the day on daily food intake are relatively unknown. OBJECTIVES: The aims were to test 1) whether the consumption of higher-protein (HP) compared with normal-protein (NP) meals consumed at each eating occasion reduce free-living, daily carbohydrate and fat intakes in overweight women during energy balance conditions and 2) whether the distribution of protein consumed throughout the day affects food intake outcomes. METHODS: Seventeen women [mean ± SEM age: 33 ± 1 y; body mass index (in kg/m2): 27.8 ± 0.1] completed the following tightly controlled, crossover design study. Participants were provided with and randomly consumed three 6-d eucaloric diets containing NP or HP (15% or 25% of energy as protein, respectively). The protein content within the NP diet used an even distribution pattern (EVEN; 21 ± 1 g protein/meal) throughout the day, whereas the protein contents within the HP diets used either EVEN (35 ± 1 g protein/meal) or an uneven distribution pattern (UNEVEN; 19 ± 1 g protein/breakfast, 26 ± 1 g protein/lunch, 63 g protein/dinner). On day 7 of each diet, the participants were asked to consume the diet-specific absolute protein quantity (in grams) at each eating occasion but were provided with a surplus of carbohydrate- and fat-rich foods to consume, ad libitum, during each eating occasion. RESULTS: Eating more protein (HP compared with NP) or evenly distributing protein throughout the day (HP-EVEN compared with HP-UNEVEN) did not reduce the consumption of ad libitum fat- and carbohydrate-rich foods throughout the day (NP-EVEN: 2850 ± 240 kcal/d; HP-EVEN: 2910 ± 240 kcal/d; HP-UNEVEN: 3160 ± 200 kcal/d). Despite the lack of differences in daily energy intake, the breakfast meal within the HP-EVEN diet led to lower ad libitum carbohydrate and fat intakes than the breakfast meals in the NP-EVEN and HP-UNEVEN diet conditions (P < 0.05). CONCLUSION: Providing 30 g protein/meal at each eating occasion throughout the day did not influence free-living, daily intake of highly palatable, carbohydrate- and fat-rich foods in overweight women. This trial was registered at clinicaltrials.gov as NCT02614729

Examination of Protein Quantity and Protein Distribution across the Day on Ad Libitum Carbohydrate and Fat Intake in Overweight Women

BACKGROUND: The effects of meal-specific protein quantity and protein distribution throughout the day on daily food intake are relatively unknown. OBJECTIVES: The aims were to test 1) whether the consumption of higher-protein (HP) compared with normal-protein (NP) meals consumed at each eating occasion reduce free-living, daily carbohydrate and fat intakes in overweight women during energy balance conditions and 2) whether the distribution of protein consumed throughout the day affects food intake outcomes. METHODS: Seventeen women [mean ± SEM age: 33 ± 1 y; body mass index (in kg/m2): 27.8 ± 0.1] completed the following tightly controlled, crossover design study. Participants were provided with and randomly consumed three 6-d eucaloric diets containing NP or HP (15% or 25% of energy as protein, respectively). The protein content within the NP diet used an even distribution pattern (EVEN; 21 ± 1 g protein/meal) throughout the day, whereas the protein contents within the HP diets used either EVEN (35 ± 1 g protein/meal) or an uneven distribution pattern (UNEVEN; 19 ± 1 g protein/breakfast, 26 ± 1 g protein/lunch, 63 g protein/dinner). On day 7 of each diet, the participants were asked to consume the diet-specific absolute protein quantity (in grams) at each eating occasion but were provided with a surplus of carbohydrate- and fat-rich foods to consume, ad libitum, during each eating occasion. RESULTS: Eating more protein (HP compared with NP) or evenly distributing protein throughout the day (HP-EVEN compared with HP-UNEVEN) did not reduce the consumption of ad libitum fat- and carbohydrate-rich foods throughout the day (NP-EVEN: 2850 ± 240 kcal/d; HP-EVEN: 2910 ± 240 kcal/d; HP-UNEVEN: 3160 ± 200 kcal/d). Despite the lack of differences in daily energy intake, the breakfast meal within the HP-EVEN diet led to lower ad libitum carbohydrate and fat intakes than the breakfast meals in the NP-EVEN and HP-UNEVEN diet conditions (P < 0.05). CONCLUSION: Providing 30 g protein/meal at each eating occasion throughout the day did not influence free-living, daily intake of highly palatable, carbohydrate- and fat-rich foods in overweight women. This trial was registered at clinicaltrials.gov as NCT02614729

Process evaluation of a technology-delivered screening and brief intervention for substance use in primary care

Psychotherapy process research examines the content of treatment sessions and their association with outcomes in an attempt to better understand the interactions between therapists and clients, and to elucidate mechanisms of behavior change. A similar approach is possible in technology-delivered interventions, which have an interaction process that is always perfectly preserved and rigorously definable. The present study sought to examine the process of participants' interactions with a computer-delivered brief intervention for drug use, from a study comparing computer- and therapist-delivered brief interventions among adults at two primary health care centers in New Mexico. Specifically, we sought to describe the pattern of participants' (N = 178) choices and reactions throughout the computer-delivered brief intervention, and to examine associations between that process and intervention response at 3-month follow-up. Participants were most likely to choose marijuana as the first substance they wished to discuss (n = 114, 64.0%). Most participants indicated that they had not experienced any problems as a result of their drug use (n = 108, 60.7%), but nearly a third of these (n = 32, 29.6%) nevertheless indicated a desire to stop or reduce its use; participants who did report negative consequences were most likely to endorse financial or relationship concerns. However, participant ratings of the importance of change or of the helpfulness of personalized normed feedback were unrelated to changes in substance use frequency. Design of future e-interventions should consider emphasizing possible benefits of quitting rather than the negative consequences of drug use, and—when addressing consequences—should consider focusing on the impacts of substance use on relationship and financial aspects. These findings are an early but important step toward using process evaluation to optimize e-intervention content

A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol.

BACKGROUND: Substance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services. METHODS/DESIGN: Each of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two implementation intervention components together would be more likely than staff training alone to improve the process of referring opioid- and alcohol-dependent adults under community supervision to appropriate addiction pharmacotherapy. Outcomes were measured at the client (referrals), line staff (attitudes), and organizational (linkage) levels. DISCUSSION: Through closer collaboration among criminal justice agencies and treatment providers, improved linkages to effective substance abuse treatment should yield significant clinical, public health and public safety benefits