Advancing the Science

Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

April 18, 2019

Research driving improvements in the health care experience

By Elizabeth Zimmermann

Staff touchpoint meeting in ICUExperts in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery collaborate within Mayo’s medical practice to rapidly discover solutions to the most pressing problems in health care, and to find ways to improve the health care experience.

Addressing disparities in care

This experience is different for each person – be they patient, family member, care provider or hold another role. One of the things Mayo Clinic researches is disparities in care, or differences in the care received based on sex, age, race, body size and other characteristics of patients; as well as differences based on where people live, how much education they've had, and so forth.

A recent center publication in the American Journal of Surgery identifies disparities for patients having diverticulitis surgery. This surgery may be conducted by opening the abdomen, or through minimally invasive surgery. In general, minimally invasive surgery is associated with less pain, a shorter hospital stay and fewer complications.

Mayo researchers reviewed Florida inpatient discharge data for 5,857 patients with diverticulitis undergoing elective surgery between 2013 and 2015. The team found that older, sicker patients, residing in rural areas or with Medicaid insurance were less likely to receive minimally invasive surgery. The choice of surgeon affected this as well. Being treated by general surgeons who had a high volume practice or colorectal specialty-trained surgeons made it more likely that patients would receive minimally invasive surgery.

The paper reports "as expected, minimally invasive surgery is associated with decreased odds of developing a post-operative complication." However, it goes on to note that there are specific patient characteristic that reduce access to minimally invasive surgery, increasing the odds of complications.

Older, sicker patients, as well as patients who live in rural or lower income areas, or had Medicaid, were less likely to receive minimally invasive surgery. While these findings are from Florida alone, it does shine the light on a wider national problem – the need for improved access to trained and experienced surgeons.

Improving experience for ICU patients, caregivers

Another study published in Chest in March 2019 looked at patient experience in intensive care units. The research team examined whether patients and family members agreed with treatment intensity, and if there was disagreement, did it affect actual outcomes for the patient?

The team already knew from existing research that physicians and nurses delivering treatment they perceive as inappropriate are at increased risk for distress and burnout. However, until now, no one had looked at whether patient and/or family perceptions of appropriateness of treatment affected outcomes.

They collected 1,332 surveys reflecting the experience of 151 patients. These surveys were collected from patients, family members (or other patient surrogates), nurses and physicians from six adult ICUs in the U.S. and Hungary. The researchers found that for approximately one third of ICU patients there was a disagreement between the health care providers and the patient/surrogate regarding the appropriateness of treatment. This appeared substantially connect to prognostic discordance. (This refers to when patient/surrogate had different expectations as compared to the physician regarding whether and when death was imminent.)

When these mismatches in expectations occurred, patients/surrogates simultaneously reported lower satisfaction and trust of the ICU team. The researchers did not find any emerging symptoms of depression or anxiety in these patients/surrogates. However, as the paper states, "these findings highlight the importance of improving prognostic communication and understanding."

The research team recommends building and implementing collaborative decision-making processes for the ICU. These should include regular, structured communications and strive for a shared understanding of the goals of care and how to achieve those goals.

One of the Mayo Clinic Kern Center for the Science of Health Care Delivery key competencies is the center's ability to take massive amounts of data and rapidly convert that into innovative solutions to problems people find in health care. Much of this work is designed to assist physicians in decision-making, improving health care experience for both patients and providers.

Improving experience for those who care for veterans

Research into what works best for individuals in similar situations sometimes focuses on the patient, but in other projects, Mayo Clinic researchers look at what might improve experiences for the family or other caregivers of patients.

According to AARP, more than 40 million adults in the United States act as caregivers to a family member. Some 5 million of these Americans care for injured, sick or disabled veterans. These caregivers form an important part of the health care continuum for patients. Thus, protecting their health and wellbeing is as important as improving the health of their loved ones.

Another center-led study published in PLOS One, in March 2019, examined the satisfaction of family caregivers regarding inpatient care for veterans with traumatic brain injuries and polytrauma.

Using fixed information, such as caregiver and care recipient demographics, and details of care recipients' military service and injury; along with responses to a national Veterans Administration-led Family and Caregiver Experience survey, the research team hoped to identify caregiver subgroups who would benefit from customized interventions.

They found a majority (75%) of the 524 caregivers in the study group reported being mostly or very satisfied with their care recipient’s inpatient care. The paper states, "Higher satisfaction with inpatient care was significantly associated with greater caregiver social support, receipt of training from the VA, and perceptions of being valued by the VA."

In contrast, caregiver dissatisfaction was associated with some fixed factors such as relationship to the care recipient, but also with a number of factors that health care organizations could address. These included "lack of social support, lack of caregiver training received, and low caregiver perceptions of being valued by the health care system."

The lessons in this study could apply to the greater community of caregivers. A support network and training for family caregivers are programs that organizations can build or strengthen. Further, letting those caregivers know they are appreciated as a valuable part of the health care continuum for their family member could improve caregiver satisfaction.

NOTE: This study was a secondary analysis of de-identified data from the Family and Caregiver Experience Study. Joan Griffin, Ph.D., Robert D. and Patricia E. Kern Scientific Director for Care Experience, was the principal investigator of the parent study and a research scientist at the Minneapolis VA Health Care System when data were collected. The study was originally funded by a grant from the Department of Veteran Affair’s Health Services Research and Development service.

These three research papers illustrate a small percentage of the research done every day at Mayo Clinic. For more than 150 years, Mayo Clinic has pursued continuous improvements in health and health care delivery. Since our beginning, we have collected, organized and analyzed patient health care data as well as global health care knowledge to build the evidence base for best practices and personalized care.

Visit the websites for more information about Mayo Clinic Research and Education – the driving forces behind our ability to provide the best possible care for patients.


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Tags: care transitions, caregivers, Center for the Science of Health Care Delivery, health disparities, ICU, intensive care unit, minimally invasive surgery, News, patient experience, shared decision making, veterans

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