Beyond satisfaction: Using the dynamics of care assessment to better understand patients' experiences in care Journal Article


Authors: Rapkin, B.; Weiss, E.; Chhabra, R.; Ryniker, L.; Patel, S.; Carness, J.; Adsuar, R.; Kahalas, W.; DeLeMarter, C.; Feldman, I.; DeLorenzo, J.; Tanner, E.
Article Title: Beyond satisfaction: Using the dynamics of care assessment to better understand patients' experiences in care
Abstract: Background: Patient perceptions of and satisfaction with care have become important indicators of the quality of services and the relationship of services to treatment outcomes. However, assessment of these indicators continues to be plagued by measurement problems, particularly the lack of variance in satisfaction data. In this article, we present a new approach to better capture patient perceptions of experiences in care, the Dynamics of Care (DoC) assessment. It is an in-depth approach to defining and assessing patients' perspectives at different junctures in care, including their decisions about whether and where to seek care, the barriers encountered, and the treatments and services received. Methods: The purpose of this article is to describe, validate, and discuss the benefits and limitations of the DoC, which was administered as part of a longitudinal study to evaluate the New York State HIV Special Needs Plan (SNP), a Medicaid managed care model for people living with HIV/AIDS. Data are from 426 study respondents across two time points. Results: The results demonstrate the validity and value of the DoC. Help seeking decisions and satisfaction with care appear to be situation-specific, rather than person-specific. However, barriers to care appear to be more cross-situational for respondents, and may be associated with clients' living situations or care arrangements. Inventories in this assessment that were designed to identify potential deterrents to help seeking and difficulties encountered in care demonstrated clear principal component structures, and helped to explain satisfaction with care. The problem resolution index was found to be independent from satisfaction with care and the data were more normally distributed. DoC data were also associated with subsequent utilization and change in quality of life. Conclusion: The DoC was designed to be aflexible, integrated measure to determine individuals' salient service needs, help seeking and experiences in care. One of the many strengths of the assessment is its focus on specific problems in context, thus providing a more sensitive and informative way to understand processes in care from the patient's perspective. This approach can be used to direct new programs and resources to the patients and situations that require them. © 2008 Rapkin et al; licensee BioMed Central Ltd.
Keywords: adult; treatment outcome; middle aged; patient satisfaction; major clinical study; united states; human immunodeficiency virus infection; quality of life; clinical assessment; health survey; validation study; health care quality; health care utilization; health service; medicaid; medicare; patient care; interviews as topic; sexuality; health status; longitudinal studies; predictive validity; outcome and process assessment (health care); interview; patient decision making; regression analysis; new york; patient attitude; health care delivery; health care planning; health care access; hiv infections; longitudinal study; sexual partners; health services needs and demand; medical fee; fee-for-service plans; health services accessibility; structured questionnaire; health care need; state health plans; aids patient; dynamics of care assessment; managed care organization
Journal Title: Health and Quality of Life Outcomes
Volume: 6
ISSN: 1477-7525
Publisher: Biomed Central Ltd  
Date Published: 2008-03-10
Start Page: 20
Language: English
DOI: 10.1186/1477-7525-6-20
PUBMED: 18331632
PROVIDER: scopus
PMCID: PMC2323370
DOI/URL:
Notes: --- - "Cited By (since 1996): 7" - "Export Date: 17 November 2011" - "Source: Scopus"
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MSK Authors
  1. Roberto Adsuar
    7 Adsuar
  2. Bruce D Rapkin
    45 Rapkin
  3. Elisa S Weiss
    7 Weiss
  4. Shilpa Patel
    3 Patel