Using PREMs to support patient-centred care

This report explores key findings from CIHIā€™s patient-reported experience measures (PREMs) in Canadian acute care hospitals for 2017ā€“2018 to 2020ā€“2021.

• About the CPES-IC survey
• Methodology notes (PDF)
• Frequently asked questions
• Patient experience web page

Overall Hospital Experience is a global PREM that provides information on a patientā€™s entire experience during their most recent hospital stay. Itā€™s a frequently used and important measure because we know that patients who have a better experience of care generally have better health outcomes. Conversely, a poor experience generally leads to higher care costs as patients may have poorer outcomes, require longer stays and/or be readmitted for further treatment. 

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65% of patients said that their overall hospital experience was very good.

Province	Poor	Good	Very good	Number of respondents
Nova Scotia	13%	22%	65%	2,750
New Brunswick	15%	25%	60%	5,821
Ontario	12%	24%	64%	44,848
Manitoba	14%	23%	62%	10,640
Alberta	9%	23%	67%	22,242

Note
Data years vary: Ontario, Manitoba and Alberta, 2020ā€“2021; New Brunswick, 2018ā€“2019; and Nova Scotia, 2017ā€“2018.

To understand how to improve results for the Overall Hospital Experience measure, it can help to understand what other measures are strongly associated with it. These key drivers can be a great starting point for prioritizing specific areas of patient experience for quality improvement efforts, and for enhancing the quality of care for patients.

ā€œOur health system is going through a bit of a transformation, like other provinces. Thereā€™s a performance measurement dashboard that we use on a monthly basis, and [CIHIā€™s CPES-IC] survey is reported within that,ā€ says Ales Morga with Southern ŗģĮģ½ķ¹Ļ±Ø ā€” SantĆ© Sud in Manitoba. ā€œThe focus indicator thatā€™s used is Overall Hospital Experience, and organizations are able to choose enablers that measure up to that.ā€

ŗģĮģ½ķ¹Ļ±Ø

In our region, we use the enablers that were most highly correlated [with overall experience], such as Communication With Nurses and Doctors, [which we] monitor very closely. ā€” Ales Morga, Director, Performance and Planning, Southern ŗģĮģ½ķ¹Ļ±Ø ā€” SantĆ© Sud, Manitoba

The following 3 key drivers have been identified for the Overall Hospital Experience measure. A key driver is a patient experience measure that is strongly associated with or that influences results for this measure. Key drivers can potentially be used as areas of focus when planning quality improvement initiatives. 

For more information on the methodology used in the key drivers analysis, please refer to Acute Care Patient-Reported Experience Measures ā€” Methodology Notes (PDF). 

Once an area of focus has been identified, you can compare your result with the peer group or national average, or look at trends to see whether the result has changed over time. 

To enable comparisons and benchmarking year over year, all results have been

• Sample weighted
• Non-response adjusted
• Ageā€“sex standardized
• Adjusted for mode (mail, telephone, online)
• Adjusted for service line (medical, surgical, maternity)

• Frequently asked questions
• Methodology notes (PDF)
• About the CPES-IC survey
• Patient experience web page

The following 3 key drivers have been identified for the Communication With Doctors and Communication With Nurses measures. A key driver is a patient experience measure that is strongly associated with or that influences results for these measures. Key drivers can potentially be used as areas of focus when planning quality improvement initiatives. 

For more information on the methodology used in the key drivers analysis, please refer to Acute Care Patient-Reported Experience Measures ā€” Methodology Notes (PDF). 

Key drivers: Communication With Doctors 

Received Information About Condition and Treatment

Whether patients felt they received all of the information they needed about their condition and treatment.

Internal Coordination of Care

Whether patients felt there was good communication between doctors, nurses and other hospital staff. This measure also looks at whether patients felt that hospital staff seemed informed about and up to date on their hospital care.

Communication With Nurses

Whether patients felt that nurses treated them with courtesy and respect, listened carefully to them and explained things in a way they could understand.

Key drivers: Communication With Nurses

Internal Coordination of Care

Whether patients felt there was good communication between doctors, nurses and other hospital staff. This measure also looks at whether patients felt that hospital staff seemed informed about and up to date on their hospital care.

Emotional Support

Whether patients felt they were supported and helped with any anxieties, fears or worries during their hospital stay.

Communication With Doctors

Whether patients felt that doctors treated them with courtesy and respect, listened carefully to them and explained things in a way they could understand.

The following success story is an example of how health organizations have showcased the use and value of patient experience data to drive quality improvement.

Service delivery organizations in Manitoba have access to a performance measurement dashboard that includes data for overall patient experience from CIHIā€™s Canadian Patient Experiences Survey ā€” Inpatient Care. Although this data gives an overall score for patient experience, each organization pinpoints which areas to focus on for quality improvement. 

Choosing an area of focus

To help organizations focus their improvement efforts, Southern ŗģĮģ½ķ¹Ļ±Ø ā€” SantĆ© Sud annually prepares summary reports that highlight trends from year to year, comparisons with the regional average and key drivers of the overall patient experience measure, such as Communication With Doctors and Communication With Nurses. 

ā€œWhat we found we needed to do was to create a bit of a summary of the information that our sites could then use and kind of jump off from,ā€ says Ales Morga, the director of Performance and Planning at Southern ŗģĮģ½ķ¹Ļ±Ø ā€” SantĆ© Sud. ā€œThis is so that they can understand whatā€™s going on with the data and how it links together. Instead of just focusing on the questionnaire as a whole, what we do is focus on the ones that are most highly correlated to overall experience for the region. Otherwise, itā€™s just sending them a spreadsheet. Itā€™s not very meaningful; we have found it has not been very actionable.ā€

Providing in-person demos has also helped organizations gather suggestions for improvement and develop an action plan.

ā€œWe would walk the sites through their data and give them some clues in terms of where the site is showing improvements and to be able to do that as a celebration, and then also highlight for them some of the areas for improvement that they might need to develop action plans around, especially if theyā€™re noticing trends over time,ā€ says Ms. Morga. ā€œSo itā€™s not just ā€˜Hereā€™s the data. What are you going to do about it?ā€™ā€

Implementing change

By leveraging patient experience data, Portage District General Hospital and Boundary Trails ŗģĮģ½ķ¹Ļ±Ø Centre focused on an area that highly affects the overall experience of their patients: support for anxiety and fears, which falls under Emotional Support (a key driver). 

Using a patient-centred approach, they implemented a quality improvement initiative called ā€œWhat matters to me?ā€ This is a bedside tool meant to gather information from patients on what they find is most important to them during their hospital stay.

ā€œThe staff have reported that this has really made a huge difference for them and for the care that they provide to that patient. Sometimes those conversations will lead to fears and worries, but itā€™s also just an opportunity to ask and communicate with the patient about what concerns they might have and just to get to know them a little bit better,ā€ says Ms. Morga.

This collaborative effort not only helped providers understand what aspects mattered most to patients during their hospital stay, but also nurtured valuable conversations and understanding between patients and providers.

ā€œThe biggest lesson is you can put a change inā€¦ but in order to sustain it, people have to understand why itā€™s important to the patients,ā€ says Ms. Morga.

• Methodology notes (PDF)

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55% of patients said that their own or their friendsā€™ and familyā€™s involvement in decisions about their care and treatment was very good.

Province	Poor	Good	Very good	Number of respondents
Nova Scotia	5%	29%	66%	2,873
New Brunswick	6%	32%	61%	5,931
Ontario	12%	33%	55%	44,168
Manitoba	15%	32%	52%	10,835
Alberta	10%	34%	56%	21,294

Note
Data years vary: Ontario, Manitoba and Alberta, 2020ā€“2021; New Brunswick, 2018ā€“2019; and Nova Scotia, 2017ā€“2018.

Nationally, Involvement in Decision-Making and Treatment Options had the lowest proportion of patients reporting the most positive response compared with the other 4 PREMs featured in this report.

Of the PREMs in this report, this measure was the only one that declined between 2019ā€“2020 and 2020ā€“2021; this decrease may be due to the impact of COVID-19 on patient experience in acute care hospitals.

The following 3 key drivers have been identified for the Involvement in Decision-Making and Treatment Options measure. A key driver is a patient experience measure that is strongly associated with or that influences results for this measure. Key drivers can potentially be used as areas of focus when planning quality improvement initiatives. 

For more information on the methodology used in the key drivers analysis, please refer to Acute Care Patient-Reported Experience Measures ā€” Methodology Notes (PDF).

Key drivers: Involvement in Decision-Making and Treatment Options

Emotional Support

Whether patients felt they were supported and helped with any anxieties, fears or worries during their hospital stay.

Received Information About Condition and Treatment

Whether patients felt they received all of the information they needed about their condition and treatment.

Internal Coordination of Care

Whether patients felt there was good communication between doctors, nurses and other hospital staff. This measure also looks at whether patients felt that hospital staff seemed informed about and up to date on their hospital care.

How does patient experience differ across socio-demographic groups?

Hospitals across Canada serve diverse communities with various needs. To support understanding and ensure equitable care in these populations, CIHIā€™s Canadian Patient Experiences Survey ā€” Inpatient Care (CPES-IC) collects information on several socio-demographic variables, including age, recorded sex or gender, race/ethnicity and education. 

Note
* Percentages do not add up to 100% due to rounding.
 

Note
* At the time the report was published, gender was considered accurate for only the cisgender population (i.e., those whose sex at birth aligns with their gender identity). Collection of gender identities beyond the binary is now possible with the CPES-IC-6M and CPES-IC-20M survey options. 

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Racialized group	Percentage of respondents	Number of respondents
White	79%	294,927
Unknown	6%	23,679
East Asian	4%	15,507
Another	3%	12,942
South Asian	3%	11,845
Black	2%	7,701
Middle Eastern	1%	3,812
Latin American	1%	3,345
First Nations, Inuit and MĆ©tis Peoples	Less than 1%	1,491

Note
* Results for First Nations, Inuit and MĆ©tis Peoples can be requested, with permission from Indigenous authorities, in keeping with CIHIā€™s policy. 

Exploring patient experiences by different socio-demographic variables can uncover gaps in care and inform tailored programs and services to support an equitable care experience for all patients. For example, while there is little difference between age groups in terms of how they feel about their friendsā€™ and familyā€™s involvement, older patients feel that they themselves are less involved in decision-making and treatment options compared with younger patients. The size of this gap may vary depending on cultural and language differences between patients and care providers; this is important because patient and family involvement is connected to safer, higher-quality care. 

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Percentage of patients responding they were involved as much as they wanted in decisions about their care and treatment, by age and racialized group

Racialized group	Age group (in years) 18ā€“59	Age group (in years) 60ā€“79	Age group (in years) 80+
Another	59%	56%	49%
Black	59%	53%	47%
East Asian	58%	51%	41%
Middle Eastern	59%	53%	42%
South Asian	59%	52%	42%
White	61%	57%	48%

Notes
Data is shown for all provinces and years of available data (2015 to 2021).
Data from Latin American respondents is suppressed due to small numbers. 
Results for First Nations, Inuit and MĆ©tis Peoples can be requested, with permission from Indigenous authorities, in keeping with CIHIā€™s policy. 

Percentage of patients responding that their family and friends were involved as much as they wanted in decisions about their care and treatment, by age and racialized group.

Racialized group	Age group (in years) 18ā€“59	Age group (in years) 60ā€“79	Age group (in years) 80+
Another	64%	67%	69%
Black	64%	65%	73%
East Asian	63%	65%	69%
Middle Eastern	64%	66%	74%
South Asian	65%	66%	68%
White	66%	66%	68%

Notes
Data is shown for all provinces and years of available data (2015 to 2021).
Data from Latin American respondents is suppressed due to small numbers. 
Results for First Nations, Inuit and MĆ©tis Peoples can be requested, with permission from Indigenous authorities, in keeping with CIHIā€™s policy. 

The results presented above demonstrate broad, national trends using all available years of data; however, you may find different relationships among the communities you serve. Given the small proportion of respondents in some racialized groups, caution should be taken when interpreting differences between groups. Nevertheless, the socio-demographic information collected from the CPES-IC can uncover new opportunities to improve patient experiences by minimizing health inequalities. For more information on health inequalities, please visit CIHIā€™s ŗģĮģ½ķ¹Ļ±Ø equity and population health web page. 

• Impact of COVID-19 on patient experience in acute care hospitals
• Methodology notes (PDF)
• A Path Forward: Toward Respectful Governance of First Nations, Inuit and MĆ©tis Data Housed at ŗģĮģ½ķ¹Ļ±Ø(PDF)
• ŗģĮģ½ķ¹Ļ±Ø equity and population health

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61% of patients said they had very good information and understanding when leaving the hospital. 

Province	Poor	Good	Very good	Number of respondents
Nova Scotia	7%	33%	60%	2,800
New Brunswick	7%	31%	62%	5,946
Ontario	6%	34%	60%	44,973
Manitoba	7%	35%	59%	10,933
Alberta	4%	33%	63%	21,870

Note
Data years vary: Ontario, Manitoba and Alberta, 2020ā€“2021; New Brunswick, 2018ā€“2019; and Nova Scotia, 2017ā€“2018.

52% of patients said that they had a better understanding of their condition when they left the hospital than when they entered.

74% of patients reported that they had a clear understanding about all of their prescribed medications before they left the hospital.

The following 3 key drivers have been identified for the Information and Understanding When Leaving the Hospital measure. A key driver is a patient experience measure that is strongly associated with or that influences results for this measure. Key drivers can potentially be used as areas of focus when planning quality improvement initiatives. 

For more information on the methodology used in the key drivers analysis, please refer to Acute Care Patient-Reported Experience Measures ā€” Methodology Notes (PDF). 

Key drivers: Information and Understand When Leaving the Hospital

Received Information About Condition and Treatment

Whether patients felt they received all of the information they needed about their condition and treatment.

Emotional Support

Whether patients felt they were supported and helped with any anxieties, fears or worries during their hospital stay.

Internal Coordination of Care

Whether patients felt there was good communication between doctors, nurses and other hospital staff. This measure also looks at whether patients felt that hospital staff seemed informed about and up to date on their hospital care.

PREMs improve our understanding of hospital visits and allow the patient voice to provide context on whether clinical aspects of care are meeting patientsā€™ needs. When exploring health indicator results, itā€™s important to consider patient experience together with other results. Considering other health system performance indicators with PREMs can help identify targeted and patient-centred opportunities for improvement. 

For example, the Dryden Regional ŗģĮģ½ķ¹Ļ±Ø Centre uses patient experience data and service-level indicators to determine where there are opportunities to improve care. 

ŗģĮģ½ķ¹Ļ±Ø

Departmental reports are used by service leaders to examine and address opportunities to improve patient care across the spectrum from admission to discharge. Our health care system cannot work in silo without connecting all the contributing factors. ā€” Katherine Campbell, Director, Risk, Quality, Safety, Dryden Regional ŗģĮģ½ķ¹Ļ±Ø Centre, Ontario

Other measures that could be considered alongside patient experience results include indicators focused on length of stay, wait times, hospital harms and readmissions.

What is the experience of patients readmitted to hospital? 

Looking at additional measures like readmission through the lens of patient experience is important, especially if your facility has high readmission rates. For instance, readmissions and repeat hospital visits can be influenced by discharge factors such as patients receiving enough information upon discharge. At a national level, 57% of those who were readmitted to hospital reported that they were adequately prepared when leaving the hospital, compared with 60% of non-readmitted patients (readmitted n = 3,369; non-readmitted n = 85,507), a statistically significant difference.

Understanding the experience of patients who were readmitted can highlight ways to improve future communication between patients and care providers. By linking patient experience results with clinical factors, patients with poorer experiences can be identified so that initiatives can be developed to improve health outcomes, reduce costs and improve patient-centred care.Reference2

• Methodology notes (PDF)