Using multimedia patient feedback to reduce disparities in VA healthcare
P. Adam Kelly PhD MBA
Southeast Louisiana Veterans Health Care System, New Orleans, LA
New Orleans, LA
Funding Period: July 2009 - March 2013

BACKGROUND/RATIONALE:
From our analysis of extensive pilot study data, consisting of multimedia (audio-video) recordings of over 200 VA- and community-based primary care visits, we were able to identify 4 "best acts" of provider communication that patients believe to be most important in a clinical interaction. We propose to develop and evaluate a provider clinical communication intervention that focuses specifically on these best acts. In addition, our pilot study data included samples of patients representing various races/ethnicities, enabling us to tailor our intervention to clinical communication that appeals to patients across race/ethnicity groups. Evaluating this intervention with providers and patients in 2 independent VA primary care settings will help determine whether a patient-centered focus in clinical communication built on multimedia feedback from patients of varied race/ethnicity can help "close the gap" in health outcomes between white and minority veterans.

OBJECTIVE(S):
We aim to (1) demonstrate the efficacy of using "best acts" of provider communication as content for an intervention to improve provider communication skills overall and reduce variation in communication with white versus racial/ethnic minority patients, and (2) assess the impact of patient experiences of "best acts" on patients' perceptual and behavioral outcomes.

METHODS:
We are testing an educational intervention for providers that trains them to use 4 "best acts" of provider communication that we identified in our prior research. Scripts of the 4 "best acts" were developed, and professional-quality training videos were produced using experienced actors. We are conducting a longitudinal observational study of the educational intervention at two VA primary care sites, Site A and Site B, involving approximately 16 primary care physicians (8 from each site) and 28 patients of each physician. At Site A, physicians will attend 4 instructional sessions, presented in 3-month intervals. Each session consists of viewing a video of one best act, and participating in group discussion, role-playing re-enactment of the act, and formulation of bulleted "take-away" points to facilitate subsequent recall. Once completed at Site A, the sequence of sessions will occur at Site B. At both sites, clinical interactions of participating physicians and patients will be audio recorded, and audio recordings will be analyzed for frequency of occurrence of the 4 "best acts" in the conversations. After each study visit, each patient will complete validated surveys measuring patients' perceptions of their physician and the VA on 6 affective dimensions known to impact patients' subsequent perceptual and behavioral outcomes. Efficacy will be assessed across patient demographics.

FINDINGS/RESULTS:
At Site A, all 4 instructional sessions have been presented, and data collection is nearly complete. A total of 12 providers (8 MDs, 2NPs, 2PAs) participated for all or part of the intervention, and we expect to have complete data for the entire duration of the intervention from 7 providers. To date, data have been collected for 205 patients out of a target sample size of 224. Initial analyses of Site A survey data show statistically significant increases in patients' perceptions of their provider and of the VA. This finding offers empirical evidence that as providers incorporate some or all of the 4 "best acts" into their clinical repertoires, patients respond positively on average. We have corroborating evidence that this is indeed happening, in the form of positive provider testimonial statements recorded during interactive discussions at the instructional sessions, as well as from brief follow-up surveys that providers fill out approximately 2 weeks after each session. Analyses of the audio recordings of office visit conversations is ongoing in order to determine the frequency of provider use of the best acts over the duriation of the intervention.

IMPACT:
The proposed research will provide important insight into two serious problems for veterans' healthcare: 1) mixed effectiveness of communication improvement interventions in the VA to date, and 2) persistence of racial/ethnic disparities in VA healthcare.

PUBLICATIONS:
None at this time.

DRA: Health Systems
DRE: Treatment - Observational
Keywords: Behavior (provider), Best Practices, Communication -- doctor-patient, Disparities, Ethnic/cultural, Ethnicity/Race, Patient-Provider Interaction, Provider Education
MeSH Terms: none