Health Quality Ontario

Home and Community Care

Patient Experience

Best Practices

Created on October 03, 2017

“Insanity is doing things the way we’ve always done them and expecting different results.”
Albert Einstein

Patient Experience with Care Coordinators and Service Providers is a priority indicator for the QIP. This indicator provides information on the overall experience of home care patients. It reports the percentage of home care patients who responded "good", "very good", or "excellent" on a five-point scale to three survey questions about whether they were satisfied with: the services provided by the Community Care Access Centres (CCACs); the handling of their care by the care coordinators and the services they received from the service providers. A higher percentage on this indicator is better. In Ontario 91.8% of home care patients are satisfied with their overall experience of care.

Below are best practices for maintaining and increasing patient experience in the home care sector. They are graded according to Type of Evidence. Evidence-informed best practices are based on quality evidence, they can optimize outcomes and should be implemented into practice where possible.

To help you move from best evidence to best practice refer to one of Health Quality Ontario’s relevant reports


Or browse the interactive table below for a quick summary of how to improve and maintain high quality patient experience in the home care sector.

  1. Beaumann M., Le Bihan E., Chau K., Chau N. (2014).
    Association between quality of life and socioeconomic factors, functional impairments and dissatisfaction with received information and home-care services among survivors living at home two years after stroke onset.
    BMC Neurology. 14: 92.

  2. Carpenter RA., Tracy DK. (2015).
    Home treatment teams: what should they do? A qualitative study of patient opinions.
    Journal of Mental Health. 24(2): 98 – 102.

  3. Dawson J; NHS Employers.
    Staff experience and patient outcomes: what do we know?
    A report commissioned by NHS Employers on behalf of NHS England. 2014.
    Retrieved from: http://www.nhsemployers.org/~/media/Employers/Publications/Research%20report%20Staff%20experience%20and%20patient%20outcomes.pdf

  4. Dixon S., Nancarrow SA., Enderby P M., Moran A M., Parker S G. (2015).
    Assessing patient preferences for the delivery of different community-based models of care using a discrete choice experiment.
    Health Expectations. 18(5): 1204 – 1214.

  5. Funk L., Stajduhar K. (2013).
    Analysis and proposed model of family caregivers’ relationships with home health providers and perceptions of the quality of formal services.
    Journal of Applied Gerontology. 32(2): 188 – 206.

  6. Grant L A., Rockwood T., Stenness L. (2015).
    Client satisfaction with telehealth services in home healthcare agencies.
    Journal of Telemedicine and Telecare. 21 (2): 88 – 92.

  7. Health Quality Ontario (HQO).
    Measuring Up a Yearly Report on how Ontario’s health system is performing.
    Queens Printer for Ontario, 2016, Toronto ON.

  8. Health Quality Ontario (HQO).
    Insights into Quality Improvement Home Care Impressions and Observations 2016/17 Quality Improvement Plans.
    Queens Printer for Ontario 2017. Toronto, ON.
    Retrieved from: http://www.hqontario.ca/Portals/0/documents/qi/qip/analysis-home-care-2016-17-en.pdf

  9. Health Quality Ontario.
    Patient Relations Indicator Specifications v1.0.
    Retrieved from: http://www.hqontario.ca/Portals/0/documents/qi/patient-relations/patient-relations-indicator-specifications-en.pdf

  10. McCaffrey N., Gill L., Kaambwa B., Cameron I D., Patterson J., Crotty M., Ratcliffe J. (2015).
    Important features of home-based support services for older Australians and their informal caregivers.
    Health and Social Care in the Community. 23 (60): 654 – 664.

  11. Millard, L., Hallett, C., Luker, K. (2006).
    Nurse-patient interaction and decision-making in care: patient involvement in community nursing.
    Issues and Innovations in Nursing Practice.

  12. Muntinga ME., Mokkink LB., Knol DL., Nijpels G., Jansen APD. (2014).
    Measurement properties of the client-centred care questionnaire (CCCQ): factor structure, reliability and validity of a questionnaire to assess self-reported client-centredness of home care services in a population of frail older people.
    Quality of Life Research. 23(7): 2063-2072.

  13. Reckrey JM., Soriano TA., Hernandez CR., Cameron R., DeCherrie LV., Chavez S., Zhang M., Ornstein K. (2015).
    The team approach to home-based primary care: restructuring care to meet individual, program and system needs.
    Journal of the American Geriatric Society. 63(2): 358 – 364.

  14. Ricci Rp., Morichelli L. (2013).
    Workflow, time and patient satisfaction from the perspective of home monitoring.
    Europace. 15 Supplement 1: i49 – i53.

  15. Ryan DP., Puri M., Liu BA. (2013).
    Comparing patient and provider perceptions of home and community- based services: social network analysis as a service integration metric.

  16. Smith LM., Anderson WL., Kenyon A., Kinyara E., With SK., Teichman L., Dean Whittaker D., Goldstein E., (2015).
    Racial and Ethnic Disparities in Patients’ Experience with Skilled Home Health Care Services.
    Medical Care Research and Review. 72 (6): 756-774.

Measurement

Created on October 03, 2017

“While all changes do not lead to improvement, all improvement requires change”
Institute for Healthcare Improvement

How do we know if a change is an improvement? Measurement is a critical step in QI to assess the impact of a change. Quality indicators are used in the QIPs to measure how well something is performing. There are three types of quality indicators used to measure QI efforts:

  • Outcome Indicators: capture clinical outcomes and or system performance,
  • Process Indicators: track the processes that measure whether the system is working as planned, and
  • Balancing Indicators: ensure that changing one part of the system does not cause new problems in another.

Indicator Patient Experience with Care Coordinators and Service Providers
Topic Patient Reported Measures
Quality Dimension Patient-Centred
Type of Indicator Outcome
Measure Percentage (%)
Data Source Client and Caregiver Experience Evaluation (CCEE) Survey
Data Collection Instrument Collected by Health Shared Services Ontario (formerly the Ontario Association of Community Care Access Centres (OACCAC))
How to Calculate

The percentage is calculated as: (Numerator/Denominator) x 100

Numerator: The sum of the number of positive responses ("good", "very good", or "excellent") registered to each of the three questions on the CCEE survey.

Denominator: # of total responses to the three questions on the CCEE survey minus the total number of responses not applicable to these questions.

Target Higher is better
Range 0 – 100%
HQO Reporting Tool Public reporting, Quality Improvement Plans (QIPs)

To read more about general measurement in QI refer to Measurement for Quality Improvement or the QI Getting Started Section.

Background

Created on October 03, 2017

Issue

In 2015, the province paid for about 6.9 million nursing visits and 28.7 million hours of personal support and homemaking services to approximately 650,000 home care patients – 60% of whom were aged 65 or older (CIHI, 2016). Asking home care patients about their experience with the services they receive is vital to improving quality of care. Patients who have positive experiences often have better health outcomes (Home Care Ontario, 2014; OACCAC, 2015; Tipper, 2010). Patients across Ontario can participate in a phone survey which asks them to rate the home care services they receive/received. Response options are “Excellent,” “Very Good,” “Good,” “Fair,” or “Poor.”

Overall, for Ontario as a whole, the percentage of positive patient experiences has remained stable at 92% since 2013/14 (Figure 1).

FIGURE 1: Percentage of home care patients satisfied with their overall experience of care, in Ontario, 2013/14 to 2015/16

Data source: Client and Caregiver Evaluation Survey, provided by the Ontario Association of Community Care Access Centres.

Among those who had a positive experience –rating it as “Excellent,” “Very Good” or “Good” – over half rated their care as “Excellent.” The total percentage of positive responses ranged from 90% in the Central West LHIN region to 94% in the South East and Erie St. Clair LHIN regions. More than 90% of the responses were positive for 98% of Ontario’s 182 home care service providers with reportable data (Figure 2).

FIGURE 2: Percentage of home care patients satisfied with their overall experience of care, in Ontario, 2013/14 to 2015/16

Data source: Client and Caregiver Evaluation Survey, provided by the Ontario Association of Community Care Access Centres.


Call to Action

The Patients First Act, 2016 was passed in December 2016. It aims to move Ontario’s health system toward a more local and integrated system that will provide higher-quality care, improve access to health care services, and improve the overall patient experience (Patients First Act FAQs, 2017). One focus of this legislation was the transition of home and community care services from the CCACs to the LHINs. With this transition now complete, the continuity of patient services has been preserved and all services have been maintained in the same form under the LHINs as each CCAC has transferred over its responsibilities.

Health Quality Ontario was given new responsibilities related to patient satisfaction and relations as a result of the passing of Bill 8, the Public Sector and MPP Accountability and Transparency Act, 2014 (which includes amendments to the Excellent Care for All Act, 2010). This includes supporting continuous quality improvement by providing patient relations assistance to the home and community care sector, developing patient relations performance indicators and experience benchmarks and using these to monitor and report on quality of performance.

  1. Canadian Institute for Health Information (CIHI).
    Home Care Reporting System 2012/2013 – 2015/2016.
    Retrieved from: https://www.cihi.ca/en/home-care-reporting-system-metadata

  2. Home Care Ontario.
    Facts & Figures – Publicly Funded Home Care 2014.
    Retrieved from: http://www.homecareontario.ca/home-care-services/facts-figures/publiclyfundedhomecare

  3. Health Quality Ontario (HQO).
    Measuring Up a Yearly Report on how Ontario’s health system is performing.
    Queens Printer for Ontario, 2016, Toronto ON.

  4. Health Quality Ontario.
    Patient Relations Indicator Specifications v1.0.
    Retrieved from: http://www.hqontario.ca/Portals/0/documents/qi/patient-relations/patient-relations-indicator-specifications-en.pdf

  5. Ontario Association of Community Care Access Centres (OACCAC).
    How CCACs Care: An Update on Quality Improvement for Patients November 2015.
    Available from: http://oaccac.com/Quality/Documents1/Quality-updateNovember-2015.pdf.

  6. Tipper, B., The Change Foundation.
    Survey Review: A scan of existing and planned surveys of patient/client or caregiver experiences in transitions across care providers in Ontario.
    The Change Foundation, 2010.
    Retrieved from: http://www.changefoundation.ca/site/wp-content/uploads/2016/05/ExperienceSurveyReview-Tipper.pdf

  7. Patients First Act (FAQ) Frequently Asked Questions. (2017).
    Retrieved from: http://health.gov.on.ca/en/news/bulletin/2017/hb_20170127_7.aspx