Research in the Care Experience Program focuses on the entire health care journey, rather than a single disease, test or treatment.
The needs of patients and caregivers are foremost in Mayo Clinic researchers' minds as they choose their projects. By developing, testing and implementing ideas that will benefit patients and caregivers, investigators in the Care Experience Program honor patients' voices and work to meet their needs. The result is person-centered research that improves health care quality, safety and outcomes for patients and their families and for health care providers.
The Care Experience Program's work focuses on research at the point of care, which is understood to be anywhere that care is provided and received: in the patient's home, at a clinic or in a hospital. Researchers work closely with health care providers, patients and family caregivers. Together, they identify the wants, needs and values of the stakeholders involved. Researchers then develop, test and implement strategies that improve experiences and outcomes for patients and families.
Program objectives are to:
- Identify barriers and facilitators that affect receipt of high-quality, evidence-based care
- Test strategies to overcome barriers or replicate successes to improve care and patient outcomes
- Compare innovations and test the most acceptable, equitable and sustainable strategies to transform evidence into routine clinical practice
Areas of focus
Research in the Care Experience Program spans the continuum of health care delivery. The program team uses implementation science to compare approaches for assuring successful integration and sustainability of evidence-based practices. The program's patient-centered research focuses on the following areas:
- Variation in care. Identifying variation in care delivery and determining how variation affects care outcomes.
- Patient-reported outcomes. Developing, testing and implementing patient-reported outcome measures in research, in clinical practice and for performance measurement within the health care system.
- Self-management. Testing and applying interventions to improve patient self-management of diseases or chronic conditions.
- Health communication. Analyzing, comparing and carrying out effective health communication strategies.
- Caregiver support. Trying out and comparing innovations to improve family and caregiver support.
Methods used to achieve program objectives include:
- Surveys to understand the distribution of attitudes, beliefs and behavior
- Secondary analysis of data to assess changes or trends in patient or provider behavior or outcomes
- Randomized controlled or pragmatic trials to test efficacy of interventions to improve care and trials to compare the effectiveness of different interventions
- Statistical and psychometric methods to ensure validity and robustness of outcome measurement, and to maximize the potential impact that patient-reported outcomes can have on clinical care, including health care decision-making
- Qualitative methods — including video reflexive ethnography, photo elicitation, interviews, observations and focus groups — to understand patient or family caregiver experiences of care
Do shared medical appointments make sense in cardiology?
Shared medical appointments (SMAs) are an evidence-based clinical practice sometimes offered for patients who have chronic health conditions or for wellness visits. SMAs typically include six to eight patients sharing the same 90-minute visit with a health care provider, focusing on health education and disease management. These shared appointments allow health care providers to devote more time to patient education than they could normally spend in one-on-one appointments. SMAs also offer coping support through group sharing and help increase patients' understanding of their disease.
The Care Experience Program is partnering with the Mayo Clinic Heart Rhythm Clinic on a quality improvement initiative to test whether an SMA approach will work better than the standard care among patients who have been diagnosed with atrial fibrillation and are scheduled to be evaluated for cardiac ablation to treat the atrial fibrillation.
The research team hopes to determine whether SMAs are a good choice for this patient group. Investigators are considering factors including patient-reported outcomes on knowledge, stress, satisfaction, confidence in their ability to self-manage, anxiety or depression, and symptom severity. For shared medical appointments to be considered a viable alternative care plan, research needs to demonstrate that SMAs show equal or improved clinical outcomes compared with one-on-one appointments.
OB Nest — A new approach to prenatal care
Modern prenatal care consists of a fixed schedule of 12 to 14 visits with an obstetrician-gynecologist. Visits are often very short check-ins that assure mothers of steady heartbeat and growing baby, yet add little or no clinical value. Pregnancy is approached in the same way as illness, with a prescribed "treatment" of scheduled exams and little room for patient-centric, personalized experiences.
The Mayo Clinic Department of Obstetrics and Gynecology sought to identify ways to more actively engage mothers and families and to identify a new family-centered construct that would make pregnancy a wellness experience. With the Mayo Clinic Center for Innovation, researchers created 14 experiments to introduce pregnant women, their families and health care providers to new experiences and environments.
The Care Experience Program, in collaboration with the Department of Obstetrics and Gynecology and the Center for Innovation, conducted a clinical trial to test these new ways to deliver care to women with low-risk pregnancies.
The randomized trial included home monitoring for fetal heart rate and blood pressure, optional membership in an online care community, a dedicated nurse and nurse call line, and only eight required office visits. Researchers measured differences in patient and provider satisfaction and differences in mother and baby outcomes compared to the traditional model.
Results and feedback from both patients and providers were so positive that Mayo Clinic is moving to implement this model across its entire obstetrics practice.
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The Care Experience Program is led by Joan M. Griffin, Ph.D., scientific director, and Andrea L. Cheville, M.D., medical director, who work together with a multidisciplinary team of social and behavioral scientists, clinicians, statisticians, programmers, and managers to conduct scientifically rigorous and methodologically diverse research that has clinical impact for patients, families and providers.