Understanding Patients' Comments Fuels Innovative Care Delivery

08.15.2017 • Senem Guney, PhD, CPXP

iStock-507448869.jpgRecently, I had the pleasure of chatting with Angie Hochhalter, PhD, Director of Strategic Initiatives at Baylor Scott & White Health. We had a very interesting conversation about leveraging patients’ comments as evidence for social determinants of health. Here are some highlights from our conversation.

Senem Guney, PhD, CPXP: What are your thoughts on the current state of learning from patients’ comments to monitor, improve and innovate care delivery?

Angie Hochhalter, PhD: Healthcare leaders and direct care teams are increasingly interested in patient comments and in finding ways to respond. While vendors have been offering analytical capabilities at varying degrees of sophistication for narrative data, comment analysis and the output of this analysis are not well understood by most in healthcare. It is critical that comment analysis produces useful information from the overwhelming volume of available patients’ comments. The output must be easily understood and aligned with more familiar healthcare metrics. For example, organizations want to know how to move metrics that impact Hospital Value-Based Purchasing. Showing how themes that emerge from comments connect to these metrics is a good starting point for showing practical value and introducing the power of comment analysis.

There is a growing interest from healthcare teams to listen to their patients’ comments on surveys, social media, and other communications. New analytical capabilities that draw insights from patients’ comments, plus the frustration and fatigue that patients experience around long check-box surveys, make comment analysis very useful for patient experience improvement. I see comment analysis as a critical capability that will help reduce our reliance on surveys in the future.

SG: What is one specific area where you think there is a significant need for comment analysis to hear the voice of patients?
AH: One area where I have not seen comment analysis used systematically is in understanding the context in which patients live and work. There is strong evidence that social determinants of health (SDOH) are associated with mortality, quality of life, and health outcomes. While some measures exist, they can be difficult to implement consistently or they represent neighborhood-level characteristics that may not fully capture patients’ unique circumstances. For example, self-reported survey questions and geocoding using zip codes are common methods for understanding SDOH. Comment analysis may give us a fuller picture of the SDOH impacting populations and individuals.

SG: Who collects comment data on SDOH and how is this type of data currently being documented and analyzed?
AH: Some healthcare systems, insurers, and states are gathering structured data on SDOH. In addition, providers, social workers, nurses, case managers, and others regularly document patient social histories and barriers to care. This documentation is often in narrative form. Most institutions lack tools for analyzing these narrative data in medical records. Our industry may benefit from a rigorous application of comment analysis in this area to understand which SDOH have the strongest impact on patients’ health and which types of interventions should be prioritized to address specific outcomes.  

Comment analysis could be used to identify a profile of SDOH for patients that would allow the care team to efficiently deploy needed services or referrals that would be customized for each patient or family. The profiles could change over time, just as the context in which we live changes over time.

SG: What type of institutions would benefit the most from such an application of comment analysis?
AH: Many health systems, insurers, state Medicaid programs, and others are looking for more effective ways to measure SDOH. Much of the information needed may already exist in narrative form. The full potential of comment analysis to capture this information in a usable format has yet to be explored. Many organizations want to better understand the context in which health and quality of life are playing out every day for individuals and communities. Applications of comment analysis could play an important role for getting individuals the services they need to become and stay healthy without adding extra burden to care processes, such as adding structured data fields and patient questionnaires. Comment analysis could extract insights from existing documentation.

SG: What would be the immediate impact of leveraging comment analysis to measure SDOH? How would applications of comment analysis change how providers, social workers, nurses, case managers, and others approach SDOH today?
AH: I don’t think we know the full potential of comment analysis for measuring SDOH. Now is an ideal time to evaluate that potential. Strong recognition of the importance of SDOH is evident in programs like CMS’s Accountable Health Communities Model, whereby selected communities are assessing SDOH with a standard questionnaire and connecting individuals to community organizations to meet the social needs that impact health. Comment analysis opens up a new set of data to better understand which SDOH have the greatest impact on targeted outcomes and have the most potential to be mitigated over time with interventions.

Comment analysis also holds the potential for understanding SDOH with existing narrative data - for example, clinician notes in EMRs - instead of or in addition to conducting more interviews with patients.

Senem Guney, PhD, CPXP is the Founder and Chief Experience Officer at NarrativeDx. 

Senem Guney, PhD, CPXP

Senem Guney, PhD, CPXP

Founder and Chief Patient Experience Officer, NarrativeDx

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