Patient-Centered Outcomes in Emergency Departments and Adult Sickle Cell Infusion Centers
Abu Al Hamayel, Nebras
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BACKGROUND: Adults with sickle cell disease (SCD) frequently experience acute painful vaso-occlusive crises (VOC), which are the most common indication for hospitalizations and emergency department (ED) visits. As an alternative to ED care, an infusion center (IC) is a comprehensive model of acute care delivery and may provide care that is more patient-centered. The goal of this dissertation was to evaluate the psychometric properties of a satisfaction scale and to investigate the association between the setting of care and patient-centered outcomes - patient satisfaction with pain management and patients’ perception of safety after the treatment of an acute VOC. METHODS: A cross-sectional analysis was conducted using first time visits of adult patients with SCD who were enrolled in a multisite prospective cohort study. Surveys were administered to patients within 72 hours after the visit. In the first study, I conducted an exploratory factor analysis (EFA), tested for construct validity, and internal consistency reliability for the Patient Satisfaction with Pain Management in Adults with SCD (PSPS) scale. In the second study, I used structural equation modeling to examine the association between the setting of care and patient satisfaction. In the third study, I fit regression models for patients’ perception of safety as a function of setting of care. RESULTS: EFA revealed a single factor of patient satisfaction with pain management that was represented by 15 survey items. Correlations between the mean satisfaction score and two validated safety measures demonstrated construct validity and the scale had a high Cronbach’s α (0.97). Receiving care at an IC is statistically significantly associated with higher levels of satisfaction compared to receiving care at an ED. Relative to the ED, patients who received care at an IC were significantly less likely to experience lower perceptions of overall patient safety, less likely to perceive medication errors and mistakes by nurses, and had fewer numbers of specific safety concerns. CONCLUSIONS: The IC provides care that is more patient-centered compared to the ED for treating acute VOC. Further studies are needed to control for system-level factors that may affect the relationship between the setting of care and patient-centered outcomes.