Beyond satisfaction: Using the Dynamics of Care assessment to better understand patients' experiences in care
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Beyond satisfaction: Using the Dynamics of Care assessment to better understand patients' experiences in care Bruce Rapkin1, Elisa Weiss*1, Rosy Chhabra3, Laura Ryniker1, Shilpa Patel1, Jason Carness1, Roberto Adsuar1, Wendy Kahalas2, Carol DeLaMarter2, Ira Feldman2, Judy DeLorenzo2 and Ellen Tanner2 Address: 1Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA, 2AIDS Institute, New York State Department of Health, Albany, USA and 3Department of Pediatrics, Albert Einstein College of Medicine, Bronx, USA Email: Bruce Rapkin - [email protected]; Elisa Weiss* - [email protected]; Rosy Chhabra - [email protected]; Laura Ryniker - [email protected]; Shilpa Patel - [email protected]; Jason Carness - [email protected]; Roberto Adsuar - [email protected]; Wendy Kahalas - [email protected]; Carol DeLeMarter - [email protected]; Ira Feldman - [email protected]; Judy DeLorenzo - [email protected]; Ellen Tanner - [email protected] * Corresponding author
Published: 10 March 2008 Health and Quality of Life Outcomes 2008, 6:20
doi:10.1186/1477-7525-6-20
Received: 12 July 2007 Accepted: 10 March 2008
This article is available from: http://www.hqlo.com/content/6/1/20 © 2008 Rapkin et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Patient perceptions of and satisfaction with care have become important indicators of the quality of services and the relationship of services to treatment outcomes. However, assessment of these indicators continues to be plagued by measurement problems, particularly the lack of variance in satisfaction data. In this article, we present a new approach to better capture patient perceptions of experiences in care, the Dynamics of Care (DoC) assessment. It is an in-depth approach to defining and assessing patients' perspectives at different junctures in care, including their decisions about whether and where to seek care, the barriers encountered, and the treatments and services received. Methods: The purpose of this article is to describe, validate, and discuss the benefits and limitations of the DoC, which was administered as part of a longitudinal study to evaluate the New York State HIV Special Needs Plan (SNP), a Medicaid managed care model for people living with HIV/AIDS. Data are from 426 study respondents across two time points. Results: The results demonstrate the validity and value of the DoC. Help seeking decisions and satisfaction with care appear to be situation-specific, rather than person-specific. However, barriers to care appear to be more cross-situational for respondents, and may be associated with clients' living situations or care arrangements. Inventories in this assessment that were designed
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