Perceived Usefulness of Patient Narrative Feedback in Primary Care Settings

Research suggests that using insights from patient narratives ? stories about care experiences in patients’ own words ? has the potential to improve care. Qualitative reports, however, largely indicate that narratives have evoked mixed response among healthcare providers. Systematic study of which individuals and settings perceive narratives to be useful versus not to offer a clearer account of the variance in perceived usefulness has been lacking. Such analysis is critical because perception of value often dictates if and how information is used, which shapes the opportunity to leverage narratives for quality improvement. Our objective in this study was to assess perceived usefulness of patient narratives in primary care and identify individual- and clinic-related correlates of perceived usefulness. To do this, we conducted a cross-sectional study of 276 clinical and administrative personnel in nine primary care clinics affiliated with a health system in the United States. We collected their impressions of narratives, individual characteristics, and perceptions of some of their clinic’s characteristics. We used multilevel regression to examine possible correlates of perceived usefulness suggested by prior qualitative research. Perceived usefulness of patient comments was high overall (3.92 out of 5). Of the individual-related characteristics examined: burnout (ß=0.128, p=0.045) and professional role were associated with perceived usefulness. Care team roles (e.g., physicians) reported greater usefulness than administrative support roles (ß=0.242, p=0.027) and similar usefulness as administrators/supervisors (ß=0.191, p=0.420). Job dissatisfaction, tenure, and sex had no association with perceived usefulness. Of the clinic-related characteristics reported by participants, frequency of seeing patient comments was not associated with perceived usefulness (ß=0.003, p=0.948), whereas greater belief that their clinic engaged in more improvement efforts linked to patient feedback (ß=0.225, p=0.001) and had a learning orientation (ß=0.171, p=0.080) were associated with higher perceived usefulness. Overall primary care staff perceive narratives to be useful. However, perception varies by individual characteristics and clinic-related perceptions. Therefore, organizations should continue collecting and sharing narratives with their personnel, and ensure that structures and resources are available to support initiatives to learn from and respond to patients’ narrative feedback, as much of the variance is linked to organizational support.