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JOURNAL ARTICLE
RESEARCH SUPPORT, U.S. GOV'T, P.H.S.
Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives.
Health Services Research 2016 June
OBJECTIVE: To design a methodology for rigorously eliciting narratives about patients' experiences with clinical care that is potentially useful for public reporting and quality improvement.
DATA SOURCES/STUDY SETTING: Two rounds of experimental data (N = 48 each) collected in 2013-2014, using a nationally representative Internet panel.
STUDY DESIGN: Our study (1) articulates and operationalizes criteria for assessing narrative elicitation protocols; (2) establishes a "gold standard" for assessment of such protocols; and (3) creates and tests a protocol for narratives about outpatient treatment experiences.
DATA COLLECTION/EXTRACTION METHODS: We randomized participants between telephone and web-based modalities and between protocols placed before and after a closed-ended survey.
PRINCIPAL FINDINGS: Elicited narratives can be assessed relative to a gold standard using four criteria: (1) meaningfulness, (2) completeness, (3) whether the narrative accurately reflects the balance of positive and negative events, and (4) representativeness, which reflects the protocol's performance across respondent subgroups. We demonstrate that a five-question protocol that has been tested and refined yields three- to sixfold increases in completeness and four- to tenfold increases in meaningfulness, compared to a single open-ended question. It performs equally well for healthy and sick patients.
CONCLUSIONS: Narrative elicitation protocols suitable for inclusion in extant patient experience surveys can be designed and tested against objective performance criteria, thus advancing the science of public reporting.
DATA SOURCES/STUDY SETTING: Two rounds of experimental data (N = 48 each) collected in 2013-2014, using a nationally representative Internet panel.
STUDY DESIGN: Our study (1) articulates and operationalizes criteria for assessing narrative elicitation protocols; (2) establishes a "gold standard" for assessment of such protocols; and (3) creates and tests a protocol for narratives about outpatient treatment experiences.
DATA COLLECTION/EXTRACTION METHODS: We randomized participants between telephone and web-based modalities and between protocols placed before and after a closed-ended survey.
PRINCIPAL FINDINGS: Elicited narratives can be assessed relative to a gold standard using four criteria: (1) meaningfulness, (2) completeness, (3) whether the narrative accurately reflects the balance of positive and negative events, and (4) representativeness, which reflects the protocol's performance across respondent subgroups. We demonstrate that a five-question protocol that has been tested and refined yields three- to sixfold increases in completeness and four- to tenfold increases in meaningfulness, compared to a single open-ended question. It performs equally well for healthy and sick patients.
CONCLUSIONS: Narrative elicitation protocols suitable for inclusion in extant patient experience surveys can be designed and tested against objective performance criteria, thus advancing the science of public reporting.
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