Journal of Interprofessional Care
ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijic20
A comparative evaluation of patient satisfaction outcomes in an interprofessional student-run free clinic David Lawrence, Tara K. Bryant, Tamar B. Nobel, Mary A. Dolansky & Mamta K. Singh To cite this article: David Lawrence, Tara K. Bryant, Tamar B. Nobel, Mary A. Dolansky & Mamta K. Singh (2015) A comparative evaluation of patient satisfaction outcomes in an interprofessional student-run free clinic, Journal of Interprofessional Care, 29:5, 445-450, DOI: 10.3109/13561820.2015.1010718 To link to this article: http://dx.doi.org/10.3109/13561820.2015.1010718
Published online: 20 Feb 2015.
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Date: 06 November 2015, At: 04:27
http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(5): 445–450 ! 2015 Taylor & Francis Group, LLC. DOI: 10.3109/13561820.2015.1010718
ORIGINAL ARTICLE
A comparative evaluation of patient satisfaction outcomes in an interprofessional student-run free clinic David Lawrence1, Tara K. Bryant1, Tamar B. Nobel1, Mary A. Dolansky2, and Mamta K. Singh3 Downloaded by [University of California Santa Barbara] at 04:27 06 November 2015
1
Student Run Free Clinic, Case Western Reserve University, Cleveland, OH, USA, 2Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA, and 3School of Medicine, Case Western Reserve University, Cleveland, OH, USA
Abstract
Keywords
As the evidence supporting the value of well-coordinated healthcare teams continues to grow, so to do the calls from medical educators and policy makers for the development of meaningful interprofessional educational experiences for health professions students. The student-run clinic has emerged as a unique venue for such experiential interprofessional learning experiences, with over 100 such clinics now in operation across North America. As the number and variety of these clinics rises, it has become increasingly important to understand the quality of care which they deliver. Here, patient satisfaction data from an interprofessional student-run free clinic are described, and these results are quantitatively compared to similar data obtained from a non-interprofessional, non-student-run clinic in a post-experience only, non-equivalent groups design. Student-run free clinic patients reported high levels of satisfaction with the patient care team and the facility quality, and lower levels of satisfaction with waiting times. When compared to the non-student-run clinic, there was no significant difference in the high levels of patient satisfaction with the patient care teams between the clinics. Student-run free clinic patients did, however, report significantly lower levels of satisfaction with the accessibility of care and with the perceived privacy of protected health information. Overall, this report provides evidence that an interprofessional student-run free clinic is capable of performing at the level of an experienced free clinic across many domains of patient satisfaction, while also identifying notable areas for improvement within the domains of clinic accessibility and the perception of the privacy of protected health information.
Interprofessional care, interprofessional education, interprofessional outcomes, quantitative method, surveys, team-based care
Introduction There is growing evidence to support the claim that care delivered by well-functioning teams is superior to that provided by uncoordinated health professionals. Care that is well-coordinated between health professionals from multiple disciplines has been shown to benefit patient’s health status directly through improvements in short and long-term health outcomes (Mukamel et al., 2006; Sipila¨, Ketola, Tala, & Kumpusalo, 2008; W Hutchison, 2014) and indirectly through reductions in lengths of stay, readmission rates and overall per-patient healthcare costs (Gon˜i, 1999; Hallin, Henriksson, Dale´n, & Kiessling, 2011; Manville, Klein, & Bainbridge, 2014; Shortell & Zimmerman, 1994; Zwarenstein, Bryant, & Reeves, 2003). Such coordinated, teambased and patient-centered healthcare is best described as interprofessional care (IPC), defined as: ‘‘the development of a cohesive practice between professionals from different professions [. . .] involv[ing] continuous interaction and knowledge
Correspondence: Mr David Lawrence, Student Run Free Clinic, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA. E-mail: [email protected]
History Received 19 September 2013 Revised 15 November 2014 Accepted 19 January 2015 Published online 20 February 2015
sharing between professionals [. . .] while seeking to optimize the patient’s participation’’ (D’Amour & Oandasan, 2005, p. 9). To realize the value promised by interprofessional care, medical educators and policy makers have recognized the need for a new focus in the training of health professionals: interprofessional education (IPE). Such training has been defined by the Centre for the Advancement of Interprofessional Education as occurring, ‘‘when two or more professions learn with, from and about each other to improve collaboration and quality of care’’ (Barr, 2002, p. 17). IPE must be distinguished from multidisciplinary learning, in which students from different professions learn or even work in a group. For an educational interaction to be truly interprofessional, purposeful integration and collaboration between the professions is required. An additional key component of effective IPE, as identified by the Institute of Medicine, is experiential learning, wherein health professions students practice collaboratively and learn with and from each other in real-life clinical environments (Institute of Medicine, 2013). One increasingly prevalent venue for this kind of experiential IPE are Student-Run Clinics (SRCs); healthcare delivery programs in which health professional students take primary responsibility for the logistics, operational management and treatment of patients under the guidance and supervision of
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licensed providers. In fact, of the 21 SRC models which are fully described in the literature, 16 (76%) reported involvement of student volunteers from two or more health professions. Medicine, nursing, pharmacy, public health and social work students are those most frequently involved in SRC care models across the country. However, the involvement of disciplines as diverse as acupuncture, nutrition, and law, have also been reported (Beck, 2005; Dvoracek, Cook, & Klepser, 2010; Hastings, Zulman, & Wali, 2007). According to one nationwide survey, the average SRC had 16 student volunteers per week, provided care to predominantly uninsured and minority patients and received the majority of its revenue through private grants (Simpson & Long, 2007). With over 100 SRCs in operation across North America, however, the particular setting, patient population, and nature of care which these clinics provide is quite heterogeneous (Society of Student-Run Free Clinics, 2013). A number of distinctive SRC care-delivery models have been described in the literature, from large and well-established clinics which manage the acute and chronic health needs of a vast panel of underserved patients (Beck, 2005; Hemba & Plumb, 2011), to those which focus on a particular niche, like urgent care (Berman et al., 2012; Wang & Bhakta, 2013), post-acute care (Kent & Keating, 2013) or the care of immigrant (Ojeda et al., 2013) or homeless populations (Batra et al., 2009; Moskowitz, Glasco, Johnson, & Wang, 2006). Another notable arena for the delivery of IP care and education is the interprofessional training ward (IPTW), a model with popularity across Western Europe and Australia where medical, nursing, physiotherapy and social work students collaborate in the delivery of care to geriatric and orthopedic patients in an inpatient ‘‘teaching ward’’ setting (Reeves & Freeth, 2002; Wahlstro¨m, Sanden, & Hammar, 1997). As interprofessional SRCs and IPTWs become increasingly prevalent, there is a growing body of literature examining the quality of care provided by these unique care environments. Studies have examined SRCs’ adherence to national preventive care guidelines (Butala et al., 2012; Butala, Chang, Horwitz, Bartlett, & Ellis, 2013; Zucker, Lee, Khokhar, Schroeder, & Keller, 2013), chronic disease treatment guidelines (Liberman et al., 2011; Zucker, Gillen, Ackrivo, Schroeder, & Keller, 2011) and both objective (Ryskina, Meah, & Thomas, 2009) and subjective (Ellett, Campbell, & Gonsalves, 2010; Kent & Keating, 2013) indicators of quality. Several studies in the IPTW literature have also examined subjective indicators of care quality (Brewer & Stewart-Wynne, 2013; Reeves, Freeth, McCrorie, & Perry, 2002). These previous studies are either descriptive in nature or compare their data to a guideline or national average. There are as of yet no studies which directly compare quality indicator data from an interprofessional SRC to a non-interprofessional, nonstudent-run control clinic. In this article, we examine the quality indicator of patient satisfaction, as reported by an interprofessional SRC that provides urgent care to an underserved urban population. These data are then quantitatively compared to a non-interprofessional, nonstudent-run control clinic, towards understanding how the quality of care provided at an interprofessional SRC stacks up against the traditional outpatient care model.
Background Intervention clinic The Case Western Reserve University (CWRU) Schools of Medicine and Nursing are part of an academic health center located in Cleveland, Ohio. Founded during the 2010–2011 academic calendar year, the CWRU Student-Run Free Clinic
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(SRFC) was established as a twice-monthly Saturday walk-in clinic which provides free acute care services to the local urban underserved population. This SRFC operates within the facilities of a local free clinic which had previously been closed on Saturdays, and was granted access to the same physical waiting and exam room spaces, electronic health record system and laboratory capabilities. The SRFC patient population was primarily referred as overflow from the local free clinic, as described in more detail in the ‘‘Control Clinic’’ section below. Student-run clinic volunteers receive approximately 4 h of training across two sessions, which include an orientation to the clinic’s philosophy, patient-flow model and documentation methods, as well as a review of techniques for presenting patient information to preceptors. There were no IPE experiences explicitly integrated into these training sessions or into either professional school’s curriculum prior to the 4-month volunteer period. Student volunteers provide care at two clinic sessions, where they are organized into IP care teams comprised of a preclinical medical or nursing student and an upper-level student from the complementary program. The upper-level student operates as a mentor to the pre-clinical student, coaching them through the patient interview and exam, and in presenting their findings, assessment and plan to an attending nurse practitioner or physician preceptor. The IP care team is thus designed to bring medical and nursing students together into a single unit focused on patient care with a mentor and mentee relationship defined by clinical experience, rather than medical or nursing paradigms. Pre-clinical medical and nursing students also carry out patient intake, check vital signs and coordinate with the patient care teams to provide relevant after-visit health education materials and referrals to appropriate community resources. There were 29 pre-clinical medical and nursing students engaged as volunteers at the time of the study period, of which 15 (52%) were first-year masters of science in nursing students, and 14 (48%) were first or second year medical students. The volunteer base consisted of 7 (24%) male and 22 (76%) female preclinical medical and nursing students. The interprofessional SRFC has the capacity to provide care for up to approximately 25 patients per Saturday session, and is able to address acute chief complaints only. Control clinic The Free Medical Clinic of Greater Cleveland serves as this study’s non-student-run control clinic, and shall henceforth be referred to as the ‘‘non-SRFC’’. The non-SRFC is located in East Cleveland near the Case Western Reserve University medical campus. During the time of the study period, the non-SRFC operated as a not-for profit, 501(C)3 non-governmental organization, providing free and low-cost healthcare at sliding-scale rates. The non-SRFC primarily operates on an appointment-based model, though it also accommodates patients with limited walkin hours. Patients unable to be seen on these walk-in days were often referred to the next Saturday SRFC session, and these overflow patients thus comprised the primary patient panel for the student-run clinic. The makeup of the staff at the non-SRFC is typical of outpatient medical clinics, involving a front-desk receptionist who manages the waiting room, a medical assistant or nurse who acquires patient vital signs and reviews intake forms and a physician or nurse practitioner who conducts the care encounter. The non-SRFC operates on-site pharmacy, phlebotomy and point of care laboratory services. Patients have access to acute, chronic, and specialty services, including dental, dermatologic and ophthalmologic care.
Patient satisfaction in an interprofessional SRFC
DOI: 10.3109/13561820.2015.1010718
Methods A pseudo-experimental study design (Trochim, 2000) was employed to generate comparative results from post-experience patient satisfaction surveys in a non-equivalent groups design.
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Data collection During the 10-month study period, trained research assistants routinely offered patient satisfaction surveys to every SRFC patient at the end of their visit, while non-SRFC patients were offered the survey in a random, non-routine fashion. Patient participation was anonymous and optional. Satisfaction surveys used simple language and brief questions adapted from the Health Center Patient Satisfaction Survey (US Department of Health & Human Services, 2009). The SRFC survey consisted of 28 fivepoint Likert scale items ranking the level of satisfaction in particular clinic domains on a scale from ‘‘poor’’ (1 point) to ‘‘great’’ (5 points). The non-SRFC survey consisted of 21 fivepoint Likert scale items which also ranked level of satisfaction of clinic domains on a scale from ‘‘poor’’ (1 point) to ‘‘great’’ (5 points). A retrospective chart review of each SRFC patient seen during the study period was also carried out to acquire the basic demographic characteristics of the patient population and a general categorization of each encounter’s chief complaint. Data analysis Responses for each five-point Likert scale survey item were averaged for a mean score and a standard deviation, as described in Tables 2 and 3. Non-responses were excluded when calculating mean values. Due to the differences in staff composition between the two clinics, a number of survey domains related to staffing were ineligible for direct comparison, such as the SRFC survey domains which focused on patient interactions with student volunteers. Analysis of the survey language identified nine domains from each survey eligible for direct comparison. These domains were grouped into three themes: accessibility, licensed provider and facility quality. Domains within those themes were assessed for skew-ness utilizing the adjusted Fisher–Pearson Table 1. Demographic characteristics and chief complaint categories of the student-run free clinic patient population during the study period. Domain Total Age (in years) 18–24 25–34 35–44 45–54 55–64 465 Race White African American Hispanic Gender Male Female Chief Complaint Sexually transmitted infection Work/school physical Dermatological/ophthalmological Otolaryngological Miscellaneous
N (% total) 96 24 23 24 15 10
(25%) (24%) (25%) (16%) (10%) 0
15 (16%) 80 (83%) 1 (1%) 45 (47%) 51 (51%) 39 (41%) 31 (33%) 10 (10%) 6 (6%) 10 (10%)
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standardized moment coefficient, and each response-set was found to be significantly skewed from the standard distribution, towards more positive or more negative responses (Pearson & Hartley, 1970). The Mann–Whitney U test was thus utilized for the comparative assessment of these skewed distributions. Analysis was performed using the Microsoft Excel statistical package. The themes, specific domains and comparative statistics are described in Table 4. Ethical considerations The study was approved by the Institutional Review Board of Case Western Reserve University.
Results Results from the study are presented in three main sections. Student-run free clinic survey participant demographic data A total of 87 out of 96 (91%) patients seen at the SRFC over a 10-month period completed satisfaction surveys. The majority of respondents (53%) were females and over 80% were African American. Respondents were relatively young, with the majority (74%) split equally among the 18–24, 25–34 and 35–44 age ranges. Chief complaints for each encounter during the study period were also recorded. Concern for a sexually transmitted infection (41%) or need for a work/school physical (33%) was found to be the most common reasons for a visit to the SRFC. Complete demographic and chief complaint data are presented in Table 1. Student-run free clinic survey Results of the SRFC surveys are presented in Tables 2 and 3 below. A mean Likert scale value and standard deviation for each domain is reported. Domains are further organized thematically; accessibility, wait time and facility related domains are reported in Table 2, and licensed provider, student assessment team and case manager related domains are summarized in Table 3.
Table 2. Patient satisfaction in care accessibility and facility quality at the student-run free clinic. Domain Accessibility Ability to be seen Hours of operation Convenience of location Prompt return on calls Waiting time Time in waiting room Time in exam room Waiting for tests to be performed Waiting for test results Facility Neat and clean building Ease of finding where to go Comfort and Safety while waiting Privacy of facilities Staff kept my personal information private Likelihood of referring others
Mean (SD) 3.92 4.11 4.36 4.03
(1.20) (0.91) (0.83) (0.97)
3.36 3.71 3.40 4.03
(1.32) (1.24) (1.04) (0.95)
4.73 4.66 4.68 4.66 4.63 4.62
(0.55) (0.57) (0.60) (0.68) (0.69) (0.74)
Assessed domains have been organized thematically. Satisfaction in these domains was assessed by five-point Likert scale based survey responses, where 1 ¼ ‘‘poor,’’ 2 ¼ ‘‘fair,’’ 3 ¼ ‘‘okay,’’ 4 ¼ ‘‘good,’’ and 5 ¼ ‘‘great.’’ The mean and standard deviation of the five-point Likert scale responses across all surveyed patients is reported for each domain.
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Overall, 24 of 28 items were given a satisfaction rating of ‘‘good’’ to ‘‘great’’. The highest levels of patient satisfaction were reported under the themes of the student assessment team, with the item ‘‘student answers your questions’’ the single most highly rated item. High satisfaction was also reported throughout the licensed provider domain group. Lowest levels of satisfaction were found under the theme of waiting time and the domain ability to be seen, with the item ‘‘time in waiting room’’ the most poorly rated of all domains. Patients were satisfied with cleanliness and privacy of the facility. Ninety percent of patients reported the likelihood of referring friends or family to the clinic was ‘‘good’’ or ‘‘great’’.
Table 3. Patient satisfaction in provider care services at the student-run free clinic. Domain
Mean (SD)
Licensed provider Provider Listens to you Provider takes enough time with you Provider explains what you want to know Provider gives you good advice and treatment Student assessment team Students listen to you Students take enough time with you Students explain what you want to know Students are friendly and helpful to you Students answer your questions Case manager Case manager listened to you Case manager took enough time with you Case manager explained what you wanted to know Case manager was friendly and helpful to you Case manager answered your questions
4.84 4.86 4.85 4.79
(0.48) (0.41) (0.45) (0.51)
4.87 4.86 4.87 4.89 4.90
(0.37) (0.44) (0.37) (0.34) (0.34)
4.65 4.64 4.67 4.69 4.70
(0.64) (0.60) (0.60) (0.59) (0.59)
Assessed domains have been organized thematically by provider type. Satisfaction in these domains was assessed by five-point Likert scale based survey responses, where 1 ¼ ‘‘poor,’’ 2 ¼ ‘‘fair,’’ 3 ¼ ‘‘okay,’’ 4 ¼ ‘‘good,’’ and 5 ¼ ‘‘great.’’ The mean and standard deviation of the five-point Likert scale responses across all surveyed patients is reported for each domain.
Comparative results Forty patient satisfaction surveys completed by non-SRFC patients on non-SRFC clinical days were obtained for statistical comparison to the SRFC surveys described above. Nine domains from the two surveys were identified for comparison and organized under the themes of accessibility, licensed provider and facility. Comparative results between the two clinics are reported in Table 4. No significant differences between the SRFC and non-SRFC were identified across the domains related to the quality of interactions with the provider, or with the domains regarding the cleanliness and comfort of the facility. Significant differences indicating greater levels of satisfaction among the non-SRFC patients were however identified in the domains of ability to be seen, hours of operation, information privacy and likelihood of recommending the clinic to others.
Discussion There is ample evidence to support the measurement and reporting of patient satisfaction as an indicator of care quality. High levels of satisfaction are correlated with improved continuity of care, compliance with treatment, health status and the objective measures of quality inpatient care defined by the Hospital Quality Alliance (Fitzpatrick, Bury, Frank, & Donnelly, 1987; Jha, Orav, Zheng, & Epstein, 2008; Weiss & Senf, 1990). Numerous factors shown to positively influence patient satisfaction have also been identified. Chief among these are quality communication between the patient and provider, positive employee teamwork climates and the involvement of IP teams in patient care (Finley et al., 2003; Jackson, Chamberlin, & Kroenke, 2001; Lyu, Wick, Housman, Freischlag, & Makary, 2013). Patient satisfaction is thus discussed here as a well validated and particularly relevant indicator of care quality within the interprofessional environment of a SRC. The SRFC satisfaction survey data reveals high levels of patient satisfaction among a majority of respondents across the vast majority of domains assessed. Such data suggest that an interprofessional SRC can indeed provide high quality care; particularly across those domains related to the quality of the clinic’s staff, with the student assessment team receiving the
Table 4. Summary of comparable domains of the student-run free clinic and non-student run free clinic survey data. Student run free clinic
Non-student-run free clinic
Survey question
Mean (SD)
Accessibility Ability to be seen
3.92 (1.20)
Hours of operation Licensed provider Provider Listens to you Provider explains what you want to know Staff is friendly and helpful to you Facility Neat and clean building Comfort and Safety while waiting Staff kept my personal information private Likelihood of referring your friends and relatives
4.11 (0.91) 4.84 (0.48) 4.85 (0.45) 4.89 (0.34) 4.73 (0.55) 4.68 (0.6) 4.63 (0.69) 4.62 (0.74)
Survey question Accessibility How easy was it to schedule this appointment? How convenient are our location and hours? Licensed provider How well did the care provider listen? How well did the care provider explain your treatment? How friendly and courteous were we? Facility How clean does the clinic seem to you? How comfortable and safe do you feel in our waiting area? How well did we respect your privacy? How likely are you to recommend the free clinic?
Mean (SD)
Comparison p Value
4.67 (0.58)
50.05
4.5 (1.02)
50.05
4.9 (0.31) 4.83 (0.45)
0.77 0.61
4.85 (0.44)
0.66
4.71 (0.52) 4.76 (0.5)
0.76 0.67
4.83 (0.68) 4.91 (0.38)
50.05 50.05
Domains have been organized thematically. Reported values are the mean and standard deviation of five-point Likert scale survey responses across all patients of the respective clinic for the respective domain. The comparison column reports the p value derived from the Mann–Whitney U-comparison between the two clinic’s survey outcomes for each comparable domain.
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DOI: 10.3109/13561820.2015.1010718
highest overall satisfaction scores. Conversely, the lowest satisfaction scores were associated with waiting times, a result which is not unexpected for a clinic which operates by a firstcome-first-served, walk-in model of care. In fact, waiting time has been described as the primary area for improvement at the other SRFC and IPTW models which have reported patient satisfaction results in the literature (Ellett et al., 2010; Reeves et al., 2002). Our comparison of satisfaction data from patients at an interprofessional SRFC to similar data from a non-SRC revealed three notable findings. First, there were no significant differences identified between the two clinic’s extremely high levels of patient satisfaction for their patient care teams. SRFC and nonSRFC patients were equally satisfied with their providers listening skills, ability to explain medical information to them and general friendliness or courteousness. These data suggest that providers’ precepting interprofessional student teams are able to achieve the same high levels of patient satisfaction as those operating within a non-IP care model. These findings are a valuable addition to the small body of literature that directly compares the quality of care provided at an interprofessional SRC to an objective control. In a review of the literature, there is only one other SRC, and one IPTW that have reported such data. In the inpatient setting, Reeves et al. (2002) showed that a London-based IP training ward was able to achieve patient satisfaction scores equal to or greater than those earned by a comparable non-IPTW across most domains – findings consistent with those reported here (Reeves & Freeth, 2002). In the outpatient setting, Liberman et al. (2011) showed that the SRC of the Mt. Sinai School of Medicine delivered major depression care at or above the levels of quality reported by commercial and public insurers in the state of New York, while Ryskina et al. (2009) favorably compared the Mt. Sinai SRC’s control of its patient’s glycosylated hemoglobin and blood pressure levels to known average values in uninsured populations. Non-SRFC patients reported significantly greater levels of satisfaction with hours of operation and the availability of appointments, a discrepancy which is likely explained by comparing the two clinic’s resources. The non-SRFC operates 160 h per month (versus 16 at the SRFC) under an appointment based model of care (versus the SRFC’s walk-in model). As restrictions on facility and volunteer availability enable the SRFC to expand clinic hours, patient satisfaction within these domains is expected to improve. Student-Run Free Clinic patients also reported significantly lower levels of satisfaction with the clinic staff’s protection of their personal health information, a discrepancy which cannot be attributed to either the clinic’s physical space or health record management systems, which are identical. The number of staff involved in care at each clinic may provide an explanation, as non-SRFC patients encounter three clinic staff during their course of care, while SRFC patients routinely interact with five or more staff members. SRFC patients may perceive the exceptional number of people involved in their care as superfluous, and associate this with a reduction in privacy. Similar observations have been made in the emergency room setting, where patient’s perceptions of being seen by ‘‘irrelevant persons’’ negatively correlated with their perception of privacy (Lin & Lin, 2011; Lin et al., 2013). These findings warrant further investigation into the relationship between interprofessional teams, which are by definition comprised of a greater number of care providers, and patient’s perceptions of privacy. In relation to study limitations, data presented reflects perspectives of patients from one SRFC and may not be generalizable to clinics in alternate settings. Although care was taken to offer surveys to every SRFC patient, 9% of patients were
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not surveyed. It is possible that these patients may represent a disproportionally dissatisfied population who were more likely to terminate participation in care or refuse participation in the survey. While the SRFC surveys were administered to all patients within the survey period, the surveys acquired from the non-SRFC were administered to a random sample of patients within the study period, which may represent a sampling bias. Though demographic data of non-SRFC patients were not collected for comparison, non-SRFC patients served as the primary referral source for SRFC patients, and thus likely share comparable demographic characteristics with the SRFC patients described in Table 1. Finally, despite extremely similar language, domains of the two surveys compared were non-identical and discrepancies in survey content and administration may have affected the validity of comparisons.
Concluding comments The results of this study describe high levels of patient satisfaction in an interprofessional SRFC. A comparison of satisfaction data between an interprofessional SRFC and a noninterprofessional, non-student-run control clinic reveal equivalent performance within the domains of provider listening skills, provider’s ability to explain health information and general friendliness of staff. The domains related to clinic accessibility – waiting times, hours of operation and ability to be seen – were identified as the primary areas for improvement at the SRFC. The comparative assessment also identified reduced patient satisfaction in the privacy of protected health information as an important area for improvement at the SRFC. Altogether, these positive descriptive and comparative results add evidence to the small but growing body of literature supporting the claim that SRFCs are not only capable of creating unique and valuable environments for experiential IPE, but also able to deliver high quality care to their patients.
Acknowledgements The authors gratefully acknowledge the time and effort volunteered by the students and providers who participated in the student-run clinic and thank the Free Medical Clinic of Greater Cleveland for contributing their facility to this project.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the writing and content of this article.
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ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijic20
A comparative evaluation of patient satisfaction outcomes in an interprofessional student-run free clinic David Lawrence, Tara K. Bryant, Tamar B. Nobel, Mary A. Dolansky & Mamta K. Singh To cite this article: David Lawrence, Tara K. Bryant, Tamar B. Nobel, Mary A. Dolansky & Mamta K. Singh (2015) A comparative evaluation of patient satisfaction outcomes in an interprofessional student-run free clinic, Journal of Interprofessional Care, 29:5, 445-450, DOI: 10.3109/13561820.2015.1010718 To link to this article: http://dx.doi.org/10.3109/13561820.2015.1010718
Published online: 20 Feb 2015.
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Date: 06 November 2015, At: 04:27
http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(5): 445–450 ! 2015 Taylor & Francis Group, LLC. DOI: 10.3109/13561820.2015.1010718
ORIGINAL ARTICLE
A comparative evaluation of patient satisfaction outcomes in an interprofessional student-run free clinic David Lawrence1, Tara K. Bryant1, Tamar B. Nobel1, Mary A. Dolansky2, and Mamta K. Singh3 Downloaded by [University of California Santa Barbara] at 04:27 06 November 2015
1
Student Run Free Clinic, Case Western Reserve University, Cleveland, OH, USA, 2Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA, and 3School of Medicine, Case Western Reserve University, Cleveland, OH, USA
Abstract
Keywords
As the evidence supporting the value of well-coordinated healthcare teams continues to grow, so to do the calls from medical educators and policy makers for the development of meaningful interprofessional educational experiences for health professions students. The student-run clinic has emerged as a unique venue for such experiential interprofessional learning experiences, with over 100 such clinics now in operation across North America. As the number and variety of these clinics rises, it has become increasingly important to understand the quality of care which they deliver. Here, patient satisfaction data from an interprofessional student-run free clinic are described, and these results are quantitatively compared to similar data obtained from a non-interprofessional, non-student-run clinic in a post-experience only, non-equivalent groups design. Student-run free clinic patients reported high levels of satisfaction with the patient care team and the facility quality, and lower levels of satisfaction with waiting times. When compared to the non-student-run clinic, there was no significant difference in the high levels of patient satisfaction with the patient care teams between the clinics. Student-run free clinic patients did, however, report significantly lower levels of satisfaction with the accessibility of care and with the perceived privacy of protected health information. Overall, this report provides evidence that an interprofessional student-run free clinic is capable of performing at the level of an experienced free clinic across many domains of patient satisfaction, while also identifying notable areas for improvement within the domains of clinic accessibility and the perception of the privacy of protected health information.
Interprofessional care, interprofessional education, interprofessional outcomes, quantitative method, surveys, team-based care
Introduction There is growing evidence to support the claim that care delivered by well-functioning teams is superior to that provided by uncoordinated health professionals. Care that is well-coordinated between health professionals from multiple disciplines has been shown to benefit patient’s health status directly through improvements in short and long-term health outcomes (Mukamel et al., 2006; Sipila¨, Ketola, Tala, & Kumpusalo, 2008; W Hutchison, 2014) and indirectly through reductions in lengths of stay, readmission rates and overall per-patient healthcare costs (Gon˜i, 1999; Hallin, Henriksson, Dale´n, & Kiessling, 2011; Manville, Klein, & Bainbridge, 2014; Shortell & Zimmerman, 1994; Zwarenstein, Bryant, & Reeves, 2003). Such coordinated, teambased and patient-centered healthcare is best described as interprofessional care (IPC), defined as: ‘‘the development of a cohesive practice between professionals from different professions [. . .] involv[ing] continuous interaction and knowledge
Correspondence: Mr David Lawrence, Student Run Free Clinic, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA. E-mail: [email protected]
History Received 19 September 2013 Revised 15 November 2014 Accepted 19 January 2015 Published online 20 February 2015
sharing between professionals [. . .] while seeking to optimize the patient’s participation’’ (D’Amour & Oandasan, 2005, p. 9). To realize the value promised by interprofessional care, medical educators and policy makers have recognized the need for a new focus in the training of health professionals: interprofessional education (IPE). Such training has been defined by the Centre for the Advancement of Interprofessional Education as occurring, ‘‘when two or more professions learn with, from and about each other to improve collaboration and quality of care’’ (Barr, 2002, p. 17). IPE must be distinguished from multidisciplinary learning, in which students from different professions learn or even work in a group. For an educational interaction to be truly interprofessional, purposeful integration and collaboration between the professions is required. An additional key component of effective IPE, as identified by the Institute of Medicine, is experiential learning, wherein health professions students practice collaboratively and learn with and from each other in real-life clinical environments (Institute of Medicine, 2013). One increasingly prevalent venue for this kind of experiential IPE are Student-Run Clinics (SRCs); healthcare delivery programs in which health professional students take primary responsibility for the logistics, operational management and treatment of patients under the guidance and supervision of
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licensed providers. In fact, of the 21 SRC models which are fully described in the literature, 16 (76%) reported involvement of student volunteers from two or more health professions. Medicine, nursing, pharmacy, public health and social work students are those most frequently involved in SRC care models across the country. However, the involvement of disciplines as diverse as acupuncture, nutrition, and law, have also been reported (Beck, 2005; Dvoracek, Cook, & Klepser, 2010; Hastings, Zulman, & Wali, 2007). According to one nationwide survey, the average SRC had 16 student volunteers per week, provided care to predominantly uninsured and minority patients and received the majority of its revenue through private grants (Simpson & Long, 2007). With over 100 SRCs in operation across North America, however, the particular setting, patient population, and nature of care which these clinics provide is quite heterogeneous (Society of Student-Run Free Clinics, 2013). A number of distinctive SRC care-delivery models have been described in the literature, from large and well-established clinics which manage the acute and chronic health needs of a vast panel of underserved patients (Beck, 2005; Hemba & Plumb, 2011), to those which focus on a particular niche, like urgent care (Berman et al., 2012; Wang & Bhakta, 2013), post-acute care (Kent & Keating, 2013) or the care of immigrant (Ojeda et al., 2013) or homeless populations (Batra et al., 2009; Moskowitz, Glasco, Johnson, & Wang, 2006). Another notable arena for the delivery of IP care and education is the interprofessional training ward (IPTW), a model with popularity across Western Europe and Australia where medical, nursing, physiotherapy and social work students collaborate in the delivery of care to geriatric and orthopedic patients in an inpatient ‘‘teaching ward’’ setting (Reeves & Freeth, 2002; Wahlstro¨m, Sanden, & Hammar, 1997). As interprofessional SRCs and IPTWs become increasingly prevalent, there is a growing body of literature examining the quality of care provided by these unique care environments. Studies have examined SRCs’ adherence to national preventive care guidelines (Butala et al., 2012; Butala, Chang, Horwitz, Bartlett, & Ellis, 2013; Zucker, Lee, Khokhar, Schroeder, & Keller, 2013), chronic disease treatment guidelines (Liberman et al., 2011; Zucker, Gillen, Ackrivo, Schroeder, & Keller, 2011) and both objective (Ryskina, Meah, & Thomas, 2009) and subjective (Ellett, Campbell, & Gonsalves, 2010; Kent & Keating, 2013) indicators of quality. Several studies in the IPTW literature have also examined subjective indicators of care quality (Brewer & Stewart-Wynne, 2013; Reeves, Freeth, McCrorie, & Perry, 2002). These previous studies are either descriptive in nature or compare their data to a guideline or national average. There are as of yet no studies which directly compare quality indicator data from an interprofessional SRC to a non-interprofessional, nonstudent-run control clinic. In this article, we examine the quality indicator of patient satisfaction, as reported by an interprofessional SRC that provides urgent care to an underserved urban population. These data are then quantitatively compared to a non-interprofessional, nonstudent-run control clinic, towards understanding how the quality of care provided at an interprofessional SRC stacks up against the traditional outpatient care model.
Background Intervention clinic The Case Western Reserve University (CWRU) Schools of Medicine and Nursing are part of an academic health center located in Cleveland, Ohio. Founded during the 2010–2011 academic calendar year, the CWRU Student-Run Free Clinic
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(SRFC) was established as a twice-monthly Saturday walk-in clinic which provides free acute care services to the local urban underserved population. This SRFC operates within the facilities of a local free clinic which had previously been closed on Saturdays, and was granted access to the same physical waiting and exam room spaces, electronic health record system and laboratory capabilities. The SRFC patient population was primarily referred as overflow from the local free clinic, as described in more detail in the ‘‘Control Clinic’’ section below. Student-run clinic volunteers receive approximately 4 h of training across two sessions, which include an orientation to the clinic’s philosophy, patient-flow model and documentation methods, as well as a review of techniques for presenting patient information to preceptors. There were no IPE experiences explicitly integrated into these training sessions or into either professional school’s curriculum prior to the 4-month volunteer period. Student volunteers provide care at two clinic sessions, where they are organized into IP care teams comprised of a preclinical medical or nursing student and an upper-level student from the complementary program. The upper-level student operates as a mentor to the pre-clinical student, coaching them through the patient interview and exam, and in presenting their findings, assessment and plan to an attending nurse practitioner or physician preceptor. The IP care team is thus designed to bring medical and nursing students together into a single unit focused on patient care with a mentor and mentee relationship defined by clinical experience, rather than medical or nursing paradigms. Pre-clinical medical and nursing students also carry out patient intake, check vital signs and coordinate with the patient care teams to provide relevant after-visit health education materials and referrals to appropriate community resources. There were 29 pre-clinical medical and nursing students engaged as volunteers at the time of the study period, of which 15 (52%) were first-year masters of science in nursing students, and 14 (48%) were first or second year medical students. The volunteer base consisted of 7 (24%) male and 22 (76%) female preclinical medical and nursing students. The interprofessional SRFC has the capacity to provide care for up to approximately 25 patients per Saturday session, and is able to address acute chief complaints only. Control clinic The Free Medical Clinic of Greater Cleveland serves as this study’s non-student-run control clinic, and shall henceforth be referred to as the ‘‘non-SRFC’’. The non-SRFC is located in East Cleveland near the Case Western Reserve University medical campus. During the time of the study period, the non-SRFC operated as a not-for profit, 501(C)3 non-governmental organization, providing free and low-cost healthcare at sliding-scale rates. The non-SRFC primarily operates on an appointment-based model, though it also accommodates patients with limited walkin hours. Patients unable to be seen on these walk-in days were often referred to the next Saturday SRFC session, and these overflow patients thus comprised the primary patient panel for the student-run clinic. The makeup of the staff at the non-SRFC is typical of outpatient medical clinics, involving a front-desk receptionist who manages the waiting room, a medical assistant or nurse who acquires patient vital signs and reviews intake forms and a physician or nurse practitioner who conducts the care encounter. The non-SRFC operates on-site pharmacy, phlebotomy and point of care laboratory services. Patients have access to acute, chronic, and specialty services, including dental, dermatologic and ophthalmologic care.
Patient satisfaction in an interprofessional SRFC
DOI: 10.3109/13561820.2015.1010718
Methods A pseudo-experimental study design (Trochim, 2000) was employed to generate comparative results from post-experience patient satisfaction surveys in a non-equivalent groups design.
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Data collection During the 10-month study period, trained research assistants routinely offered patient satisfaction surveys to every SRFC patient at the end of their visit, while non-SRFC patients were offered the survey in a random, non-routine fashion. Patient participation was anonymous and optional. Satisfaction surveys used simple language and brief questions adapted from the Health Center Patient Satisfaction Survey (US Department of Health & Human Services, 2009). The SRFC survey consisted of 28 fivepoint Likert scale items ranking the level of satisfaction in particular clinic domains on a scale from ‘‘poor’’ (1 point) to ‘‘great’’ (5 points). The non-SRFC survey consisted of 21 fivepoint Likert scale items which also ranked level of satisfaction of clinic domains on a scale from ‘‘poor’’ (1 point) to ‘‘great’’ (5 points). A retrospective chart review of each SRFC patient seen during the study period was also carried out to acquire the basic demographic characteristics of the patient population and a general categorization of each encounter’s chief complaint. Data analysis Responses for each five-point Likert scale survey item were averaged for a mean score and a standard deviation, as described in Tables 2 and 3. Non-responses were excluded when calculating mean values. Due to the differences in staff composition between the two clinics, a number of survey domains related to staffing were ineligible for direct comparison, such as the SRFC survey domains which focused on patient interactions with student volunteers. Analysis of the survey language identified nine domains from each survey eligible for direct comparison. These domains were grouped into three themes: accessibility, licensed provider and facility quality. Domains within those themes were assessed for skew-ness utilizing the adjusted Fisher–Pearson Table 1. Demographic characteristics and chief complaint categories of the student-run free clinic patient population during the study period. Domain Total Age (in years) 18–24 25–34 35–44 45–54 55–64 465 Race White African American Hispanic Gender Male Female Chief Complaint Sexually transmitted infection Work/school physical Dermatological/ophthalmological Otolaryngological Miscellaneous
N (% total) 96 24 23 24 15 10
(25%) (24%) (25%) (16%) (10%) 0
15 (16%) 80 (83%) 1 (1%) 45 (47%) 51 (51%) 39 (41%) 31 (33%) 10 (10%) 6 (6%) 10 (10%)
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standardized moment coefficient, and each response-set was found to be significantly skewed from the standard distribution, towards more positive or more negative responses (Pearson & Hartley, 1970). The Mann–Whitney U test was thus utilized for the comparative assessment of these skewed distributions. Analysis was performed using the Microsoft Excel statistical package. The themes, specific domains and comparative statistics are described in Table 4. Ethical considerations The study was approved by the Institutional Review Board of Case Western Reserve University.
Results Results from the study are presented in three main sections. Student-run free clinic survey participant demographic data A total of 87 out of 96 (91%) patients seen at the SRFC over a 10-month period completed satisfaction surveys. The majority of respondents (53%) were females and over 80% were African American. Respondents were relatively young, with the majority (74%) split equally among the 18–24, 25–34 and 35–44 age ranges. Chief complaints for each encounter during the study period were also recorded. Concern for a sexually transmitted infection (41%) or need for a work/school physical (33%) was found to be the most common reasons for a visit to the SRFC. Complete demographic and chief complaint data are presented in Table 1. Student-run free clinic survey Results of the SRFC surveys are presented in Tables 2 and 3 below. A mean Likert scale value and standard deviation for each domain is reported. Domains are further organized thematically; accessibility, wait time and facility related domains are reported in Table 2, and licensed provider, student assessment team and case manager related domains are summarized in Table 3.
Table 2. Patient satisfaction in care accessibility and facility quality at the student-run free clinic. Domain Accessibility Ability to be seen Hours of operation Convenience of location Prompt return on calls Waiting time Time in waiting room Time in exam room Waiting for tests to be performed Waiting for test results Facility Neat and clean building Ease of finding where to go Comfort and Safety while waiting Privacy of facilities Staff kept my personal information private Likelihood of referring others
Mean (SD) 3.92 4.11 4.36 4.03
(1.20) (0.91) (0.83) (0.97)
3.36 3.71 3.40 4.03
(1.32) (1.24) (1.04) (0.95)
4.73 4.66 4.68 4.66 4.63 4.62
(0.55) (0.57) (0.60) (0.68) (0.69) (0.74)
Assessed domains have been organized thematically. Satisfaction in these domains was assessed by five-point Likert scale based survey responses, where 1 ¼ ‘‘poor,’’ 2 ¼ ‘‘fair,’’ 3 ¼ ‘‘okay,’’ 4 ¼ ‘‘good,’’ and 5 ¼ ‘‘great.’’ The mean and standard deviation of the five-point Likert scale responses across all surveyed patients is reported for each domain.
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Overall, 24 of 28 items were given a satisfaction rating of ‘‘good’’ to ‘‘great’’. The highest levels of patient satisfaction were reported under the themes of the student assessment team, with the item ‘‘student answers your questions’’ the single most highly rated item. High satisfaction was also reported throughout the licensed provider domain group. Lowest levels of satisfaction were found under the theme of waiting time and the domain ability to be seen, with the item ‘‘time in waiting room’’ the most poorly rated of all domains. Patients were satisfied with cleanliness and privacy of the facility. Ninety percent of patients reported the likelihood of referring friends or family to the clinic was ‘‘good’’ or ‘‘great’’.
Table 3. Patient satisfaction in provider care services at the student-run free clinic. Domain
Mean (SD)
Licensed provider Provider Listens to you Provider takes enough time with you Provider explains what you want to know Provider gives you good advice and treatment Student assessment team Students listen to you Students take enough time with you Students explain what you want to know Students are friendly and helpful to you Students answer your questions Case manager Case manager listened to you Case manager took enough time with you Case manager explained what you wanted to know Case manager was friendly and helpful to you Case manager answered your questions
4.84 4.86 4.85 4.79
(0.48) (0.41) (0.45) (0.51)
4.87 4.86 4.87 4.89 4.90
(0.37) (0.44) (0.37) (0.34) (0.34)
4.65 4.64 4.67 4.69 4.70
(0.64) (0.60) (0.60) (0.59) (0.59)
Assessed domains have been organized thematically by provider type. Satisfaction in these domains was assessed by five-point Likert scale based survey responses, where 1 ¼ ‘‘poor,’’ 2 ¼ ‘‘fair,’’ 3 ¼ ‘‘okay,’’ 4 ¼ ‘‘good,’’ and 5 ¼ ‘‘great.’’ The mean and standard deviation of the five-point Likert scale responses across all surveyed patients is reported for each domain.
Comparative results Forty patient satisfaction surveys completed by non-SRFC patients on non-SRFC clinical days were obtained for statistical comparison to the SRFC surveys described above. Nine domains from the two surveys were identified for comparison and organized under the themes of accessibility, licensed provider and facility. Comparative results between the two clinics are reported in Table 4. No significant differences between the SRFC and non-SRFC were identified across the domains related to the quality of interactions with the provider, or with the domains regarding the cleanliness and comfort of the facility. Significant differences indicating greater levels of satisfaction among the non-SRFC patients were however identified in the domains of ability to be seen, hours of operation, information privacy and likelihood of recommending the clinic to others.
Discussion There is ample evidence to support the measurement and reporting of patient satisfaction as an indicator of care quality. High levels of satisfaction are correlated with improved continuity of care, compliance with treatment, health status and the objective measures of quality inpatient care defined by the Hospital Quality Alliance (Fitzpatrick, Bury, Frank, & Donnelly, 1987; Jha, Orav, Zheng, & Epstein, 2008; Weiss & Senf, 1990). Numerous factors shown to positively influence patient satisfaction have also been identified. Chief among these are quality communication between the patient and provider, positive employee teamwork climates and the involvement of IP teams in patient care (Finley et al., 2003; Jackson, Chamberlin, & Kroenke, 2001; Lyu, Wick, Housman, Freischlag, & Makary, 2013). Patient satisfaction is thus discussed here as a well validated and particularly relevant indicator of care quality within the interprofessional environment of a SRC. The SRFC satisfaction survey data reveals high levels of patient satisfaction among a majority of respondents across the vast majority of domains assessed. Such data suggest that an interprofessional SRC can indeed provide high quality care; particularly across those domains related to the quality of the clinic’s staff, with the student assessment team receiving the
Table 4. Summary of comparable domains of the student-run free clinic and non-student run free clinic survey data. Student run free clinic
Non-student-run free clinic
Survey question
Mean (SD)
Accessibility Ability to be seen
3.92 (1.20)
Hours of operation Licensed provider Provider Listens to you Provider explains what you want to know Staff is friendly and helpful to you Facility Neat and clean building Comfort and Safety while waiting Staff kept my personal information private Likelihood of referring your friends and relatives
4.11 (0.91) 4.84 (0.48) 4.85 (0.45) 4.89 (0.34) 4.73 (0.55) 4.68 (0.6) 4.63 (0.69) 4.62 (0.74)
Survey question Accessibility How easy was it to schedule this appointment? How convenient are our location and hours? Licensed provider How well did the care provider listen? How well did the care provider explain your treatment? How friendly and courteous were we? Facility How clean does the clinic seem to you? How comfortable and safe do you feel in our waiting area? How well did we respect your privacy? How likely are you to recommend the free clinic?
Mean (SD)
Comparison p Value
4.67 (0.58)
50.05
4.5 (1.02)
50.05
4.9 (0.31) 4.83 (0.45)
0.77 0.61
4.85 (0.44)
0.66
4.71 (0.52) 4.76 (0.5)
0.76 0.67
4.83 (0.68) 4.91 (0.38)
50.05 50.05
Domains have been organized thematically. Reported values are the mean and standard deviation of five-point Likert scale survey responses across all patients of the respective clinic for the respective domain. The comparison column reports the p value derived from the Mann–Whitney U-comparison between the two clinic’s survey outcomes for each comparable domain.
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DOI: 10.3109/13561820.2015.1010718
highest overall satisfaction scores. Conversely, the lowest satisfaction scores were associated with waiting times, a result which is not unexpected for a clinic which operates by a firstcome-first-served, walk-in model of care. In fact, waiting time has been described as the primary area for improvement at the other SRFC and IPTW models which have reported patient satisfaction results in the literature (Ellett et al., 2010; Reeves et al., 2002). Our comparison of satisfaction data from patients at an interprofessional SRFC to similar data from a non-SRC revealed three notable findings. First, there were no significant differences identified between the two clinic’s extremely high levels of patient satisfaction for their patient care teams. SRFC and nonSRFC patients were equally satisfied with their providers listening skills, ability to explain medical information to them and general friendliness or courteousness. These data suggest that providers’ precepting interprofessional student teams are able to achieve the same high levels of patient satisfaction as those operating within a non-IP care model. These findings are a valuable addition to the small body of literature that directly compares the quality of care provided at an interprofessional SRC to an objective control. In a review of the literature, there is only one other SRC, and one IPTW that have reported such data. In the inpatient setting, Reeves et al. (2002) showed that a London-based IP training ward was able to achieve patient satisfaction scores equal to or greater than those earned by a comparable non-IPTW across most domains – findings consistent with those reported here (Reeves & Freeth, 2002). In the outpatient setting, Liberman et al. (2011) showed that the SRC of the Mt. Sinai School of Medicine delivered major depression care at or above the levels of quality reported by commercial and public insurers in the state of New York, while Ryskina et al. (2009) favorably compared the Mt. Sinai SRC’s control of its patient’s glycosylated hemoglobin and blood pressure levels to known average values in uninsured populations. Non-SRFC patients reported significantly greater levels of satisfaction with hours of operation and the availability of appointments, a discrepancy which is likely explained by comparing the two clinic’s resources. The non-SRFC operates 160 h per month (versus 16 at the SRFC) under an appointment based model of care (versus the SRFC’s walk-in model). As restrictions on facility and volunteer availability enable the SRFC to expand clinic hours, patient satisfaction within these domains is expected to improve. Student-Run Free Clinic patients also reported significantly lower levels of satisfaction with the clinic staff’s protection of their personal health information, a discrepancy which cannot be attributed to either the clinic’s physical space or health record management systems, which are identical. The number of staff involved in care at each clinic may provide an explanation, as non-SRFC patients encounter three clinic staff during their course of care, while SRFC patients routinely interact with five or more staff members. SRFC patients may perceive the exceptional number of people involved in their care as superfluous, and associate this with a reduction in privacy. Similar observations have been made in the emergency room setting, where patient’s perceptions of being seen by ‘‘irrelevant persons’’ negatively correlated with their perception of privacy (Lin & Lin, 2011; Lin et al., 2013). These findings warrant further investigation into the relationship between interprofessional teams, which are by definition comprised of a greater number of care providers, and patient’s perceptions of privacy. In relation to study limitations, data presented reflects perspectives of patients from one SRFC and may not be generalizable to clinics in alternate settings. Although care was taken to offer surveys to every SRFC patient, 9% of patients were
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not surveyed. It is possible that these patients may represent a disproportionally dissatisfied population who were more likely to terminate participation in care or refuse participation in the survey. While the SRFC surveys were administered to all patients within the survey period, the surveys acquired from the non-SRFC were administered to a random sample of patients within the study period, which may represent a sampling bias. Though demographic data of non-SRFC patients were not collected for comparison, non-SRFC patients served as the primary referral source for SRFC patients, and thus likely share comparable demographic characteristics with the SRFC patients described in Table 1. Finally, despite extremely similar language, domains of the two surveys compared were non-identical and discrepancies in survey content and administration may have affected the validity of comparisons.
Concluding comments The results of this study describe high levels of patient satisfaction in an interprofessional SRFC. A comparison of satisfaction data between an interprofessional SRFC and a noninterprofessional, non-student-run control clinic reveal equivalent performance within the domains of provider listening skills, provider’s ability to explain health information and general friendliness of staff. The domains related to clinic accessibility – waiting times, hours of operation and ability to be seen – were identified as the primary areas for improvement at the SRFC. The comparative assessment also identified reduced patient satisfaction in the privacy of protected health information as an important area for improvement at the SRFC. Altogether, these positive descriptive and comparative results add evidence to the small but growing body of literature supporting the claim that SRFCs are not only capable of creating unique and valuable environments for experiential IPE, but also able to deliver high quality care to their patients.
Acknowledgements The authors gratefully acknowledge the time and effort volunteered by the students and providers who participated in the student-run clinic and thank the Free Medical Clinic of Greater Cleveland for contributing their facility to this project.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the writing and content of this article.
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