A provider experience survey in integrated care. Closing out the quadruple aim
Bibliographic record
Abstract
Background: Capturing the provider’s experience, delivering care and provider well-being has become a major focus of health system leaders and recognized as the fourth component of the Quadruple Aim. However, tools to measure the experience of provider care are limited, with few examples in integrated care. Existing measurement is both specific to provider types/professional groups or is narrowly focused on teamwork measures. Instruments are needed to assess interprofessional health care providers experience and well-being in the context of integrated care. We sought to develop and test a provider experience scale applicable across provider types and organizations engaged in integrated care models. Approach: A provider experience survey was developed through a three-phase approach. The first phase included a rapid literature review of provider experience surveys and research team consensus meetings to identify thematic areas and candidate items from existing survey tools. The second phase involved 4 focus groups with 16 providers including physicians, therapists, social workers, nurses and community health workers. The third phase was a field test of the survey in 3 health system interventions aimed to advance integrated care. The field test took place with providers in Ontario, Canada in the implementation of population-based integrated care models called Ontario Health Teams. Exploratory factor analysis was used to group items into domains and domain-specific factor scores and reliability was assessed. Results: A 39-item survey was fielded to 2145 respondents with an average 22% response rate and 472 returned surveys. Factor analysis resulted in 5 subscales: 1) care coordination; 2) workplace culture; 3) autonomy; 4) burnout/satisfaction; and 5) digital/virtual care. The internal consistency estimates of reliability of each subscale ranged from 0.72 to 0.94, and overall reliability was 0.82. Conclusions: This provider experience survey addresses gaps important for integrated care in that it was developed and validated with multiple professions and applied in the context of integrated care. Statistical results from an initial survey of 472 respondents in Ontario, Canada suggests strong internal consistency and reliability while engagement with providers in the development of the survey tool provides support for content validity. This tool is publicly available in French and English for integrated care programs to use to assess provider experience as essential outcome of integrated care initiatives. Further testing and refinement of the measure will strengthen the measurement of provider experience in quadruple aim evaluation of integrated care programs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".