Enhancing Patient Experience With Cognitive Assessment

Patient experience refers to the sum of all interactions that patients have with the healthcare system. It is different from patient satisfaction, which measures whether a patient’s expectations were met. By enhancing patient experience, both specialists and general practitioners can set patients up for better healthcare outcomes, including in cognitive care, where cognitive assessment tools and strategies can contribute to a positive experience.

Nearly two-thirds of Americans find coordinating and managing healthcare to be overwhelming and time consuming, resulting in them avoiding seeing their doctor until they are already sick, according to the American Academy of Physician Associates.

In this post, we review key aspects of patient experience, along with practical examples in cognitive care, mental health, and primary care settings.

What is patient experience?

Patient experience encompasses touchpoints with people and policies, the culture and physical environment of healthcare facilities, continuum of care, and the perception of patients and families. Healthcare frameworks aimed at improving patient experience prioritize health equity and the consistent delivery of patient-centered care.

Measuring patient experience involves identifying if each step in the healthcare journey is adequately met. This is different from patient satisfaction, which measures if a patient’s expectations were met. For example, emailing an appointment reminder would be a part of patient experience, but taking feedback that a patient expected to receive a phone call would fall under patient satisfaction.

According to the Agency for Healthcare Research and Quality’s CAHPS program (Consumer Assessment of Healthcare Providers and Systems), there are 8 measurable aspects of patient experience:

1. Culturally appropriate care. Whole person care includes being aware of how patients’ cultural backgrounds contribute to their treatment preferences. Recognizing and considering patients’ backgrounds and beliefs increases patient engagement and health equity in health organizations.
2. Care coordination. A recent poll showed that adults spend up to eight hours every month on care coordination and healthcare navigation in the U.S. With the currently tumultuous state of global healthcare, reducing the strain of navigating the health system is a major part of patient experience.
3. Courtesy and respect. Respect is crucial to building trust between patients and clinicians, and is heavily correlated with patient satisfaction. In 23 of 28 medical specialties, showing respect was the item most predictive of overall physician ratings.
4. Access to care. 56% of adults wait more than a week for a doctor’s appointment, which is alarming because 61% only seek care when they are sick. Telehealth services, streamlined referrals, and flexible scheduling are a few tools and strategies to improve this aspect of patient experience.
5. Communication with clinicians. Active listening, using verbal and non-verbal communication, and providing written information and visual aids can lead to more effective communication between patients and clinicians. This is especially important when it comes to neurological health.
6. Shared decision-making. Collaborating with patients and their families is a primary aspect of patient-centered care. Integrating this strategy into patient experience is especially valuable in cognitive care, as it addresses the unique needs of patients and their caregivers.
7. Getting information. Understanding the health system plays a crucial role in applying treatment plans. 54% of patients believe their health would improve if clinicians helped them understand the system.
8. Self-management support. Connecting patients with educational material, community resources, and caregiver resources empowers them to actively engage with their health plan between primary care appointments.

How do you measure patient experience?

An effective way to assess patient experience is by sending patients surveys that connect to the 8 aspects of care. By gathering and applying patient feedback, care teams can not only learn about the current experience, but also improve it in the future.

To return to the example of appointment reminders, a survey could ask:

• Did you receive our appointment reminder?
• Was the reminder helpful for you?
• Did the reminder include all the information you needed?
• Is there anything that you would change about our reminder system?

Including questions about patient satisfaction helps identify patterns in patient expectations, which makes it easier to effectively update your organization’s processes.

Why is patient experience important?

Patient experience begins when patients are booking their first appointment, and continues through all aspects of their treatment. Every interaction with doctors and staff members, as well as the quality of the organization’s healthcare technology, shapes a patient’s relationship with their clinic or hospital.

Implementing patient-centered practices has many benefits, including:

• Higher rates of patient compliance. Studies suggest that high-quality communication has a higher impact on patient compliance than overall time spent with clinicians. With the right systems and tools in place for patient engagement, clinicians can have meaningful conversations without sacrificing valuable time.
• Improved patient retention rates. Positive relationships with clinicians are the leading factor in patient loyalty to a practice. A good patient experience is the first step in building trust between patients and clinicians.
• Better health outcomes. There are significant associations between quality patient experience and improved health outcomes, as well as increased patient safety.
• Higher profit margins for clinics. When 3,767 hospitals were observed over six years, researchers found that positive patient experience is associated with increased profitability.
• Reductions in malpractice. When reviewing patient satisfaction surveys, one study found that minimum satisfaction scores were significantly associated with malpractice activity. This highlights the impact of an organization’s culture on quality of treatment.

Prioritizing patient experience leads to positive outcomes for patients, doctors, and the healthcare system itself.

Patient experience examples in cognitive, mental health, and primary care

Measuring patient experience looks somewhat different depending on the health care setting, but the benefits exist across all specialties.

Here are a few examples of how this framework leads to better healthcare outcomes in cognitive care, mental health, and primary care settings:

Cognitive care scenario

According to Alzheimer’s Research UK, 49% of people of all ages said that dementia was the disease they feared most. As a result, conversations about cognitive care can bring up anxiety in patients, which makes cultivating positive patient experience extra important for building trust.

Melissa Picchione, Medical Director of Yukon Neurology, noted that, “Many people think that even beginning to investigate memory issues means they're definitely going to find a severe problem, so they avoid it.”

Implementing improved patient experience measures in cognitive care may involve:

• Making routine testing quick and easy
• Tracking longitudinal data to measure significant change over time, as opposed to using the MoCA Test when decline is already apparent
• Delivering reports that are easy for patients and clinicians to understand

Mental health care scenario

For patients with mental illness, missing appointments is associated with a significantly greater risk of all-cause mortality. Providing patients with digital options for delivering health care can make it easier for these patients to get help from home, which can improve patient safety in the long run.

Effective patient experience measures also implement evidence-based practice for effective and timely diagnoses. When Dr. Toy of Telapsychiatry used the Creyos ADHD Condition-Focused Protocol, he could gather objective data that improved the accuracy of ADHD diagnoses. This curbed ADHD diagnoses by over 30%, allowing him to identify the root causes of patients’ inattention while getting those with ADHD the accommodations they needed.

Improving the diagnostic step in patient experience helps:

• Determine comorbidities
• Compare test results over time to measure the effectiveness of treatment plans
• Facilitate relevant self-management strategies
• Identify appropriate treatments for patients’ needs

Primary care scenario

According to the Canadian Medical Association's 2021 National Physician Health Survey (NPHS), 61% of primary care physicians feel excessively burdened by administrative work as opposed to 40% of their specialist colleagues. This has led to both burnout among clinicians as well as reduced quality in healthcare delivery.

With Alzheimer’s Research UK projecting that worldwide dementia rates will triple by 2050, streamlining cognitive testing is becoming a necessity for keeping administrative work sustainable across specialties. This is especially important because higher administration demands mean clinicians are spending less time with patients, which directly impacts patient experience.

Including scientifically-backed protocols at patients’ annual wellness visit can gather key data in under ten minutes, reducing unnecessary referrals. CPT Code 99483 can also be used for billing for cognitive care planning.

Strategies for enhancing patient experience in cognitive care

Improving patient experience can be achieved both with small day-to-day changes and larger systemic transformations.

Here are 7 strategies for creating positive patient experience in cognitive care settings:

Adapt the clinical setting

Improving the accessibility and overall sensory pleasantness of a healthcare setting is a simple way to improve patient engagement and satisfaction. For example, 30% of people report having sensitivity to scents, which isn’t just off-putting in a waiting room, but can also aggravate symptoms of asthma.

A few ways to create a more comfortable and accessible environment in a cognitive healthcare setting include:

• Dim lighting in neurology offices for patients with chronic conditions like migraines
• Signs with instructive images for patients with cognitive impairment
• Turning off the news in waiting rooms to reduce patient anxiety

Offer virtual care options

For patients with cognitive, mental, and physical disabilities, virtual primary care removes barriers to healthcare that can negatively impact long term health outcomes. While telemedicine isn’t right for every patient, studies have shown that this form of care can be equivalent to in-person care for some acute and chronic conditions.

Plus, in 2019, virtual care saved Canadians 3.5 million hours and $530 million in avoided travel costs, according to Canada Health Infoway. As the cost of living continues to rise in North America, reducing the time and financial burden of accessing healthcare will promote health equity across multiple degrees of marginalization.

Focus on patient-centered care

Patient-centered care is a model that centers patients’ individual wants, needs, and goals. In this model, clinicians’ jobs are to educate patients, advise them on treatment options, and provide the tools and resources they need to succeed. This lets patients lead their health plans and have autonomy in their treatments.

In cognitive care settings, having control over decision making is a key part of self-esteem for people with dementia, according to the Alzheimer Society of Canada. As explored above, shared decision-making is generally one of the keys to cultivating positive experiences for patients. Using a collaborative model with the clinician, patient, and their caregivers gives these patients more autonomy while also keeping cognitive challenges in mind.

Streamline administrative tasks

Achieving shorter waiting times for appointments and referrals plays the largest role in patient satisfaction across primary care, hospital, and walk-in settings. By streamlining administrative tasks, staff members and clinicians can get to patients faster and improve the quality of their appointments.

This also reduces the likelihood of aggression in waiting rooms, which harms the emotional wellness of staff members like clerks and security guards, according to Harvard Business Review. This leads to higher turnover and understaffing, which contributes to the cycle of increased wait times, distressed patients, decreased patient satisfaction, and worse health outcomes. Maintaining courtesy and respect are important to patient experiences, as explored above.

Automate communications

Forgetfulness is a common symptom of mild cognitive impairment, which can lead to missed appointments. Automated appointment reminders keep medical care top of mind, and give patients the opportunity to cancel if they realize the time no longer works. This opens up appointments for other patients, reducing wait times.

Implement longitudinal reporting

While neuropsychological testing is effective for diagnosing different cognitive health issues, referrals can take up to ten months for adults. These gaps lead to even longer times between follow-up appointments, which loses patients crucial time for interventions. Along with this, these assessments can take between 6 and 8 hours, causing heightened anxiety in patients that can skew results.

Cognitive health assessments from Creyos can be used in primary care or nearly any medical specialty, and many of them take under 10 minutes to complete. This allows for regular testing that helps doctors track patterns over time. Instead of one brief look at a patient’s health, data can be built over time.

Use accessible assessment tools

If patients feel confused by assessment tools, it can be difficult to gauge the accuracy of the results. Accessible, gamified assessments from Creyos can examine a patient’s short term memory, reasoning, concentration, and verbal ability in a way that is quick and even enjoyable. Along with this, many of these tools can be used remotely for patients who cannot always come to appointments in person.

Using patient feedback to improve care delivery

For patients, positive experiences contribute to higher satisfaction scores. Regularly gathering patient feedback through surveys can help identify if all the steps designed to improve the patient experience were achieved. With the data in place, a clinic can improve the quality of its care on both an administrative and medical level.