Measuring health outcomes, experience of care and cost of healthcare in student-led healthcare services: A literature review
DOI:
https://doi.org/10.11157/fohpe.v23i1.389Keywords:
student-led healthcare service, Triple Aim, population health, patient experience, cost of care, evaluation, quality improvementAbstract
Introduction: In student-led healthcare services, health students take responsibility for the management and delivery of health services as part of clinical training. Like all healthcare services, student-led healthcare services need to be evaluated to ensure they provide high quality, safe and cost-effective services. The aim of this literature review was to understand how student-led healthcare services have been evaluated to date and to assess alignment of previous evaluations with the Triple Aim framework. The Triple Aim is a conceptual framework offering a systematic approach to evaluating healthcare services that may be appropriate for evaluation of student-led services.
Methods: Electronic databases were searched for articles describing a student-led healthcare service and were screened for studies that evaluated the impact of a student-led healthcare service on patient outcomes. Critical appraisal was informed by Stiefel and Nolan’s (2012) IHI white paper A Guide to Measuring the “Triple Aim”, and each article was appraised against the Triple Aim measurement principles and dimensions of care.
Results: Fourteen of 211 identified articles met the inclusion criteria. All 14 studies met the Triple Aim measurement principles of “a defined population”, “gather data over time” and “distinguish between measures”, while only eight of the 14 studies achieved “comparison data”. All 14 studies measured at least one or more of the Triple Aim dimensions.
Conclusions: There was little consistency across the evaluations of student-led healthcare services, limiting the extent to which the benefits of student-led healthcare services can be shown to be a valuable resource to the healthcare system. Further investigation is required to determine a suitable evaluation framework for student-led healthcare services.
References
Atakro, C. A., Armah, E., Menlah, A., Garti, I., Addo, S. B., Adatara, P., & Boni, G. S. (2019). Clinical placement experiences by undergraduate nursing students in selected teaching hospitals in Ghana. BMC Nursing, 18(1), Article 1. https://doi.org/10.1186/s12912-018-0325-8
Adams, R. P., Barton, G., Bhattacharya, D., Grassby, P. F., Holland, R., Howe, A., Norris, N., Shopstone, L., & Wright, D. J. (2015). Supervised pharmacy student-led medication review in primary care for patients with type 2 diabetes: A randomised controlled pilot study. BMJ Open, 5(11), Article e009246. https://doi.org/10.1136/bmjopen-2015-009246
Austin, S. R., Wong, Y.-N., Uzzo, R. G., Beck, J. R., & Egleston, B. L. (2015). Why summary comorbidity measures such as the Charlson Comorbidity Index and Elixhauser score work. Medical Care, 53(9), e65–e72. https://doi.org/10.1097/MLR.0b013e318297429c
Australian Institute of Health and Welfare (AIHW). (2020). Australia’s health 2020: Data insights. https://www.aihw.gov.au/reports/australias-health/australias-health-2020-data-insights/data
Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a tool towards quality improvement. Oman Medical Journal, 29(1), 3–7. https://doi.org/10.5001/omj.2014.02
Bernhardt, J., Borschmann, K., Boyd, L., Carmichael, S. T., Corbett, D., Cramer, S. C., Hoffman, T., Kwakkel, G., Savitz, S. I., Saposnik, G., Walker, M., & Ward, N. (2017). Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research. Neurorehabilitation and Neural Repair, 31(8), 694–698. https://doi.org/10.1177/1545968317724290
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annerican Family Medicine, 12(6), 573–576. https://doi.org/10.1370/afm.1713
Boxall, A. (2011). What are we doing to ensure the sustainability of the health system? Parliament of Australia. https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1112/12rp04
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(1), 19–31. https://doi.org/10.1177/00333549141291S206
Burgess, A., & Mellis, C. (2015). Feedback and assessment for clinical placements: Achieving the right balance. Advances in Medical Education and Practice, 6, 373–381. https://doi.org/10.2147/AMEP.S77890
Butala, N. M., Chang, H., Horwitz, L. I., Bartlett, M., & Ellis, P. (2013). Improving quality of preventive care at a student-run free clinic. PLoS ONE, 8(11), Article e81441. https://doi.org/10.1371/journal.pone.0081441
Chen, T., Li, L., & Kochen, M. M. (2005). A systematic review: How to choose appropriate health-related quality of life (HRQOL) measures in routine general practice? Journal of Zhejiang University Science B, 6(9), 936–940.
Clark, J. S., Bollaert, A., Sills, S. O., Clark, J. H., & Norris, D. (2014). Patient perception of care received by students at the Jackson Free Clinic. Journal of the Mississippi State Medical Association, 55(4), 113–118.
Cowing, M., Davino-Ramaya, C. M., Ramaya, K., & Szmerekovsky, J. (2009). Health care delivery performance: Service, outcomes, and resource stewardship. The Permanente Journal, 13(4), 72–78. https://doi.org/10.7812/TPP/08-100
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613–619. https://doi.org/10.1016/0895-4356(92)90133-8
Evans, R. G., & Stoddart, G. L. (1990). Producing health, consuming health care. Social Science & Medicine, 31(12), 1347–1363. https://doi.org/10.1016/0277-9536(90)90074-3
Frakes, K., Brownie, S., Davies, L., Thomas, J., Miller, M., & Tyack, Z. (2014). Capricornia Allied Health Partnership (CAHP): A case study of an innovative model of care addressing chronic disease through a regional student-assisted clinic. Australian Health Review, 38(5), 483–486. https://doi.org/10.1071/AH13177
Frakes, K., Tyack Z., Miller, M., Davies, L., Swanston, A., & Brownie, S. (2011). The Capricornia project: Developing and implementing an interprofessional student-assisted allied health clinic. ClinEdQ. https://research-repository.griffith.edu.au/handle/10072/42605
Frendl, D. M., & Ware, J. E., Jr. (2014). Patient-reported functional health and well-being outcomes with drug therapy: A systematic review of randomized trials using the SF-36 Health Survey. Medical Care, 52(5), 439–445. https://doi.org/10.1097/MLR.000000000000010311
Fröberg, M., Leanderson, C., Flackman, B., Hedman-Lagerlof, E., Bjorklund, K., Nilsson, G. H., & Stenfors, T. (2018). Experiences of a student-run clinic in primary care: A mixed-method study with students, patients and supervisors. Scandinavian Journal of Primary Health Care, 36(1), 36–46. https://doi.org/10.1080/02813432.2018.1426143
Gorrindo, P., Peltz, A., Ladner, T. R., Reddy, I., Miller, B. M., Miller, R. F., & Fowler, M. J. (2014). Medical students as health educators at a student-run free clinic: Improving the clinical outcomes of diabetic patients. Academic Medicine, 89(4), 625–631. https://doi.org/10.1097/ACM.0000000000000164
Hall, R. E., Porter, J., Quan, H., & Reeves, M. J. (2019). Developing an adapted Charlson comorbidity index for ischemic stroke outcome studies. BMC Health Services Research, 19(1), 930. https://doi.org/10.1186/s12913-019-4720-y
Institute of Healthcare Improvement (IHI). (2017). IHI Triple Aim prototyping partners. Retrieved May 24, 2017, from http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/Participants.aspx
Kenny, A., Hyett, N., Sawtell, J., Dickson-Swift, V., Farmer, J., & O’Meara, P. (2013). Community participation in rural health: A scoping review. BMC Health Services Research, 13(1), Article 64. https://doi.org/10.1186/1472-6963-13-64
Kent, F., Drysdale, P., Martin, N., & Keating, J. (2014). The mixed-discipline aged-care student clinic: An authentic interprofessional learning initiative. Journal of Allied Health, 43(1), 51–56.
Kent, F., Lai, F., Beovich, B., & Dodic, M. (2016). Interprofessional student teams augmenting service provision in residential aged care. Australasian Journal on Ageing, 35(3), 204–209. https://doi.org/10.1111/ajag.12288
Lawrence, D., Bryant, T. K., Nobel, T. B., Dolansky, M. A., & Singh, M. K. (2015). A comparative evaluation of patient satisfaction outcomes in an interprofessional student-run free clinic. Journal of Interprofessional Care, 29(5), 445–450. https://doi.org/10.3109/13561820.2015.1010718
Lee, J. S., Combs, K., & Pasarica, M. (2017). Improving efficiency while improving patient care in a student-run free clinic. Journal of the American Board of Family Medicine, 30(4), 513–519. https://doi.org/10.3122/jabfm.2017.04.170044
Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12(1), Article 18. https://doi.org/10.1186/1475-9276-12-18
Liberman, K. M., Meah, Y. S., Chow, A., Tornheim, J., Rolon, O., & Thomas, D. C. (2011). Quality of mental health care at a student-run clinic: Care for the uninsured exceeds that of publicly and privately insured populations. Journal of Community Health, 36(5), 733–740. https://doi.org/10.1007/s10900-011-9367-5
Mann, C. L., Rifkin, R. A., Nabel, E. M., Thomas, D. C., Meah, Y. S., & Katz, C. L. (2019). Exploring antidepressant adherence at a student-run free mental health clinic. Community Mental Health Journal, 55(1), 57–62. https://doi.org/10.1007/s10597-018-0301-5
Manoochehri, H., Imani, E., Atashzadeh-Shoorideh, F., & Alavi-Majd, A. (2015). Competence of novice nurses: Role of clinical work during studying [Special Issue 4]. Journal of Medicine and Life, 8, 32–38.
Martin, S., Williams, E., Huerth, B., & Robinson, J. (2015). A pharmacy student-facilitated interprofessional diabetes clinic with the Penobscot Nation. Preventing Chronic Disease, 12, Article 150295. https://doi.org/10.5888/pcd12.150295
Meek, R., Morphet, J., Hood, K., Leech, M., & Sandry, K. (2013). Effect of interprofessional student-led beds on emergency department performance indicators. Emergency Medicine Australasia, 25(5), 427–434. https://doi.org/10.1111/1742-6723.12118
Mohan, D. A., & Kumar, K. (2011). A study on the satisfaction of patients with reference to hospital services. International Journal of Business Economics & Management Research, 1(3), 15–25. http://www.zenithresearch.org.in/images/stories/pdf/2011/Dec/ZIBEMR/2_ZIBEMR_VOL1_ISSUE3.pdf
National Health Information and Performance Principal Committee (NHIPPC). (2017). The Australian health performance framework. https://meteor.aihw.gov.au/content/index.phtml/itemId/721590
Nayak, B. K. (2010). Understanding the relevance of sample size calculation. Indian Journal of Ophthalmology, 58(6), 469–470. https://doi.org/10.4103/0301-4738.71673
Nuffer, W., McCollum, M., Ellis, S. L., & Turner, C. J. (2012). Further development of pharmacy student-facilitated diabetes management clinics. American Journal of Pharmaceutical Education, 76(3), Article 50. https://doi.org/10.5688/ajpe76350
Obucina, M., Harris, N., Fitzgeralda, J. A., Chaia, A., Radforda, K., Rossc, A., Carrc, L., & Vecchioa, N. (2018). 2018–04: The triple aim framework in the context of primary healthcare: A systematic literature review (Working paper). Griffith University. https://research-repository.griffith.edu.au/handle/10072/390503
Ojeda, V. D., Eppstein, A., Lozada, R., Vargas-Ojeda, A. C., Strathdee, S. A., Goodman, D., & Burgos, J. L. (2014). Establishing a binational student-run free-clinic in Tijuana, Mexico: A model for US–Mexico border states. Journal of Immigrant & Minority Health, 16(3), 546–548. https://doi.org/10.1007/s10903-012-9769-1
Ouyang, D., Yuan, N., Sheu, L., Lau, G., Chen, C., & Lai, C. J. (2012). Community health education at student-run clinics leads to sustained improvement in patients' hepatitis B knowledge. Journal of Community Health, 38(3), 471–479. https://doi.org/10.1007/s10900-012-9631-3
Panzera, A., Murray, R., Stewart, R., Mills, J., Beaton, N., & Larkins S. (2016). Regional health workforce planning through action research: Lessons for commissioning health services from a case study in Far North Queensland. Australian Journal of Primary Health, 22(1), 63–68. https://doi.org/10.1071/PY15149
Portela, M. C., Pronovost, P. J., Woodcock, T., Carter, P., & Dixon-Woods, M. (2015). How to study improvement interventions: A brief overview of possible study types. BMJ Quality & Safety, 24(5), 325–336. https://doi.org/10.1136/bmjqs-2014-003620
Prior, M., McManus, M., White, P., & Davidson, L. (2014). Measuring the “triple aim” in transition care: A systematic review. Pediatrics, 134(6), e1648–e1661. https://doi.org/10.1542/peds.2014-1704
Rasmussen, S., Sperling, P., Poulsen, M. S., Emmersen, J., & Andersen, S. (2020). Medical students for health-care staff shortages during the COVID-19 pandemic. The Lancet, 395(10234), e79–e80. https://doi.org/10.1016/S0140-6736(20)30923-5
Rockey, N. G., Weiskittel, T. M., Linder, K. E., Ridgeway, J. L., & Wieland, M. L. (2021). A mixed methods study to evaluate the impact of a student-run clinic on undergraduate medical education. BMC Medical Education, 21(1), Article 182. https://doi.org/10.1186/s12909-021-02621-y
Schoenfelder, T., Klewer, J., & Kugler, J. (2011). Determinants of patient satisfaction: A study among 39 hospitals in an in-patient setting in Germany. International Journal for Quality in Health Care, 23(5), 503–509. https://doi.org/10.1093/intqhc/mzr038
Schutte, T., Tichelaar, J., Donker, E., Richir, M. C., Westerman, M., & van Agtmael, M. A. (2018). Clarifying learning experiences in student-run clinics: A qualitative study. BMC Medical Education, 18(1), Article 244. https://doi.org/10.1186/s12909-018-1352-6
Simmons, B. B., DeJoseph, D., Diamond, J., & Weinstein, L. (2009). Students who participate in a student-run free health clinic need education about access to care issues. Journal of Health Care for the Poor & Underserved, 20(4), 964–968. https://doi.org/10.1353/hpu.0.0225
Stiefel, M., & Nolan, K. (2012). A guide to measuring the Triple Aim: Population health, experience of care, and per capita cost [White paper]. Institute of Healthcare Improvement. http://www.ihi.org/resources/Pages/IHIWhitePapers/AGuidetoMeasuringTripleAim.aspx
Stiefel, M. C., Perla, R. J., & Zell, B. L. (2010). A healthy bottom line: Healthy life expectancy as an outcome measure for health improvement efforts. The Milbank Quarterly, 88(1), 30–53. https://doi.org/10.1111/j.1468-0009.2010.00588.x
Stuhlmiller, C. M., & Tolchard, B. (2015). Developing a student-led health and wellbeing clinic in an underserved community: Collaborative learning, health outcomes and cost savings. BMC Nursing, 14, Article 32. https://doi.org/10.1186/s12912-015-0083-9
Stuhlmiller, C. M., & Tolchard, B. (2018). Population health outcomes of a student-led free health clinic for an underserved population: A naturalistic study. Journal of Community Health, 43, 193–200. https://doi.org/10.1007/s10900-017-0402-z
Suen, J., Attrill, S., Thomas, J. M., Smale, M., Delaney, C. L., & Miller, M. D. (2020). Effect of student-led health interventions on patient outcomes for those with cardiovascular disease or cardiovascular disease risk factors: A systematic review. BMC Cardiovascular Disorders, 20(1), Article 332. https://doi.org/10.1186/s12872-020-01602-1
Thakkar, A. B., Chandrashekar, P., Wang, W., & Blanchfield, B. B. (2019). Impact of a student-run clinic on emergency department utilization. Family Medicine, 51(5), 420–423. https://doi.org/10.22454/FamMed.2019.477798
Vahidi, M., Jalilian Khave, L., Sanadgol, G., Shirini, D., & Karamouzian, M. (2020). Student-led initiatives’ potential in the COVID-19 response in Iran. International Journal of Health Policy and Management, 9(10), 464–465. https://doi.org/10.34172/ijhpm.2020.82
Valaitis, R. K., Wong, S. T., MacDonald, M., Martin-Misener, R., O'Mara, L., Meagher-Stewart, D., Isaacs, S., Murray, N., Baumann, A., Burge, F., Green, M., Kaczorowski, J., & Savage, R. (2020). Addressing quadruple aims through primary care and public health collaboration: Ten Canadian case studies. BMC Public Health, 20(1), Article 507. https://doi.org/10.1186/s12889-020-08610-y
Wahle, B., Meyer, K., Faller, M., Kochhar, K., & Sevilla, J. (2017). Assessment of hypertension management and outcomes at an Indianapolis student-run free clinic. Journal of Health Care for the Poor and Underserved, 28(2), 694–706. https://doi.org/10.1353/hpu.2017.0068
Whitehead, A. L., Julious, S. A., Cooper, C. L., & Campbell, M. J. (2016). Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods in Medical Research, 25(3), 1057–1073. https://doi.org/10.1177/0962280215588241
Whittington, J. W., Nolan, K., Lewis, N., & Torres, T. (2015). Pursuing the triple aim: The first 7 years. The Milbank Quarterly, 93(2), 263–300. https://doi.org/10.1111/1468-0009.12122
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
On acceptance for publication in FoHPE the copyright of the manuscript is signed over to ANZAHPE, the publisher of FoHPE.
