Secondary analysis of qualitative video health experience interviews to inform policy and practice - what matters most to users about quality of care?

我们的建议旨在利用二次分析为以用户为中心的卫生和社会保健质量改进提供证据。它建立在两个现有倡议的基础上：1。1 .牛津大学健康体验研究小组（HERG）就80多个主题对用户进行了3000次定性视频和音频采访，内容涉及他们的健康和疾病经历（并在DIPEx慈善机构运营的www.healthtalkonline.org上公开传播）。以经验为基础的共同设计（EBCD）是一种参与性行动研究方法，它使服务使用者积极参与服务设计，自2006年试行以来，已在六个不同国家的60多个护理服务中实施。过去的评价表明，它在实现质量改进和文化变革方面是有效的。这两项倡议都包括对人们讲述自己经历的视频深度采访。HERG访谈是在全国范围内收集的，范围广泛，而EBCD访谈是在当地收集的，更具体地关注每个护理环境中的“接触点”——用户和服务之间可以提高质量的关键互动。在EBCD中，对这些接触点的分析被用来创建一个“触发”电影，工作人员和用户一起观看，在建立共同设计工作组共同规划和实施变化之前，开始讨论如何改善当地的护理。这两项倡议已经在国家卫生研究所（NIHR）最近的一项研究中进行了合作，该研究表明，基于对HERG访谈的二次分析，EBCD在两种护理途径中的效果与新的当地访谈一样好，节省了时间和成本。这为提出进一步的二次分析提供了强有力的证据基础，以支持护理组织寻求在更多条件下以负担得起和及时的方式应用基于经验的质量改进。我们将重新分析现有的10个采访资料。在每种情况下，次要分析的主要研究问题将是：用户在他们的护理体验中确定哪些接触点可以提高质量？HERG集合通常集中在一个特定的条件或健康主题。然而，收集的许多材料可以为服务设置和跨部门护理的整合提供信息。除了分析每种情况下的接触点外，我们还会问：a)门诊护理和b)在一系列不同情况下可用于重新设计服务的健康和社会护理之间的相互作用的接触点是什么？二次分析将涉及研究人员回到完整的成绩单收集，以确定接触点。在healthtalkonline上，我们也有一组外行总结，确定了在每种情况下采访参与者的重要关键话题（尽管没有针对接触点进行具体分析）。因此，需要进一步提出的一个关键实证问题是：与重新分析完整文本相比，重新分析网站摘要会产生哪些接触点？通过这种方法可以进一步节省识别接触点的时间吗？还是在过程中浪费了太多时间？我们还将让服务用户参与二次分析过程，支持他们分析选定的文本和选定的网站摘要，并与他们讨论与社会科学研究人员相比，他们确定的接触点的异同。我们将以与DIPEx慈善机构合作制作的一系列触发影片的形式传播二次分析的结果，使用我们现有的视频记录来说明我们确定的接触点，并通过www.healthtalkonline.org和护理点基金会在线EBCD工具包提供这些结果。在英国国家医疗服务体系的密切和积极支持下，我们的研究结果将对政策和实践产生明确的影响

Our proposal aims to use secondary analysis to provide evidence for user-centred quality improvement in health and social care. It builds on two existing initiatives:1. An archive of 3000 qualitative video and audio interviews on over 80 topics with users about their health and illness experiences held by the Health Experiences Research Group (HERG), University of Oxford (and disseminated publicly on www.healthtalkonline.org run by the DIPEx Charity)2. Experience-Based Co-Design (EBCD), a participatory action research approach which actively involves service users in service design and has been implemented in over 60 care services in six different countries since being piloted in 2006. Past evaluations have shown it to be effective in achieving quality improvement and cultural change.Both initiatives include video-recorded in-depth interviews with people talking about their experiences. HERG interviews are nationally collected and wide-ranging, whereas EBCD interviews are collected locally with a more specific focus on 'touchpoints' - key interactions between users and services where quality improvements can be made - in each care setting. In EBCD analysis of these touchpoints is used to create a 'trigger' film which staff and users watch together to start a discussion about improving care locally, before setting up co-design working groups to plan and implement changes together.These two initiatives have already collaborated on a recent study for the National Institute for Health Research (NIHR) which demonstrated EBCD in two care pathways based on secondary analysis of HERG interviews rather than new local interviews worked just as well, saving time and cost.This provides a strong evidence base to propose further secondary analysis to support care organisations seeking to apply experience-based quality improvement in an affordable and timely way across more conditions. We will reanalyse ten of our existing interview collections. In each case the primary research question for the secondary analysis will be: What touchpoints do users identify in their experiences of care where quality could be improved?The HERG collections are generally focused around a particular condition or health topic. However, there is much material in the collections that could inform service settings and integration of care across sectors. Alongside the analysis for touchpoints in each condition, we will also ask: What are the touchpoints for a) outpatient care and b) interactions between health and social care across a range of different conditions which could be used to redesign services? The secondary analyses will involve a researcher going back to the full transcript collection to identify touchpoints. On healthtalkonline, we also have a set of lay summaries identifying key topics of importance to interview participants in each condition (though not specifically analysed for touchpoints). A key further empirical question to ask is therefore: What touchpoints would emerge from a re-analysis of the website summaries, compared to re-analysis of the full transcripts? Can further time savings be made in identifying touchpoints by this method or is too much lost in the process?We will also involve service users in the secondary analysis process, supporting them in analysing both selected transcripts and selected website summaries, and discussing with them similarities and differences in the touchpoints they identify compared to the social science researcher.We will disseminate findings from the secondary analysis in the form of a series of trigger films made in collaboration with the DIPEx Charity, using our existing video recordings to illistrate the touchpoints we identify, and make these available through both www.healthtalkonline.org and the Point of Care Foundation online EBCD toolkit. With the close and active support of NHS England our findings will have a clear route to impact on policy and practice