Advertisement

Adolescent and Young Adult Perspectives on Quality and Value in Health Care

Published:October 23, 2022DOI:https://doi.org/10.1016/j.acap.2022.10.010

      Abstract

      Objective

      To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment.

      Methods

      A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define “good health care,” 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14–18) and young adult (19–24) responses.

      Results

      Response rate was 61.0% (782/1283). Most participants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality.

      Conclusions

      When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs’ perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-centered care delivery and value-based payment models.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nussbaum S
        • McClellan M
        • Metlay G.
        Principles for a framework for alternative payment models.
        JAMA. 2018; 319: 653-654https://doi.org/10.1001/jama.2017.20226
        • Wong CA
        • Perrin JM
        • McClellan M.
        Making the case for value-based payment reform in children's health care.
        JAMA Pediatr. 2018; 172: 513-514https://doi.org/10.1001/jamapediatrics.2018.0129
        • Alley DE
        • Ashford NC
        • Gavin AM.
        Payment innovations to drive improvements in pediatric care—the integrated care for kids model.
        JAMA Pediatr. 2019; 173: 717-718https://doi.org/10.1001/jamapediatrics.2019.1703
        • Perrin JM
        • Zimmerman E
        • Hertz A
        • et al.
        Pediatric accountable care organizations: insight from early adopters.
        Pediatrics. 2017; 139e20161840https://doi.org/10.1542/peds.2016-1840
        • Wray-Lake L
        • Crouter AC
        • McHale SM.
        Developmental patterns in decision-making autonomy across middle childhood and adolescence: European American parents’ perspectives.
        Child Dev. 2010; 81: 636-651https://doi.org/10.1111/j.1467-8624.2009.01420.x
        • Miller VA
        • Drotar D.
        Discrepancies between mother and adolescent perceptions of diabetes-related decision-making autonomy and their relationship to diabetes-related conflict and adherence to treatment.
        J Pediatr Psychol. 2003; 28: 265-274https://doi.org/10.1093/jpepsy/jsg014
        • Aalsma MC
        • Gilbert AL
        • Xiao S
        • et al.
        Parent and adolescent views on barriers to adolescent preventive health care utilization.
        J Pediatr. 2016; 169: 140-145https://doi.org/10.1016/j.jpeds.2015.10.090
        • Marcell AV
        • Breuner CC
        • Hammer L
        • et al.
        Targeted reforms in health care financing to improve the care of adolescents and young adults.
        Pediatrics. 2018; 142e20182998https://doi.org/10.1542/peds.2018-2998
        • Chatterjee P
        • Joynt KE
        • Orav EJ
        • et al.
        Patient experience in safety-net hospitals: implications for improving care and value-based purchasing.
        Arch Intern Med. 2012; 172: 1204-1210https://doi.org/10.1001/archinternmed.2012.3158
        • Fenton JJ
        • Jerant A
        • Kravitz RL
        • et al.
        Reliability of physician-level measures of patient experience in primary care.
        J Gen Intern Med. 2017; 32: 1323-1329https://doi.org/10.1007/s11606-017-4175-y
        • Caswell RJ
        • Ross JD
        • Lorimer K.
        Measuring experience and outcomes in patients reporting sexual violence who attend a healthcare setting: a systematic review.
        Sex Transm Infect. 2019; 95: 419-427https://doi.org/10.1136/sextrans-2018-053920
      1. Patient Satisfaction Surveys. NEJM Catalyst. 2018. Available at: https://catalyst.nejm.org/doi/abs/10.1056/CAT.18.0288. Accessed April 27, 2020.

        • Ong WL
        • Schouwenburg MG
        • van Bommel ACM
        • et al.
        A standard set of value-based patient-centered outcomes for breast cancer: the International Consortium for Health Outcomes Measurement (ICHOM) initiative.
        JAMA Oncol. 2017; 3: 677-685https://doi.org/10.1001/jamaoncol.2016.4851
        • Smith LAM
        • Critoph DJ
        • Hatcher HM.
        How can health care professionals communicate effectively with adolescent and young adults who have completed cancer treatment? A systematic review.
        J Adolesc Young Adult Oncol. 2020; 9: 328-340https://doi.org/10.1089/jayao.2019.0133
      2. Committee on Improving the Health, Safety, and Well-Being of Young Adults, Board on Children, Youth, and Families. Investing in the Health and Well-Being of Young Adults. Bonnie RJ, Stroud C, Breiner H, eds. Published online 2015:502. Available at: https://www.ncbi.nlm.nih.gov/books/NBK284795/. Accessed April 20, 2020.

        • Rae CS
        • Tsangaris E
        • Klassen AF
        • et al.
        Comparison of patient-reported outcome measures for use as performance metrics in adolescent and young adult psychosocial cancer care.
        J Adolesc Young Adult Oncol. 2020; 9: 262-270https://doi.org/10.1089/jayao.2019.0033
        • Chang T
        • Gossa W
        • Sharp A
        • et al.
        Text messaging as a community-based survey tool: a pilot study.
        BMC Public Health. 2014; 14: 936https://doi.org/10.1186/1471-2458-14-936
        • DeJonckheere M
        • Nichols LP
        • Moniz MH
        • et al.
        MyVoice national text message survey of youth aged 14 to 24 years: study protocol.
        JMIR Res Protoc. 2017; 6e247https://doi.org/10.2196/resprot.8502
        • Spencer DL
        • McManus M
        • Call KT
        • et al.
        Health care coverage and access among children, adolescents, and young adults, 2010–2016: implications for future health reforms.
        J Adolesc Health. 2018; 62: 667-673https://doi.org/10.1016/j.jadohealth.2017.12.012
        • DeJonckheere M
        • Zhao A
        • Lane J
        • et al.
        Results of a national text message poll of youth: perspectives on primary care.
        J Adolesc Health. 2020; 67: 814-820https://doi.org/10.1016/j.jadohealth.2020.04.017
        • Ford CA
        • Cheek C
        • Culhane J
        • et al.
        Parent and adolescent interest in receiving adolescent health communication information from primary care clinicians.
        J Adolescent Health. 2016; 59: 154-161https://doi.org/10.1016/j.jadohealth.2016.03.001
        • Ford CA
        • Millstein SG
        • Halpern-Felsher BL
        • Irwin CE.
        Influence of physician confidentiality assurances on adolescents’ willingness to disclose information and seek future health care: a randomized controlled trial.
        JAMA. 1997; 278: 1029-1034https://doi.org/10.1001/jama.1997.03550120089044
        • Bojcic JL
        • Sue VM
        • Huon TS
        • et al.
        Comparison of paper and electronic surveys for measuring patient-reported outcomes after anterior cruciate ligament reconstruction.
        Perm J. 2014; 18: 22-26https://doi.org/10.7812/TPP/13-142
        • Kaddas HK
        • Pannier ST
        • Mann K
        • et al.
        Age-related differences in financial toxicity and unmet resource needs among adolescent and young adult cancer patients.
        J Adolescent Young Adult Oncol. 2019; 9: 105-110https://doi.org/10.1089/jayao.2019.0051
        • Richard P
        • Walker R
        • Alexandre P.
        The burden of out of pocket costs and medical debt faced by households with chronic health conditions in the United States.
        PLoS One. 2018; 13e0199598https://doi.org/10.1371/journal.pone.0199598
        • Galbraith AA
        • Ross-Degnan D
        • Soumerai SB
        • et al.
        Nearly half of families in high-deductible health plans whose members have chronic conditions face substantial financial burden.
        Health Aff (Millwood). 2011; 30: 322-331https://doi.org/10.1377/hlthaff.2010.0584
        • Johansson N
        • Jakobsson N
        • Svensson M.
        Effects of primary care cost-sharing among young adults: varying impact across income groups and gender.
        Eur J Health Econ. 2019; 20: 1271-1280https://doi.org/10.1007/s10198-019-01095-6
        • Darney BG
        • Jacob RL
        • Hoopes M
        • et al.
        Evaluation of Medicaid expansion under the affordable care act and contraceptive care in US Community Health Centers.
        JAMA Netw Open. 2020; 3e206874https://doi.org/10.1001/jamanetworkopen.2020.6874
        • Wong CA
        • Asch DA
        • Vinoya CM
        • et al.
        Seeing health insurance and HealthCare.gov through the eyes of young adults.
        J Adolescent Health. 2015; 57: 137-143https://doi.org/10.1016/j.jadohealth.2015.04.017
      3. Bureau UC. Adults age 26 Had Highest Uninsured Rate Among All Ages, Followed By 27-Year-Olds. Census.gov. https://www.census.gov/library/stories/2020/10/uninsured-rates-highest-for-young-adults-aged-19-to-34.html. Accessed August 29, 2022.

      4. Sandhu S, Saunders RS, McClellan MB, et al. Health equity should be a key value in value-based payment and delivery reform. Health Affairs Forefront. doi:10.1377/forefront.20201119.836369.

        • Hirpa M
        • Woreta T
        • Addis H
        • et al.
        What matters to patients? A timely question for value-based care.
        PLOS ONE. 2020; 15e0227845https://doi.org/10.1371/journal.pone.0227845
        • Mejia-Lancheros C
        • Lachaud J
        • O'Campo P
        • et al.
        Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness.
        PLoS One. 2020; 15e0229385https://doi.org/10.1371/journal.pone.0229385
        • Liu C
        • Uffenheimer M
        • Nasseri Y
        • et al.
        “But his yelp reviews are awful!”: analysis of general surgeons’ Yelp reviews.
        J Med Internet Res. 2019; 21: e11646https://doi.org/10.2196/11646
        • Sobin L
        • Goyal P.
        Trends of online ratings of otolaryngologists: what do your patients really think of you?.
        JAMA Otolaryngol Head Neck Surg. 2014; 140: 635-638https://doi.org/10.1001/jamaoto.2014.818
        • Liddon N
        • Pampati S
        • Steiner RJ
        • et al.
        Truth be told: adolescents’ disclosure of sexual activity to healthcare providers.
        J Adolesc Health. 2021; 68: 623-625https://doi.org/10.1016/j.jadohealth.2020.07.005
        • Silverstein L
        • Zander E
        • Middleman AB.
        Adolescent identity: the importance of the social history.
        SAGE Open Med Case Rep. 2020; 8 (2050313X20952980)https://doi.org/10.1177/2050313X20952980
        • Anderson M
        • Jiang J
        Teens, Social Media & Technology 2018.
        Pew Research Center, Internet, Science & Tech2018 (Published May 31, 2018. Accessed April 18, 2020)
        • Barney A
        • Buckelew S
        • Mesheriakova V
        • et al.
        The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation.
        J Adolesc Health. 2020; 67: 164-171https://doi.org/10.1016/j.jadohealth.2020.05.006