title: Health Care User Perspectives on Constructing, Contextualizing, and Co-Producing "Quality of Care".
abstract: Most of the research on health care user "quality of care" perspectives seeks discrete and measurable indicators to advance quality improvement (QI) goals. This lacks sufficiently grounded query about the meaning of "quality of care" for health users, and how context influences their ideas and experiences. We studied this between 2010 and 2011, repeatedly interviewing and shadowing 45 individuals in three of New York's hospital-based outpatient HIV care settings during routine visits. We found participants using common terminology, but across the cohort meaning varied and employed personal narratives. Participants conveyed the impact of historic and current experiences of stigma and discrimination on limiting access to care, and showed its destabilizing effects on quality constructs. Participants also felt they contributed to their health care settings' delivery of quality care. From our findings, we discuss the applicability and implications of "co-production" to conceptualize health care as jointly delivered by typical "givers" and "receivers" of care.
authors: University College London, London, United Kingdom a.baim-lance@ucl.ac.uk.
authors: Abigail
authors: A
authors: Baim-Lance
authors: New York State Department of Health, Albany, NY, USA.
authors: Daniel
authors: D
authors: Tietz
authors: New York State Department of Health, New York City, NY, USA.
authors: Madeleine
authors: M
authors: Schlefer
authors: New York State Department of Health, New York City, NY, USA.
authors: Bruce
authors: B
authors: Agins
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009518:New York; D010044:Outpatient Clinics, Hospital; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D012449:Safety; D057545:Social Stigma
keywords: HIV/AIDS; co-production; context; narratives; quality improvement; quality of care