title: Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives.
abstract: To design a methodology for rigorously eliciting narratives about patients' experiences with clinical care that is potentially useful for public reporting and quality improvement.
  
  
  
  Two rounds of experimental data (N = 48 each) collected in 2013-2014, using a nationally representative Internet panel.
  
  
  
  Our study (1) articulates and operationalizes criteria for assessing narrative elicitation protocols; (2) establishes a "gold standard" for assessment of such protocols; and (3) creates and tests a protocol for narratives about outpatient treatment experiences.
  
  
  
  We randomized participants between telephone and web-based modalities and between protocols placed before and after a closed-ended survey.
  
  
  
  Elicited narratives can be assessed relative to a gold standard using four criteria: (1) meaningfulness, (2) completeness, (3) whether the narrative accurately reflects the balance of positive and negative events, and (4) representativeness, which reflects the protocol's performance across respondent subgroups. We demonstrate that a five-question protocol that has been tested and refined yields three- to sixfold increases in completeness and four- to tenfold increases in meaningfulness, compared to a single open-ended question. It performs equally well for healthy and sick patients.
  
  
  
  Narrative elicitation protocols suitable for inclusion in extant patient experience surveys can be designed and tested against objective performance criteria, thus advancing the science of public reporting.
authors.affiliation: Center for Patient Partnerships, UW Law School, University of Wisconsin-Madison, Madison, WI.|Department of Family Medicine, UW Medical School, University of Wisconsin-Madison, Madison, WI.
authors.forename: Rachel
authors.initials: R
authors.lastname: Grob
authors.affiliation: Yale University School of Public Health, New Haven, CT.
authors.forename: Mark
authors.initials: M
authors.lastname: Schlesinger
authors.affiliation: RAND Center for Decision Making under Uncertainty, Pittsburgh, PA.|RAND, Pittsburgh, PA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Parker
authors.affiliation: Shaller Consulting Group, Stillwater, MN.
authors.forename: Dale
authors.initials: D
authors.lastname: Shaller
authors.affiliation: Department of Health Services Research, Policy, and Practice, Brown University School of Public Health, Providence, RI.
authors.forename: Lacey Rose
authors.initials: LR
authors.lastname: Barre
authors.affiliation: RAND Health, Pittsburgh, PA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Martino
authors.affiliation: RAND, Pittsburgh, PA.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Finucane
authors.affiliation: The Severyn Group, Ashburn, VA.
authors.forename: Lise
authors.initials: L
authors.lastname: Rybowski
authors.affiliation: RAND, Pittsburgh, PA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Cerully
mesh_terms: D006801:Humans; D020407:Internet; D033262:Narration; D005791:Patient Care / Q000592:standards; D010358:Patient Participation / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012107:Research Design; D011795:Surveys and Questionnaires
keywords: Patient narratives; consumers; patient experiences; patient-centered care; public reporting; qualitative methods