Adolescent Patient Experience: How to Measure Quality Healthcare for Teens

We’ve decided to feature a particular and often overlooked demographic in healthcare: adolescents. In this three-part blog series, we’ll discuss barriers and ways to measure adolescent patient experience, gather adolescent perspectives on their healthcare, and provide methods and tools to support adolescent patients in the hospital.


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It’s no surprise that there has been an ongoing shift in the way quality healthcare is being defined and measured. Patient- and family-centered care is becoming the norm for how hospitals treat patients. However, we often observe this framework being implemented with adults and children; the same principles of care for these two populations ought to be translated into a way that applies to the developmental needs of teens. Current evidence is largely derived from adult settings and efforts to ensure that adolescents experience high quality care have been limited by the absence of appropriate measurement tools for patient-centered adolescent care.

Adolescents are in a specific and unique phase of life. No longer children, they have more autonomy in decisions and a deeper understanding of what’s going on. Not yet adults, they’re not equipped to make potentially life-altering healthcare decisions. A balance must be achieved where adolescents are involved in decision-making without disregarding the known benefits of including parents/caregivers in their child’s healthcare. Teens are also in a phase of life where social interaction plays a key role. Confined in a hospital and unable to participate in milestone or even “normal” events, adolescents can quickly feel isolated, lonely, and misunderstood.

About 1 in 5 adolescents has a severe chronic health condition including physical, developmental, and mental disorders. Many more experience health risk behaviors like obesity, substance abuse, or unsafe sexual practices. In addition, adolescent patient experience is formative in helping teens develop positive associations with their healthcare that can follow them for the rest of their lives. Thus, a 2014 study developed a conceptual framework that could more clearly define quality healthcare for adolescents in the hospital. It resulted in 14 indicators which are summary measures that quantify “adolescent-friendly” healthcare. The indicators are broken up into two categories: experience of care (how patients and their caregivers experience the hospital) and evidence-informed care (what the hospital and clinicians are expected to provide). The results are as follows:

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Experience of Care

  1. Feeling welcome in the hospital: Does the hospital provide a welcoming environment for adolescent patients and their parents?

  2. Age appropriate environment: Does the hospital provide an age appropriate environment?

  3. Respected by clinicians: Do adolescent patients and their parents feel respected as a person by their care team at the hospital?

  4. Trust in clinicians: Do adolescent patients and their parents trust their/their child’s care team?

  5. Understanding of health information: Do adolescent patients and their parents fully understand the health information provided to them?

  6. Involvement in decisions about care or treatment: Do adolescent patients and their parents feel sufficiently involved in decisions about their/their child’s care and treatment?

  7. Comfort asking questions about health and wellbeing: Do adolescent patients and their parents feel comfortable to ask questions about their/their child’s health and wellbeing?

Evidence Informed Care

  1. Psychosocial assessment: Do adolescent patients have discussions about health risk behaviors and psychosocial issues with their care team?

  2. Confidentiality discussions: Do adolescent patients and their parents have confidentiality discussed with them?

  3. Time alone in consultations: Do adolescent inpatients and outpatients over the age of 14 years spend at least some of a consultation alone without their parents?

  4. Self management: Do adolescent patients and their parents have a discussion with their care team about self management?

  5. Transfer to adult health services: Do adolescent patients aged 16 and above feel prepared/confident about transferring to adult health services?

  6. Supported to continue education: Do adolescent inpatients feel sufficiently supported to continue their education?

  7. Connection to external supports: Do adolescent inpatients feel sufficiently connected to their external social supports?

These indicators of quality healthcare for adolescents are a vital launching point for hospitals looking to implement measurement strategies for developing benchmarks across departments and services. Using measures that are directly catered to adolescents are important for quality improvement initiatives, as opposed to those made for adults or young children. The indicators are also helpful for all hospital staff to keep in mind when treating adolescents in order to inform the way they approach their interactions and care to provide the best possible patient experience.

Rachel MartindaleComment