Research In Action
Research In Action
Understanding patient and family healthcare experiences is critical to building stronger, more responsive, and more patient-centered systems of care. While health systems routinely gather feedback from inpatient and outpatient settings, community-based sites of care—especially those addressing violence-related injury—often do not systematically collect patient-reported outcomes. Our team recently published results of a quality improvement (QI) initiative to improve data collection from patients and families after participation in the CHOP Violence Intervention Program (VIP). Our methods offer a practical roadmap for optimizing collection of patient-reported outcomes in other clinical program settings.
Why Patient Feedback in Community Settings Matters
Hospital-based violence intervention programs (HVIPs), such as VIP, play a critical role in bridging acute care and long-term recovery for youth affected by interpersonal violence. These multidisciplinary programs connect patients to mental health services, education, basic needs, and other supports to address social determinants of health that may influence recovery after violence.
HVIP evaluations often rely on administrative data sources—such as reinjury rates or healthcare utilization—rather than patient-reported experiences of care or short-term outcomes. Without direct input from patients and families, programs risk missing key insights into satisfaction, perceived benefit and outcomes, and unmet needs.
The challenge is not just collecting feedback but collecting it equitably. Traditional survey approaches, especially those administered through automated and digital tools, may underrepresent the experiences of marginalized populations due to disparities in technology access, digital literacy, and engagement preferences. This raises an important concern: whose voices are shaping program evaluation and improvement?
A Quality Improvement Approach to More Complete Data
The HVIP-CSQ is a brief, 12-item survey assessing patient and caregiver satisfaction; perceived responsiveness of staff; and self-reported short-term outcomes related to recovery, knowledge of resources, and ability to access services. In the initial launch, we distributed CSQs through automated text messages and emails, with modest response rates hovering around 23% for adolescent patients and 29% for caregivers.
Recognizing the limited representativeness of responses, we initiated a rapid-cycle QI intervention with the goal of increasing and sustaining response rates at 50%. The key change: adding personalized outreach for non-respondents through phone calls and text follow-ups by a dedicated outreach coordinator. After implementing this multimodal strategy, which combined automation with personalized outreach, response rates increased to 52% and 78% for youth and caregivers, respectively. Importantly, our improvements were observed across demographic groups and sustained over two years.
Insights for the Pediatric Injury Prevention Field
Beyond automation, personal outreach drives engagement
Automated surveys are efficient and scalable, but they may fail to engage some families, particularly those facing structural barriers. A simple phone call can do more than remind—it builds trust, reinforces the value of feedback, and offers flexible participation options.
Response preferences vary by population
Caregivers often preferred completing surveys during live phone calls, while adolescents were more likely to respond to a text message requesting a survey to be resent. Tailoring engagement strategies to respondent preferences can meaningfully improve participation, better capture diverse perspectives, and reduce non-response bias.
Equity implications
This QI initiative carries broader lessons for program leaders, advocates, evaluators, and funders:
- The voices of youth and families must be heard to design responsive, effective programs. Collecting patient-reported outcomes and experiences of care can be feasibly integrated into workflows to ensure these perspectives are reflected in evaluation and improvement efforts.
- Survey methodology matters. Mixed-mode data collection (e.g, web-based, telephone, text) can improve both response rates and representativeness, strengthening the utility of findings.
- Investment in “high touch” data collection infrastructure (e.g., outreach staff) is not just operational and may be foundational to equity.
Moving Forward: From Data Collection to Action
Improving response rates is only the first step. Our long-term goal is to translate patient and caregiver feedback into meaningful program changes—whether that means adapting service delivery to address unmet social needs, refining program engagement strategies, or advocating for expansion of services.
As community-based injury recovery programs continue to expand, the field must prioritize evaluative methods that capture the full spectrum of patient experience. Without this, even the most well-intentioned interventions risk reinforcing the very inequities they aim to address.
This project demonstrates a clear takeaway: when we make it easier and more personal for families, they are more likely to share their experiences, outcomes, and feedback.
Read more about our quality improvement initiative in our recent publication in Pediatric Quality and Safety.
