Background: Issues with the quality and safety of hospital care have been well-documented, and serve as the basis for improvement strategies and research. However, what is less understood are the perspectives of patients, families, caregivers, and other stakeholders regarding what they feel are the most important targets of improvement research. We systematically engaged a broad sample of these groups to solicit their input on important questions and suggestions for improvement in hospital care. Our goal was to develop a prioritized agenda to drive Hospital Medicine research and quality improvement.

Methods: The study was led by 9 researchers, 8 patients, and 2 administrators recruited from 8 academic medical centers, who formed a Steering Committee that managed all stages of the project. We applied a collaborative and consultative approach to stakeholder engagement based on validated methods from the James Lind Alliance. The project included multiple and iterative stages to our project (see Figure 1) which included a: 1) multi-pronged, inclusive strategy for patient and stakeholder engagement; 2) an online survey of patients and stakeholder organization leadership and members asking them to submit questions related to hospitalization; 3) rigorous qualitative thematic analysis; 4) a two-day in-person meeting with patients and stakeholders to prioritize the submitted unanswered questions and plan dissemination efforts.

Results: In total, 499 respondents (including 267 healthcare providers, 244 patients and caregivers and 63 researchers) from 47 organizations submitted a total of 782 high-priority research questions and suggestions for improving hospital care. These questions were categorized into 73 distinct topics, 53 that were health-system related and 20 disease-specific. Thematic analysis of categories revealed 36 commonly submitted question domains. Following a two-step prioritization process involving the study team and representatives from 30 stakeholder organizations, 11 questions were identified as top priorities (see Figure 2).

Conclusions: Through a dynamic and collaborative stakeholder engagement process, key patient and family-centered research questions have been identified and developed. These results can help drive a national conversation in the Hospital Medicine community about how to address these priority areas and should inform stakeholder agencies about key areas of research focus.

IMAGE 1: Figure 1: Stages of patient, family, caregiver and stakeholder engagement to identify and prioritize important questions about hospitalization and suggestions for improvement

IMAGE 2: Figure 2: Outstanding Questions Prioritized by Patients, Families, Caregivers and Other Stakeholders in Hospital Medicine