Tailoring tools to older patients

3 minute read

Tailoring tools to older patients

< 1 minute read

Peninsula Circle of Care at Mills Peninsula redesigned their home assessment form to better meet the needs of their elderly patients.

The Issue

We have detailed evaluation processes to determine whether our efforts are having an impact on the patient experience. These include surveys like our home assessment form that we administer to patients at the bedside. One example question is “How confident are you that you know what to do and can manage your health?” Patients had to choose from a 10-point scale from “very confident” to “not confident at all.” Another example question is “When you left the hospital, did you clearly understand when and how to take each of your medications?” Patients had to choose from a Likert scale from “strongly agree” to “strongly disagree.” We realized that many of our older patients weren’t able to answer our surveys—partly because the language was too complicated and partly because it was hard for them to quantify the difference between 7 and 8 or “strongly agree” and “agree.”


Mills Peninsula is a non-profit hospital in Burlingame, CA that has partnered with the Palo Alto Medical Foundation and Peninsula Family Services to develop the Peninsula Circle of Care program. The hospital has 241 beds and serves a primarily elderly population (average age of 81) living alone with 90% on Medicare. Peninsula Circle of Care, their transitions program, began in 2012 and is influenced by the Care Transitions Program and a community based model.

What We Tried

We worked with the Research Institute at the Palo Alto Medical Foundation to review all of our surveys and modify them for older adults. We were using validated questions in our assessment, so we wanted to make sure that modifying the questions didn’t affect the validity of our results.

The first thing we realized was that older patients didn’t understand the 10-point scale nor the Likert scale. It’s hard for them to understand the subtle differences, so we changed the questions to a 3-point scale with “very much,” “somewhat,” and “not at all.” We also rephrased a lot of the questions to make them easier to understand.


We’ve seen a definite improvement in our patients’ ability to answer the survey questions. It’s also easier for our staff to field the surveys since they don’t have to explain each question in as much detail.


We went through a rigorous process to redesign our forms, starting all the way from “what do we really want to learn from patients?” From there, we had to craft the right wording of questions to get what we needed to learn without overwhelming patients. We want to spend more time on coaching than asking them survey questions.

Program Challenges: Communicating with Patients

Patient and Family Challenges: Low Health Literacy

Topics: Measuring and improving

Organizational Background

Organization Name: Mills Peninsula Hospital

Location: 1501 Trousdale Drive, Burlingame, CA 94010, United States

Organization Type: Hospital