Abstract
BackgroundExcellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients’ perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication.Study designWe designed a comprehensive physician-training module focused on improving specific “etiquette-based” physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent “always” scores for questions related to patients’ perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists.ResultsA total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent “always” responses, for the HCAHPS questions of doctors “treating patients with courtesy” “explaining things in a way patients could understand,” and “overall teamwork” showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors “keeping patient informed” (adjusted intercept shift 9.9% P = 0.019), “overall teamwork” (adjusted intercept shift 11%, P = 0.037), and “using words the patient could understand” (adjusted intercept shift 14.8%, p = 0.001).ConclusionA simulation based physician communication coaching method focused on specific “etiquette-based” communication behaviors through a deliberate practice framework was not associated with significantly improved HCAHPS physician communication patient experience scores. Further research could reveal ways that this model affects patients’ perceptions of physician communication relating to specific physicians or behaviors.
Highlights
Patient experience is an important metric for measuring hospital performance
We aimed to determine whether a training module could improve patients’ perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication
Physician communication coaching effects on patient experience excellent survey results increased significantly post-intervention for the questions of specified individual doctors “keeping patient informed”, “overall teamwork”, and “using words the patient could understand”
Summary
Patient experience is an important metric for measuring hospital performance. Since 2012, the Centers for Medicare and Medicaid Services (CMS) have tied patient experience to reimbursement through the Value Based Purchasing (VBP) program. In 2016, 1.75% of a hospital’s Diagnosis Related Group (DRG) base operating payment is at stake and 30% of this payment is linked to a hospital’s patient experience scores.[1] Commercial payers are linking patient experience outcomes to value-based payments, and many physician groups include patient experience as a metric for physicians’ variable compensation.[2] This increased scrutiny is appropriate, as multiple studies have shown a strong correlation between the quality of physician communication and the quality of clinical care.[3,4,5,6,7,8] many problems with the effective delivery of health care can be attributed to ineffective communication between patient and provider.[9] Practically speaking, good physician communication will be a requirement for hospitals to sustain reimbursement at current levels. We aimed to determine whether a training module could improve patients’ perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication
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