Doctor Communication Research Articles

Development and validation of Parents’ Health Literacy Scale on Preventing Road Traffic Injuries for children aged 0–6 years in China

BackgroundRoad traffic injuries are the leading cause of death in children. Parents’ health literacy (HL) is closely related to child safety, especially for the young children. This study aimed to...

Impact of Shared Decision-Making on Family Satisfaction With Intensive Care Services: 'Share With Care' has a New Meaning in ICU.

Background: Physician's clinical inputs and informed bystander opinions are essential for successful intensive care unit (ICU) patient outcomes. There is insufficient data regarding the impact of shared decision-making on treatment outcomes and family satisfaction in Indian ICU settings. We aimed to determine the effect of shared decision-making factors on family satisfaction with ICU services. Patients and Methods: Family bystanders of 336 ICU patients with a stay >72 hours were conveniently surveyed across 13 months prospectively using Family Satisfaction in the Intensive Care Unit 24 Revised (FS-ICU 24R) questionnaire. We analyzed the responses to determine shared decision-making factors impacting family satisfaction. Results: Univariate analysis of ten variables of FS-ICU 24R questionnaire decision-making subscale revealed that consistency of information (OR 8.71, P < 0.001), honesty of information (OR 7.04, P < 0.001), and frequency of communication with doctors (OR 6.25, P < 0.001) were associated with highest odds of family involvement and satisfaction. Multivariable logistic regression showed that consistency of information (adjusted OR 3.85, P < 0.001) and frequent doctor communication (adjusted OR 2.22, P = 0.02) were independent predictors associated with family satisfaction. The number of decision-makers (P = 0.463) or family's prior ICU experience (P = 0.430) was not associated with family satisfaction. Conclusion: A consistent and honest effort to cater to the family's information needs and frequent physician-bystander interaction is essential for family's satisfaction with ICU services. This even outweighs other decision-making factors such as number of decision-makers and their prior ICU experience. Incorporating shared decision-making in counseling should be a continuing practice.Trial registry name: Clinical Trials Registry - India.Registration number: CTRI/2022/09/045571.

Knowledge related to breast cancer screening programs by physicians in Brazil.

Antonini et al. evaluated gynecologists', obstetricians', and family and community physicians knowledge of breast cancer screening and their adherence to recommendations defined by the BI-RADS™ system. The study demonstrated that inadequate training resulted in insufficient screening and failure to follow the protocols recommended by the BIRADS™ system. ■ Variability in screening protocols: only 42.8% of gynecologists and obstetricians follow the 40-74 years protocol, while 76.6% of family physicians follow the 50-69 years protocol. ■ High rate of incorrect BIRADS. interpretation: there were 46.3% incorrect responses among gynecologists and obstetricians and 77.9% among family physicians, highlighting significant knowledge gaps. ■ Misconception about breast ultrasound: 39.1% of gynecologists and obstetricians and 20.3% of family physicians incorrectly consider ultrasound as a screening method. ■ Impact of inadequate training: inadequate training leads to improper screening practices that do not align with the BIRADS. recommended guidelines. To evaluate the knowledge and practices of gynecologists, obstetricians, and family and community physicians in Brazil regarding breast cancer screening, mammographic findings defined by the BIRADS™ system, and their approach to suspected clinical lesions. This was an observational, cross-sectional, descriptive study conducted using an online research questionnaire distributed via email to 9,000 gynecologists and obstetricians and 5,600 family and community and preventive medicine doctors actively practicing in Brazil. Among gynecologists and obstetricians, 42.8% follow the 40-74 years screening, 33.5% follow the 50-69 years screening, and 23.6% do not follow any specific protocol. Among the family and community physicians, 76.6% follow the 50-69 years screening protocol, and 23.4% do not follow any specific protocol. When we evaluated the responses regarding the behaviors of each BIRADS™ classification, 46.3% of responses were wrong among gynecologists and obstetricians, and 77.9% were wrong among community and preventive medicine doctors, exhibiting a significant difference. The role of breast ultrasound in screening was evaluated; 39.1% of gynecologists and obstetricians and 20.3% of community and preventive medicine doctors consider it as a screening method. Among gynecologists and obstetricians who do not follow any screening protocol, 94.7% consider ultrasound as a screening method. Among community and preventive medicine doctors, only 26.5% of physicians who follow the 50-69 years screening method consider it as a screening method. Inadequate training results in gynecologists and obstetricians, and family and community physicians performing inadequate screening and not following the recommended practices outlined in the BIRADS™ system.

Binary and Nonbinary Transgender Patient Experiences Accessing Gender-affirming Top Surgery.

Transgender and gender diverse (TGD) individuals face barriers when seeking top surgery, or bilateral mastectomies, as part of surgical transition, leading to delayed care and adverse health outcomes. Understanding differential experiences between nonbinary and binary patients is crucial for improving TGD patient care, but this distinction is seldom made in the current literature. This single-center cross-sectional mixed-methods survey study conducted between 2022 and 2023 enrolled all consecutive TGD patients undergoing top surgery. Significant differences between datasets were determined by two-sample unpaired t tests. Summative content analysis and descriptive analysis were performed for free-text responses. Thirty-seven binary and 71 nonbinary patients completed the survey. Lack of funding, long wait times within the healthcare system, and long wait times to access surgery were the three most impactful barriers for both cohorts. Nonbinary patients were more impacted by a lack of TGD-friendly surgeons and community physicians, prejudice from surgical center staff and community doctors, and employment concerns. More binary patients desired a "masculine chest" and to stop using a binder. The nonbinary group more frequently desired a "smaller chest" and had greater variability of surgical goals. Binary and nonbinary TGD patients both experience barriers to top surgery; however nonbinary patients may experience distinct barriers and have differential surgical goals. It is important to discuss specific surgery goals and offer top surgery options beyond bilateral mastectomy with nipple grafting, especially with nonbinary patients.

MA10.11 Patient-Reported Doctor Communication and Preference on Treatment Decision Making: Oligometastatic vs Metastatic Lung Cancer

MA10.11 Patient-Reported Doctor Communication and Preference on Treatment Decision Making: Oligometastatic vs Metastatic Lung Cancer

EXPERIENCES IN THE AMAZON

The text explores the formation of family and community doctors with a specific focus on acting in rural areas and the health of the indigenous population, a frequently neglected aspect in residency programs in large urban centers. The narrative details an internship at the Macapá Indigenous Health Support House (Casai) and at the base hub of the Manga village, located in Oiapoque, Amapá. During this internship, the resident doctor of the municipality of Rio de Janeiro-RJ had the opportunity to provide medical attention directly to indigenous communities of the villages of Amapá and northern Pará. A central aspect of the text is the importance of exchange between scientific knowledge and traditional indigenous practices. The respect demonstrated by the indigenous population and the credibility attributed to their beliefs were essential to the effectiveness of the care performed. This experience offered the resident significant learning about person -centered medicine, allowing enriching contact with different cultures and traditions. These cultures have unique visions and understandings about the process of getting sick and healing, which contributed to a broader and more integrated understanding of health care. The internship stressed the importance of recognizing and respecting cultural practices in medical practice.

Being a ‘Teams’ player: a quality improvement project expanding the role of Microsoft Teams to improve communication and efficiency of junior doctors in a ward-based hospital setting

Being a ‘Teams’ player: a quality improvement project expanding the role of Microsoft Teams to improve communication and efficiency of junior doctors in a ward-based hospital setting

Educational activities of continuing professional development as a platform for constant professional improvement of dentists

Continuing professional development lasts throughout the entire period of professional activity and enables a doctor not only to constantly maintain, but also to improve the standards of professional activity in accordance with the needs of the dental industry. Public professional associations are an effective platform for professional communication and improvement of knowledge and doctors’ practical skills. During the first half of 2024, the NGO “Association of Dentists of Ukraine” organized and conducted several educational events for dentists, both in real time and in classroom format. During educational events, doctors had the opportunity to familiarize themselves with the latest technologies in dentistry, were provided with educational and methodological materials for better knowledge acquisition and mastering skills, as well as regulatory and other documents providing medical dental care. The NGO “Association of Dentists of Ukraine” constantly monitors the satisfaction of doctors with educational events and, based on the results of the survey, publishes relevant articles in a professional journal.

External Auditory Canal Exostosis and the California Surfer Population: A Cross-Sectional Study.

California has the most surfers in the United States and a high prevalence of external auditory canal exostoses (EACEs) among them. We aimed to characterize their EACE knowledge, use of earplugs, and barriers toward earplug use. A RedCap survey was distributed to online surfing forums and surfers at California beaches. Descriptive statistics and regression analyses were used to characterize responses. Our cohort included 334 primarily male (n = 269, 81.52%), college-educated (n = 237, 71.17%) surfers who were on average 30.79 years old (SD = 11.07). Two hundred and ninety-seven (90.00%) heard of EACE and 317 (96.06%) believed earplugs prevent EACE. However, 214 (64.85%) had never used earplugs. Multivariable logistic regression found increased age (OR = 1.04, 95% CI = [1.00-1.08], p = 0.03), higher EACE knowledge quiz scores (OR = 1.47, 95% CI = [1.19-1.80], p < 0.001), and primarily surfing in Southern California (OR = 2.19, 95% CI = [1.15-4.16], p = 0.02) increased the likelihood of earplug use. Common reasons against earplug use included reduced hearing, discomfort, and social hindrance. Two hundred and eighty-seven (86.45%) would wear earplugs following more EACE knowledge. They preferred learning from surf community members, doctors, and surf events. Low earplug use despite awareness of EACE preventability suggests a need for EACE education among California surfers and more accessible, user-friendly earplugs. Younger, less-skilled surfers who were more commonly unaware of EACE may represent a key intervention group. Education could be promoted through partnerships between health professionals and renowned surf organizations, as most participants indicated a willingness to use earplugs post-education. N/A Laryngoscope, 2024.

Patient experience with hospital care following the Maryland global budget revenue model: A difference-in-difference analysis.

As a result of the success of Maryland's full risk capitated payment model experiment (Global Budget Revenue) in constraining healthcare costs, there is momentum for expanding the reach of such models. However, as these models are implemented, studies analyzing their long-term effects suggest unintended spillover effects that may ultimately influence patient experiences. The aim of this study was to determine whether implementation of the GBR was associated with changes in patient experience. Cross-sectional study using a difference-in-difference analysis to examine changes in patient experiences according to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) domains before and after implementation of the GBR model. Acute care hospitals from 2010-2016 with completed HCAHPS surveys were included. Hospitals identified for inclusion were then matched, based on county location, to area level characteristics using the Area Health Resource File. A total of 844 hospitals were included. Compared to hospitals in non-GBR states, hospitals in GBR states experienced significant declines in the following HCAHPS domains: "would definitely recommend the hospital to others" [Average treatment effect (ATT) = -1.19, 95% CI = -1.97, -0.41)] and 9-10 rating of the hospital (ATT = -0.93, 95% CI = -1.71, -0.15). Results also showed significant increases in the HCAHPS domains: "if patient's rooms and bathroom were always kept clean" (ATT = 1.10, 95% CI = 0.20, 2.00). There were no significant differences in changes for the other domains, including no improvements in: nursing communication, doctor communication, help from hospital staff, pain control, communication on medicines, discharge information, and quietness of the patient environment. These findings suggest there should be efforts made to ascertain and mitigate potential adverse effects of care transformation initiatives on patient experience. Patients are stakeholders and their inputs should be sought and incorporated in care transformation efforts to ensure that these models align with improved patient experiences.

Appendicectomy pathway: Insights from electronic medical records of a local health district in Australia

BackgroundThis study aims to identify the common pathways of appendicectomy, the most common emergency surgery in Australia’s public hospitals and any variations within a regional public health district in New South Wales, Australia. MethodsWe analyzed the electronic medical records of 3,943 patients who underwent appendicectomy between January 2014 and July 2020 at 2 hospitals in the Illawarra Shoalhaven Local Health District, New South Wales, Australia, using the PM2 approach for surgical pathway identification and subsequent statistical analyses. ResultsAmong 3,943 patients, 3,606 (91.5%) followed an 11-step main pathway: (1) emergency department admission, (2) surgery booking, (3) anesthesia start, (4) operating room entry, (5) surgery start, (6) surgery end, (7) anesthesia end, (8) operating room discharge, (9) postanesthesia care unit admission, (10) postanesthesia care unit discharge, and (11) hospital discharge. The median length of stay was 48.13 hours (interquartile range 32.74). The main pathway differed from either variation 1 (n = 246, 6.2%) or variation 2 (n = 30, 0.8%) only in the timing and location of anesthesia administration or conclusion. Variation 3 (n = 26, 0.7%) included patients who underwent appendicectomy twice, whereas variation 4 (n = 25, 0.6%) included patients booked for surgery before emergency department admission through community doctor referrals. Thirteen exceptional cases experienced combinations of the aforementioned pathways. The length of stay and phase durations varied between the main pathway and these variations. ConclusionThe appendicectomy pathway was largely standardized across the studied hospitals, with the location of anesthesia administration or conclusion affecting specific stages but not the overall length of stay. Only a complex 2-surgery pathway increased length of stay.

Patient Satisfaction in Rural Versus Non‐Rural US Hospitals

ABSTRACTIntroductionAssessing patient satisfaction is an effective way to provide an evaluation of the quality of healthcare services. As a result, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Patient Survey was established as the first standardized national survey to publicly report patient ratings on hospital care. There remains a lack of research that examines rural–urban distinctions in patient satisfaction. The objective of this study was to investigate if there is a difference in hospital determinants of patient satisfaction among hospitals based on rural status.MethodsThe study utilized two public datasets containing HCAHPS survey results from 4714 US hospitals and from eligible cancer hospitals that participate in the Prospective Payment System‐Exempt Cancer Hospital Quality Reporting. The data were collected from July 1, 2021 to June 30, 2022 and published by Centers for Medicare &amp; Medicaid Services. Rural status of each hospital was determined by matching zip codes with data provided by the Health Resources &amp; Services Administration.ResultsA total of 3248 hospitals were included in the analysis, with approximately 51.14% located in rural areas. There was a significant difference across every hospital determinant when comparing rural and non‐rural status. Rural hospitals had a higher score for every hospital determinant (Cleanliness, Nurse communication, Doctor communication, Staff responsiveness, Communication about medicines, Discharge information, Care transition, Overall hospital rating, Quietness, and Willingness to recommend the hospital), indicating better performance.ConclusionRural hospitals demonstrated better HCAHPS performance across every hospital determinant in comparison to urban hospitals, suggesting possible recent improvements. Future research is necessary to investigate this trend and its consistency, which can inform targeted interventions to better address the healthcare needs of diverse populations in the United States.

Ordinary defensive medicine: in the shadows of general practitioners’ postures toward (over-)medicalisation

This paper draws on qualitative research using focus groups involving 38 general practitioners (GPs). It explores their attitudes and feelings about (over-)medicalisation. Our main findings were that GPs had a complex representation of (over-)medicalisation, composed of many professional, social, technological, economic and relational issues. This representation led GPs to feel uncomfortable. They felt pressure from all sides, which led them to question their social roles and responsibilities. We identified four main GP-driven proposals to deal with (over-)medicalisation: (1) focusing on the communication in doctor–patient relationships; (2) grounding practices in evidence-based medicine; (3) relying on clinical skills, experience and intuition; and (4) promoting training, leadership bodies and social movements. Drawing on these proposals, we identify and discuss five paradigms that underpin GPs’ attitudes toward (over-)medicalisation: underlying social factors, preventing medicalisation, managing uncertainties, sharing medical decision-making and thinking about care as a rationale. We suggest that these paradigms constitute a defensive posture against GPs’ uncomfortable feelings. All five defensive paradigms were identified in our focus groups, echoing contemporary political debates on public health. This non-exhaustive framework forms the outline of what we call ordinary defensive medicine. GPs’ uncomfortable feelings are the origin of their defensive solutions and the manifestation of their vulnerability. This professional vulnerability can be shared with the patient’s vulnerability. In our view, this creates an opportunity to rediscover patient–doctor relationships and examine patients’ and doctors’ vulnerabilities together.“There are many cases in which—though the signs of a confusion of tongues between the patient and his doctor are painfully present—there is apparently no open controversy. Some of these cases demonstrate the working of two other, often interlinked, factors. One is the patient’s increasing anxiety and despair, resulting in more and more fervently clamouring demands for help. Often the doctor’s response is guilt feelings and despair that his most conscientious, most carefully devised examinations do not seem to throw real light on the patient’s “illness”, that his most erudite, most modern, most circumspect therapy does not bring real relief.” (Balint M. The Doctor, His Patient and the Illness. New York: International Universities; 2005. [1957].)“Theories about care put an unprecedented emphasis on vulnerability—taking up that challenge to transform what really counts in today’s hospitals implies letting colleagues inside previously closely guarded professional boundaries” (2, our translation).

Towards knowledge-infused automated disease diagnosis assistant

With the advancement of internet communication and telemedicine, people are increasingly turning to the web for various healthcare activities. With an ever-increasing number of diseases and symptoms, diagnosing patients becomes challenging. In this work, we build a diagnosis assistant to assist doctors, which identifies diseases based on patient–doctor interaction. During diagnosis, doctors utilize both symptomatology knowledge and diagnostic experience to identify diseases accurately and efficiently. Inspired by this, we investigate the role of medical knowledge in disease diagnosis through doctor–patient interaction. We propose a two-channel, knowledge-infused, discourse-aware disease diagnosis model (KI-DDI), where the first channel encodes patient–doctor communication using a transformer-based encoder, while the other creates an embedding of symptom-disease using a graph attention network (GAT). In the next stage, the conversation and knowledge graph embeddings are infused together and fed to a deep neural network for disease identification. Furthermore, we first develop an empathetic conversational medical corpus comprising conversations between patients and doctors, annotated with intent and symptoms information. The proposed model demonstrates a significant improvement over the existing state-of-the-art models, establishing the crucial roles of (a) a doctor’s effort for additional symptom extraction (in addition to patient self-report) and (b) infusing medical knowledge in identifying diseases effectively. Many times, patients also show their medical conditions, which acts as crucial evidence in diagnosis. Therefore, integrating visual sensory information would represent an effective avenue for enhancing the capabilities of diagnostic assistants.

Mental health and quality of life in patients with chronic liver disease: a single-center structural equation model

BackgroundChronic liver disease (CLD) is one of the leading disease burdens in Pakistan. Until now, there has only been limited focus in the country on providing health services through tertiary services in urban cities, whereas there is almost no research in Pakistan on the mental health and quality of life of CLD patients. This study aimed to understand which predictors influence the mental health and quality of life of CLD patients in order to advise better policy protection.MethodsData was collected from CLD patients at the Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan. A total of 850 respondents were part of the final sample. The age of respondents ranged from 18 to 79 years and included the following diagnosis: (i) Chronic Viral Hepatitis (n = 271), (ii) Cirrhosis (n = 259), (iii) Hepatocellular Carcinoma (n = 193), and (iv) Non-viral Liver Disease (n = 127).ResultsMean results reveal that females as well as illiterate patients need more support for mental health and communication with their physician; whereas men need more support to develop coping strategies. Structural equation modelling results reveal that the severity of symptoms (β = 0.24, p < 0.001), coping strategies (β=-0.51, p < 0.001), and doctor communication (β=-0.35, p < 0.001) predict mental health. Quality of life is associated with the severity of symptoms (β=-0.36, p < 0.001), coping strategies (β = 0.26, p < 0.05), and doctor communication (β = 0.09, p < 0.05).ConclusionsA ‘bio-psycho-social-spiritual’ model is recommended for Pakistan’s CLD patients which includes the integration of social officers to provide support in four key areas to secure mental health and quality of life of patients.

Association of patient-reported experience of care with cancer clinical trial participation.

11117 Background: Few individuals diagnosed with cancer participate in clinical trials. Patient-reported experience of care (PEC), assessing patients’ perspectives on interactions with healthcare providers and systems, is important in evaluating quality of care. To help identify patient-centered strategies that may enhance trial enrollment, we examined whether PEC may predict enrollment in clinical trials. Methods: This study utilized Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, including SEER registry data, CAHPS PEC surveys, and Medicare claims. Individuals in SEER-CAHPS who were diagnosed with lung cancer 2000-2018 and completed a CAHPS survey ≥6 months following diagnosis were included. The study outcome, clinical trial enrollment after cancer diagnosis, was determined using Medicare claims; among individuals who enrolled in clinical trials, only those completing a CAHPS survey before trial enrollment were included. PEC was assessed using 5 global ratings (Overall Care, Personal Doctor, Specialist, Health Plan, and Prescription Drug Plan) and 6 composite measures (Doctor Communications, Getting Needed Care, Getting Care Quickly, Getting Needed Drugs, Care Coordination, and Customer Service); all were scored 0 (worse PEC) to 10 (best PEC). Associations of trial participation and PEC were assessed using multivariable logistic regression, controlling for age, race/ethnicity, dual Medicaid status, fee-for-service vs Medicare Advantage plan at diagnosis, and physical problems limiting activities, and were weighted to correspond to the overall SEER population. Results: The study included 5,361 individuals diagnosed with lung cancer; 4.8% of the weighted population enrolled in a clinical trial. Patients with higher PEC ratings for their Specialist (odds ratio [OR] for a 1-point higher PEC score 0.86, 95% CI 0.76, 0.98); for their Health Plan (OR 0.87, 95% CI 0.80, 0.96); and for Getting Needed Care (OR 0.89, 95% CI 0.81, 0.98) had significantly (p&lt;0.05) lower oddsof having enrolled in a clinical trial. Among individuals without physical limitations, association of PEC and trial enrollment were similar. Among individuals with physical limitations, higher PEC ratings for Getting Care Quickly were associated with higher odds (OR 1.20, 95% CI 1.03, 1.39) of having enrolled in a trial. Conclusions: In this population, reporting worse PEC in certain domains was significantly associated with increased clinical trial enrollment. This suggests patients less happy with their clinical care may be more likely to enroll in trials, perhaps to receive different types of care and/or from different providers. PEC associations with trial enrollment differ between patients with vs without physical limitations, suggesting different strategies may be effective for increasing trial enrollment among these two sub-groups.

Satisfaction levels experienced by Ventricular Septal Defect patients aged 18-30 years-old at Ribat University Hospital in regards to their doctor's communication skills between November 2021 and December 2021

Satisfaction levels experienced by Ventricular Septal Defect patients aged 18-30 years-old at Ribat University Hospital in regards to their doctor's communication skills between November 2021 and December 2021

An evaluation of outpatient satisfaction based on the national standard questionnaire: a satisfaction survey conducted in a tertiary hospital in Shenyang, China.

Patient satisfaction survey serves as a pivotal tool in evaluating the quality of healthcare services. China's nationwide standard patient satisfaction measurement tool was introduced in 2019. This study aimed to assess the model fit of the national standard outpatient satisfaction questionnaire in a tertiary hospital and evaluate the outpatient satisfaction levels using this tool. A cross-sectional survey using the national outpatient satisfaction questionnaire was conducted via message links to all hospital outpatients who registered between April and July 2022. The data collected underwent descriptive analysis, comparative analysis, and confirmatory factor analysis (CFA). A total of 6,012 valid responses were received and analyzed during this period, with 52.9% of the participants being women. The confirmatory factor analysis (CFA) model showed a good fit and identified doctor communication as having a positive effect and environmental factors as having a negative effect on outpatients' satisfaction, with standardized regression weights of 0.46 and 0.42, respectively. Despite the remarkably high satisfaction levels, patients' recommendation for using the services of this hospital surpassed the overall evaluation and total satisfaction scores. A disparity was identified between the expectations and real experiences of outpatients, leading to some extent of dissatisfaction. To enhance satisfaction levels, the hospital should improve the communication skills of all clinical staff, simplify the environment layout for first-time visitors, and manage patient overloads.

Patient satisfaction toward doctor communication in medical clinics: a study from northern Sri Lanka

Patient satisfaction toward doctor communication in medical clinics: a study from northern Sri Lanka

Trends in HCAHPS Survey Scores, 2008-2019: A Quality Improvement Perspective.

HCAHPS' 2008 initial public reporting, 2012 inclusion in the Hospital Value-Based Purchasing Program (HVBP), and 2015 inclusion in Hospital Star Ratings were intended to improve patient experiences. Characterize pre-COVID-19 (2008-2019) trends in hospital consumer assessment of healthcare providers and systems (HCAHPS) scores. Describe HCAHPS score trends overall, by phase: (1) initial public reporting period (2008-2013), (2) first 2 years of HVBP (2013-2015), and (3) initial HCAHPS Star Ratings reporting (2015-2019); and by hospital characteristics (HCAHPS decile, ownership, size, teaching affiliation, and urban/rural). A total of 3909 HCAHPS-participating US hospitals. HCAHPS summary score (HCAHPS-SS) and 9 measures. The mean 2007-2019 HCAHPS-SS improvement in most-positive-category ("top-box") responses was +5.2 percentage points/pp across all hospitals (where differences of 5pp, 3pp, and 1pp are "large," "medium," and "small"). Improvement rate was largest in phase 1 (+0.8/pp/year vs. +0.2pp/year and +0.1pp/year for phases 2 and 3, respectively). Improvement was largest for Overall Rating of Hospital (+8.5pp), Discharge Information (+7.3pp), and Nurse Communication (+6.5pp), smallest for Doctor Communication (+0.8pp). Some measures improved notably through phases 2 and 3 (Nurse Communication, Staff Responsiveness, Overall Rating of Hospital), but others slowed or reversed in Phase 3 (Communication about Medicines, Quietness). Bottom-decile hospitals improved more than other hospitals for all measures. All HCAHPS measures improved rapidly 2008-2013, especially among low-performing (bottom-decile) hospitals, narrowing the range of performance and improving scores overall. This initial improvement may reflect widespread, general quality improvement (QI) efforts in lower-performing hospitals. Subsequent slower improvement following the introduction of HVBP and Star Ratings may have reflected targeted, resource-intensive QI in higher-performing hospitals.