Hospital Consumer Assessment Of Healthcare Providers And Systems Data Research Articles

Patient Experience Coordinator

The aim of this study was to test the impact of an innovative nonclinical support role to improve patient experiences while supporting nurse work on inpatient units. On the basis of the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey, patients' experience declined nationally during the COVID-19 pandemic. A nonclinical support role, titled an Experience Coordinator, was created as a test of change to collaborate with care teams and respond to patients' and families' nonclinical needs. This is a quality improvement (QI) project for a supportive role development and implementation. The health system's HCAHPS data were compared before and after the role was tested on 3 inpatient units. The HCAHPS data indicated that 5 of the 10 domains' top box ratings increased during the QI project month compared with the previous month. The study findings may support the implementation of new innovative nonclinical positions to alleviate nurses' workload and promote patients' hospital experience.

Utilization of Family as Faculty: A Patient Directed Simulation Education to Improve Patient and Family Communication during Patient-Family Centered Rounds (PFCR).

Introduction:Patient-family-centered care (PFCC) is based on the understanding that the family is the child’s source of strength and support. Effective communication between families and providers is an essential component of PFCC. Our interprofessional team designed an initiative to improve medical providers’ communication in partnership with the Patient and Family Advisory Council (PFAC). Strategies included the creation of a competency rubric and simulation curriculum using the family as faculty. The SMART aim was to improve the percentage of respondents who answered “Always” to doctor communication domains from 72% to 75.6% in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) by December 2020.Methods:Pediatric residents, medical students, faculty, nurses, and PFAC members formed a Quality Improvement (QI) team to address PFCR competency. The team created a PFCC checklist to address competency. PFAC volunteers served as standardized parents in an in situ simulation of PFCR scenarios involving interprofessional in-patient teams. Evaluators observed rounds for the pre and postintervention assessment using the checklist. The outcome measure was the percentage of respondents who answered “Always” in the HCAPHS domain for physician communication. The process measure was the PFCR pre and postintervention, using Fisher’s exact test for analysis.Results:Using a statistical process chart (SPC), HCAHPS data from 2018 to 2020 showed that we exceeded our aim of >5% increase in the physician communication performance. Pre-post intervention data showed improvement in PFCR competency.Conclusion:Family as faculty simulation led to improved physician communication, translating to improved performance in the HCAHPS score and PFCR competency communication domains.

Contribution of HCAHPS Specific Care Experiences to Global Ratings Varies Across 7 Countries: What Can be Learned for Reporting These Global Ratings?

Given the increased international interest in improvement strategies for patient experiences with care, it is important to understand whether the same specific care experiences affect global ratings across countries. Moreover, reporting of these global ratings currently substantially varies in both research and public reporting. The objectives of this study were to examine the differential magnitude of associations between Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) specific care experiences and global ratings, and to explore implications for reporting these global ratings. HCAHPS data were collected from 11,289 patients across 7 European countries. We studied the association between 11 experience items and 2 global ratings (0-10 hospital rating, hospital recommendation) using multilevel ordered logistic regression analysis. Using interaction terms, we examined consistency of these associations across countries. Assuming homogeneous use and interpretations of response categories of these specific experiences across patients within and between countries, we investigated what the associations between specific experiences and global ratings imply for reporting global ratings across countries. All specific experiences were associated with both global ratings. "Being talked to about care after leaving the hospital" showed the strongest association. There were relatively little differential effects across countries. A reporting strategy with different cutpoints across countries might provide a more equitable comparison of global ratings. Our findings highlight a differential contribution of HCAHPS specific experiences to overall ratings across countries. Research and public reporting may consider examining in more detail within and across populations global rating cutpoints that represent the same true level of positive patient experiences.

National patient experience data and correlation with in-hospital adverse gynecologic cancer surgical outcomes.

21 Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a patient experience and quality of care measure that impacts hospital reimbursement. HCAHPS data is made available to the public through Centers for Medicare and Medicaid. Given the potential implications for healthcare decision-making, this study sought to determine the utility of hospital-level data from the HCAHPS survey as a predictor of in-hospital postoperative outcomes in gynecologic cancer patients by creating a link with the Nationwide Inpatient Sample (NIS) database, an inpatient care database developed for the Healthcare Cost and Utilization Project (HCUP). Methods: 2009-2011 HCAHPS survey data was used to assign hospitals into terciles by scores. The NIS database was used to identify admissions for cancer-specific surgeries for patients with ovarian, uterine, and cervical cancers. Outcomes included complications, mortality, and prolonged length of stay. Mixed effects models compared correlation of outcomes and HCAHPS scores, after adjustment for patient-level and hospital-level variables. Results: 17,509 linked encounters in 651 hospitals across the U.S. were identified, with 51% uterine, 40% ovarian, and 9% cervical cancer surgical admissions. In-hospital mortality was less likely in hospitals in the highest vs. lowest tercile of summary HCAHPS scores (odds ratio (OR) 0.54, 95% CI: 0.31-0.94). While higher scores were not associated with overall postoperative complications, by complication subcategory, admissions in top tercile hospitals were less likely to have surgical complications (OR 0.82, 95% CI 0.69-0.98). No differences were found in risk of medical or nursing-related complications, or prolonged hospitalization (p > 0.05). Conclusions: For patients undergoing gynecologic oncology surgery, assessment of patient experience has limited correlation with in-hospital adverse surgical outcomes. Awareness of the limitations of HCAHPS survey data may better inform patients as consumers and highlights the importance for transparency of relevant quality measures.

Patient experience and quality of urologic cancer surgery in US hospitals.

Care interactions as perceived by patients and families are increasingly viewed as both an indicator and lever for high-value care. To promote patient-centeredness and motivate quality improvement, payers have begun tying reimbursement with related measures of patient experience. Accordingly, the authors sought to determine whether such data correlate with outcomes among patients undergoing surgery for genitourinary cancer. The authors used the Nationwide Inpatient Sample and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data from 2009 through 2011. They identified hospital admissions for cancer-directed prostatectomy, nephrectomy, and cystectomy, and measured mortality, hospitalization length, discharge disposition, and complications. Mixed effects models were used to compare the likelihood of selected outcomes between the top and bottom tercile hospitals adjusting for patient and hospital characteristics. Among a sample of 46,988 encounters, the authors found small differences in patient age, race, income, comorbidity, cancer type, receipt of minimally invasive surgery, and procedure acuity according to HCAHPS tercile (P<.001). Hospital characteristics also varied with respect to ownership, teaching status, size, and location (P<.001). Compared with patients treated in low-performing hospitals, patients treated in high-performing hospitals less often faced prolonged hospitalization (odds ratio, 0.77; 95% confidence interval, 0.64-0.92) or nursing-sensitive complications (odds ratio, 0.85; 95% confidence interval, 0.72-0.99). No difference was found with regard to inpatient mortality, other complications, and discharge disposition (P>.05). Using Nationwide Inpatient Sample and HCAHPS data, the authors found a limited association between patient experience and surgical outcomes. For urologic cancer surgery, patient experience may be optimally viewed as an independent quality domain rather than a mechanism with which to improve surgical outcomes. Cancer 2016;122:2571-8. © 2016 American Cancer Society.

Effect of HCAHPS reporting on patient satisfaction with physician communication.

Prior studies, using limited data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, reported that public reporting increases satisfaction scores in all domains except physician communication. Our objective was to examine changes in patient satisfaction with physician communication using all available data. We used publicly accessible datasets: HCAHPS (2007-2013), socioeconomic datasets from the US Census Bureau, and hospital service area (HSA) dataset from the Dartmouth Atlas of Health Care. Satisfaction scores were determined by the percentage of responses to "doctors always communicated well." Hospitals were grouped into quartiles based on 2007 scores. We used multilevel models to account for correlation between within-hospital observations. HCAHPS data were reported by 2273 hospitals in 2007. During the 7-year period, overall satisfaction scores with physician communication increased by 2.8% (P < 0.001). The lowest quartile hospitals had significant increase in satisfaction scores, whereas the highest quartile scores decreased (0.87% per year vs -0.23% per year; P < 0.001). These differences remained significant after adjusting for hospital and local population characteristics. Survey response rate and the number of acute-care beds and physicians in the HSA were positively associated, whereas HSA population size and being a teaching hospital were negatively associated with patient satisfaction scores (all P < 0.005). Although there has been an improvement in patient satisfaction with physicians during the past 7 years, this improvement was not seen in all hospitals. The overall gap between hospitals has narrowed, which can be further improved through sharing best practices.

Abstract P152: Patient Satisfaction at America's Worst Performing Hospitals

BACKGROUND Previous studies have identified hospitals with significantly lower performance for cardiac care than the national average. Little is known about patient satisfaction at these consistently low performing hospitals. METHODS We used 2006-08 Hospital Compare data to identify hospitals that reported acute myocardial infarction (AMI) and heart failure (HF) process measures. We calculated performance scores as the total number of patients receiving recommended therapies divided by the total number of eligible patients for AMI and HF respectively. We classified hospitals as low performing (lowest decile for all 3 years [N= 92 for AMI, N= 177 for HF]), top performing (highest decile for all 3 years [N= 43 for AMI, N =123 for HF]), and intermediate hospitals (all others [N= 2440 for AMI, N =3283 for HF]). We obtained hospital characteristics from the AHA 2006 survey. We used 2008 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data to determine the proportion of patients who 1) definitely recommend the hospital to others and b) rate hospital care as ≥ 9 on a scale of 1 - 10. We compared patient satisfaction ratings across hospital categories. RESULTS Low performing hospitals had significantly lower performance scores (77% vs. 95% vs. 100% for AMI, 43% vs. 85% vs. 99% for HF), had fewer beds (142 vs. 261 vs. 319 for AMI, 59 vs. 207 vs. 244 for HF), and were less likely to be teaching hospitals (0% vs. 11% vs. 11% for AMI, 0% vs. 8% vs. 12% for HF) as compared to intermediate and top performing hospitals (p &lt; .01 for all). Low performing hospitals were more likely to not report HCAHPS data as compared to intermediate and top performing hospitals (15% vs. 0% vs. 0% for AMI, 28% vs. 5% vs. 5%, p &lt; .01). Among those reporting, low performing hospitals had lower rates for recommending a hospital (60% vs. 67% vs. 70% for AMI, 64% vs. 67% vs. 70% for HF, p&lt; .01) and rating the hospital at least 9 out of 10 (58% vs. 62% vs. 65% for AMI, 62% vs. 63% vs. 65% for HF p &lt; .01). CONCLUSION Consistently low performing hospitals are less likely to report patient satisfaction data. Among those reporting, patients at low performing hospitals have significantly lower satisfaction. Efforts to improve hospital quality should focus both on improving performance and satisfaction with care.