Hospital Consumer Assessment Of Healthcare Providers And Systems Measures Research Articles

At the Intersection of Patient Experience Data, Outcomes Research, and Practice: Analysis of HCAHPS Scores in Neurology Patients.

ObjectiveTo assess variation in patient-reported experience in inpatient neurology patients.Patients and MethodsWe retrospectively identified 1045 patients 18 years and older admitted to a neurology service and discharged from January 1, 2013, through September 30, 2016, who completed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Multivariable logistic regression evaluated the associations of patient factors with HCAHPS measures. Key driver analysis identified associations between HCAHPS measures and the Global score (combination of 0-10 hospital rating and likelihood to recommend). Multivariable logistic regression compared HCAHPS scores between neurology patients and those admitted to a neurosurgery (n=2190) or internal medicine (n=3401) service during the same period.ResultsAmong patients admitted to a neurology service, overall (summary) scores did not vary significantly by diagnosis after adjustment for age, education, and overall health, but patients with neurologic diagnoses other than stroke, epilepsy, and neurodegenerative disease were more likely to report lower Pain Management scores compared with patients with cancer. Key driver analysis showed Care Transition scores as drivers of the Global score. After adjustment, general internal medicine service patients were more likely to report low Summary scores and neurosurgery service patients were significantly less likely to report low Summary scores compared with neurology service patients.ConclusionEfforts to improve how neurology patients experience their care should be aimed at targeting patients' perceptions of pain management, and improving care transitions is an important first-priority target for improvement. This analysis may help other institutions improve hospital rating, value-based payments, and patient-centered outcomes.

Association of Magnet Status and Nurse Staffing With Improvements in Patient Experience With Hospital Care, 2008-2015.

Little is known about the longitudinal association of hospital Magnet status (an indicator of nursing excellence) and nurse-staffing level with inpatient care experience. To examine temporal trends in hospital performance on patient experience measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the association of these trends with Magnet status and nurse-staffing level. Longitudinal study of hospital-level data from the HCAHPS survey, the American Hospital Association Annual Survey, and the American Nurses Credentialing Center. Growth curve models were used for the analysis of longitudinal associations. A total of 26,752 hospital-year observations from 3614 US hospitals that collected at least 3 years of HCAHPS data from patients discharged between 2008 and 2015. Dependent variables were 7 HCAHPS measures. Independent variables included linear and quadratic time terms, hospital Magnet status, and nurse-staffing level. There were significant improvements (P<0.001) in all 7 HCAHPS measures, but the trends were nonlinear; the improvement rates have decreased over time. Magnet hospitals and hospitals with more favorable nurse staffing consistently performed better on HCAHPS but did not improve faster than other hospitals during the study period. In subgroup analyses, HCAHPS scores did not improve for hospitals after they received Magnet recognition during the period from 2009 to 2015. The hospital organizational attributes that lead to Magnet recognition or better nurse staffing may be associated with higher performance on HCAHPS. Magnet status and favorable nurse staffing may be markers of hospital commitment to better patient-centered care.

Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey

In 2012, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to capture key elements of patient satisfaction, including pain management. HCAHPS surveys are administered to patients 48 hours to 6 weeks after discharge, and scores are used to determine hospital payments.1 However, patients complete surveys during a time when many are filling postdischarge opioid prescriptions. This timing has raised concerns that HCAHPS measures could inadvertently incentivize clinicians to overprescribe opioids after discharge to ensure satisfactory ratings and reimbursement.2,3 Citing these concerns, CMS announced it will remove pain management from its determination of hospital payments beginning in 2018, even though little is known regarding the potential correlation between HCAHPS scores and postdischarge opioid prescribing.3 We sought to evaluate the association between HCAHPS pain measures and postoperative opioid prescribing in surgical patients, which accounts for nearly 40% of surgical prescriptions.

Effect of Hospital Case Mix on the Hospital Consumer Assessment of Healthcare Providers and Systems Star Scores: Are All Stars the Same?

We aimed to evaluate variations in patient experience measures across different surgical specialties and to assess the impact of further case-mix adjustment. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported survey of patients' hospital experiences that directly influence Medicare reimbursement. All adult surgical inpatients meeting criteria for HCAHPS sampling from 2013 to 2014 at a single academic center were identified. HCAHPS measures were analyzed according to published top-box and Star-rating methodologies, and were dichotomized ("high" vs "low"). Multivariable logistic regression was used to identify independent associations of high patient scores on various HCAHPS measures with specialty, diagnosis-related group complexity, cancer diagnosis, sex, and emergency admission after adjusting for HCAHPS case-mix adjusters (education, overall health status, language, and age). We identified 36,551 eligible patients, of which 30.8% (n = 11,273) completed HCAHPS. Women [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.72-0.85, P < 0.001], complex cases (OR 0.90, 95% CI 0.82-0.99, P = 0.02), and emergency admissions (OR 0.67, 95% CI 0.55-0.82, P < 0.001) had lesser Star scores on adjusted analysis, whereas patients with a cancer diagnosis had greater Star scores (OR 1.15, 95% CI 1.03-1.29, P = 0.01). Using general surgery as the reference, the Star scores varied significantly across 12 specialties (range OR 0.65 for plastics to 1.29 for transplant surgery). Patient responses to individual composite scores (pain, care transition, physician, and nurse) varied by specialty. HCAHPS case-mix adjustment does not include adjustment for specialty or diagnosis, which may result in artificially lower scores for centers that provide a high level of complex care. Further research is needed to ensure that the HCAHPS is an unbiased comparison tool.

Achieving a 5-star rating: Analysis of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores among patients undergoing elective colorectal operations

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported survey of patients' hospital experience. All inpatient, elective colorectal resections with completed HCAHPS surveys at a single institution between June 2012 and April 2015 were identified. HCAHPS measures were analyzed according to published methodologies. Univariate logistic regression evaluated associations of various HCAHPS measures with age, sex, ostomy, approach, diagnosis, and prolonged length of stay (PLOS; ≥7days). Key driver analysis demonstrated associations between the individual HCAHPS measures and the global hospital rating measure. We identified 755 patients. Younger age, inflammatory bowel disease, open approach, ostomy construction, and PLOS were associated with low quality of pain management. Patients with inflammatory bowel disease, open approach, and PLOS had a low overall star score (all P<.05). Care transitions and communication about medications received low scores but were associated highly with the global hospital rating measure. Efforts aimed at improving pain management among patients with colorectal resection should focus on patients with inflammatory bowel disease, open operations, ostomies, and PLOS. Improving care transitions and communication about medications are important targets for improvement to increase the overall hospital score. Considering the importance of improving patient-centered outcomes, we suggest that all institutions utilize their existing HCAHPS data in this manner.

Electronic Healthcare's Relationship With Patient Satisfaction and Communication.

Healthcare information technology (HIT) has been examined and shown to be a tool to improve patient healthcare quality. This study seeks to define the relationship between HIT applications such as computerized physician order entry, clinical decision support systems, and handheld device use and select Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures (doctor and nurse communication, discharge instructions, and whether the patient would highly recommend the hospital). Several control variables were used that represent the hospital level and contextual hospital service area level. The analysis had mixed results: the aforementioned HIT applications may add and support certain HCAHPS measures (Always Given Discharge Information), whereas there were no significant findings for the more interpersonal quality measures (nurse and doctor communication, recommendation). These results show that although patients may not score doctors and nurses significantly higher for their communication in hospitals that use HIT, they did receive discharge instructions significantly at a higher rate than the non-HIT hospitals.