Hospital Consumer Assessment Of Healthcare Providers And Systems Scores 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.

HCAHPS Scores and Community Factors.

The objective was to examine associations between patient experience, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and the sociodemographic, cultural, and access-to-care factors of the surrounding community. Using an empty model, this study found that 27% of the variation in HCAHPS scores was at the level of the county in which the hospital was located. The county factors examined explained about half of this county-level variation. Among community factors most strongly associated with increased HCAHPS scores were higher numbers of primary care physicians per capita, fewer specialists per capita, and smaller percentages of African Americans and Hispanics in the county. A number of community factors beyond the hospitalization experience may influence HCAHPS scores. As HCAHPS gains importance as a measure of quality of care and is linked to higher payments over time, it will be essential to understand the possible effects of community factors.

Effects of Multimethod Intervention on Bedside Report Compliance and Patient Satisfaction.

Miscommunication is a large contributing factor to hospital sentinel events. Communication with nurses is a component of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The HCAHPS survey not only assesses patient satisfaction but also impacts how hospitals are reimbursed. A literature review reveals that nursing bedside shift positively impacts patient satisfaction and nurse communication. There is limited research on how to implement bedside report as well as what to include during report. A pilot study evaluated an educational intervention and its impact on nurses' compliance with bedside report. The study also evaluated whether bedside report compliance affected HCAHPS scores. A test of independent proportions showed that overall compliance scores increased significantly from period 1 (46%) to period 3 (81%), z = 2.23, P = -.017, one-tailed. HCAHPS scores for nursing communication went from 69.9% in quarter 1 of 2015 to 73.8% in quarter 4 of 2016, but there was no statistically significant change.

Bridging gaps in care: Implementation of a pharmacist-led transitions-of-care program.

The development and implementation of a hospitalwide, pharmacist-led transitions-of-care (TOC) program are described. This 21-week quality improvement initiative was conducted from October 1, 2015, to February 26, 2016, at Memorial Hospital Pembroke. A TOC team was comprised of pharmacists, a pharmacy resident, pharmacy students, a physician, case managers, and nurses. All patients over the age of 18 admitted to the inpatient telemetry unit were included in this initiative. The primary endpoint was a sustained improvement in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for "Communication About Medications" and "Care Transitions: Understood the Purpose of Taking Medications." Secondary outcomes included 90% of admission and 80% of discharge medication reconciliations reviewed by a pharmacist. A total of 661 patients were included. The HCAHPS scores for "Communication About Medications" and "Care Transitions: Understood the Purpose of Taking Medications" had a sustained improvement during the study period. A pharmacist completed 94% and 75% of admission and discharge medication reviews, respectively, and a total of 1,579 interventions were made. Discharge education was completed at a rate of 73%. After a quality improvement initiative developed by pharmacists was implemented, HCAHPS scores showed improvement and more patients received medication reconciliation.

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.

A Multimodal Analgesic Pathway Improves Postpartum Pain Management Scores as Reflected by HCAHPS scores

Background: Postpartum pain is an important issue in obstetrics. A standardized method of monitoring pain scores is provided by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) national survey. In an effort to improve pain management ans subsequently improve HCAHPS scores in our obstetrics unit, we implemented a multimodal analgesic pathway with the intent to maximize analgesia while minimizing opioid use. Methods: Traditional postpartum analgesia methods were replaced with a multimodal pathway, including patientcontrolled epidural anesthesia for the first 12-24 hours after cesarean delivery plus acetaminophen and ketorolac IV as needed. Upon initiation of oral intake, scheduled acetaminophen and ibuprofen are administered. Transdermal lidocaine patches and opioids are added as needed. The oral medication pathway is initiated following vaginal delivery. Baseline and post-implementation responses to HCAHPS pain management questions 1) How often was your pain well controlled? 2) How often did the hospital staff do everything they could to help you with your pain were compared. Results: Prior to analgesia protocol implementation, pain management scores were below the desired benchmark of 78%. Post-implementation, responses of “Always” or “Top-box” for Question 1 significantly increased [73% versus 65%; p=0.05]. Post-intervention Top-box responses for Question 2 increased from 82% to 89% (p<0.03). Conclusions: The development of a postpartum multimodal analgesic regimen resulted in significantly improved pain management scores, reflected by HCAHPS scores. No other systematic intervention occurred to explain these positive changes.

Can Multimodal Pain Management in TKA Eliminate Patient-controlled Analgesia and Femoral Nerve Blocks?

TKA pain management protocols vary widely with no current consensus on a standardized pain management regimen. Multimodal TKA pain management protocols aim to address pain control, facilitate functional recovery, and maintain patient satisfaction. (1) Did changes to our pain management protocol, specifically adding liposomal bupivacaine, eliminating patient-controlled analgesia (PCA), and discontinuing femoral nerve blocks (FNBs), affect narcotic consumption after TKA? (2) Did these changes to our pain management protocols affect patient-reported pain scores? (3) Does the use of an immediate postoperative PCA affect rapid rehabilitation and functional recovery? (4) How did changes to our pain management regimen affect discharge disposition and pain-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores? We retrospectively analyzed an institutional arthroplasty database between September 2013 and September 2015 containing 1808 patients who underwent primary TKA. Departmental pain management protocols were compared in 6-month periods as the protocol changed. All patients received a multimodal pain management protocol including preoperative oral medications, spinal or general anesthesia, a short-acting intraoperative pericapsular injection, and continued postoperative oral narcotics for breakthrough pain. From September 2013 to April 2014, all patients received an intraoperative FNB and a PCA for the first 24 hours postoperatively (Cohort 1). From May 2014 to October 2014, a periarticular injection of liposomal bupivacaine was added to the protocol and FNBs were discontinued (Cohort 2). After April 2015, PCA was eliminated (Cohort 3). No other major changes were made to the TKA pain management pathways. Narcotic use, pain scores on 8-hour intervals, physical therapy milestones, and discharge disposition were compared. Total narcotic use was the least in Cohort 3 (Cohort 3: 66 ± 54 morphine milligram equivalents versus Cohort 2: 82 ± 72 versus Cohort 1: 96 ± 62; p < 0.001). There was an increase in pain score immediately after surgery in Cohort 3 (4.0 ± 3.5 versus 1.2 ± 2.2 versus 1.2 ± 2.5, post hoc analysis of Cohort 2 versus 3: mean difference 2.6, 95% confidence interval [CI] 2.2-3.0; p < 0.001); however, it was not different for the remainder of the hospital stay. Patients who did not receive PCA reached functional milestones for both gait and stairs faster by postoperative day 1 (47% [328 of 698] versus 30% [158 of 527] versus 16% [93 of 583], p < 0.001; Cohort 3 versus 2: odds ratio 2.1, 95% CI 1.6-2.6; p < 0.001). Discharge to home occurred more frequently (84% [583 of 698] versus 78% [410 of 527] versus 72% [421 of 583], p = 0.010) in Cohort 3. There were no differences in pain-related HCAHPS scores across all cohorts. Discontinuing PCAs and FNBs from our multimodal TKA pain management protocols and adding liposomal bupivacaine resulted in fewer narcotics consumed with no difference in pain control and faster functional recovery while maintaining high HCAHPS scores relating to pain. Level III, therapeutic study.

Hospital consumer assessment of healthcare providers and systems scores relating to pain following the incorporation of clinical pharmacists into patient education prior to joint replacement surgery.

Background:Pharmacist involvement has been shown to improve various aspects of patient care. Patients undergoing knee and hip replacement surgery generally experience post-operative pain and discomfort. Pain control can impact patient satisfaction, as reported by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.Objective:The current pilot study aims to measure the potential impact that incorporating pharmacists into preoperative patient education programs has on the response to select HCAHPS questions.Methods:Patient responses to two select HCAHPS questions related to pain were recorded for a year prior to pharmacist involvement in a comprehensive preoperative patient education program (2012) and a year after pharmacists became actively involved (2013).Results:In all reporting surgical patients, there was a modest 3.68% improvement in mean scores reflecting patient’s feelings that hospital staff did “everything they could” to attend to their pain (mean2012=3.66, SD=0.63 versus mean2013=3.80, SD=0.43, p=0.018, Mann-Whitney U test). There was a non-significant 2.98% improvement in scores reflecting the level that pain was “well controlled” (mean2012=3.54, SD=0.651 versus mean2013=3.65, SD=0.554, p=0.069, Mann-Whitney U test) in surgical patients.Conclusion:The results suggest comprehensive pharmacist involvement in patient education prior to joint replacement surgery may impact HCAHPS scores related to pain control. While the observed potential improvements were modest, the current results justify larger, multi-institution prospective studies to better elucidate the impact pharmacists can have on pain management in patients undergoing joint replacement.

The Association Between Readmission and Patient Experience in a Total Hip Arthroplasty Population

BackgroundOur goal was to determine whether readmissions within 30 or 90 days following discharge are associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for total hip arthroplasty (THA) patients. MethodsHCAHPS surveys from all patients who underwent THA between January 2016 and September 2016 in our institution were analyzed. Readmissions, demographics, baseline joint pain, joint function, and Veterans RAND-12 scores were collected. Statistical analyses involved Pearson's chi-squared tests for categorical variables and Student's t-tests for continuous variables. Multivariable logistic regression models were used to determine whether 30-day or 90-day readmissions were independently associated with HCAHPS scores. ResultsA total of 1868 patients were identified, the survey was sent to 969 patients and 578 completed the survey (59.6%). Eight patients (1.4%) were readmitted within 30 days, and 28 patients (4.8%) within 90 days. These patients were more likely to undergo revision THA (P < .001). For the 30-day readmission cohort, 4 of 8 patients (50.0%) rated the hospital a 9 or 10 out of 10 compared to 466 of 567 patients (82.2%) of the non-readmitted cohort (P = .019). Thirty-day readmissions were associated with significantly lower likelihood of rating the hospital a 9 or 10 out of 10 (odds ratio 0.18). ConclusionsOur results demonstrate a significant negative association between readmission and HCAHPS scores under several dimensions of the survey including nurse communication, doctor communication, pain management, and global satisfaction with the hospital experience.

Applying mindfulness to influence the patient and care team experience

Objective: In today’s work environment, specifically in health care, mindfulness is a personal and professional strategy to improve performance and productivity. To influence the patient and care team hospital experience through the concepts of mindfulness and perception.Methods: This was a prospective observational project completed by medical/surgical nurses using an online survey pre- and post an educational program and an aggregate score of the 5 nurse-sensitive questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a survey based in the United States that is mailed to patients post discharge to home to measure patient satisfaction with their hospitalization. The HCAHPS survey is a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for all hospitals in the United States. The purpose of the HCAHPS survey is to provide a standardized survey instrument and data collection methodology for measuring patients’ perspectives on their hospital care and hospital experience.Results: The aggregate nurse-sensitive HCAHPS scores increased from 85.5 to 89.8 over one month. For mindfulness, after the educational program, among the ten nurse survey questions the percentage went up as much as 0.57%.Conclusions: An educational program related to the benefits of mindfulness can positively effect nurses’ engagement in the workplace and positively increase HCAHPS scores. Continuing education on mindfulness should carry over month to month. In this research project, participants provided feedback to the researcher of feeling empowered to bring in new ideas, present different ways to grow, and tackle challenges.

HCAHPS survey to measure pain communication, not management.

Starting with patients discharged on January 1, hospitals and vendors administering the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey will ask 3 questions concerning communication about pain during the hospital stay. The 3 questions replace the ones about pain management that have appeared in the survey for the past several years. Items 12, 13, and 14 on the 2018 version of the survey ask recently discharged adults to answer the following questions: These changes stem from a decision announced a year ago by the Centers for Medicare and Medicaid Services (CMS) to remove the survey’s pain management measures from the Hospital Value-Based Purchasing (VBP) Program. The 6-year-old CMS program links an acute care hospital’s performance on a set of quality measures to a portion of the agency’s Medicare reimbursements under the inpatient prospective payment system. A low-scoring hospital can have up to 2% of reimbursements withheld, while a top scorer can receive the equivalent of a 2% bonus. One fourth of a hospital’s total performance score comes from HCAHPS survey data. The survey’s pain management measures had been part of the program since its beginning. CMS indicated that some stakeholders have expressed concern that with inclusion of those measures on the survey, a hospital’s staff could feel pressured to prescribe more opioids so that the hospital would receive higher HCAHPS scores for pain management.

Hospital Consumer Assessment of Healthcare Providers and Systems Scores Do Not Predict Outcomes After Total Hip Arthroplasty

BackgroundWith the establishment of the Hospital Value-Based Purchasing program, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score has been incorporated into the calculation of the total performance score, which determines redistribution of up to 2% of Medicare payments. This study aims to assess whether the HCAHPS score correlates with validated outcome measures after total hip arthroplasty. MethodsData from 63 patients who underwent a total hip arthroplasty and completed both an HCAHPS score and patient-reported outcome measures (PROMs) at our institution during the study period from January 1, 2015 to September 2016 were analyzed. The HCAHPS overall hospital rating scores were correlated with the preoperative to postoperative change in validated PROMs, namely EuroQol-EQ-5D Instrument and Hip Disability and Osteoarthritis Outcome Score. ResultsThere was no statistically significant correlation between the HCAHPS overall hospital rating score and PROMs. ConclusionThis study shows a lack of correlation between established validated PROMs used in orthopedic surgery, and the HCAHPS survey scores, an important determinant of compensation in the pay-for-performance reimbursement models.

Engage2: Implementing a Health Literacy Protocol for Patient Assessment and Engagement

ABSTRACTThe purpose of this evidence-based project was to implement a standardized patient engagement strategy to assess health literacy using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores to measure improvement in the domain of RN Communication. A project team created two verbal questions, developed specifically for the hospital setting, that would bypass written assessment for health literacy and initiate positive interactions between nurses and patients. The registered nurses (RNs) on the unit implemented this protocol for all new admissions. The oral assessments of patient knowledge regarding their health condition, as recorded by the RNs, demonstrated the need to clarify with patients the reasons for their hospitalization. The HCAHPS scores improved during the trial period, which indicated that implementing this protocol had positive implications for patient satisfaction. The additional data included in this study were drawn from a Pulse Check survey of patient preferences that underscored the success of the Engage2 project.

Association Between Patient Satisfaction and Short-Term Outcomes After Major Cancer Surgery.

The aim of this study was to investigate whether patient satisfaction, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, is associated with short-term outcomes after major cancer surgery. We first used national Medicare claims to identify patients who underwent a major extirpative cancer surgery from 2011 to 2013. Next, we used Hospital Compare data to assign the HCAHPS score to the hospital where the patient underwent surgery. We then performed univariate statistical analyses and fit multilevel logistic regression models to evaluate the relationship between excellent patient satisfaction and short-term cancer surgery outcomes for all surgery types combined and then by each individual surgery type. We identified 373,692 patients who underwent major cancer surgery for one of nine cancers at 2617 hospitals. In both unadjusted and adjusted analyses, hospitals with higher proportions of patients reporting excellent satisfaction had lower complication rates (p<0.001), readmissions (p<0.001), mortality (p<0.001), and prolonged length of stay (p<0.001) than hospitals with lower proportions of satisfied patients, but with modest differences. This finding held true broadly across individual cancer types for complications, mortality, and prolonged length of stay, but less so for readmissions. Hospital-wide excellent patient satisfaction scores are associated with short-term outcomes after major cancer surgery overall, but are modest in magnitude.

Do HCAHPS Doctor Communication Scores Reflect the Communication Skills of the Attending on Record? A Cautionary Tale from a Tertiary-Care Medical Service.

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores measure patient satisfaction with hospital care. It is not known if these reflect the communication skills of the attending physician on record. The Four Habits Coding Scheme (4HCS) is a validated instrument that measures bedside physician communication skills according to 4 habits, namely: investing in the beginning, eliciting the patient's perspective, demonstrating empathy, and investing in the end. To investigate whether the 4HCS correlates with provider HCAHPS scores. Using a cross-sectional design, consenting hospitalist physicians (n = 28), were observed on inpatient rounds during 3 separate encounters. We compared hospitalists' 4HCS scores with their doctor communication HCAHPS scores to assess the degree to which these correlated with inpatient physician communication skills. We performed sensitivity analysis excluding scores returned by patients cared for by more than 1 hospitalist. A total of 1003 HCAHPS survey responses were available. Pearson correlation between 4HCS and doctor communication scores was not significant, at 0.098 (-0.285, 0.455; P = 0.619). Also, no significant correlations were found between each habit and HCAHPS. When including only scores attributable to 1 hospitalist, Pearson correlation between the empathy habit and the HCAHPS respect score was 0.515 (0.176, 0.745; P = 0.005). Between empathy and overall doctor communication, it was 0.442 (0.082, 0.7; P = 0.019). Attending-of-record HCAHPS scores do not correlate with 4HCS. After excluding patients cared for by more than 1 hospitalist, demonstrating empathy did correlate with the doctor communication and respect HCAHPS scores. Journal of Hospital Medicine 2017;12:421-427.

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.

The Gift of Feedback: Child HCAHPS.

* Abbreviations: CMS — : Centers for Medicare and Medicaid Services HCAHPS — : Hospital Consumer Assessment of Healthcare Providers and Systems Instruments to measure and assess patient experience are widely used in US hospitals. The Centers for Medicare and Medicaid Services (CMS) implemented a standardized survey, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), for adult hospitals in 2006, and public reporting of HCAHPS results commenced in 2008. Widespread adoption of the adult HCAHPS tool has been facilitated by federal policy. The Deficit Reduction Act of 2005 and the Patient Protection and Affordable Care Act of 2010 created incentives for acute care hospitals to participate in HCAHPS. Hospitals subject to the Inpatient Prospective Payment System must collect and submit HCAHPS data to receive full reimbursement. In 2012, Hospital Value-Based Purchasing linked a portion of Inpatient Prospective Payment System hospital payment from CMS to a set of quality metrics. HCAHPS data are the basis for the Patient and Caregiver Centered Experience of Care/Care Coordination metric, which is 25% to 30% of a hospital’s Total Performance Score. Also, since 2008, adult hospital HCAHPS scores are publicly reported based on 4 consecutive quarters … Address correspondence to Kerry L. Rosen, MD, MBA, 700 Children’s Drive, T3108, Columbus, OH 43205. E-mail: kerry.rosen{at}nationwidechildrens.org

American College of Surgeons Level I trauma centers outcomes do not correlate with patients' perception of hospital experience.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a data collection methodology for measuring a patient's perception of his/her hospital experience, and it has been selected by the Centers of Medicare and Medicaid Services as the validated and transparent national survey tool with publicly available results. Since 2012, hospital reimbursements rates have been linked to HCAHPS data based on patient satisfaction scores. The aim of this study was, therefore, to assess whether HCAHPS scores of Level I trauma centers correlate with actual hospital performance. Retrospective analysis of the latest publicly available HCAHPS data (2014-2015) was performed. American College of Surgeons (ACS) verified Level I trauma centers for each state were identified from the ACS registry and then the following data points were collected for each hospital: HCAHPS linear mean scores regarding cleanliness of the hospital, doctor and nurse communication with the patient, staff responsiveness, pain management, overall hospital rating, and patient willingness to recommend the hospital. Our outcome measure were serious complication scores, failure-to-rescue (FTR) scores and readmission-after-discharge scores. Spearman correlation analysis was performed. A total of 119 ACS verified Level I trauma centers across 46 states were included. The median [IQR] overall hospital rating score for Level I trauma centers was 89 (87-90). The mean ± SD score for serious complication was 0.96 ± 0.266, FTR was 123.06 ± 22.5, and readmission after discharge was 15.71 ± 1.07. The Spearman correlation analysis showed that overall HCAHP-based hospital rating scores did not correlate with serious complications (correlation coefficient = 0.14 p = 0.125), FTR (correlation coefficient = -0.15 p = 0.073), or readmission after discharge (correlation coefficient = -0.18 p = 0.053). The findings of our study suggest that no correlation exists between HCAHPS patient satisfaction scores and hospital performance for Level I trauma centers. Consequently, the Centers of Medicare and Medicaid Services should reconsider hospital reimbursement decisions based on HCAHP patient satisfaction scores. Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Nurse Engagement in Shared Governance and Patient and Nurse Outcomes.

The objectives of this study were to examine differences in nurse engagement in shared governance across hospitals and to determine the relationship between nurse engagement and patient and nurse outcomes. There is little empirical evidence examining the relationship between shared governance and patient outcomes. A secondary analysis of linked cross-sectional data was conducted using nurse, hospital, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. Engagement varied widely across hospitals. In hospitals with greater levels of engagement, nurses were significantly less likely to report unfavorable job outcomes and poor ratings of quality and safety. Higher levels of nurse engagement were associated with higher HCAHPS scores. A professional practice environment that incorporates shared governance may serve as a valuable intervention for organizations to promote optimal patient and nurse outcomes.

Comprehensive Unit-based Safety Program (CUSP) to Improve Patient Experience: How a Hospital Enhanced Care Transitions and Discharge Processes

To determine whether Comprehensive Unit-based Safety Program (CUSP) teams could be used to enhance patient experience by improving care transitions and discharge processes in a 318-bed community hospital. In 2015, CUSP teams produced feasible solutions by participating in a design-thinking initiative, coupled with performance improvement tools involving data analytics and peer-learning communities. Teams completed a 90-day sprint challenge, involving weekly meetings, monthly department leader meetings, and progress trackers. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used, and the percent top (best) scores were reported for overall hospital ratings, discharge information, and care transitions. The percentage of patients choosing the top score increased from 61.0% preintervention to 68.0% postintervention for overall hospital rating and from 71.4% to 80.7% for recommending the hospital. The top scores increased from 76.0% preintervention to 84.5% postintervention for the discharge information domain and from 49.2% to 53.6% for the care transitions domain. CUSP teams improved patient experience. The teams could expand their scope to be the unit-level resource focused not only on safety but also on external quality measures to which patient experience is a broad category for HCAHPS scores, and potentially on value in future work.