Hospital Consumer Assessment Of Healthcare Providers And Systems Research Articles

Evaluating the effects of a high-tech call system on patient-staff communication.

Evaluating the effects of a high-tech call system on patient-staff communication.

A scheduling-based methodology for improving patient perceptions of quality of care in intensive care units.

Research has found that hospitals with better scores on patient experience of care surveys have better patient safety records and outcomes. Therefore, targeting ways of improving patient experience of care is becoming relevant for hospitals not only for the patient health outcomes but also for the financial implications. Therefore, the goal of this paper is to develop new operation management strategies for improving patient experience of care in intensive care units (ICUs). A new scheduling-based methodology is developed that considers two of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey dimensions, doctor communication and discharge information. Two hypotheses are studied. The first hypothesis postulates that to improve doctor communication with the patient, a nurse must be present in the patient room when the doctor performs ward rounds. The second hypotheses states that to improve the patient-doctor communication of discharge information aspect, doctors must see the patient expected to be discharged early in the day. A computational study is performed to gather insights and to measure the performance of the scheduling-based methodology on a case study from an intensive care unit located in a hospital in central Texas. The results show hospital improvement in the studied dimensions of the HCAHPS survey after 1 year of the hospital adoption of the study recommendations.

Patient Perception of Pain Control (Not Opiate Amount) Affects Hospital Consumer Assessment of Healthcare Providers and Systems and Press Ganey Satisfaction Scores After Orthopaedic Trauma.

Opiate abuse is a public health issue linked to prescribing. Prescribing increased partly in response to adopting pain as the fifth vital sign. Assessing pain control on patient satisfaction surveys, including government-mandated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and optional private surveys (Press Ganey) administered on hospital discharge, may contribute. This study evaluates whether opiate amounts affect orthopaedic trauma patient perception of pain control and overall hospital rating on HCAHPS and Press Ganey surveys. Consecutive adult patients >18 years surgically treated for isolated fractures (UE = upper extremity, LE = lower extremity, and PA = pelvis/acetabulum) at a level 1 trauma center between January 1, 2014, and December 31, 2016, were retrospectively analyzed. Hospital charts, HCAHPS, and Press Ganey data were reviewed; patients without survey responses were excluded. Data included comorbidities, psychiatric history, substance use, injury type, and surgery. Analysis included Spearman's rho for correlations, Wilcoxon rank-sum and Kruskal-Wallis for continuous variables, and adjusted ordinal regression to estimate association between opioid prescribing and patient ratings. One hundred fifty-two total patients (UE 29, LE 112, and PA 11) with mean age of 57 years and median length of stay 3 days were included. Adjusted models showed longer duration outpatient prescriptions were associated with lower rating on how often inpatient pain was controlled (P = 0.002), lower total MME inpatient was associated with higher ratings (HCAHPS P = 0.015; Press Ganey, P = 0.03), lower average daily MME inpatient was associated with lower ratings (HCAHPS P = 0.008; Press Ganey, P = 0.037), and shorter outpatient prescription duration was associated with lower ratings (P = 0.008). Patient perception of pain control was strongly associated with overall HCAHPS (P < 0.05) and Press Ganey (P < 0.001) ratings. Inpatient and outpatient opiate amounts and duration demonstrated some associations with overall scores. However, patients' pain control perception seems to have the strongest relationship with hospital rating. Counseling and multimodal pain control may lead to strong satisfaction scores without needing high opiates after orthopaedic trauma.

Patient-centered communication: an extension of the HCAHPS survey

PurposeThe Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has been recognized as a “gold standard” set of “practical standardized measures” for assessing hospital service quality. Beginning with the HCAHPS, the purpose of this paper is to extend efforts to assess patient-centered communication (PCC) and the quality of healthcare and presents a scale for measuring patient perceptions and expectations of service quality in an emerging economy context.Design/methodology/approachA self-administered survey of patients in private hospitals (N = 171) was conducted to test the proposed framework. Exploratory and confirmatory factor analyses were used to establish the measurement model. Multiple regression analysis was used to explain the scale's predictive ability. ANOVA was used to analyze service quality gaps and rank patients' priorities.FindingsFive components of PCC are identified. Among these, nurse affective communication has a significant positive effect on patient satisfaction. The gap analysis shows that patients have high expectations for doctors' affective communication, while they perceive a low level of service performance in the realm of nurse affective communication. The study highlights a new means of measuring “reliability” in healthcare. Important findings on patients' priorities are evaluated and discussed.Practical implicationsHealthcare organizations and practitioners can improve patient-centered care by stressing the dimensions of PCC, including clinicians' affective and instrumental communication.Originality/valueThe study expands the understanding of HCAHPS instruments in an emerging economy context and opens avenues for more widespread use of the measures. The research contributes to the literature on patient-centered care and healthcare service quality by proposing a scale for managing specific practices and interactions in healthcare.

Seasonal Variation in Parental Satisfaction With Pediatric Orthopaedics.

The degree of parental satisfaction with health care is determined by the family's characteristics and expectations. Many aspects of human physiology and behavior have seasonal rhythms. The purpose of the present study was to determine whether parental satisfaction scores vary across the year in a pediatric orthopaedic outpatient population. We retrospectively reviewed a total of 22,951 parental satisfaction scores related to outpatient pediatric orthopaedic encounters between October 2015 and April 2019. Parental satisfaction was measured using the provider subdomain of the shortened version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Families were stratified according to various pediatric orthopaedic subspecialty services. The satisfaction scores of all pediatric orthopaedic encounters combined did not vary significantly across the year (P=0.8745). When the families were stratified into groups by pediatric orthopaedic subspecialty clinic, variation in seasons was not associated with statistically significant variation in satisfaction scores for the elective surgery, sports medicine, trauma/fracture care, and hand/upper extremity services. However, satisfaction with the spine service was significantly lower in the winter compared with the summer and fall (73.9±3.8 vs. 83.5±5.3 and 82.6±3.6, respectively; P=0.0147). The provision of pediatric spine care in a region with 4 distinct seasons received lower parental satisfaction scores during the winter than during the summer and fall. This seasonal variation is an additional source of bias in the measurement of satisfaction with health care. Level II-retrospective study.

Predictors of a Top-Box Patient Experience: A Retrospective Observational Study of HCAHPS Data at a Safety Net Institution.

Hospitals commonly seek to improve patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, yet there are limited data to guide improvement efforts. The HCAHPS survey was developed for interhospital comparisons, whereas its use in intrahospital comparisons has not been validated. We sought to better understand the validity of utilizing intrahospital score comparisons and to identify the factors that may predict top-box HCAHPS scores. We performed a retrospective observational cohort study at an academic urban safety-net hospital examining 4898 HCAHPS surveys completed by hospitalized patients. We found that while most Patient-Mix Adjustment factors for which HCAHPS scores are adjusted were associated with top-box scores on intrahospital comparisons, few additional variables were associated with top-box scores. Further, HCAHPS questions pertaining to nurse and doctor communication were highly correlated with overall hospital rating, suggesting that communication-related factors may influence a patient’s hospital experience more strongly than do administrative factors.

Capturing the patient's voice: Kano Analysis of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

BACKGROUND:Traditional methods are not able to differentiate which feature customers regard as attractive, mandatory, performance, and which feature customers are indifferent about. These categories can only be differentiated based on a specific technique called Kano survey. Specific aim of this study was to categorize the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey questions into Kano categories.MATERIALS AND METHODS:Design of the study was survey research. It was conducted from 6/2019 to 8/2019 at OSF Saint Francis Medical Centre in Peoria, Illinois, USA. A 34 question Kano survey (17 positive and 17 negative questions) based on HCAHPS patient questionnaire was designed. Surveys were analyzed using Kano analysis template. Comparative analysis of Kano categories based on demographics was also performed.RESULTS:39 current patients and 25 caregivers completed the survey. All of the 17 HCAHPS questions except “noise level at night” were classified as mandatory requirement with highest number for information on “indications of medicines.” There was a minimum variability in the satisfaction coefficients but large variation in the dissatisfaction coefficients. More patients above 50 years consider “help going to bathroom” as mandatory (70.2% vs. 40.7%, P = 0.01). Sixty-four percent of caregivers considered “explain things (nurse)” as mandatory as opposed to 51.2% of patients (P = 0.03).CONCLUSION:Current U. S healthcare consumers have high expectations from healthcare delivery and consider most HCAHPS questions as mandatory requirements. Kano analysis needs to be done on a larger, more diverse hospital setting and potentially the HCAHPS survey needs to be modified to reflect prevailing healthcare customer requirements.

Patient Satisfaction After Lower Extremity Total Joint Arthroplasty: An Analysis of Medical Comorbidities and Patient Demographics

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has received increased attention to determine which demographics may influence patient satisfaction after Total Hip and Knee Arthroplasty. The purpose of this study was to evaluate the various effects that patient-specific factors, medical comorbidities, and demographics had on patient satisfaction. Two thousand and ninety-two patients underwent lower extremity total joint arthroplasty at our institution between 2014 and 2018. Nine hundred twenty-three of these patients responded to their HCAHPS survey (44%). Most patients (609, 66%) underwent primary total knee arthroplasty followed by 244 (26.4%) total hip arthroplasties, 35 (3.8%) revision total knee arthroplasties, 28 (3.0%) bilateral total knee arthroplasties, and 7 (0.8%) revision total hip arthroplasties. Increasing age and length of stay were associated with a decrease in patient satisfaction whereas patients who were married reported higher satisfaction. Patients discharged to a rehabilitation facility had a 12% decrease in top-box response rate compared to those discharged home. Contrary to our hypothesis, specific procedure type and the presence of comorbidities failed to predict patient satisfaction. The results of this study shed light on the intricate relationship between patient satisfaction and patient-specific factors. Furthermore, health care workers can counsel patients on expected satisfaction when considering total hip and knee arthroplasty.

Pre-operative patient education does not necessarily reduce length of stay or pain after spinal surgery

BackgroundPrevious research has shown pre-operative education may have a beneficial impact on postoperative recovery for elective surgery including: reduced length of hospital stay, improved post-operative pain management, and improved patient satisfaction. ObjectiveWe conducted a retrospective study to elucidate the impact of pre-operative education on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, postoperative pain, and length of stay (LOS) following spinal surgery. MethodsA retrospective matched case control study was conducted between patients who participated in pre-operative education (n = 113) and those who did not (n = 116). Univariate analysis through a Two-Samples Independent T-Test was conducted for postoperative pain and LOS. Multivariate analysis for LOS was evaluated using Poisson Generalized Estimating Equation (GEE) Standard Errors regression while pain multivariate analysis was conducted using a linear GEE regression model. HCAHPS univariate and multivariate analyses were also performed. ResultsUnivariate analysis showed no statistically significant difference with LOS (3.58 days vs. 3.63 days, p = 0.85) and post-operative pain (4.65 vs. 4.59, p = 0.80). Multivariate analysis of HCAHPS metrics revealed patients who attended the preoperative education class reported statistically significant lower “how well your pain was controlled” responses (−36p = 0.024) as well as “staff effort in including the patient in treatment decisions” responses (−37p = 0.046). ConclusionsAccording to our data preoperative education prior to spinal surgery does not necessarily result in improved pain management, shorter length of stay, or higher patient satisfaction. Prospective research may help determine the proper measures that can improve the likelihood of achieving the intended results.

A multifaceted study of hospital variables and interventions to improve inpatient satisfaction in a multi-hospital system.

Knowing the areas of service, actions, and parameters that can influence patient perception about a service provided can help hospital executives and healthcare workers to devise improvement plans, leading to higher patient satisfaction.To identify inpatient satisfaction determinants, assess their relationships with hospital variables, and improve patient satisfaction through interventions.We studied the inpatient population of an eight-hospital tertiary medical center in 2015. The satisfaction determinants were based on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey answers and included clinical and organizational variables.Interventions began at the end of 2016 included bedside care coordination rounds (BCCR), medications best practices alert (BPA), connect transitions post-discharge calls (CONNECT Transitions) and a framework for provider-patient interactions called AIDET (Acknowledge, Introduce, Duration, Explain, and Thank). Substantial impact upon patient satisfaction was observed after the introduction of these interventions.Three groups were identified: 1.high satisfaction, which correlated with race, surgery, and cancer care;2.low satisfaction, correlated with elderly, emergency room, intensive care unit, chronic obstructive pulmonary disease, and vascular diseases; and3.neutral, correlated with hospital-acquired complications, several diagnostic procedures, and medical care delay.Significant improvements in the 3 groups were achieved with interventions that optimize care provider interactions with patients and their families.Based on the HCAHPS-based analysis, we implemented new measures and programs for addressing coordination of care, improving patient safety, reducing the length of stay, and ultimately improving patient satisfaction.

Does prioritizing patient safety during the COVID-19 pandemic come at the expense of patient satisfaction?

Does prioritizing patient safety during the COVID-19 pandemic come at the expense of patient satisfaction?

Predictors of Patient Satisfaction in Spine Surgery: A Systematic Review

Recently, there has been increased interest in patient satisfaction measures such as Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. In this systematic review, the spine surgery literature is analyzed to evaluate factors predictive of patient satisfaction as measured by these surveys. A thorough literature search was performed in PubMed/MEDLINE, Google Scholar, and Cochrane databases. All English-language articles from database inception to July 2020 were screened for study inclusion according to PRISMA guidelines. Twenty-four of the 1899 published studies were included for qualitative analysis. There has been a statistically significant increase in the number of publications across years (P= 0.04). Overall, the studies evaluated the relationship between patient satisfaction and patient demographics (71%), preoperative and intraoperative clinical factors (21%), and postoperative factors (33%). Top positive predictors of patient satisfaction were patient and nursing/medical staff relationship (n= 4; 17%), physician-patient relationship (n= 4; 17%), managerial oversight of received care (n= 3; 13%), same sex/ethnicity between patient and physician (n= 2; 8%), and older age (n= 2; 8%). Top negative predictors of patient satisfaction were high Charlson Comorbidity Index/high disability/worse overall health functioning (n= 7; 29%), increased length of hospital stay (n= 4; 17%), high rating for pain/complications/readmissions (n= 4; 17%), and psychosocial factors (n= 3; 13%). There is heterogeneity in terms of different factors, both clinical and nonclinically related, that affect patient satisfaction ratings. More research is warranted to investigate the role of hospital consumer surveys in the spine surgical patient population.

Provider-patient communication and hospital ratings: perceived gaps and forward thinking about the effects of COVID-19.

ObjectivesTo highlight clinical and operational issues, identify factors that shape patient responses in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and test the correlations between composite measures and overall hospital ratings.DesignResponses to HCAHPS surveys were used in a partial correlation analysis to ascertain those HCAHPS composite measures that most relate to overall hospital ratings. The linear mean scores for the composite measures and individual and global items were analyzed with descriptive analysis and correlation analysis via JMP and SPSS statistical software.SettingHCAHPS is a patient satisfaction survey required by the Centers for Medicare and Medicaid Services for hospitals in the USA. The survey is for adult inpatients, excluding psychiatric patients.Participants3382 US hospitals.InterventionNone.Main Outcome MeasurePearson correlation coefficients for the six composite measures and overall hospital rating.ResultsThe partial correlations for overall hospital rating and three composite measures are positive and moderately strong for care transition (0.445) and nurse communication (0.369) and weak for doctor communication (0.066).ConclusionsFrom a health policy standpoint, it is imperative that hospital administrators stress open and clear communication between providers and patients to avoid problems ranging from misdiagnosis to incorrect treatment. Additional research is needed to determine how the coronavirus of 2019 pandemic influences patients’ perceptions of quality and willingness to recommend hospitals at a time when nurses and physicians show symptoms of burnout due to heavy workloads and inadequate personal protective equipment.

Telerounding Offers High Patient Satisfaction After Total Joint Arthroplasty.

BackgroundResearch in surgical fields other than orthopedics has demonstrated high patient satisfaction with non-traditional telerounding modalities.Questions/PurposesWe sought to determine patient satisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores of patients who experienced telerounding in the post-operative period after undergoing total joint arthroplasty (TJA).MethodsFifty consecutive TJA patients were prospectively enrolled to receive telerounding. The patients were divided into two groups based on their satisfaction with telerounding. The HCAHPS scores of the patients who received telerounding were compared with 50 control patients.ResultsOverall, the telerounding cohort had a positive reaction to telerounding. Comparing patients who were highly satisfied to those who were dissatisfied with telerounding, younger patients were found to be more frequently satisfied with telerounding. Compared with patients who did not receive telerounding, patients who experienced telerounding rated the hospital higher on a 10-point scale were more likely to recommend the hospital to others, more frequently believed their physicians treated them with courtesy and respect, and more often believed their physicians always listened to them carefully.ConclusionAn overwhelming majority of our patients found telerounding using FaceTime enhanced their care while recovering post-operatively from TJA. Those patients were typically younger and had significantly higher HCAHPS scores, which potentially can enhance the physician-patient relationship.Electronic supplementary materialThe online version of this article (10.1007/s11420-020-09813-0) contains supplementary material, which is available to authorized users.

Moving beyond the measure: Understanding patients' experiences of communication with nurses

Under Medicare's Value-Based Purchasing Program, scores derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey are used in the determination of incentive payments and financial penalties for healthcare organizations. Organizations, therefore, invest in approaches to improve the likelihood of positive patient responses. Evidence suggests that nurse communication as measured by HCAHPS influences overall patient satisfaction, yet little is known regarding what patients believe constitutes effective communication with nurses. In this qualitative descriptive study, we conducted phone interviews with 49 recently hospitalized patients to better understand patients' perceptions of their communication with nurses. Our findings indicate that patients perceived their communication with nurses to unfold via nurses' behaviors. Namely, nurses' engagement with patients, anticipation of patients' needs, responsiveness to patients' concerns, and teaching practices positively influence patient satisfaction with communication with nurses. These behaviors resonated most strongly with patients during particularly memorable moments of uncertainty and vulnerability over the course of a hospital stay. These findings suggest that focusing on the development of nurses' behaviors, ensuring processes are in place to support positive behaviors and creating organizational environments that position nurses to consistently apply these behaviors, can improve patients' perceptions of their communication with nurses. These findings also provide a foundation for further research focused on developing and testing specific behavioral interventions and their effect on communication perception.

Translation, adaptation and validation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) for use in Japan: a multicentre cross-sectional study

ObjectivesThe Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a well-established and internationally recognised scale for measuring patients’ experience with hospital inpatient care. This study aimed to develop...

Redesigning care coordination from the patient’s perspective.

6 Background: Cancer patients are frequently admitted to the hospital requiring medical oncologists to take an active role in coordinating with multiple teams. In an effort to redesign care to put patients at the center and address increasing demands on our medical oncologist’s time, we created the Oncology Coordinator (OC) role focused on care setting transitions. We aimed to evaluate whether the OC would improve quality of care and decrease healthcare utilization. Methods: The OCs, are non-clinical and serve as a single point of contact for disease-based teams as patients prepare for elective admissions or discharge from the hospital. The 3 OCs received specialized training in systems and processes in both settings. They coordinate outpatient appointments, prescription delivery, transportation while also providing clinical support. Additionally, they facilitate two interdisciplinary rounds per day across three dedicated oncology units and assist with patients off-unit. We evaluated all patient discharges facilitated by the OCs during 1/1/19-2/29/20 and compared that to non-OC facilitated discharges. Using descriptive statistics, we evaluated the OCs impact on 7- and 30-day readmissions, discharge before noon rate (DBN), average time from admission to chemotherapy start and patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Results: We had a total of 2,818 discharges between 1/1/19-2/29/20; 1,032 (36.6%) facilitated by the OCs. For those OC facilitated discharges we observed a 5.07% reduction in 7-day readmissions and 30-day readmissions (2.6%). We observed an overall higher average monthly rate of DBN (4.85%) compared to non-OC facilitated discharges. In addition, the average time from admission to chemotherapy administration decreased by 1 hour 31 minutes (6.8%) for the OC facilitated admissions. In the HCAHPS survey, there were improvements in Discharge Information and Care Transitions on the inpatient units where OCs were most active. Conclusions: At our academic medical center, the OCs have contributed to reduction in readmissions, time from admission to chemotherapy administration as well as improvements in discharges before noon and patient experience. This pilot demonstrates that investment in dedicated lay staff to facilitate admissions and discharges for cancer patients across care settings could lead to meaningful improvements in healthcare utilization, quality and the patient experience. Future work will evaluate the sustainability of this program and evaluate association with healthcare costs.

Flooring impact sound: An overview of the new test standard, its application for healthcare design, and potential updates to the standard

Noise is a major concern in many healthcare environments, and the “Quietness of Hospital Environment” item on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) consistently receives one of the lowest scores. A recent study showed that among many acoustic metrics, peak occurrence rates were one of the best correlated with HCAHPS scores for Quietness of Hospital Environment. Flooring impact sound from footsteps, rolling carts, and dropped items can be a significant source of noise in hospitals, and that impact sound is likely to contribute to peak occurrence rates. Flooring-generated noise is often a concern for healthcare designers, and is a primary consideration when picking flooring materials, but until recently there has been no standard for assessing the floor impact sound radiation of various floor coverings. A new standard, ASTM E3133, provides this assessment. In this presentation, data from recent testing to the ASTM E3133 standard will be given for various floor coverings. Additionally, the presentation will cover issues with the test methodology and potential solutions. Finally, preliminary results from a proposed field test standard will be discussed.

A guide to acoustics healthcare guidelines

Over the past few decades a number of guidelines describing recommended acoustics performance have been developed for hospitals and healthcare environments. These include documents from the Federal Guidelines Institute (FGI), World Health Organization (WHO), ANSI/ASA, ASHRAE, and LEED. Each of these guidelines include numerous acoustical recommendations (some that even contradict one another), regarding such topics as background noise levels in patient rooms, sound isolation requirements, reverberation times, and speech privacy. These guidelines strive to improve the overall acoustical comfort within healthcare environments in addition to patient perception, as measured in surveys like the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). In this project, the implementation of hospital guidelines in the United States was assessed, focusing on when and where specific guidelines were instituted, the impact these guidelines have had on acoustics performance, and what can be done to improve acoustics conditions within hospitals and healthcare environments across the country.

Improving Quiet at Night on a Telemetry Unit: Introducing a Holistic Sleep Menu Intervention.

In a patient's recovery process, restful sleep is crucial. Although the essential role of sleep in healing has long been recognized, excessive noise in hospital environments remains a persistent and pervasive problem. For hospitalized patients, environmental noise can result in sleep deprivation and adverse health outcomes; not surprisingly, hospital noise ranks as a major patient complaint. At a small suburban community hospital, patients responding to a quiet-at-night question in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey gave the hospital's telemetry unit the lowest possible score: 1 out of 5 points. In response, the unit's quality improvement team, coordinated by a clinical nurse leader, introduced a holistic "sleep menu" intervention. The multicomponent intervention subsequently improved patients' care experience and staff engagement. The percentage of patients who self-reported five or more hours of uninterrupted sleep rose from 31% at baseline to 80% during the intervention. This improvement was sustained over the three-month intervention period and led to a quiet-at-night HCAHPS score of 4. The sleep menu initiative resulted in substantial benefits that optimized both patient and organizational outcomes.