Hospital Consumer Assessment Research Articles

A Rapid-Cycle Intervention to Enhance Patient and Family Satisfaction in the Intensive Care Unit.

Patient and family satisfaction with care in intensive care units is not reflected in Hospital Consumer Assessment of Healthcare Providers and Systems surveys. Gaps may be unknown. In a cardiothoracic intensive care unit, patient satisfaction scores were not assessed and gaps could not be addressed. The primary aim was to obtain baseline data on patient and family satisfaction. The secondary aim was to improve identified gaps in satisfaction. A preintervention-postintervention, 2-cycle quality improvement project and a 12-month sustainability assessment were conducted to evaluate patient and family satisfaction in a cardiothoracic intensive care unit in a large academic health system from August 2022 to August 2023. The Nursing Intensive Care Satisfaction Scale was used to measure patients' satisfaction and the European Quality Questionnaire was used to measure family members' satisfaction with intensive care unit nursing care. Standardized scripting, processes for patient and family engagement during rounds, and structured communication were used to enhance patient and family engagement. At baseline (47 patients, 35 family members), overall patient and family satisfaction was high (mean [SD] satisfaction scores: patients, 87.6 [19.3]; family members, 94.6 [9.7]; P = .06). After intervention cycle 2, family members (n = 50) had high mean satisfaction scores on the Information Needs sub-scale of the European Quality Questionnaire. Family participation in rounds improved from 18.5% of rounds at baseline to 76.5% after intervention cycle 2 and was 61.5% at 12 months. Strategies that engage family members in rounds improve communication and satisfaction.

Implementing Communication Boards at the Bedside to Improve Patient-Centered Care in an Inpatient Obstetric Unit.

To implement use of custom whiteboards to improve bedside communication and shared knowledge between clinicians and patients. Quality improvement project using a seven-step evidence-based practice framework and Plan-Do-Study-Act cycles to redesign custom communication boards for specific patient (antepartum, labor, postpartum) populations. Two California university medical center inpatient obstetric units where Hospital Consumer Assessment of Healthcare Providers and Systems scores in nursing communication had trended down at a time when whiteboards were being underused in patient rooms. Staff of approximately 170 nurses, 30 physicians, and 8 midwives. The project was implemented from January 2020 through July 2020; the first phase was completed in the postpartum unit, and the second phase was completed in the antepartum unit. Staff surveys and board use audits were used to collect preimplementation and postimplementation data. Third-phase labor boards were designed but were not yet implemented due to budget constraints. Project data supported that the new boards encouraged more complete information and facilitated bedside communication better than the previous iteration. A customized communication board designed for a specific patient population is an effective tool to promote patient-centered care. Communication boards can reinforce safe nursing practice, facilitate discussion, and improve the patient experience.

Evaluation of Proposed New Measures for the Hospital CAHPS Survey

Background: Since its 2006 launch, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become the most used hospital patient experience survey, included in public reporting and accountability systems. Responding to emerging evidence of possible gaps in survey content, the Centers for Medicare & Medicaid Services undertook extensive efforts to develop and test new HCAHPS measures. Objectives: Describe the development and testing of new HCAHPS measures. Research Design: Activities supporting the development and refinement of survey items and measures included 4 patient focus groups, 27 cognitive interviews, and a 12-member technical expert panel. Psychometric testing of proposed survey items and measures used data from a 2021 large-scale randomized experiment. Results: Patient focus groups, cognitive testing, psychometric analyses, and a technical expert panel supported the addition of 2 new multi-item measures (Care Coordination and Restfulness of Hospital Environment), a new single-item measure (Information about Symptoms), and the placement of one current HCAHPS item (Quietness) within one of the new composite measures. All proposed measures had strong psychometric properties, including good construct validity and hospital-level reliabilities that ranged from 0.73 for the Information about Symptoms standalone measure to 0.87 for Restfulness of Hospital Environment. Cronbach alpha for the 3 new or modified composite measures ranged from 0.74 to 0.76. Conclusions: The new content would broaden HCAHPS by adding new aspects of care that are important to patients. The public reporting of the new measures and their role in payment may support hospital quality improvement efforts.

P-2027. Care at Home for Remdesivir Treatment of COVID-19: A Mixed Methods Study of Patient and Physician Experiences

Abstract Background Hospital in the home and virtual models of care were rapidly implemented during the COVID-19 pandemic. We sought to assess patient and provider perspectives of care at home integrating a three or five-day remdesivir (RDV) treatment regimen in a large integrated health care system in California.Figure 1.Patient Survey Recruitment Consort Flow Diagrama. Identified as unreachable prior to and during recruitment (deceased, no longer health system members, cognitive impairment, invalid contact information)b. Lost to follow- no response after exhausting all contacts Methods A mixed methods study was conducted to assess patient and physician experiences using an online/telephone survey questionnaire developed based on components of the Health Belief Model and Hospital Consumer Assessment of Healthcare Providers. Patients > 18 years of age who received RDV in the outpatient setting (N=1544) and prescribing physicians (N=406) from December 15, 2020-August 31, 2022 were eligible. Descriptive statistics were used to describe categorical responses. A cross-sectional analysis was performed to identify factors associated with patient adherence defined as taking > 80% of prescribed doses and physician adoption of treatment guidelines. Qualitative data were triangulated to determine whether patient/prescriber perceptions about value were validated by health outcomes measured as reduction of COVID-19 related readmission within 30 days of entry into treatment program.Figure 2.Provider Survey Recruitment Consort Flow Diagrama. No longer health system providersb. Lost to follow-up- no response after exhausting all contacts Results Of 540 patient respondents (response rate: 38%, mean age: 58.4 years (SD 16.2), 55.2% male), the majority was of Hispanic ethnicity (48.4.2%), followed by White (32.3%), and Black (12.6%). Of 140 physician respondents (response rate: 34%, mean age: 46.9 years (SD 8.4), 58% male), the majority was of Asian ethnicity (65.8%), followed by White (23%), and Hispanic (7.1%). Adherence was found in 99% of patients having completed > 80% of RDV doses. Adherent patients reported returning to their own home (95.2%), nurses always listened to them (87%), and high health literacy (65%). Feeling knowledgeable was significantly associated with physician prescribing of new unfamiliar medications while under emergency use authorization. (p=0.0007). Patients (80.3%) reporting “Very Satisfied” with medical follow-up were less frequently readmitted within 30 days. (p=0.045) Conclusion Patients and physicians responded favorably to value-based care at home integrating RDV for treatment of COVID-19. This finding is key to informing future design of alternative modes of health care delivery. Disclosures Julia K. Nguyen, PharmD, Gilead Sciences: Grant/Research Support Rulin C. Hechter, MD, PhD, MS, Gilead Sciences: Grant/Research Support William Towner, MD, GSK: Grant/Research Support|Janssen: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support

Changes in Patient Care Experience After Private Equity Acquisition of US Hospitals

Private equity acquisitions of health care facilities have rapidly increased over the past decade. However, little is known about the effects of private equity acquisitions of US hospitals on patient care experience. To evaluate whether the acquisition of hospitals by private equity firms was associated with changes in measures of patient-reported experience compared with matched control hospitals from 2008 through 2019. This cohort study identified 73 US hospitals newly acquired by private equity firms and 293 matched control (nonacquired) US hospitals from 2008 through 2019. An event study, difference-in-differences design was used to evaluate changes in patient experiences measures from 3 years before to 3 years after private equity acquisition. The primary outcomes were 2 global measures of patient-reported care experience from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which included patients' overall hospital rating and willingness to recommend the hospital. Secondary outcomes included the 7 other HCAHPS measures encompassing clinical process, communication, and environmental measures. There were 73 private equity-acquired hospitals and 293 matched control hospitals. The percentage of patients rating hospitals as a 9 or 10, on a scale of 0 to 10, decreased at private equity-acquired hospitals (65.0% before acquisition and 65.2% after acquisition) when compared with control hospitals (66.2% to 69.2%) during the postacquisition period relative to the preacquisition period with a difference-in-differences estimate of -2.4 percentage points (95% CI, -3.9 to -0.9). In addition, the percentage of patients who would definitely recommend the hospital also decreased at private equity-acquired hospitals (66.9% before acquisition and 65.5% after acquisition) compared with control hospitals (68.2% to 69.3%) with a difference-in-difference estimate of -2.1 percentage points (95% CI, -3.6 to -0.7). For both of these global measures of patient experience, the difference between private equity-acquired and control hospitals increased over time and was largest in year 3 after acquisition (-5.2 percentage points [95% CI, -8.8 to -1.5] and -4.4 percentage points [95% CI, -8.0 to -0.70] for each measure, respectively). For secondary measures of patient care experience, there was a decrease in patient-reported responsiveness of hospital staff at private equity-acquired hospitals compared with control hospitals (-1.3 percentage points [95% CI, -2.4 to -0.2]), but no differential change across other measures of clinical process, communication, and environment. Patient care experience worsened after private equity acquisition of hospitals. These findings raise concern about the implications of private equity acquisitions on patient care experience at US hospitals.

Inpatient Care Experiences Differ for VA and Non-VA Hospitals, With Different Patterns by Health, Race, and Ethnicity.

This article estimates differences and difference-in-differences in patient experiences for Veterans Health Administration (VA) compared to non-VA patients in 2017, when there was concern about the health quality of VA hospitals, and in 2021, the second year of the COVID-19 pandemic, both overall, and for specific patient groups. We used data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In 2017, HCAHPS performance was somewhat better for non-VA than for VA hospitals, with Care Transition being the only measure for which VA hospitals performed better on average. By 2021, HCAHPS performance was better for VA than for non-VA hospitals for all but two measures (Quietness and Discharge Information), for which there were no differences from non-VA hospitals. In 2017, the VA provided worse experiences than non-VA hospitals for Black and poor-health patients; in 2021, VA hospitals outperformed non-VA hospitals for these, and all patient subgroups examined.

Influence of the Nursing Assistant Role in Nurse Satisfaction, Efficiency, and Patient Satisfaction in the Postanesthesia Care Unit

In response to nurse concerns of the need for additional support from unit nursing assistants (NA) at the bedside, we set a goal to improve RN satisfaction with the role of the NA in the postanesthesia care unit (PACU). Prospective pre/post design. Using LEAN methodology, the NA role was expanded to encompass their full scope of practice at the bedside, and the responsibility of performing patient transport fromthePACU was reallocated to a Centralized Transport Service over a 6-month period. The total number of transports performed by NA decreased by approximately 20%. Time spent waiting for a Centralized Transporter decreased from an average of 56 to 11minutes. RN satisfaction increased in the 3 areas explored, with a 12.5% increase in median overall satisfaction with the NA role. Our facility's Hospital Consumer Assessment of Healthcare Providers and Systems scores also increased from previous months after this project, alluding to more effective care delivered to patients in thePACU. Realignment of roles can promote efficiency and throughput. Communication fosters teamwork and can improve staff satisfaction.

Clinical Oncology Pharmacy Technician: Impact of a New Role on Pharmacy and Patient Metrics at a Large Academic Cancer Center.

To describe the impact of an inpatient clinical oncology pharmacy technician program. A retrospective study was conducted to observe outcomes in patients discharged from the hematology/oncology or bone marrow transplant (BMT) units at Indiana University Health in the year before (April 1, 2016-March 31, 2017) compared with the year after (April 1, 2018-March 31, 2019) the implementation of expanded technician services. The technician performed admission medication histories and ensured access to discharge medications. There were 1,169 and 1,112 encounters included in the pre- and post-technician cohorts. The median age was lower (54 v 61 years; P < .001), and there was a higher percentage of male patients (62% v 52.3%; P < .001) in the pre- compared with post-technician cohort. There were a higher percentage of oncology (36.4% v 31%; P = .007) and no difference in hematology (37.4% v 40.2%; P = .17) nor BMT encounters (26.3% v 28.8%; P = .18) in the pre- compared with post-technician cohort. The discharge prescription capture rate increased (42.7% v 78.5%; P < .001) from the pre- to post-technician cohort, resulting in a 34.2% increase ($314,639.46 in US dollars [USD]-$422,129.20 USD) in retail pharmacy revenue. More admission medication histories were completed by pharmacy staff (64.4% v 91.9%; P < .001), and there was an increase in the Hospital Consumer Assessment of Healthcare Providers and Systems-derived patient satisfaction results for both hematology/oncology (79% v 88%; P < .001) and BMT units (77% v 84%; P = .02) in the pre- compared with post-technician cohort. There was no difference in rates of unplanned readmissions (16.4% v 18.2%; P = .69) in the pre- compared with post-technician cohort. The overall capture rate of discharge prescriptions, revenue for the retail pharmacy, and patient satisfaction scores significantly increased after the implementation of expanded, inpatient clinical pharmacy technician services.

Seizing the Teachable Moment: A Pilot Study of Preventive Lifestyle Education in the Emergency Department.

Background Preventive measures are critical in avoiding and limiting the severity of diseases. Key lifestyle behaviors include sleep hygiene, habitual exercise, a healthy diet, and avoidance of risky substances, particularly the use of tobacco. The transtheoretical model (TTM) of change suggests that patients can move towards healthful changes through education. This emergency department (ED) pilot study assessed patients' readiness and confidence to adopt healthy lifestyle behaviors after receiving a brief video educational intervention. The study also investigated the impact of this preventive education on patient satisfaction. Methods Adult patients with low-acuity chest pain were prospectively randomized to a 10-minute video-based educational intervention. The sample size of 105 patients was chosen to demonstrate feasibility and provide data that could be used to design a larger study with a more diverse population. The outcome of this study used validated Readiness-to-Change and Confidence-to-Change questionnaires, along with selected questions from the U.S. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Patient Satisfaction Survey. A Student t-test was used to measure the difference in means between comparison groups where normal distribution could be assumed. A logistic regression model assessed the relationship between various factors and participants' readiness in changing their lifestyle behaviors. Results Of the 105 subjects enrolled in the study, 63 were female, and 42 were male. This pilot study found a nonsignificant increase in Readiness-to-Change among those older (40-80 years) who watched the video, more than those younger (18-39 years). This study shows positive trends toward patients being receptive to change and increased patient satisfaction when an educational video is shown. Feasibility was demonstrated by using a video prevention tool in the ED. Conclusion The ED presents a unique "teachable moment" for preventive lifestyle health education. However, lifestyle behavioral health interventions have been largely absent from this setting. This pilot study demonstrates the feasibility of a video teaching model for use while patients wait for their episodic care. Studies with more robust and diverse populations are needed to confirm these findings and to implement more engaging models of behavior change.

Abstract 4138609: Patient Care Experience Worsens After Private Equity Acquisition of US Hospitals: Implications for Cardiovascular Outcomes

Background: Patient care experience is strongly associated with outcomes among individuals with cardiovascular disease. There is growing concern that the recent and precipitous rise in private equity acquisitions of US hospitals may worsen patient-centered care, and ultimately, cardiovascular outcomes. However, little is known about how private equity acquisitions of hospitals impact patient care experience. Research Question: To evaluate whether the acquisition of US hospitals by private equity firms was associated with changes in measures of patient-reported experience compared with matched control hospitals (not acquired by private equity) between 2007-2019. Methods: This cohort study identified 74 US acute care hospitals newly acquired by private equity firms and 298 matched control (non-acquired) hospitals from 2007 to 2019. CMS Hospital Compare files were used to obtain patient experience measure scores for each hospital from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) survey results. A quasi-experimental difference-in-differences design was used to evaluate changes in patient experience measures at private-equity acquired hospitals compared with matched control hospitals 3 years before vs 3 years after acquisition. Results: The percentage of patients rating hospitals as a 9 or 10 out of 10 at private equity acquired hospitals and control hospitals is shown in the Figure. There was a differential decrease in patient ratings (of 9 or 10 out of 10) at hospitals acquired by private equity firms compared with control hospitals (-2.4 percentage points [95% CI -3.9, -0.9]). A similar trend was seen in the percentage of patients that would definitely recommend the hospital, with a differential decrease at private equity-acquired hospitals relative to control hospitals (-2.2 percentage points [95% CI -3.6, -0.7]). For both measures, the relative decrease in patient care experience at private equity hospitals compared with control hospitals steadily grew with each subsequent year after acquisition. Conclusion: In this national study, patient-reported care experience worsened after private equity acquisition of US hospitals, which has important implications for cardiovascular care and outcomes.

Association Between an Enhanced Clinical Pharmacy Service and Patient Experience in Hospitalized Adults: A Cohort Study.

Purpose. To determine if implementation of an enhanced clinical pharmacy service (ECPS) at a community hospital could improve patient experience as measured by medication-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Methods. A cohort study of 260 patients at a community hospital was conducted. Patients in the intervention group received additional pharmacy services from the standard of care (SOC) group, including daily medication counseling, pharmacist-driven medication administration, discharge medication reconciliation and education, consistent offers to enroll in a bedside medication delivery program (BMDP), and a telephone call following discharge. The primary outcome of patient experience was assessed through patients' responses to a care transitions HCAHPS survey question regarding understanding of the purpose of taking medications following discharge. Results. Among patients in the ECPS cohort, 75.8% had a top-box response to the care transitions HCAHPS question, compared to 63.3% of patients in the SOC cohort (OR = 1.81; 95% CI [0.61-5.37]). Top-box responses increased for all assessed HCAHPS questions but were not statistically significant. The HCAHPS survey response rate was 29.3% in the SOC cohort and 29.9% in the ECPS cohort. Conclusion. Following an ECPS intervention, patient experience as determined by HCAHPS scores increased, but the results did not reach statistical significance. Further, larger studies are needed on this topic.

Enhancing Inpatient Sleep Environments: A Design Thinking Case Study.

Research shows how vital sleep is to total health, with poor sleep having a strong correlation with morbidity and mortality, yet fewer than half of top hospitals have sleep-friendly practices. This article describes a project motivated by the lived experiences of a nurse manager and a hospitalist who partnered to improve the sleep environments on two inpatient units. They used design thinking, empathizing with the patients' experiences with the sleep environment, to design interventions to promote quality sleep. Results showed improvements in patient experience on the Hospital Consumer Assessment of Healthcare Providers & Systems question, "During your hospital stay how often was the area around your room quiet at night?" Patient measures on how well the hospital created conditions for sleep on the unit also showed improvements, as well as the patients' perception of how well they slept. Care teams can use design thinking to replicate this project and listen to their patients to build and deploy interventions on their units to improve sleep environments.

Changes in Patient Care Experiences and the Nurse Work Environment: A Longitudinal Study of U.S. Hospitals.

Addressing patient experience is a priority in the health care system. Hospital Consumer Assessment of Providers and Systems (HCAHPS) survey results incentivize hospitals to elevate patient experience, a factor in patient-centered care. Although hospital nursing resources have been positively associated with better HCAHPS ratings, it is unknown how changes in nursing resources are associated with changes in HCAHPS ratings over time. This two-period longitudinal study ranked the associations between changes in nurse staffing, skill mix, nurse education, and work environment on HCAHPS ratings and found that changes in the work environment had the strongest associations (β = 2.29; p < .001) with improved HCAHPS ratings. Our findings provide hospital administrators with empirical evidence that may help make informed decisions on how to best invest limited resources to improve HCAHPS ratings, including the potential utility of improving the work environment through enhancing Nursing Quality of Care and Nurse Participation in Hospital Affairs.

An Interactive, Case-Based Workshop on the Patient Experience for Internal Medicine Residents.

The technological revolution has narrowed the information gap between physician and patient. This has led to an evolution in medicine from paternalistic to patient-centric, with health care systems now prioritizing patient experience to achieve higher satisfaction scores. Therefore, it is imperative to start early in educating trainees on how to best address the holistic needs of the patient while also delivering high-quality care. We implemented a 1-hour workshop that was repeated weekly over 8 weeks to capture all internal medicine residents in our program. During the workshop, we reviewed the historical evolution of patient care from paternalistic to patient-centered, presented the Hospital Consumer Assessment of Healthcare Providers and Systems survey questions, and discussed evidence-based strategies for physicians to improve their patients' experience utilizing four case-based scenarios. Over the 8-week period, a total of 195 residents participated in the workshop. One hundred thirty-nine residents (71%) completed the pre- and postsession survey. Results demonstrated significant knowledge improvement (p < .001) in all of the topics discussed. Additionally, the majority of residents felt the workshop would be useful in their clinical practice and found the clinical scenarios useful. Given the evolution towards patient-centered care, it is important to take a proactive approach in providing residents with the tools to best address their patients' needs. Early understanding of patient satisfaction surveys and the impacts they have on hospital metrics can help trainees in their careers as practicing physicians.

CONNECT: Coordinating Options for Neurovascular Patients Needing Electrophysiology Consults and Treatments.

Though Event Monitors (EM) and Implantable Loop Recorders (ILR) are prevalent in stroke workups, complex processes to obtain placement of these device might result in delays. Our aim was to determine if the CONNECT (Coordinating Options for Neurovascular patients Needing Electrophysiology Consults and Treatments) pathway could improve Stroke-to-Electrophysiology (EP) communications, increase EM and ILR device placements prior to discharge, shorten placement time, and preserve satisfaction. We assessed device placements when an EP consult was obtained [Pre-CONNECT (5/1/21-4/30/22), CONNECT (5/1/22-4/30/23)] for patients with stroke. In the Pre- period, consults were sent via EPIC electronic medical record (EMR), with additional direct communication when desired. In the CONNECT period, the pathway and module allowed for immediate communication between services. Outcomes included case rate, times, length of stay, and satisfaction. Hospital reports detailed Order to Activation (O-A) days. EM report review was used to obtain O-A time. Clinician satisfaction was assessed using Qualtrics survey. Patient satisfaction was assessed with Hospital Consumer Assessment of Health care Clinicians and Systems (HCAHPS) survey. Man-Whitney U test was used. 78 patients were included (30EM(38.5%), 48ILR(61.5%)). Age was 68years (P = 0.58). For ILRs, inpatient placements prior to discharge increased (3Pre vs 51 CONNECT; P < 0.0001) as did outpatient placements (5 vs 16; P = 0.02). Order to Activation (O-A) time savings were significant for ILR overall (32days vs 1day; P = 0.03) and for Inpatient EM (13days vs 3days; P = 0.003). Time for consultant to view was 4min and to respond was 6min. Devices were placed at a median 6hrs 32min (EM: 4hrs 19min; ILR:7hrs36min). All (12/12) clinicians preferred the technique. Patient satisfaction improved on 13/19 (68%) questions. There was a 1600% increase in ILR placements prior to discharge that was associated with the time period that the CONNECT process was in place. The robust improvement in ILR placements prior to discharge, high satisfaction, ease of use, closed loop communication, and respect for autonomy allowing more organic parallel discussions with patients improved clinician workflow which could potentially improve future risk reduction strategies.

Hospital consumer assessment of healthcare providers and systems (HCAHPS) for measuring patients’ satisfaction: A literature review

Background: Hospital managers, healthcare providers, patients, and their families all share the same goal of enhancing the patient experience. Surveys are the predominant method for assessing patient experience and happiness, since they offer a convenient means of gathering the viewpoints of a substantial number of individuals and discerning patterns inside one or multiple establishments. HCAHPS is an acronym that stands for Hospital Consumer Assessment of Healthcare Providers and Systems. Hospitals are becoming more concerned with enhancing patient happiness due to the fact that medicare reimbursement is now partially dependent on patient satisfaction scores. Nevertheless, limited knowledge exists regarding the distinct attributes linked to increased patient satisfaction. Purpose: To conduct a comprehensive analysis of existing literature on patient satisfaction and determine the factors that predict patient happiness, utilizing data from the HCAHPS survey. Method: A comprehensive literature review was conducted using the Wiley Online Library, PubMed, and Frontiers databases. Additionally, a literature search was performed using Google Scholar. The authors performed an extensive database search covering the period from 2014 to 2023, which led to the identification of 15 papers that met the inclusion criteria. Out of a total of 95 article titles and abstracts, 15 papers were selected based on the inclusion and exclusion criteria. Results: After reviewing 15 relevant articles, it was determined that patient satisfaction is affected by every aspect of the service. This is due to the fact that all components form a cohesive and interconnected system. Conclusion: The key to enhancing patient satisfaction lies in adopting a patient-centered approach that focuses on ensuring patients fully understand and actively engage in their care. Research shows a strong link between higher patient satisfaction and significantly better outcomes.

Impact of Early Admission Surveys on Physicians' Communication Skills on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores: A Quality Improvement Initiative.

Introduction Effective communication between doctors and patients is one of the 19 core questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Positive patient experiences, as reflected in HCAHPS scores, are associated with higher quality of care, reduced mortality, and fewer readmissions. These scores also influence a hospital's financial bonuses or penalties from the Centers for Medicare & Medicaid Services. Methods This quality improvement (QI) initiative evaluated how early surveys of patients' feedback on doctors' communication skills during admission impacted discharge communication scores. The approach involved promptly sharing patients' feedback with physicians and focusing on improving communication skills for those with less-than-perfect scores. Results This QI initiative involved 41 patients. By surveying patients early during admission and addressing communication issues for those with less-than-perfect scores, the percentage of patients achieving a perfect score on all survey questions increased from 18 (43.9%) at admission to 34 (82.9%) at discharge. The largest improvement was seen in perfect scores for doctors' explanations of patients' conditions, which rose from 59% at admission to 90% at discharge. Conversely, the increase in perfect scores for doctors' respectful treatment was smaller, rising from 88% at admission to 98% at discharge. Conclusion Surveying patients about their doctors' communication skills early in admission to identify those with less-than-perfect scores and improving communication for this group resulted in a 39% increase in satisfaction with doctors' communication.

Association between nurse-child communication and family caregivers' global ratings to hospital: a retrospective study

Effective nurse-child communication is a fundamental aspect of delivering pediatric nursing care. Family caregivers' global ratings to hospital are considered a proxy-reported measure for assessing a child's inpatient stay experience. We investigate the associations between nurse-child communication and family caregivers' global ratings to hospital. A retrospective analysis of a national child patient experience survey data was conducted. Patient experience with nurse-child communication and the family caregivers' global ratings of hospital were measured using the Child Hospital Consumer Assessment of Healthcare Providers and Systems. Hierarchical linear models were constructed to examine the association between nurse-child communication measures and family caregivers' global ratings to hospital. Data from 1010 patients at six National Regional Centers for Pediatric in China were collected. The overall rating of hospitals and the willingness to recommend the hospital showed increasing trends as the nurse-child communication score increased. How often nurses encourage children to ask questions was significantly associated with family caregivers' overall ratings of hospital and the family caregivers' willingness to recommend the hospital. Effective communication by nurses with the child is associated with significantly higher global ratings to the hospital by family caregivers during inpatient care. Encouraging children to ask questions is a promising contributor to caregivers' global ratings to hospital. Pediatric nurses should emphasis encouraging children to ask questions for effective communication in nursing practice. Future research is also needed to develop more targeted strategies to assist pediatric nurse to communicate with child better.

Rurality and patients' hospital experience: A multisite analysis from a US healthcare system.

The association between rurality of patients' residence and hospital experience is incompletely described. The objective of the study was to compare hospital experience by rurality of patients' residence. From a US Midwest institution's 17 hospitals, we included 56,685 patients who returned a post-hospital Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. We defined rurality using rural-urban commuting area codes (metropolitan, micropolitan, small town, rural). We evaluated the association of patient characteristics with top-box score (favorable response) for 10 HCAHPS items (six composite, two individual, two global). We obtained adjusted odds ratios (aOR [95% CI]) from logistic regression models including patient characteristics. We used key driver analysis to identify associations between HCAHPS items and global rating (combined overall rating of hospital and recommend hospital). Of all items, overall rating of hospital had lower odds of favorable response for patients from metropolitan (0.88 [0.81-0.94]), micropolitan (0.86 [0.79-0.94]), and small towns (0.90 [0.82-0.98]) compared with rural areas (global test, P = .003). For five items, lower odds of favorable response was observed for select areas compared with rural; for example, recommend hospital for patients from micropolitan (0.88 [0.81-0.97]) but not metropolitan (0.97 [0.89-1.05]) or small towns (0.93 [0.85-1.02]). For four items, rurality showed no association. In metropolitan, micropolitan, and small towns, men vs. women had higher odds of favorable response to most items, whereas in rural areas, sex-based differences were largely absent. Key driver analysis identified care transition, communication about medicines and environment as drivers of global rating, independent of rurality. Rural patients reported similar or modestly more favorable hospital experience. Determinants of favorable experience across rurality categories may inform system-wide and targeted improvement.

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.