Survey Of Health Care Providers Research Articles

Patient and clinician perspectives about cannabis use while receiving cancer treatment at a comprehensive cancer center (CCC).

e24169 Background: Cannabis is gaining popularity worldwide including in the United States with 37 states legalizing access to cannabis. Limited data exist regarding why patients are using cannabis while receiving anticancer treatments. Methods: Patients with cancer who received treatment at a National Cancer Institute (NCI) designated CCC were approached from August of 2021 to August of 2022 to participate in a cross-sectional survey as part of a national NCI-funded effort. Consenting patients completed a survey during a medical visit asking about cannabis use (past and present), reason for use (including if cancer-related), type of cannabis, and frequency of use. A follow-up phone call occurred within 30 days to confirm medications used, and to collect further details about cannabis use, if reported. A healthcare provider survey was also conducted to explore perspectives regarding patients’ use of cannabis during active treatment. Results: A total of 315 cancer patients completed the survey (43% response rate) with a median age of 60.7 (±12.8), 58% female, and a variety of cancer types (hematologic 21.3%, breast 17%, gastrointestinal 11.7%, lung 10.2%). The respondents were of a diverse racial/ethnic backgrounds (White 61.6%, Black 22.5%, Other 7.3%), education (high school 27%, college 42.5%, post-graduate 14.9%), and employment status (retired 35.2%, employed 25.7%, unemployed or disabled 21.9%). Among respondents, nearly half (48.4%) had used cannabis before, one-third (32.1%) had used cannabis since their cancer diagnosis, and almost one in five (18.5%) were currently using cannabis. Among current or past users of cannabis the forms used were smoked (31%), gummy (29%), liquid (19%), edible (7%), and pill (6%). The most common reported reasons for use by respondents were insomnia (79%), pain (72%), mood (68%), poor appetite (68%), and gastrointestinal symptoms (51%). For the clinician survey, a total of 165 completed surveys (25% response rate) were received. Approximately half of respondents were nurses (54% nurses, 22% advance practice providers, and 21% physicians) and of White race (73%) with a mean age of 46 years. Approximately one-fourth (24%) reported discussing the topic of cannabis and about half of these conversations (45%) were initiated by the respondent. The healthcare providers estimated 10% of patients with cancer overall were using cannabis and that one in four patients (23%) were using cannabis during cancer treatment. Four in ten (39%) clinicians felt comfortable in providing guidance to patients about cannabis use, and only one in eight (13%) felt knowledgeable about the topic of cannabis. Conclusions: Approximately one-fifth of patients with cancer receiving treatment are actively using cannabis, despite limited data regarding the efficacy of cannabis. Management of cancer symptoms were among key reasons that cancer patients used cannabis.

FRI-213 - Pandemic preparedness and viral hepatitis-Global survey of hepatitis program managers and healthcare providers

FRI-213 - Pandemic preparedness and viral hepatitis-Global survey of hepatitis program managers and healthcare providers

Evaluation of the impact of guideline communication from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services among US healthcare providers: COVID-19 prevention counselling guidance.

To evaluate healthcare provider awareness and uptake of the Centers for Medicare & Medicaid Services (CMS) billing for coronavirus disease 2019 (COVID-19) prevention counselling and the delivery of prevention counselling to patients awaiting severe acute respiratory syndrome coronavirus 2 test results. Cross sectional survey of US-based healthcare providers in February 2021. Analysis of associations with healthcare provider-reported awareness of CMS prevention counselling guidance and billing with provider type, specialty, and work setting. A total of 1919 healthcare providers responded to the survey. Overall, 38% (726/1919) of providers reported awareness of available CMS reimbursement for COVID-19 patient counselling and 29% (465/1614) of CMS billing-eligible providers reported billing for this counselling. Among physicians, those aware of CMS guidance were significantly more likely to bill (58%) versus those unaware (10%). Among RNSights respondents eligible for CMS billing (n = 114), 31% of those aware of the guidance reported billingas compared to 0% of those not aware.

(491) Optimizing Healthcare Provider Response Rates in Sexual Dysfunction Survey Research

Abstract Introduction Survey research is common in sexual medicine literature. Healthcare providers notoriously respond poorly to surveys. Response rates of 60% are commonly accepted by academic journals, as to minimize nonresponse bias. Objective We sought to identify tactics that optimize response rates in survey studies of healthcare providers on topics related to sexual dysfunction. Methods PubMed and Web of Science were systematically reviewed for survey studies that 1) were on topics related to sexual dysfunction, 2) utilized healthcare providers as subjects, 3) reported response rate, and 4) were written in English. Using metafor package, meta-analysis was performed to determine overall response rate. Meta-regression was performed to assess survey characteristics associated with increased response rates. Results Of 122 studies reviewed, 56 met inclusion criteria. Meta-analysis revealed a response rate of 41% (95% CI [35%, 47%]). Response rates were significantly higher for in-person, paper mail, or combination of paper mail plus phone call surveys, as compared to email (Table 1). Year of publication, number of questions, use of cognitive testing, monetary incentive, follow-up correspondence, and grant funding were not significantly associated with changes in response rate. Conclusions Response rates for healthcare provider surveys on sexual dysfunction topics are lower than commonly accepted thresholds. Email surveys achieve significantly lower response rates, as compared to other modalities. Disclosure No

The Relationship between Internet Patient Satisfaction Ratings and COVID-19 Outcomes.

Our prior research showed that patient experience-as reported by Google, Yelp, and the Hospital Consumer Assessment of Healthcare Providers and Systems survey-is associated with health outcomes. Upon learning that COVID-19 mortality rates differed among U.S. geographic areas, we sought to determine if COVID-19 outcomes were associated with patient experience. We reviewed daily, U.S.-county-level-accrued COVID-19 infections and deaths during the first year of the pandemic using each locality's mean online patient review rating, correcting for county-level demographic factors. We found doctor star ratings were significantly associated with COVID-19 outcomes. We estimated the absolute risk reduction (ARR) and relative risk reduction (RRR) for each outcome by comparing the real-world-observed outcomes, observed with the mean star rating, to the outcomes predicted by our model with a 0.3 unit higher average star rating. Geographic areas with higher patient satisfaction online review ratings in our models had substantially better COVID-19 outcomes. Our models predict that, had medical practices nationwide maintained a 4-star average online review rating-a 0.3-star increase above the current national average-the U.S may have experienced a nearly 11% lower COVID-19 infection rate and a nearly 17% lower death rate among those infected.

Improving patient experience by implementing an organisational culture model

A satisfactory patient care culture model can help improve most patients’ quality of care in a hospital. This study aims to improve patients’ experiences (PX) by implementing a culture model...

Screening for Bipolar I Disorder and the Rapid Mood Screener: Results of a Nationwide Health Care Provider Survey.

Objective: Effective screening for bipolar I disorder can lead to enhanced assessment, improved diagnosis, and better patient outcomes. The Rapid Mood Screener (RMS), a new bipolar I disorder screening tool, was evaluated in a nationwide survey of health care providers (HCPs).Methods: Eligible HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the Mood Disorder Questionnaire (MDQ). Results were stratified by primary care and psychiatric specialty. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence level.Results: Among respondents (N = 200), 82% used a tool to screen for major depressive disorder (MDD), while 32% used a tool for bipolar disorder. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. According to HCPs, the RMS was significantly better than the MDQ on all screening tool attributes (eg, sensitivity/specificity, brevity, practicality, easy scoring; P < .05 for all). Significantly more HCPs reported that they would use the RMS versus the MDQ (81% vs 19%, P < .05); 76% reported that they would screen new patients with depressive symptoms, and 68% indicated they would rescreen patients with a depression diagnosis. Most HCPs (84%) said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder.Discussion: In our survey, the RMS was favorably evaluated by HCPs. A large percentage of respondents preferred the RMS over the MDQ and indicated that it would likely have a positive impact on clinicians' screening behavior.

Abstract 749: The impact of multimorbidity on the relationship between breast cancer tumor characteristics and survivorship care experiences among older women: A SEER-CAHPS analysis

Abstract Our study examined the associations between breast cancer tumor characteristics and self-reported survivorship care experiences stratified by multimorbidity among older female breast cancer survivors in the United States. Utilizing the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program and the Centers for Medicare and Medicaid Services’ Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data linkage from 2000-2019. Breast cancer (BC) survivors (N=19,017) were aged ≥65 years at CAHPS survey who completed a survey after diagnosis of primary site invasive BC. Adjusted multivariable linear regression models were used to estimate beta (β) and standard error (SE) coefficients of the relationships between tumor characteristics (extent of disease: localized, regional, distant; estrogen receptor [ER] status: ER+, ER-, missing/unknown) and several CAHPS composite and rating outcomes, overall and stratified by multimorbidity (BC only, 2-5 chronic conditions, ≥6 chronic conditions). Women were on average 76.3 years (SD=7.14) of age at survey and 4.65 years (SD=3.51) since BC diagnosis. Most survivors were non-Hispanic white (78.1%), had ≥6 chronic conditions (38.1%), were diagnosed with localized BC (80.5%) and/or ER+ tumors (56.9%). Survivors with regional BC at diagnosis reported significantly higher mean scores on Getting Needed Care (β=1.00, SE=0.46, p=0.03), and with distant BC reported significantly lower mean scores on Physician Communication (β=-1.92, SE=0.92, p=0.03) compared to those with localized BC. When stratified by multimorbidity, survivors with distant stage compared to localized, and with 2-5 chronic conditions reported significantly higher mean scores for Getting Needed Care (β=3.85, SE=1.96, p=0.04), while this association was inverse and not statistically significant (β=-2.72, SE=1.87, p=0.14) among survivors with BC only (p-interaction=0.01). While the overall associations between ER status and the CAHPS outcomes were not statistically significant, we observed significant statistical interactions by multimorbidity for the following association: among survivors with BC only, survivors with ER- tumors reported lower Health Plan Ratings (β=-1.89, SE=0.73, p=0.009) compared to survivors with ER+ tumors, while this association was positive however, marginally statistically significant (β=1.63, SE=0.86, p=0.05) among survivors with ≥6 conditions (p-interaction=0.002). BC survivors who are diagnosed with advanced stage and aggressive tumor phenotypes, such as ER- BC, experience different survivorship care experiences when they are also managing multiple chronic conditions. Remarkably, our results demonstrate that women with distant stage breast cancer and multimorbidity reported higher score on getting the care they need. Citation Format: Kate E. Dibble, Zhengyi Deng, Avonne E. Connor. The impact of multimorbidity on the relationship between breast cancer tumor characteristics and survivorship care experiences among older women: A SEER-CAHPS analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 749.

Hospice Quality, Race, and Disenrollment in Hospice Enrollees With Dementia.

Background: Racial and ethnic minoritized people with dementia (PWD) are at high risk of disenrollment from hospice, yet little is known about the relationship between hospice quality and racial disparities in disenrollment among PWD. Objective: To assess the association between race and disenrollment between and within hospice quality categories in PWD. Design/Setting/Subjects: Retrospective cohort study of 100% Medicare beneficiaries 65+ enrolled in hospice with a principal diagnosis of dementia, July 2012-December 2017. Race and ethnicity (White/Black/Hispanic/Asian and Pacific Islander [AAPI]) was assessed with the Research Triangle Institute (RTI) algorithm. Hospice quality was assessed with the publicly-available Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey item on overall hospice rating, including a category for hospices exempt from public reporting (unrated). Results: The sample included 673,102 PWD (mean age 86, 66% female, 85% White, 7.3% Black, 6.3% Hispanic, 1.6% AAPI) enrolled in 4371 hospices nationwide. Likelihood of disenrollment was higher in hospices in the lowest quartile of quality ratings (vs. highest quartile) for both White (adjusted odds ratio [AOR] 1.12 [95% confidence interval 1.06-1.19]) and minoritized PWD (AOR range 1.2-1.3) and was substantially higher in unrated hospices (AOR range 1.8-2.0). Within both low- and high-quality hospices, minoritized PWD were more likely to be disenrolled compared with White PWD (AOR range 1.18-1.45). Conclusions: Hospice quality predicts disenrollment, but does not fully explain disparities in disenrollment for minoritized PWD. Efforts to improve racial equity in hospice should focus both on increasing equity in access to high-quality hospices and improving care for racial minoritized PWD in all hospices.

P291 Evolving strategies for the routine follow-up of patients with early breast cancer and the impact of COVID-19: a survey of healthcare providers

P291 Evolving strategies for the routine follow-up of patients with early breast cancer and the impact of COVID-19: a survey of healthcare providers

Improving Access to Harm Reduction Services in People Who Inject Drugs at a Rural Health System

Background: Hospitalists are increasingly responsible for treating infectious complications related to injection-drug use. Despite these complications leading to hospitalizations, harm reduction interventions have not been widely adopted in inpatient settings. Use of naloxone is safe and effective at treating respiratory depression in patients with opioid overdose. The objectives of this study were to assess the need for a multi-modal approach to provide a standard of care in people who inject drugs (PWID), and to create and educate healthcare providers on tools that could improve delivery of harm reduction services. Methods: A review of medical records assessed the need for an intervention to increase access of harm reduction services. PWID 18 years or older who presented to the emergency department (ED) or were hospitalized were eligible. After clinician education, investigators utilized prospective audit to assess and re-educate on intervention use. Primary outcome was percentage of naloxone prescription or education provided at discharge. Secondary outcomes included percentage of disease screening, fentanyl test-strips education, safe-injection practice education, vaccination rates, and healthcare provider survey on naloxone. Results: Sixty-five patients were analyzed for the baseline group and 15 patients for the post-intervention group. The median ages were 32 years (IQR, 19–64) and 32 years (IQR, 20–56) in the baseline and post-intervention groups, respectively. Naloxone prescriptions and education had an absolute percentage increase of 2.1% and 6.7%, respectively. Secondary outcomes were not analyzed due to a delay in the intervention implementation. Conclusions: Barriers to implementation of the intervention led to lack of data for analysis of harm reduction services in PWID in a rural hospital system. Future studies could evaluate other methods to increase these services and assess ways to optimize care through transitions.

Effect of a Pharmacist-Led Discharge Counseling Service at a Children's Hospital.

To evaluate the effect of a pharmacist-led discharge counseling service at a pediatric hospital. This was a prospective observational cohort study. Patients in the pre-implementation phase were identified by the pharmacist at the time of admission medication reconciliation, whereas patients in the pos-timplementation phase were identified at the time of pharmacist discharge medication counselling. Caregivers were contacted within 2 weeks of the patients' discharge date to complete a 7-question telephone survey. The primary objective was to measure the effect of the pharmacist-led service on caregiver satisfaction, using a pre- and post- implementation telephone survey. The secondary objectives were to evaluate the effect of the service on 90-day medication-related readmissions and determine the change in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey response (Question 25) regarding discharge medications following implementation of the new service. A total of 32 caregivers were included in both the pre- and post-implementation groups. The most common reason for inclusion was high-risk medications (84%) in the pre-implementation group and device teaching (62.5%) in the post-implementation group. The primary outcome, the average composite score on the telephone survey, was 30.94 ± 3.50 (average ± SD) in the pre-implementation group and 32.5 ± 2.26 in the post-implementation group (p = 0.038). There were no medication-related readmissions within 90 days in either group. The score on HCAHPS Question 25 was not different between groups (p = 0.761). Implementation of a pharmacist-led discharge counseling service in pediatric patients improved caregiver satisfaction and understanding as shown by a postdischarge telephone survey.

Association between the nurse work environment and patient experience in Chilean hospitals: A multi-hospital cross-sectional study.

International evidence shows that nurses' work environments affect patient outcomes, including their care experiences. In Chile, several factors negatively affect the work environment, but they have not been addressed in prior research. The aim of this study was to measure the quality of the nurse work environment in Chilean hospitals and its association with patient experience. A cross-sectional study of 40 adult general high-complexity hospitals across Chile. Participants included bedside nurses (n=1632) and patients (n=2017) in medical or surgical wards, who responded to a survey. The work environment was measured through the Practice Environment Scale of the Nursing Work Index. Hospitals were categorized as having a good or poor work environment. A set of patient experience outcomes were measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Adjusted logistic regression models were used to test associations between the environment and patient experiences. For all outcomes, the percentage of patients satisfied was higher in hospitals with good as compared to poor work environments. In good environment hospitals patients had significantly higher odds of being satisfied with communication with nurses (OR 1.46, 95% CI: 1.10-1.94, p=0.010), with pain control (OR 1.52, 95% CI: 1.14-2.02, p=0.004), and with nurses' timely responses in helping them to go to the bathroom (OR 2.17, 95% CI: 1.49-3.16, p < 0.0001). Hospitals with good environments outperform hospitals with poor environments in most patient care experience indicators. Efforts to improve nurses' work environment hold promise for improving patient experiences in Chilean hospitals. Hospital administrators and nurse managers should value, especially in the context of financial constraints and understaffing, the implementation of strategies to improve the quality of nurses´ work environments so that they can provide patients with a better care experience.

What Parents Have To Say: Content and Actionability of Narrative Comments From Child HCAHPS Survey.

Narrative comments from the Child Hospital Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey from a single open-ended question are specific enough to make improvements (ie, actionable). A multiitem set might yield more insights. We compare comments from the single-item Child Hospital CAHPS and the 6-item beta version Narrative Item Set (NIS). The Child HCAHPS NIS was piloted 2021 to 2022 at an urban children's hospital that fielded the Child HCAHPS survey since 2017. We analyzed 382 NIS comments (n = 77 parents and guardians) and compared them to single-item comments. NIS respondents wrote nearly 6 times the word count compared with respondents presented with a single item, with 75% of NIS respondents providing narrative to 5 or 6 NIS items. Single-item comments were more positive (57% vs 39% NIS), yet most (61%) NIS comments included at least 1 negative remark (vs 43% single-item). Eighty-two percent of NIS comments included content on the Child HCAHPS survey (vs 51% single-item). The most common Child HCAHPS topics in NIS narratives were about being kept informed of child's care and whether doctors treated respondents with courtesy and respect. More NIS comments were deemed actionable (69% vs 39% single-item), with 1 NIS item - what a parent wished had gone differently- eliciting the most-actionable narrative. The multi-item NIS elicited high percentages of comments with sufficient detail to make improvements. A large NIS demonstration is needed to assess how quality leaders and frontline staff use NIS comments to improve inpatient pediatric care.

Unmet Medical Needs In Short Bowel Syndrome With Intestinal Failure Identified From A Qualitative Survey Of Patients And Healthcare Providers

Unmet Medical Needs In Short Bowel Syndrome With Intestinal Failure Identified From A Qualitative Survey Of Patients And Healthcare Providers

A sequential, multiple assignment randomized trial comparing web-based education to mobile video interpreter access for improving provider interpreter use in primary care clinics: the mVOCAL hybrid type 3 study protocol

BackgroundIndividuals who use a language other than English for medical care are at risk for disparities related to healthcare safety, patient-centered care, and quality. Professional interpreter use decreases these disparities but remains underutilized, despite widespread access and legal mandates. In this study, we compare two discrete implementation strategies for improving interpreter use: (1) enhanced education targeting intrapersonal barriers to use delivered in a scalable format (interactive web-based educational modules) and (2) a strategy targeting system barriers to use in which mobile video interpreting is enabled on providers’ own mobile devices.MethodsWe will conduct a type 3 hybrid implementation-effectiveness study in 3–5 primary care organizations, using a sequential multiple assignment randomized trial (SMART) design. Our primary implementation outcome is interpreter use, calculated by matching clinic visits to interpreter invoices. Our secondary effectiveness outcome is patient comprehension, determined by comparing patient-reported to provider-documented visit diagnosis. Enrolled providers (n = 55) will be randomized to mobile video interpreting or educational modules, plus standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative strategy. After another 9 months, both strategies will be available to enrolled providers for 9 more months. Providers will complete 2 surveys (beginning and end) and 3 in-depth interviews (beginning, middle, and end) to understand barriers to interpreter use, based on the Theoretical Domains Framework. Patients who use a language other than English will be surveyed (n = 648) and interviewed (n = 75) following visits with enrolled providers to understand their experiences with communication. Visits will be video recorded (n = 100) to assess fidelity to assigned strategies. We will explore strategy mechanism activation to refine causal pathway models using a quantitative plus qualitative approach. We will also determine the incremental cost-effectiveness of each implementation strategy from a healthcare organization perspective, using administrative and provider survey data.DiscussionDetermining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, the mechanisms by which they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities.Trial registrationNCT05591586.

Personalized Telehealth: Redesigning Complex Care Delivery for the 65+ During the COVID Pandemic: a Survey of Patients, Caregivers, and Health-care Providers.

In the context of the ongoing COVID-19 pandemic, rapid transitions have been made towards telehealth. Optimal use of telehealth in elderly patients remains poorly understood and adaptation challenges persist. Our study aimed at identifying perceptions, barriers, and possible facilitators to telehealth use amongst elderly patients with comorbidities, their caregivers, and health-care providers (HCPs). Health-care providers, patients 65 years and older with multiple comorbidities, and caregivers were recruited from outpatient clinics and invited to complete an electronic self-administered or telephone-administered survey on their perceptions of telehealth and of barriers to its implementation. A total of 39 health-care providers, 40 patients, and 22 caregivers responded to the survey. Most patients (90%), caregivers (82%), and HCPs (97%) had experienced telephone visits, but few were conducted via videoconference platforms. Patients and caregivers showed interest in pursuing some future telehealth visits (68%, 86%, respectively), but felt they lacked access to technology and skills (n=8, 20%), and some felt that telehealth visits may be inferior to in-person visits (n=9, 23%). HCPs showed interest in incorporating telehealth visits into practice (n=32, 82%), but identified challenges in lack of administrative support (n=37), lack of HCP (n=28) and patient (n=37) technological skills, and limited infrastructure (n=37)/internet access (n=33). Older patients, caregivers, and HCPs show interest in pursuing future telehealth visits but elucidate similar barriers. Facilitating access to technology, as well as to administrative and technology support guides, could promote high quality and equal access to virtual care for the older adult.

Counseling women of reproductive age about emergency preparedness – Provider attitudes and practices

We report healthcare provider attitudes and practices on emergency preparedness counseling for women of reproductive age (WRA), including pregnant, postpartum, and lactating women (PPLW), for disasters and weather emergencies. DocStyles is a web-based panel survey of primary healthcare providers in the United States. During March 17–May 17, 2021, obstetricians-gynecologists, family practitioners, internists, nurse practitioners, and physician assistants were asked about the importance of emergency preparedness counseling, level of confidence, frequency, barriers to providing counseling, and preferred resources to support counseling among WRA and PPLW. We calculated frequencies of provider attitudes and practices, and prevalence ratios with 95% CIs for questions with binary responses. Among 1503 respondents (family practitioners (33%), internists (34%), obstetrician-gynecologists (17%), nurse practitioners (8%), and physician assistants (8%)), 77% thought emergency preparedness was important, and 88% thought counseling was necessary for patient health and safety. However, 45% of respondents did not feel confident providing emergency preparedness counseling, and most (70%) had never talked to PPLW about this topic. Respondents cited not having time during clinical visits (48%) and lack of knowledge (34%) as barriers to providing counseling. Most respondents (79%) stated they would use emergency preparedness educational materials for WRA, and 60% said they were willing to take an emergency preparedness training. Healthcare providers have opportunities to provide emergency preparedness counseling; however, many have not, noting lack of time and knowledge as barriers. Emergency preparedness resources combined with training may improve healthcare provider confidence and increase delivery of emergency preparedness counseling.

Evidence-Based Performance Indicators of Positive Inpatient Experiences.

Patient experiences affect the competitiveness and financial viability of a hospital. The purpose of this research was to ascertain the factors that contribute to positive inpatient experiences by using empirical evidence from national databases and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. Data were assembled from four publicly available U.S. government datasets. The HCAHPS national survey responses (n = 2,472) were based on four consecutive quarters of patient surveys. Measures of clinical complications obtained from the Centers for Medicare & Medicaid Services were used to assess hospital quality. Social determinants of health were incorporated into the analysis by including data from the Social Vulnerability Index as well as zip code-level information from the Office of Policy Development and Research. The study results show that hospital quietness, nurse communication, and care transition positively affected patient experience ratings and the patient's likelihood to recommend the hospital. In addition, findings show that hospital cleanliness positively influenced patient experience ratings. However, hospital cleanliness had little impact on the likelihood of a patient's recommending the hospital, and staff responsiveness had a negligible impact on both patient experience ratings and the likelihood to recommend the hospital. The results also revealed that hospitals with better clinical outcomes received better patient experience ratings and recommendation scores, whereas hospitals that serve more vulnerable populations received worse patient experience ratings and recommendation scores. Findings from this research demonstrate that managing the physical surroundings by providing a clean and quiet environment, providing relationship-centered care through interactions with medical personnel, and working to engage patients in their health as they transition out of care contributed to positive inpatient experiences.

Association of Hospice Profit Status With Family Caregivers’ Reported Care Experiences

Expansive growth in the US hospice market has been driven almost exclusively by an increase in for-profit hospices. Prior research found that, in contrast to not-for-profit hospices, for-profit hospices focus on delivering care to patients in nursing homes, provide fewer nursing visits, and use less skilled staff. However, prior studies have not reported on the associations of these differences in care patterns with hospice care quality. Patient- and family-centeredness is a core element of hospice care quality that is measured through surveys of care experiences. To examine whether differences in profit status are associated with family caregivers' reports of hospice care experiences and assess factors that may be associated with observed differences in care experiences by profit status. Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey data from 653 208 caregiver respondents, reflecting care received from 3107 hospices between April 2017 and March 2019, were used for a cross-sectional examination of hospice care experiences by profit status. Data analysis was performed from January 2020 to November 2022. Outcomes were case-mix-adjusted and mode-adjusted top-box scores for 8 measures of hospice care experiences, including communication, timely care, symptom management, and emotional and religious support, as well as a summary score averaging across measures. Linear regression examined the association between profit status and hospice-level scores, adjusting for other organizational and structural hospice characteristics. There were 906 not-for-profit and 1761 for-profit hospices with mean (SD) time in operation of 25.7 (7.8) years and 13.8 (8.0) years, respectively. Mean (SD) decedent age at death was 82.8 (2.3) years, similar for not-for-profit and for-profit hospices. The mean proportion of patients who were Black, Hispanic, and White was 4.9%, 0.9%, and 91.4% for not-for-profit hospices and 9.0%, 2.2%, and 85.4% for for-profit hospices, respectively. Family caregivers reported worse care experiences at for-profit hospices than at not-for-profit hospices for all measures. Significant differences in average hospice performance by profit status remained after adjusting for hospice characteristics. However, for-profit hospice performance varied, with 548 of 1761 (31.1%) for-profit hospices scoring 3 or more points below the national hospice average of overall performance and 386 of 1761 (21.9%) scoring 3 or more points above the average. In contrast, only 113 of 906 (12.5%) not-for-profit hospices scored 3 or more points below the average, and 305 of 906 (33.7%) scored 3 or more points above the average. In this cross-sectional study of CAHPS Hospice Survey data, caregivers of patients receiving hospice care reported substantially worse care experiences in for-profit than in not-for-profit hospices; however, there was variation in reported experiences among both types of hospices. Public reporting of hospice quality is important.