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Li Z, Ho V, Merrell MA, Hung P. Trends in patient perceptions of care toward rural and urban hospitals in the United States: 2014-2019. J Rural Health 2024; 40:565-573. [PMID: 38031505 DOI: 10.1111/jrh.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/26/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Understanding rural-urban disparities in patient satisfaction is critical to identify gaps for improvement in patient-centered care and tailor interventions to specific patient needs, especially those in the Frontier and Remote areas (FAR). This study aimed to examine disparities in patient perceptions of care between urban, rural non-FAR, and FAR hospitals between 2014 and 2019. METHODS This is a retrospective longitudinal study using 2014-2019 Hospital Consumer Assessment of Healthcare Providers and Systems data linked to American Hospital Annual Survey data (3,524 hospitals in 2014 and 3,440 hospitals in 2019). Multivariable linear regression models were used to identify differential trends in patient perceptions of care by hospital rurality over 2014-2019, adjusting hospital- and county-level characteristics. FINDINGS In 2014, patients at rural non-FAR and FAR hospitals had lower percentages of willingness to definitely recommend these hospitals than urban hospitals (average percentage difference, 95% CI: -4.0% [-4.5%, -3.5%]; -2.0% [-2.8%, -1.2%]); yet, over the study period, rural hospitals experienced steeper increases in patient willingness to recommend (0.2% [0.07%, 0.4%]; 0.4% [0.08%, 0.7%]). FAR hospitals also showed improvements in patient experience in a clean environment, communication with nurses, communication about medicines, and responsiveness of staff. Communication with doctors showed slight decreases across hospital locations. CONCLUSIONS Patient perceptions of care were generally improved in all US hospitals from 2014 to 2019, except communications with doctors. These findings highlight the potential for enhancing patient satisfaction and experience in urban hospitals and suggest the need to improve patient willingness to recommend in rural FAR hospitals.
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Affiliation(s)
- Zhong Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Rural & Minority Health Research Center, University of South Carolina, Columbia, South Carolina, USA
| | - Vivian Ho
- Rural & Minority Health Research Center, University of South Carolina, Columbia, South Carolina, USA
| | - Melinda A Merrell
- Rural & Minority Health Research Center, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Peiyin Hung
- Rural & Minority Health Research Center, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Stephens AR, McCormick ZL, Burnham TR, Conger A. The impact of social deprivation on patient satisfaction in physical medicine and rehabilitation outpatient interventional spine and musculoskeletal medicine using the press Ganey® outpatient medical practice survey. INTERVENTIONAL PAIN MEDICINE 2023; 2:100276. [PMID: 39238904 PMCID: PMC11372889 DOI: 10.1016/j.inpm.2023.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2024]
Abstract
Introduction Multiple factors (patient age, wait time, depression, etc.) have been associated with lower patient satisfaction as assessed by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). Social deprivation has been shown to impact multiple aspects of patient care but its impact on patient satisfaction in Physical Medicine and Rehabilitation (PM&R) is limited. Objective We hypothesized that increased social deprivation would independently predict lower patient satisfaction, as measured by the PGOMPS. Design Retrospective large cohort study. Setting Single tertiary academic institution. Patients Adult patients seen by PM&R physicians practicing outpatient interventional spine and musculoskeletal medicine who completed PGOMPS between January 1, 2014 and December 31, 2019. Interventions Independent variables include: Social deprivation as measured by 2015 Area Deprivation Index (ADI), wait time, patient age, and sex. Main outcome measure Patient satisfaction was defined as receiving a perfect PGOMPS Total Score. Results A totla of 64,875 patients (mean age 52.7 ± 21.8 years, 41.4% male, mean ADI 29.9 ± 18.8) were included. Univariate analysis showed a decreased odds of achieving satisfaction for each decile increase in ADI (odds ratio 0.965; 95% confidence interval 0.957-0.973; p < 0.001). The most socially deprived quartile was significantly less likely to report satisfaction on PGOMPS compared to the least deprived quartile (91.1 vs 93.2; p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction was 0.99 (95% confidence interval 0.980 to 0.997; p = 0.009) for the Total Score, independent of age, wait time, and patient sex for each decile increase in ADI. Conclusions In this cohort, increased social deprivation independently predicted patient dissatisfaction in PM&R.
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Affiliation(s)
- Andrew R Stephens
- University of Rochester Medical Center, Department of Physical Medicine and Rehabilitation, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Zachary L McCormick
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Taylor R Burnham
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Aaron Conger
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, USA
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McLaughlin CC, Boscoe FP. The geography of Medicare's hospital value-based purchasing in relation to market demographics. Health Serv Res 2023; 58:844-852. [PMID: 36755373 PMCID: PMC10315389 DOI: 10.1111/1475-6773.14141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE To illustrate the association between the sociodemographic characteristics of hospital markets and the geographic patterns of Medicare hospital value-based purchasing (HVBP) scores. DATA SOURCES AND STUDY SETTING This is a secondary analysis of United States hospitals with a HVBP Total Performance Score (TPS) for 2019 in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare database (4/2021 release) and American Community Survey (ACS) data for 2015-2019. STUDY DESIGN This is a cross-sectional study using spatial multivariable autoregressive models with HVBP TPS and component domain scores as dependent variables and hospital market demographics as the independent variables. DATA COLLECTION/EXTRACTION METHODS We calculated hospital market demographics using ZIP code level data from the ACS, weighted the 2019 CMS inpatient Hospital Service Area file. PRINCIPAL FINDINGS Spatial autoregressive models using eight nearest neighbors with diversity index, race and ethnicity distribution, families in poverty, unemployment, and lack of health insurance among residents ages 19-64 years provided the best model fit. Diversity index had the highest statistically significant contribution to lower TPS (ß = -12.79, p < 0.0001), followed by the percent of the population coded to "non-Hispanic, some other race" (ß = -2.59, p < 0.0023), and the percent of families in poverty (ß = -0.26, p < 0.0001). Percent of the population was non-Hispanic American Indian/Alaskan Native (ß = 0.35, p < 0.0001) and percent non-Hispanic Asian (ß = 0.12, p < 0.02071) were associated with higher TPS. Lower predicted TPS was observed in large urban cities throughout the US as well as in states throughout the Southeastern US. Similar geographic patterns were observed for the predicted Patient Safety, Person and Community Engagement, and Efficiency and Cost Reduction domain scores but are not for predicted Clinical Outcomes scores. CONCLUSIONS The lower predicted scores seen in cities and in the Southeastern region potentially reflect an inherent-that is, structural-association between market sociodemographics and HVBP scores.
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Affiliation(s)
- Colleen C. McLaughlin
- Department of Population Health SciencesAlbany College of Pharmacy and Health SciencesAlbanyNew YorkUSA
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Jones KC, Austad K, Silver S, Cordova-Ramos EG, Fantasia KL, Perez DC, Kremer K, Wilson S, Walkey A, Drainoni ML. Patient Perspectives of the Hospital Discharge Process: A Qualitative Study. J Patient Exp 2023; 10:23743735231171564. [PMID: 37151607 PMCID: PMC10159238 DOI: 10.1177/23743735231171564] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Care transitions after hospitalization require communication across care teams, patients, and caregivers. As part of a quality improvement initiative, we conducted qualitative interviews with a diverse group of 53 patients who were recently discharged from a hospitalization within a safety net hospital to explore how patient preferences were included in the hospital discharge process and differences in the hospital discharge experience by race/ethnicity. Four themes emerged from participants regarding desired characteristics of interactions with the discharge team: (1) to feel heard, (2) inclusion in decision-making, (3) to be adequately prepared to care for themselves at home through bedside teaching, (4) and to have a clear and updated discharge timeline. Additionally, participants identified patient-level factors the discharge planning team should consider, including the social context, family involvement, health literacy, and linguistic barriers. Lastly, participants identified provider characteristics, such as a caring and empathetic bedside manner, that they found valuable in the discharge process. Our findings highlight the need for shared decision-making in the discharge planning process to improve both patient safety and satisfaction.
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Affiliation(s)
- Kayla C Jones
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
| | - Kirsten Austad
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston
University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Santana Silver
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
| | - Erika G Cordova-Ramos
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Department of Pediatrics, Boston Medical Center, Evans Center for Implementation & Improvement Sciences
(CIIS), Boston University Chobanian & Avedisian School of Medicine, Boston, MA,
USA
| | - Kathryn L Fantasia
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Section of Endocrinology, Diabetes and
Nutrition, Department of Medicine, Boston University Chobanian & Avedisian
School of Medicine, Boston, MA, USA
| | - Daisy C Perez
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Kristen Kremer
- Department of Ambulatory Operations, Boston Medical Center, Boston, MA, USA
| | - Sophie Wilson
- Department of Quality and Patient Safety,
Boston Medical Center, Boston, MA, USA
| | - Allan Walkey
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Section of Pulmonary, Allergy, Critical
Care and Sleep, Department of Medicine, Boston University Chobanian & Avedisian
School of Medicine, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Evans Center for Implementation &
Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian
& Avedisian School of Medicine, Boston, MA, USA
- Section of Infectious Diseases,
Department of Medicine, Boston University Chobanian & Avedisian School of
Medicine, Boston, MA, USA
- Department of Health Law Policy &
Management, Boston University School of Public
Health, Boston, MA, USA
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McLaughlin CC. Why Did New York State Hospitals Rank So Poorly? Med Care 2023; 61:295-305. [PMID: 36929772 PMCID: PMC10079295 DOI: 10.1097/mlr.0000000000001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND According to the Centers for Medicare and Medicaid Services star ratings, New York State (NYS) hospitals are relatively poor performers, with 33% achieving 1 star compared with 5% of hospitals across the United States. OBJECTIVES We compared NYS hospitals to all United States hospitals using Centers for Medicare and Medicaid Services Hospital Value-Based Purchasing (HVBP) and star ratings component measures. We perform risk adjustment for hospital and market characteristics associated poor performance. RESEARCH DESIGN This was a cross-sectional observational study. SUBJECTS All acute care hospitals in the United States which had HVBP scores for 2019 in April 21, 2021, Hospital Care Compare database. MEASURES Analysis of variance was used to compare NYS hospitals to all United States hospitals. Multivariable-based risk adjustment was applied to NYS hospitals with adjustment for hospital characteristics (eg, occupancy, size), hospital fiscal ratios (eg, operating margin), and market characteristics (eg, percent of hospital market that has a high school diploma). RESULTS NYS hospitals averaged lower patient satisfaction and higher readmissions. These domains were statistically significantly associated with lower socioeconomic status in the hospital market area. Risk adjustment reduced but did not eliminate these differences. NYS also performed poorly on pressure ulcers and deep vein thrombosis/pulmonary embolism prevention. NYS hospitals were similar to the United States in mortality and hospital-acquired infections. CONCLUSIONS Differences in the demographic makeup of hospital markets account for some of the poor performance of NYS hospitals. Some aspects, such as long length of stay, may be associated with wider regional trends.
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Patient Satisfaction with Healthcare Services and the Techniques Used for its Assessment: A Systematic Literature Review and a Bibliometric Analysis. Healthcare (Basel) 2023; 11:healthcare11050639. [PMID: 36900644 PMCID: PMC10001171 DOI: 10.3390/healthcare11050639] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
Patient satisfaction with healthcare provision services and the factors influencing it are be-coming the main focus of many scientific studies. Assuring the quality of the provided services is essential for the fulfillment of patients' expectations and needs. Thus, this systematic review seeks to find the determinants of patient satisfaction in a global setting. We perform an analysis to evaluate the collected literature and to fulfill the literature gap of bibliometric analysis within this theme. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. We conducted our database search in Scopus, Web of Science, and PubMed in June 2022. Studies from 2000-2021 that followed the inclusion and exclusion criteria and that were written in English were included in the sample. We ended up with 157 articles to review. A co-citation and bibliographic coupling analysis were employed to find the most relevant sources, authors, and documents. We divided the factors influencing patient satisfaction into criteria and explanatory variables. Medical care, communication with the patient, and patient's age are among the most critical factors for researchers. The bibliometric analysis revealed the countries, institutions, documents, authors, and sources most productive and significant in patient satisfaction.
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Dowdle TS, Hayward D, Holder KG, Broadhead A, Pham MG, Tarbox MB. Relation of satisfaction score with payer class in dermatology patients. Proc AMIA Symp 2022; 36:41-44. [PMID: 36578585 PMCID: PMC9762798 DOI: 10.1080/08998280.2022.2116968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
As value-based reimbursement continues to grow as a means of compensation in the US healthcare system, ensuring effective evaluation of patient care is becoming increasingly important. The aim of this study was to systematically collect and review data to identify potential patient bias based on a nonmodifiable patient characteristic, payer type, in patient satisfaction scores from an academic dermatology clinic setting. This retrospective study used Press Ganey self-reported, deidentified patient satisfaction surveys completed at Texas Tech University Health Sciences Center's outpatient dermatology clinic between January 1, 2010, and December 21, 2021, with a total of 21,408 surveys included in the study. The results found the self-pay/uncompensated group reported the highest mean satisfaction score (96.25%), followed by other government (94.76%), Medicare (94.34%), commercial (92.82%), workers' comp (88.10%), and Medicaid (82.78%). Analysis of variance resulted in an F value of 3.02 (P < 0.01). This study confirmed the results of existing research suggesting that payer class significantly impacts patient experience scores.
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Affiliation(s)
- Travis S. Dowdle
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas,Corresponding author: Travis Dowdle, BS, School of Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Stop 9400, Lubbock, TX79430-9400 (e-mail: )
| | - Dan Hayward
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Katherine G. Holder
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Austin Broadhead
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Meredith G. Pham
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Michelle B. Tarbox
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
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Cha E, Mathis NJ, Joshi H, Sharma S, Zinovoy M, Ru M, Cahlon O, Gillespie EF, Marshall DC. Bias in Patient Experience Scores in Radiation Oncology: A Multicenter Retrospective Analysis. J Am Coll Radiol 2022; 19:542-551. [PMID: 35247326 PMCID: PMC9017791 DOI: 10.1016/j.jacr.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient experience scores are increasingly important in measuring quality of care and determining reimbursement from payers, including the Hospital Value-Based Purchasing Program and the Radiation Oncology Model. However, the role of bias in patient experience scores in oncology is unknown, raising the possibility that such payment structures may inadvertently perpetuate bias in reimbursement. Therefore, the authors characterized patient-, physician-, and practice-level predictors of patient experience scores in patients undergoing radiation therapy. METHODS The authors retrospectively reviewed patient experience surveys for radiation oncology patients treated at two large multisite academic cancer centers. The outcome was responses on four survey questions. Covariates included self-reported patient demographics, physician characteristics, practice setting characteristics, and wait-time rating linked to each survey. Multivariable ordinal regression models were fitted to identify predictors of receiving a higher score on each of the survey questions. RESULTS In total, 2,868 patients completed surveys and were included in the analysis. Patient experience scores were generally high, with >90% of respondents answering 5 of 5 on the four survey items. Physician gender was not associated with any measured patient experience outcomes (P > 0.40 for all). Independent predictors of higher score included a wait-time experience classified as "good" as compared with "not good" (q < .001 for all). CONCLUSIONS Oncology practices aiming to improve patient experience scores may wish to focus their attention on improving wait times for patients. Although a difference in patient experience scores on the basis of physician gender was not observed, such bias is likely to be complex, and further research is needed to characterize its effects.
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Affiliation(s)
- Elaine Cha
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Noah J Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Himanshu Joshi
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sonam Sharma
- Assistant Program Director, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Zinovoy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meng Ru
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Oren Cahlon
- Deputy Physician-in-Chief for Strategic Partnerships and Vice Chair, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Ho AF, Zhou Y, Kirby JJ, Rahman MM, Tessitore K, Abdel-Raziq Y, d'Etienne JP, Schrader CD, Wang H. Causal Effect Analysis of Demographic Concordance of Physician Trust and Respect in an Emergency Care Setting. Open Access Emerg Med 2021; 13:503-509. [PMID: 34824553 PMCID: PMC8610774 DOI: 10.2147/oaem.s334495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Patient perceptions of physician trust and respect are important factors for patient satisfaction evaluations. However, perceptions are subjective by nature and can be affected by patient and physician demographic characteristics. We aim to determine the causal effect on patient-physician demographic concordance and patient perceptions of physician trust and respect in an emergency care setting. Methods We performed a causal effect analysis in an observational study setting. A near-real-time patient satisfaction survey was sent via telephone to patients within 72 h of discharge from an emergency department (ED). Patient-trust-physician (PTP) and physician-show-respect (PSR) scores were measured. Patient and physician demographics (age, gender, race, and ethnicity) were matched. Causal effect was analyzed to determine the direct effect of patient-physician demographic concordance on PTP/PSR scores. Results We enrolled 1815 patients. The treatment effect of patient-physician age concordance on PTP scores was -0.119 (p = 0.036). Other treatment effect of patient-physician demographic concordance on patient perception of physician trust and respect ranged from -0.02 to -0.2 (p > 0.05). Conclusion Patient-physician age concordance may cause a negative effect on patient perception of physician trust. Otherwise, patient-physician demographic concordance has no effect on patient perceptions of physician trust and respect.
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Affiliation(s)
- Amy F Ho
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Yuan Zhou
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, Arlington, TX, 76019, USA
| | - Jessica J Kirby
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Md Mamunur Rahman
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, Arlington, TX, 76019, USA
| | - Kathryn Tessitore
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Yousef Abdel-Raziq
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - James P d'Etienne
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Chet D Schrader
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Hao Wang
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
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Cardinali F, Carzaniga S, Duranti G, Labella B, Lamanna A, Cerilli M, Caracci G, Carinci F. A nationwide participatory programme to measure person-centred hospital care in Italy: Results and implications for continuous improvement. Health Expect 2021; 24:1145-1157. [PMID: 34014021 PMCID: PMC8369125 DOI: 10.1111/hex.13231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/01/2021] [Accepted: 02/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patient-centredness has been targeted by the Italian government as a key theme for the future development of health services. OBJECTIVE Measuring patient-centred health services in partnership with citizens, health professionals and decision makers. DESIGN National participatory survey in a large test set of hospitals at national level. SETTING AND PARTICIPANTS A total of 387 hospital visits conducted in 16 Italian regions by over 1,500 citizens and health professionals during 2017-2018. MAIN VARIABLES AND OUTCOME MEASURES An ad hoc checklist was used to assess person-centredness in hospital care through 243 items, grouped in 4 main areas, 12 sub-areas and 29 person-centred criteria (scored 0-10). GEE linear multivariate regression was used to explore the relation between hospital characteristics and person-centredness. RESULTS Person-centred scores were moderately high, with substantial variation overall (median score: 7.0, range: 3.2-9.5) and by area (Care Processes: 6.8, 2.0-9.8; Access: 7.4, 2.7-9.7; Transparency: 6.7, 3.4-9.5 and Relationship: 7.3, 0.8-10.0). Multivariate regression found higher scores for increasing volumes of activity (quartile increase: +0.21; 95% CI: 0.13, 0.29) and lower scores in the south and islands (-1.03; -1.62,-0.45). DISCUSSION The checklist has been applied successfully by over 1,500 collaborators who assessed hospitals in 16 distinct Regions and Autonomous Provinces of Italy. Despite an overall positive mark, all scores were highly variable by location and hospital characteristics. CONCLUSION AND PATIENT OR PUBLIC CONTRIBUTION A national participatory programme to improve patient-centredness in Italian hospitals highlighted critical areas with the direct input of citizens.
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Affiliation(s)
- Flavia Cardinali
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Sara Carzaniga
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Giorgia Duranti
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Barbara Labella
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | | | - Micaela Cerilli
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Giovanni Caracci
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
| | - Fabrizio Carinci
- Italian National Agency for Regional Health Services (AGENAS)RomaItaly
- University of BolognaBolognaItaly
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Cramer N, Cantwell L, Ong H, Sivasankar SM, Graff D, Lawson SL, Wilson PM, Noorbakhsh KA, Mickley M, Zuckerbraun NS, Sobolewski B, Soung JK, Azhdam DB, Wagner Neville DN, Hincapie MR, Marin JR. Pediatric emergency medicine fellowship point-of-care ultrasound training in 2020. AEM EDUCATION AND TRAINING 2021; 5:e10643. [PMID: 34568713 PMCID: PMC8448484 DOI: 10.1002/aet2.10643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The primary objective was to survey pediatric emergency medicine (PEM) leaders and fellows regarding point-of-care ultrasound (POCUS) training in PEM fellowship programs, including teaching methods, training requirements, and applications taught. Secondary objectives were to compare fellows' and program leaders' perceptions of fellow POCUS competency and training barriers. METHODS This was a cross-sectional survey of U.S. PEM fellows and fellowship program leaders of the 78 fellowship programs using two online group-specific surveys exploring five domains: program demographics; training strategies and requirements; perceived competency; barriers, strengths, and weaknesses of POCUS training; and POCUS satisfaction. RESULTS Eighty-three percent (65/78) of programs and 53% (298/558) of fellows responded. All participating PEM fellowship programs included POCUS training in their curriculum. Among the 65 programs, 97% of programs and 92% of programs utilized didactics and supervised scanning shifts as educational techniques, respectively. Sixty percent of programs integrated numerical benchmarks and 49% of programs incorporated real-time, hands-on demonstration as training requirements. Of the 19 POCUS applications deemed in the literature as core requirements for fellows, at least 75% of the 298 fellows reported training in 13 of those applications. Although less than half of fellows endorsed competency for identifying intussusception, ultrasound-guided pericardiocentesis, and transvaginal pregnancy evaluation, a higher proportion of leaders reported fellows as competent for these applications (40% vs. 68%, p ≤ 0.001; 21% vs. 39%, p = 0.003; and 21% vs. 43%, p ≤ 0.001). Forty-six percent of fellows endorsed a lack of PEM POCUS evidence as a training barrier compared to 31% of leaders (p = 0.02), and 39% of leaders endorsed a lack of local financial support as a training barrier compared to 23% of fellows (p = 0.01). CONCLUSIONS Although most PEM fellowship programs provide POCUS training, there is variation in content and requirements. Training does conform to many of the expert recommended guidelines; however, there are some discrepancies and perceived barriers to POCUS training remain.
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Affiliation(s)
- Natan Cramer
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Lauren Cantwell
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Hilary Ong
- Department of Emergency Medicine and Trauma ServicesChildren's National HospitalWashingtonDCUSA
- Present address:
Department of Emergency MedicineUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | - Shyam M. Sivasankar
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
- Dell Medical School Department of PediatricsAustinTexasUSA
| | - Danielle Graff
- Division of Emergency MedicineDepartment of PediatricsNorton Children's HospitalUniversity of Louisville School of MedicineLouisvilleKentuckyUSA
| | - Simone L. Lawson
- Department of Emergency Medicine and Trauma ServicesChildren's National HospitalWashingtonDCUSA
| | - Paria M. Wilson
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Kathleen A. Noorbakhsh
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Megan Mickley
- Section of Pediatric Emergency MedicineDepartment of PediatricsChildren's Hospital ColoradoAuroraColoradoUSA
| | - Noel S. Zuckerbraun
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Brad Sobolewski
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jane K. Soung
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Devora B. Azhdam
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | | | - Mark R. Hincapie
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Jennifer R. Marin
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
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12
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Indovina KA, Keniston A, Manchala V, Burden M. Predictors of a Top-Box Patient Experience: A Retrospective Observational Study of HCAHPS Data at a Safety Net Institution. J Patient Exp 2021; 8:23743735211034342. [PMID: 34377774 PMCID: PMC8320559 DOI: 10.1177/23743735211034342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Kimberly A Indovina
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Venkata Manchala
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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13
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Stephens AR, Potter JW, Tyser AR, Kazmers NH. Evaluating the impact of social deprivation on Press Ganey® Outpatient Medical Practice Survey Scores. Health Qual Life Outcomes 2021; 19:167. [PMID: 34147118 PMCID: PMC8214262 DOI: 10.1186/s12955-020-01639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Social deprivation has been shown to affect access to health care services, and influences outcomes for a variety of physical and psychological conditions. However, the impact on patient satisfaction remains less clear. The objective of this study was to determine if social deprivation is an independent predictor of patient satisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). Methods We retrospectively reviewed unique new adult patient (≥ 18 years of age) seen at a tertiary academic hospital and rural/urban outreach hospitals/clinics between January 2014 and December 2017. Satisfaction was defined a priori as achieving a score above the 33rd percentile. The 2015 Area Deprivation Index (ADI) was used to determine social deprivation (lower score signifies less social deprivation). Univariate and multivariable binary logistic regression were used to determine the impact of ADI on PGOMPS total and provider sub-scores while controlling for variables previously shown to impact scores (wait time, patient age, sex, race, specialty type, provider type, and insurance status). Results Univariate analysis of PGOMPS total scores revealed a 4% decrease in odds of patient satisfaction per decile increase in ADI (p < 0.001). Patients within the most deprived quartile were significantly less likely to report satisfaction compared to the least deprived quartile (OR 0.79, p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction decreased 2% for each decile increase in ADI on the Total Score (p < 0.001), independent of other variables previously shown to impact scores. For PGOMPS Provider Sub-Score, univariate analysis showed that patients in the lowest ADI quartile were significantly less likely be satisfied, as compared to the least deprived quartile (OR 0.77; 95% CI 0.70–0.86; p < 0.001). A 5% decrease in a patient being satisfied was observed for each decile increase in ADI (OR 0.95; 95% CI 0.94–0.96; p < 0.001). Conclusions Social deprivation was an independent predictor of outpatient visit dissatisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey. These results necessitate consideration when developing health care delivery policies that serve to minimize inequalities between patients of differing socioeconomic groups.
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Affiliation(s)
- Andrew R Stephens
- School of Medicine, University of Utah, 30N 1900E, Salt Lake City, UT, 84132, USA.
| | - Jared W Potter
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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14
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Park C, Zakare-Fagbamila RT, Dickson W, Garcia AN, Gottfried ON. The limited influence of neurosurgeons' behavior on inpatient satisfaction: a retrospective multihospital analysis. J Neurosurg 2021; 134:1983-1989. [PMID: 32736359 DOI: 10.3171/2020.5.jns20923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/04/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a survey that assesses patient satisfaction, which is an important measure of the quality of hospital care and ultimately the overall hospital rating (OHR). However, the survey covers several elements of patient satisfaction beyond the patient-surgeon interaction. In this study, authors investigated which admission and experience factors had the highest impact on the OHR. METHODS This was a retrospective cohort analysis of HCAHPS surveys from patients who, in the period between August 1, 2016, and January 31, 2018, had been discharged from the neurosurgical or orthopedic service at three hospitals serving a single metropolitan area. The top-box score was defined as the highest rating obtainable for each survey question. Baseline admission attributes were obtained, and multivariate logistic regression was used to determine predictors of the top-box OHR. RESULTS After application of the inclusion and exclusion criteria, 1470 patients remained in the analysis. Categories on the HCAHPS included OHR, communication, education, environment, pain management, and responsiveness. After excluding identifying questions from the survey and adjusting for subspecialty and hospital, 7 of 17 HCAHPS survey items were significant predictors of OHR. Only 2 of these were related to the surgeon: 1) discharge, "Did you get information in writing about what symptoms or health problems to look out for after you left the hospital?" (OR 5.93, 95% CI 2.52-13.94); and 2) doctor, "Did doctors explain things in a way you could understand?" (OR 2.78, 95% CI 1.73-4.46). The top three strongest correlating items were 1) discharge; 2) nursing, "Did nurses treat you with courtesy and respect?" (OR 3.86, 95% CI 2.28-6.52); and 3) hospital environment, "Were your room and bathroom kept clean?" (OR 2.86, 95% CI 1.96-4.17). CONCLUSIONS The study findings demonstrated that there are several nonmodifiable factors (i.e., specialty, experience) and items that are not under the direct purview of the neurosurgeon (e.g., nursing communication, hospital environment) that are significant influences on overall inpatient satisfaction on the HCAHPS survey. Furthermore, components of the survey that ultimately influence the OHR vary across different hospitals. Hence, HCAHPS survey results should be broadly interpreted as a way to make health systems more aware of the overall hospital factors that can improve quality of care and patient experience.
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Affiliation(s)
- Christine Park
- 1Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | | | - Wes Dickson
- 3Department of Performance Services, Duke University Health System, Durham; and
| | - Alessandra N Garcia
- 4Division of Doctor of Physical Therapy, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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15
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Bari V, Hirsch JS, Narvaez J, Sardinia R, Bock KR, Oppenheim MI, Meytlis M. An approach to predicting patient experience through machine learning and social network analysis. J Am Med Inform Assoc 2021; 27:1834-1843. [PMID: 33104210 PMCID: PMC7727354 DOI: 10.1093/jamia/ocaa194] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/26/2020] [Accepted: 09/08/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Improving the patient experience has become an essential component of any healthcare system's performance metrics portfolio. In this study, we developed a machine learning model to predict a patient's response to the Hospital Consumer Assessment of Healthcare Providers and Systems survey's "Doctor Communications" domain questions while simultaneously identifying most impactful providers in a network. MATERIALS AND METHODS This is an observational study of patients admitted to a single tertiary care hospital between 2016 and 2020. Using machine learning algorithms, electronic health record data were used to predict patient responses to Hospital Consumer Assessment of Healthcare Providers and Systems survey questions in the doctor domain, and patients who are at risk for responding negatively were identified. Model performance was assessed by area under receiver-operating characteristic curve. Social network analysis metrics were also used to identify providers most impactful to patient experience. RESULTS Using a random forest algorithm, patients' responses to the following 3 questions were predicted: "During this hospital stay how often did doctors. 1) treat you with courtesy and respect? 2) explain things in a way that you could understand? 3) listen carefully to you?" with areas under the receiver-operating characteristic curve of 0.876, 0.819, and 0.819, respectively. Social network analysis found that doctors with higher centrality appear to have an outsized influence on patient experience, as measured by rank in the random forest model in the doctor domain. CONCLUSIONS A machine learning algorithm identified patients at risk of a negative experience. Furthermore, a doctor social network framework provides metrics for identifying those providers that are most influential on the patient experience.
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Affiliation(s)
- Vitej Bari
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Jamie S Hirsch
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York, USA.,Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Joseph Narvaez
- Office of Patient and Customer Experience, Northwell Health, Lake Success, New York, USA
| | - Robert Sardinia
- Office of Patient and Customer Experience, Northwell Health, Lake Success, New York, USA
| | - Kevin R Bock
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Michael I Oppenheim
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York, USA
| | - Marsha Meytlis
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
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16
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Belasen AR, Tracey MR, Belasen AT. Demographics matter: the potentially disproportionate effect of COVID-19 on hospital ratings. Int J Qual Health Care 2021; 33:6153811. [PMID: 33644795 PMCID: PMC7989431 DOI: 10.1093/intqhc/mzab036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/11/2021] [Accepted: 02/26/2021] [Indexed: 01/08/2023] Open
Abstract
Objective To identify how features of the community in which a hospital serves differentially relate to its patients' experiences based on the quality of that hospital. Design A Finite Mixture Model (FMM) is used to uncover a mix of two latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in either group. A multiple linear regression relates the characteristics of communities served by hospitals to the patients' expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. The analysis was conducted via Stata. Setting Hospital ratings are measured by Hospital Compare using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services for hospitals in the USA. Participants 2,816 Medicare-certified acute care hospitals across all US states. Intervention None. Main Outcome Measure Differences in the marginal impacts of key community demographics on patient experiences between the two groups of hospitals. Results We provide evidence that low-rated hospitals have much more variability in patient experience ratings than high-rated ones. Moreover, the experiences at low-rated hospitals are more sensitive to county demographic factors, which means exogenous shocks, like coronavirus disease-2019 (COVID-19), will likely affect these hospitals differently, as such shocks are known to disproportionately affect their communities. Conclusions Our results imply that low-rated hospitals with more variability in their HCAHPS responses are more likely to face adverse patient experiences due to COVID-19 than high-rated hospitals. Pandemics like COVID-19 create conditions that intensify the already high demands placed on hospitals and care providers and make it even more challenging to deliver quality care.
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Affiliation(s)
- Ariel R Belasen
- Department of Economics and Finance, Southern Illinois University Edwardsville, 3144 Alumni Hall, Edwardsville, IL 62026, USA
| | - Marlon R Tracey
- Department of Economics and Finance, Southern Illinois University Edwardsville, 3144 Alumni Hall, Edwardsville, IL 62026, USA
| | - Alan T Belasen
- MBA in Healthcare Leadership, SUNY Empire State College, 113 West Avenue, Saratoga Springs, NY 12866, USA
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17
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Becker B, Nagavally S, Wagner N, Walker R, Segon Y, Segon A. Creating a culture of quality: our experience with providing feedback to frontline hospitalists. BMJ Open Qual 2021; 10:e001141. [PMID: 33674345 PMCID: PMC7938999 DOI: 10.1136/bmjoq-2020-001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/14/2021] [Accepted: 02/16/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND One way to provide performance feedback to hospitalists is through the use of dashboards, which deliver data based on agreed-upon standards. Despite the growing trend on feedback performance on quality metrics, there remain limited data on the means, frequency and content of feedback that should be provided to frontline hospitalists. OBJECTIVE The objective of our research is to report our experience with a comprehensive feedback system for frontline hospitalists, as well as report the change in our quality metrics after implementation. DESIGN, SETTING AND PARTICIPANTS This quality improvement project was conducted at a tertiary academic medical centre among our hospitalist group consisting of 46 full-time faculty members. INTERVENTION OR EXPOSURE A monthly performance feedback report was distributed to provide ongoing feedback to our hospitalist faculty, including an individual dashboard and a peer comparison report, complemented by coaching to incorporate process improvement tactics into providers' daily workflow. MAIN OUTCOMES AND MEASURES The main outcome of our study is the change in quality metrics after implementation of the monthly performance feedback report RESULTS: The dashboard and rank order list were sent to all faculty members every month. An improvement was seen in the following quality metrics: length of stay index, 30-day readmission rate, catheter-associated urinary tract infections, central line-associated bloodstream infections, provider component of Healthcare Consumer Assessment of Healthcare Providers and Systems scores, attendance at care coordination rounds and percentage of discharge orders placed by 10:00. CONCLUSIONS Implementation of a monthly performance feedback report for hospitalists, complemented by peer comparison and guidance on tactics to achieve these metrics, created a culture of quality and improvement in the quality of care delivered.
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Affiliation(s)
- Brittany Becker
- Medical student, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sneha Nagavally
- Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nicholas Wagner
- Data analytics, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Rebekah Walker
- Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Yogita Segon
- Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ankur Segon
- Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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18
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Sisodia RC, Dewdney SB, Fader AN, Wethington SL, Melamed A, Von Gruenigen VE, Zivanovic O, Carter J, Cohn DE, Huh W, Wenzel L, Doll K, Cella D, Dowdy SC. Patient reported outcomes measures in gynecologic oncology: A primer for clinical use, part I. Gynecol Oncol 2021; 158:194-200. [PMID: 32580886 DOI: 10.1016/j.ygyno.2020.04.696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Rachel C Sisodia
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, United States of America.
| | - Summer B Dewdney
- Division of Gynecologic Oncology, Rush University Medical Center, Chicago, IL, United States of America
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Stephanie L Wethington
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Vivian E Von Gruenigen
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, United States of America
| | - Oliver Zivanovic
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, 8th Floor, New York, NY, 10065, United States of America
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, 8th Floor, New York, NY, 10065, United States of America
| | - David E Cohn
- Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH 43210, United States of America
| | - Warner Huh
- Department of Obstetrics and Gynecology, University and Alabama, Birmingham, AL, United States of America
| | - Lari Wenzel
- Universtiy of California, Irvine, United States of America
| | - Kemi Doll
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - David Cella
- Department of Medical Social Sciences and Robert H Lurie Comprehensive Cancer Center, Northwestern University, United States of America
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
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19
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Kumar P, Follen M, Huang CC, Cathey A. Using Laddering Interviews and Hierarchical Value Mapping to Gain Insights Into Improving Patient Experience in the Hospital: A Systematic Literature Review. J Patient Exp 2021; 7:1740-1747. [PMID: 33457638 PMCID: PMC7786779 DOI: 10.1177/2374373520942425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hospitals are continuously facing pressures to mitigate the gap between patient’s expectations and the quality of services provided. Now with Medicare reimbursements tied to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, institutions are attempting interventions to increase satisfaction scores. However, a standard framework to understand patient values and perceptions and subsequently translate it into reliable measures of patient satisfaction does not exist, particularly in the inpatient settings. This article highlights opportunity for the addition of qualitative customer value research to augment the information providers gain from HCAHPS scores and provide additional indicators that can be used in improving the patient experience. In this article, patient laddering interviews and hierarchical value mapping are reviewed as methodologies to understand patient core satisfaction values during their hospital stay. A systematic literature search was performed to identify articles addressing laddering interviews and hierarchical value mapping as applied to health care. Inclusion criteria involved studies relating to health care and using laddering interviews. Exclusion criteria included non-health-care studies. Only 3 studies were found eligible for this review. Our systematic review of literature revealed only few studies which may help to guide us to improve patient experience using laddering interviews. These interviews can help compose a personalized bedside survey which may be more meaningful than current widely used HCAHPS survey.
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Affiliation(s)
- Pankaj Kumar
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Michele Follen
- Department of Obstetrics and Gynecology, Kings County Hospital, New York City Health and Hospital Corporation, NY, USA
| | - Chi-Cheng Huang
- Section on Hospital Medicine, Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Amy Cathey
- Haslam College of Business, University of Tennessee, Knoxville, TN, USA
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20
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Silvera G, Hamadi H, Tafili A. Hands and gloves: The relationship between CEOs and organizational context in U.S. hospitals. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1870351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Geoffrey Silvera
- Department of Political Science, Health Services Administration Program, University of Auburn, Auburn, AL, USA
| | - Hanadi Hamadi
- Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
| | - Aurora Tafili
- Department of Health Services Administration, School of Health Professionals, University of Alabama at Birmingham, Birmingham, AL, USA
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21
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Okuda M, Yasuda A, Tsumoto S. An approach to exploring associations between hospital structural measures and patient satisfaction by distance-based analysis. BMC Health Serv Res 2021; 21:63. [PMID: 33441139 PMCID: PMC7805228 DOI: 10.1186/s12913-020-06050-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient satisfaction studies have explored domains of patient satisfaction, the determinants of domains, and score differences of domains by patient/hospital structural measures but reports on the structure of patient satisfaction with respect to similarities among domains are scarce. This study is to explore by distance-based analysis whether similarities among patient-satisfaction domains are influenced by hospital structural measures, and to design a model evaluating relationships between the structure of patient satisfaction and hospital structural measures. METHODS The Hospital Consumer Assessment of Healthcare Providers and Systems 2012 survey scores and their structural measures from the Hospital Compare website reported adjusted percentages of scale for each hospital. Contingency tables of nine measures and their ratings were designed based on hospital structural measures, followed by three different distance-based analyses - clustering, correspondence analysis, and ordinal multidimensional scaling - for robustness to identify homogenous groups with respect to similarities. RESULTS Of 4,677 hospitals, 3,711 (79.3%) met the inclusion criteria and were analyzed. The measures were divided into three groups plus cleanliness. Certain combinations of these groups were shown to be dependent on hospital structural measures. High value ratings for communication and low value ratings for medication explanation, quietness and staff responsiveness were not influenced by hospital structural measures, but the varied-ratings domain group similarities, including items such as global evaluation and pain management, were affected by hospital structural measures. CONCLUSIONS Distance-based analysis can reveal the hidden structure of patient satisfaction. This study suggests that hospital structural measures including hospital size, the ability to provide acute surgical treatment, and hospital interest in improving medical care quality are factors which may influence the structure of patient satisfaction.
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Affiliation(s)
- Masumi Okuda
- Nursing Department, Matsue Red Cross Hospital, 83-1 Horo-machi, 690-8506, Matsue, Shimane, Japan.
| | - Akira Yasuda
- Department of Medical Informatics, School of Medicine, Shimane University, 89-1 Enya-cho, 693-8501, Izumo, Shimane, Japan
| | - Shusaku Tsumoto
- Department of Medical Informatics, School of Medicine, Shimane University, 89-1 Enya-cho, 693-8501, Izumo, Shimane, Japan
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22
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The Impact of Social Deprivation on Orthopaedic Outpatient Satisfaction Using the Press Ganey Outpatient Medical Practice Survey. J Am Acad Orthop Surg 2020; 28:e1111-e1120. [PMID: 32235241 DOI: 10.5435/jaaos-d-19-00852] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION In orthopaedics, multiple factors (patient age, wait time, and depression) have been associated with lower Press Ganey Outpatient Medical Practice Survey (PGOMPS) patient satisfaction scores. We hypothesized that increased social deprivation is an independent predictor of lower patient satisfaction, as measured by the PGOMPS. METHODS We retrospectively reviewed unique new outpatient orthopaedic surgery visits between January 1, 2014, and December 31, 2016, at a single tertiary academic institution. Given the high ceiling effects, satisfaction was defined a priori as achieving a score above the 33rd percentile. Social deprivation was determined using the 2015 Area Deprivation Index (ADI). Univariate and multivariable binary logistic regressions were used to detect factors associated with patient satisfaction for both the PGOMPS Total Score and Provider Sub-Score. RESULTS Of the 4,881 included patients, the mean age was 53.3 ± 15.9 years, 59.3% were women, and mean ADI was 30.1 ± 19.2. Univariate analysis revealed a significantly decreased odds of achieving satisfaction on the Total Score for each decile increase in ADI (odds ratio [OR] 0.94; P < 0.001). Compared with the least deprived quartile, patients of the most deprived quartile were significantly less likely to report satisfaction for both the Total Score (OR 0.56; P = 0.001) and Provider Sub-Score (OR 0.63; P = 0.011). Multivariable analysis revealed that the odds of achieving satisfaction for each decile increase in ADI were 0.96 for the Total Score (P = 0.014) and 0.95 for the Provider Sub-Score (P = 0.004), independent of age, wait time, race, subspecialty, provider type, and the clinic setting. CONCLUSIONS Increased social deprivation was an independent predictor of orthopaedic outpatient dissatisfaction on the PGOMPS. These findings should be considered when interpreting patient satisfaction scores and lend further support in an effort to improve healthcare inequalities. LEVEL OF EVIDENCE Level III.
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23
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Chiou SJ, Lee LH, Lee PC, Lin KC. Better Self-report Health Status and Provider-Patient Communication in Dental Service Can Improve the Patient Experience: A Cross-year Comparison from the NHI Survey. HEALTH COMMUNICATION 2020; 35:1569-1575. [PMID: 31423836 DOI: 10.1080/10410236.2019.1652390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Several factors, including healthcare outcomes and quality, influence patients' expectations of healthcare services. Currently, as patients have more understanding about dental care services, patient satisfaction is essential for continually improving the services being provided. The purpose of this study is to analyze the multiyear annual National Health Insurance (NHI) patient experience survey in Taiwan to explore the factors associated with the satisfaction rate from 2012-2016. This study used the annual NHI survey to explore patients' experiences of receiving medical service in dental care from 2012 to 2016. There were over 40 major items in the survey each year; however, we only selected suitable items that followed the Andersen model. We ran a logistics regression testing the relationship between the covariates and the items related to satisfaction in outcomes in different years. Patients who received health education from a provider in most time, self-reported better health status, felt that cost of care was not expensive, did not wait too long for counseling time and found it easy to make an appointment, had two to ten times greater satisfaction in outcomes compared with those who did not (OR: 1.83-10.06). Individuals working in the healthcare industry should implement communication strategies to improve patients' experience in the care process by including easy-to-understand explanations or sharing decision-making with patients. Furthermore, in patient experience surveys in dental care, less attention should be paid to whether patients can provide meaningful quality measures and more attention to ways in which patient experiences can be improved. This can be achieved by providing easy-to-understand explanations, giving patients an opportunity to express their concerns, and by sharing decision-making with patients.
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Affiliation(s)
- Shang-Jyh Chiou
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences
| | - Li-Hui Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences
| | - Pei-Chen Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, National Yang-Ming University
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Perkins HS, Freed AA, Cortez JD, Hazuda HP. Inpatient Culture and Satisfaction With Care: A Novel Perspective. Am J Med Sci 2020; 361:226-232. [PMID: 33097197 DOI: 10.1016/j.amjms.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/17/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospital professionals must attend to patients' satisfaction with care. Along with technical quality of care, patients' personal characteristics may affect that satisfaction, but standard demographics research often overlooks cultural links. METHODS We, therefore, asked 58 San Antonio, Texas, inpatients their satisfaction with care and examined responses for attitudes related to ethnic-Mexican-American (MA), Euro-American (EA), or African-American (AA)-and gender cultures. RESULTS Many attitudes occurred widely. Most respondents expected doctors to attend them faithfully, inform them honestly, and pursue their needs and wishes singularly. Most also trusted doctors, and expressed satisfaction with doctors' generally exemplary character and service ethic. But most respondents also feared hospital treatments, and some expressed dissatisfaction that doctors had inadequately informed them or ignored their wishes. Only rare attitudes distinguished particular ethnic-gender groups. Unlike other groups few EA or AA men expressed dissatisfactions. But some MA and EA women said hospitals use too many caregivers or coordinate care poorly. Furthermore, most AA women expressed no explicit trust in doctors, and most EA women expressed actual distrust of doctors, often doubting their technical competence or altruism. CONCLUSIONS These findings suggest a novel perspective: a unique inpatient culture, largely unaffected by ethnic group or gender. Patients interpret their hospital experience through that culture. Hospital professionals might respond with both universal measures (addressing patients' fears, dissatisfactions, and distrust) and targeted ones (explicitly asking EA and AA men about dissatisfactions, and AA and EA women about distrust). Such culturally grounded measures may help maintain or increase inpatients' satisfaction.
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Affiliation(s)
- Henry S Perkins
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas; Ecumenical Center for Religion and Health, San Antonio, Texas; Ecumenical Center for Religion and Health, Cincinnati, Ohio.
| | - Alisa A Freed
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas; South Shore Medical Center, South Shore Health System, Norwell, Massachusetts
| | - Josie D Cortez
- Intercultural Development Research Association, San Antonio, Texas
| | - Helen P Hazuda
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas
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Dermatologist demographics and patient satisfaction: A single-center survey study. Int J Womens Dermatol 2020; 6:290-293. [PMID: 33015289 PMCID: PMC7522901 DOI: 10.1016/j.ijwd.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/01/2022] Open
Abstract
Background Patient satisfaction is a proxy for quality clinical care. Understanding the factors that drive patient satisfaction scores is important because they are publicly reported, may be used in determining hospital and physician compensation, and may allow patients to preselect physicians. Objective This single-center survey study of adult patients at the Michigan Medicine outpatient dermatology clinics aimed to investigate how patients respond differently to theoretical dermatologic scenarios with varying dermatologist gender. Methods Each questionnaire contained one of four clinical scenarios illustrating overall positive or negative encounters with a male or female dermatologist, followed by questions derived from the Press Ganey survey to assess patient satisfaction. Results A total of 452 completed questionnaires were collected. There were statistically significant differences in overall patient satisfaction scores between positive versus negative female and positive versus negative male dermatologists, but there were no differences in scores between positive female and positive male dermatologists or between negative female and negative male dermatologists. There were also no differences in overall scores after controlling for patient demographic characteristics or patient–dermatologist gender concordance. Conclusion Previous studies have suggested that male physicians receive better patient satisfaction scores compared to female physicians. However, our study found that, in response to hypothetical scenarios of positive and negative dermatology encounters, dermatologist gender did not affect any domain of patient satisfaction scores. Limitations include the use of hypothetical patient–dermatologist encounters and possible lack of generalizability because the study was conducted at one academic center in southeast Michigan with a predominantly Caucasian patient population.
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Wu Y, Mu J, Zhang S. Evaluating Patient Satisfaction in Township Hospitals in the Cold Regions of China. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:145-160. [PMID: 32938234 DOI: 10.1177/1937586720958016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study focused on township hospitals in the cold regions of China and aimed to evaluate patient satisfaction during the medical care process. This study also discusses the correlation between patient needs and satisfaction. BACKGROUND Hospitals seek to improve patient satisfaction to provide better service. However, there is a lack of existing literature on grassroots medical institutions in towns and townships, especially in cold regions. Therefore, this study aimed to examine the correlation between patient needs and the satisfaction of township hospitals in the cold regions of China. METHODS First, a hierarchical task analysis method was used to build the hierarchy for patient satisfaction demands. Patients from 15 township hospitals in cold areas were subjected to semistructured interviews, and a theoretical model was proposed using the grounded theory method. Finally, each open code index was evaluated, and 270 questionnaires were issued to evaluate patient satisfaction. RESULTS The framework for patient satisfaction demands included five dimensions: tangibles, reliability, responsiveness, assurance, and empathy. A theoretical model for patient satisfaction demands was built, and four selective codes, including "Characteristic", "Perceived Quality", "Loyalty Intention", and "Environment Expectation", were extracted. The weights of these satisfaction-influencing factors were subsequently evaluated. CONCLUSIONS This study summarizes the existing problems in a basic health service provision capacity, climate adaptability, lack of environmental design, and so on; proposes four influencing factors; establishes a patient satisfaction evaluation model; and obtains the weight of influence of each factor. These results will help provide accurate and effective suggestions for hospital management.
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Affiliation(s)
- Yue Wu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
| | - Jingyi Mu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
| | - Shanshan Zhang
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, School of Architecture, 47822Harbin Institute of Technology, China
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Bauer J, Klingelhöfer D, Maier W, Schwettmann L, Groneberg DA. Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility. Int J Health Geogr 2020; 19:29. [PMID: 32718317 PMCID: PMC7384227 DOI: 10.1186/s12942-020-00223-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background The adequate allocation of inpatient care resources requires assumptions about the need for health care and how this need will be met. However, in current practice, these assumptions are often based on outdated methods (e.g. Hill-Burton Formula). This study evaluated floating catchment area (FCA) methods, which have been applied as measures of spatial accessibility, focusing on their ability to predict the need for health care in the inpatient sector in Germany. Methods We tested three FCA methods (enhanced (E2SFCA), modified (M2SFCA) and integrated (iFCA)) for their accuracy in predicting hospital visits regarding six medical diagnoses (atrial flutter/fibrillation, heart failure, femoral fracture, gonarthrosis, stroke, and epilepsy) on national level in Germany. We further used the closest provider approach for benchmark purposes. The predicted visits were compared with the actual visits for all six diagnoses using a correlation analysis and a maximum error from the actual visits of ± 5%, ± 10% and ± 15%. Results The analysis of 229 million distances between hospitals and population locations revealed a high and significant correlation of predicted with actual visits for all three FCA methods across all six diagnoses up to ρ = 0.79 (p < 0.001). Overall, all FCA methods showed a substantially higher correlation with actual hospital visits compared to the closest provider approach (up to ρ = 0.51; p < 0.001). Allowing a 5% error of the absolute values, the analysis revealed up to 13.4% correctly predicted hospital visits using the FCA methods (15% error: up to 32.5% correctly predicted hospital). Finally, the potential of the FCA methods could be revealed by using the actual hospital visits as the measure of hospital attractiveness, which returned very strong correlations with the actual hospital visits up to ρ = 0.99 (p < 0.001). Conclusion We were able to demonstrate the impact of FCA measures regarding the prediction of hospital visits in non-emergency settings, and their superiority over commonly used methods (i.e. closest provider). However, hospital beds were inadequate as the measure of hospital attractiveness resulting in low accuracy of predicted hospital visits. More reliable measures must be integrated within the proposed methods. Still, this study strengthens the possibilities of FCA methods in health care planning beyond their original application in measuring spatial accessibility.
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Affiliation(s)
- J Bauer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
| | - D Klingelhöfer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - W Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - L Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, 06099, Halle an der Saale, Germany
| | - D A Groneberg
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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Early Performance of Hospital Value-based Purchasing Program in Medicare: A Systematic Review. Med Care 2020; 58:734-743. [PMID: 32692140 DOI: 10.1097/mlr.0000000000001354] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Under the Affordable Care Act, the Centers for Medicare and Medicaid Services has greatly expanded inpatient fee-for-value programs including the Hospital Value-based Purchasing (HVBP) program. Existing evidence from the HVBP program is mixed. There is a need for a systematic review of the HVBP program to inform discussions on how to improve the program's effectiveness. OBJECTIVE To review and summarize studies that evaluated the HVBP program's impact on clinical processes, patient satisfaction, costs and outcomes, or assessed hospital characteristics associated with performance on the program. DESIGN We searched the MEDLINE/PubMed, Scopus, ProQuest database for literature published between January 2013 and July 2019 using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. RESULTS Of 988 studies reviewed, 33 studies that met the selection criteria were included. A small group of studies (n=7) evaluated the impact of the HVBP program, and no impact on processes or patient outcomes was reported. None of the included studies evaluated the effect of HVBP program on health care costs. Other studies (n=28) evaluated the hospital characteristics associated with HVBP performance, suggesting that safety-net hospitals reportedly performed worse on several quality and cost measures. Other hospital characteristics' associations with performance were unclear. CONCLUSIONS Our findings suggest that the current HVBP does not lead to meaningful improvements in quality of care or patient outcomes and may negatively affect safety-net hospitals. More rigorous and comprehensive adjustment is needed for more valid hospital comparisons.
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Nepal S, Keniston A, Indovina KA, Frank MG, Stella SA, Quinzanos-Alonso I, McBeth L, Moore SL, Burden M. What Do Patients Want? A Qualitative Analysis of Patient, Provider, and Administrative Perceptions and Expectations About Patients' Hospital Stays. J Patient Exp 2020; 7:1760-1770. [PMID: 33457641 PMCID: PMC7786759 DOI: 10.1177/2374373520942403] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patient experience is increasingly recognized as a measure of health care quality and patient-centered care and is currently measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS survey may miss key factors important to patients, and in particular, to underserved patient populations. We performed a qualitative study utilizing semi-structured interviews with 45 hospitalized English- and Spanish-speaking patients and 6 focus groups with physicians, nurses, and administrators at a large, urban safety-net hospital. Four main themes were important to patients: (1) the hospital environment including cleanliness and how hospital policies and procedures impact patients’ perceived autonomy, (2) whole-person care, (3) communication with and between care teams and utilizing words that patients can understand, and (4) responsiveness and attentiveness to needs. We found that several key themes that were important to patients are not fully addressed in the HCAHPS survey and there is a disconnect between what patients and care teams believe patients want and what hospital policies drive in the care environment.
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Affiliation(s)
- Sansrita Nepal
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Both the authors are first co-authors
| | - Angela Keniston
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Both the authors are first co-authors
| | - Kimberly A Indovina
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maria G Frank
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah A Stella
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Itziar Quinzanos-Alonso
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lauren McBeth
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Susan L Moore
- Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA.,Division of General Internal Medicine, University of Colorado, Aurora, CO, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Renee Rutter S, Park SH. Relationship between Hospital Characteristics and Value-Based Program Measure Performance: A Literature Review. West J Nurs Res 2020; 42:1010-1021. [PMID: 32443959 DOI: 10.1177/0193945920920180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Determining if the Centers for Medicare and Medicaid's value-based programs accurately represent the quality of care provided by acute-care hospitals is critical. We performed an integrative literature review to summarize research articles examining hospital characteristics associated with overall performance on the value-based program measures. The literature review was conducted by searching the PubMed and CINAHL databases. The initial search returned 18 relevant articles, 12 of which met all inclusion criteria. The emergent hospital characteristics that heavily influenced value-based program performance included size, safety-net status, geographical location, and teaching status. This review determined that many factors largely outside of acute-care hospitals' control create observed differences in value-based program performance. Additional factors such as a hospital's patient populations, socioeconomic status, and level of acuity may need to be considered prior to assigning financial penalties to under-performing hospitals.
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Affiliation(s)
| | - Shin Hye Park
- University of Kansas Medical Center School of Nursing, Kansas City, KS, USA
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31
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Dibble EH, Ryan VM, Baird GL, Swenson DW, Healey TT. Psychometric Validation of a Nonproprietary Survey of Patient Satisfaction for Use in Outpatient Radiology Centers. J Am Coll Radiol 2020; 17:423-432. [DOI: 10.1016/j.jacr.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
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Abstract
INTRODUCTION Hospital Value-Based Purchasing (HVBP) is an initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide. A hospital's trauma certification has the potential to influence HVBP scores as attaining the certification provides indication of the service quality offered by the hospital. As such, this study focuses on hospitals' level of trauma certification attainment through the American College of Surgeons and whether this certification is associated with greater HVBP. METHODS A retrospective review of the 2015 HVBP database, 2015 Area Health Resources Files (AHRF) database, and the 2015 American Hospital Association (AHA) database is utilized, and propensity score matching was employed to determine the association between level of trauma certification and scores on HVBP dimensions. RESULTS Results reveal trauma certification is associated with lower HVBP domain scores when compared to hospitals without trauma certification. In addition, hospitals with a greater degree of trauma specialization were associated with lower total performance score and efficiency domain scores. CONCLUSIONS Although payers attempt to connect hospital reimbursements with quality and outcomes, unintended consequences may occur. In response to these results, HVBP risk adjustment and scoring methods should receive further scrutiny.
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Hu L, Ding H, Liu S, Wang Z, Hu G, Liu Y. Influence of patient and hospital characteristics on inpatient satisfaction in China's tertiary hospitals: A cross-sectional study. Health Expect 2019; 23:115-124. [PMID: 31637800 PMCID: PMC6978851 DOI: 10.1111/hex.12974] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/23/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patient satisfaction has been seen as a key criterion when evaluating hospitals and is one of the main focuses of the current health-care reform in China. This paper aimed to explore patient- and hospital-level factors associated with inpatient satisfaction, which can provide policy implications for the evaluation and development of a patient-oriented health-care system. METHODS The paper analyses data from the 2017 China National Patient Survey which includes 20 300 inpatients from 131 tertiary hospitals across 31 provinces. Descriptive analysis and multivariable logistic regressions are conducted to identify key factors related to satisfaction. RESULTS Patient sociodemographic characteristics, including gender, age, income and insurance type, are found to be strongly associated with their satisfaction of inpatient experience. In terms of institutional characteristics, hospital type, size, staffing and financial performance are also significantly correlated with inpatient satisfaction. Patients are more satisfied with specialist hospitals and large hospitals measured by the number of beds and surgeries. Hospitals with higher nurse-to-bed ratio also receive more satisfaction. The financial performance of hospitals, however, is negatively associated with satisfaction. CONCLUSION Patient satisfaction contains unique information on service quality and thus should be incorporated into the matrix of hospital evaluation. Meanwhile, differences in patient composition must be adjusted to make fair comparisons across hospitals. Moreover, future reform needs to put greater efforts in the design of comprehensive public insurance scheme, efficient hospital structure and an overall well-functioning health-care delivery system in order to better serve patients in China.
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Affiliation(s)
- LinLin Hu
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hui Ding
- Department of Economics, Stanford University, Stanford, California
| | - Shiyang Liu
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zijuan Wang
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guangyu Hu
- Institute for Medical Information, Chinese Academy of Medical Science, Beijing, China
| | - Yuanli Liu
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Hoonpongsimanont W, Sahota PK, Chen Y, Nguyen M, Louis C, Pena J, Wong A, Jen M. Emergency department patient experience: Same location, same provider, different scores by different survey methods. World J Emerg Med 2019; 10:138-144. [PMID: 31171943 DOI: 10.5847/wjem.j.1920-8642.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent findings on emergency department (ED) patient experience surveys and concerns for the low response rates challenge the quality and reliability of the survey reports. We assessed the consistency of an ED patient experience survey report and identified the effects of patient demographics on ED patient experiences. METHODS We conducted a prospective, cross-sectional study at a university-based ED from July to December 2017. We obtained ED patient experience scores from an institutional version (IS) survey and the Press Ganey Associates-distributed survey (PGA). We compared top box scores from the two reports using frequency analysis and performed multivariable logistic regressions to identify associations between IS patient demographics and scores. RESULTS We obtained 289 PGA and 234 IS responses. The IS reported significant, higher top box scores in doctor-specific patient questions compared to PGA (all four P-values < 0.01). Female, Christian and White patients were more likely to give top box scores (OR 3.07, OR 2.22 and OR 2.41, P-value < 0.05, respectively). CONCLUSION We found significant differences in ED patient experience scores between the IS and PGA surveys. We recommend that healthcare providers consider patient demographic variables when interpreting ED experience score reports. Multiple survey techniques and distribution methods may be adopted to best capture ED patient experiences.
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Affiliation(s)
| | - Preet Kaur Sahota
- Department of Emergency Medicine, University of California, Orange, CA, USA
| | - Yanjun Chen
- Institute for Clinical and Translational Sciences, University of California, Irvine, CA, USA
| | - Maria Nguyen
- Department of Emergency Medicine, University of California, Orange, CA, USA
| | - Christine Louis
- Department of Emergency Medicine, University of California, Orange, CA, USA
| | - Jonathan Pena
- Department of Emergency Medicine, University of California, Orange, CA, USA
| | - Andrew Wong
- Department of Emergency Medicine, University of California, Orange, CA, USA
| | - Maxwell Jen
- Department of Emergency Medicine, University of California, Orange, CA, USA
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Zikos D, Massaria K, Graziano M, DeLellis N. Multifactorial analysis to examine drivers of CMS summary star ratings in home health agencies. Home Health Care Serv Q 2019; 38:43-60. [PMID: 31010406 DOI: 10.1080/01621424.2019.1604459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This cross-sectional study examines factors associated with the CMS Summary Star Ratings in Home Health Agencies (HHA). Using Home Health Compare, medical claims, and census data, negative binomial regression analysis was conducted at the HHA level. Positive associations were found between Summary Star Ratings and beneficiary age, the number of claims, the proportion for specific diagnoses, the agency being hospital based, HHA age since establishment, patient retainment, improved walking/moving/bathing, and homeownership. Negative associations were found for specific ICD diagnosis proportions, HHAs serving special populations, the rate of non-white patients, patients transferred to different HHAs, income, and marital status in the coverage area. These findings are relevant to both practitioners and policymakers, in that they highlight major non-service factors associated with perceived quality of care.
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Affiliation(s)
- Dimitrios Zikos
- a College of Health Sciences , Central Michigan University , Mount Pleasant , USA
| | - Katelyn Massaria
- a College of Health Sciences , Central Michigan University , Mount Pleasant , USA
| | - Marcello Graziano
- b College of Science and Engineering & Institute for Great Lakes Research , Central Michigan University , Mount Pleasant , USA
| | - Nailya DeLellis
- a College of Health Sciences , Central Michigan University , Mount Pleasant , USA
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Lee B, Hollenbeck-Pringle D, Goldman V, Biondi E, Alverson B. Are Caregivers Who Respond to the Child HCAHPS Survey Reflective of All Hospitalized Pediatric Patients? Hosp Pediatr 2019; 9:162-169. [PMID: 30709907 DOI: 10.1542/hpeds.2018-0139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The Child Hospital Consumer Assessment of Healthcare Providers and Systems (C-HCAHPS) survey was developed to measure satisfaction levels of pediatric inpatients' caregivers. Studies in adults have revealed that certain demographic groups (people of color or who are multiracial and people with public insurance) respond to surveys at decreased rates, contributing to nonresponse bias. Our primary goal was to determine if results from the C-HCAHPS survey accurately reflect the intended population or reveal evidence of nonresponse bias. Our secondary goal was to examine whether demographic or clinical factors were associated with increased satisfaction levels. METHODS This was a retrospective cohort study of responses (n = 421) to the C-HCAHPS survey of patients admitted to a tertiary-care pediatric hospital between March 2016 and March 2017. Respondent demographic information was compared with that of all hospital admissions over the same time frame. Satisfaction was defined as "top-box" scores for questions on overall rating and willingness to recommend the hospital. RESULTS Caregivers returning surveys were more likely to be white, non-Hispanic, and privately insured (P < .001). Caregivers with the shortest emergency department wait times were more likely to assign top-box scores for global rating (P = .025). We found no differences in satisfaction between race and/or ethnicity, length of stay, insurance payer, or total cost. CONCLUSIONS Caregivers who identified with underrepresented minority groups and those without private insurance were less likely to return surveys. Among the surveys received, short emergency department wait time and older age were the only factors measured that were associated with higher satisfaction. Efforts to increase patient satisfaction on the basis of satisfaction scores may exacerbate existing disparities in health care.
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Affiliation(s)
- Brian Lee
- Hasbro Children's Hospital, Providence, Rhode Island;
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | | | - Victoria Goldman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Eric Biondi
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Brian Alverson
- Hasbro Children's Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
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Factors Driving Patient Perception of Quality Care After Primary Total Hip and Total Knee Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e061. [PMID: 30656258 PMCID: PMC6324905 DOI: 10.5435/jaaosglobal-d-18-00061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Differences in female and male patient perception of care and satisfaction following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) were assessed via Hospital Consumer Assessment of Healthcare Providers and Systems survey, demographic, and clinical data. Methods: After institutional review board approval, a retrospective review of the Hospital Consumer Assessment of Healthcare Providers and Systems survey responses at a private, academic, level-I trauma center was performed from January 2011 to December 2013. Inclusion criteria were primary THA and TKA patients who were 18 years or older and returned the survey. Results: Overall, 1,166 THA and 1,411 TKA were included, with 55.0% of female THA patients and 64.5% of male THA patients highly satisfied (P = 0.002). The mean overall hospital rating was 7.2 for female THA and 7.8 for male THA (P = 0.003) patients. No significant differences was found in the TKA cohort. For all cohorts, the Nurse Communication with Nurses domain reported the greatest correlation with overall hospital rating (range, ρ = 0.418 to ρ = 0.502; P < 0.0001). Discussion: This series indicated that initiatives to improve patient care and patient perception of care should focus on nurse-patient communication, hospital staff responsiveness, the care transition process, and hospital environment. Patient sex was a significant factor in the overall satisfaction for THA, with female patients reporting significantly lower ratings than male patients.
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Chen AS, Revere L, Ratanatawan A, Beck CL, Allo JA. A Comparative Analysis of Academic and Nonacademic Hospitals on Outcome Measures and Patient Satisfaction. Am J Med Qual 2018; 34:367-375. [PMID: 30246541 DOI: 10.1177/1062860618800586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Academic hospitals contribute to health care through patient care, research, and teaching; however, their outcomes may not be equivalent to nonacademic hospitals. Multivariate analysis of variance is used to compare publicly reported data on patient satisfaction, readmission rates, mortality rates, and hospital-acquired injury scores between 1906 academic and nonacademic hospitals, while controlling for hospital-level covariates. Results show that academic hospitals have higher levels of patient satisfaction on 7 of the 11 measures and are equivalent to nonacademic hospitals on the remaining 4 measures. Academic hospitals have lower pneumonia mortality rates than nonacademic hospitals, with no difference for other mortality or disease-specific readmissions. However, academic hospitals have a slightly higher overall readmission rate. Infection rates were equivalent between academic and nonacademic hospitals for central line-associated bloodstream infections, pressure ulcers, and wound dehiscence for abdominal and pelvic injuries, but academic hospitals have higher catheter-associated urinary tract infection rates.
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Affiliation(s)
- Alissa S Chen
- 1 The University of Texas Health Science Center at Houston, TX
| | - Lee Revere
- 1 The University of Texas Health Science Center at Houston, TX
| | | | | | - Julio A Allo
- 3 The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
BACKGROUND Centers for Medicare & Medicaid Services reimbursement is now contingent on quality measures such as patient satisfaction as determined by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). In providing patient-centered care that is guided by patient satisfaction measures, it is critical to understand system-level factors that may influence how patients assess their care experiences. One important system-level influence to consider is hospital size. METHODS HCAHPS scores, number of hospital beds, and nursing magnet status were obtained from publically available Hospital Compare, American Hospital Directory, and Magnet Hospitals Web sites, respectively. An aggregate score for patient satisfaction was created across all domains of the HCAHPS. Multilevel regression modeling was performed to examine the associations between hospital size and HCAHPS aggregate and individual dimensions. RESULTS Hospital size was significantly associated with patient satisfaction such that larger size was associated with lower satisfaction (β = -.312, P < .001). Hospital size was most strongly associated with less patient satisfaction on the following HCAHPS items: "receiving help as soon as needed" (β = -.441, P < .001), "room and bathroom cleanliness" (β = -.286, P < .001), and doctor communication (β = -.213, P < .001), whereas nurse communication (β = .194, P < .001) was the one modifiable dimension that was associated with more favorable ratings in larger hospitals. Magnet nursing designation was significantly associated with larger hospital size (P < .001). CONCLUSION Patient satisfaction scores may be lower in large hospitals because of patients' perceptions of hospital cleanliness, receiving help on time, and doctor communication. Focusing on improving these factors may improve patient satisfaction scores for larger hospitals.
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Abstract
The objective was to examine associations between patient experience, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and the sociodemographic, cultural, and access-to-care factors of the surrounding community. Using an empty model, this study found that 27% of the variation in HCAHPS scores was at the level of the county in which the hospital was located. The county factors examined explained about half of this county-level variation. Among community factors most strongly associated with increased HCAHPS scores were higher numbers of primary care physicians per capita, fewer specialists per capita, and smaller percentages of African Americans and Hispanics in the county. A number of community factors beyond the hospitalization experience may influence HCAHPS scores. As HCAHPS gains importance as a measure of quality of care and is linked to higher payments over time, it will be essential to understand the possible effects of community factors.
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Affiliation(s)
- Jeph Herrin
- Yale University, New Haven, CT
- Health Research & Educational Trust/American Hospital Association, Chicago, IL
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Papanicolas I, Figueroa JF, Orav EJ, Jha AK. Patient Hospital Experience Improved Modestly, But No Evidence Medicare Incentives Promoted Meaningful Gains. Health Aff (Millwood) 2018; 36:133-140. [PMID: 28069856 DOI: 10.1377/hlthaff.2016.0808] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The Centers for Medicare and Medicaid Services (CMS) has played a leading role in efforts to improve patients' experiences with hospital care. Yet little is known about how much patient experience has changed over the past decade, and even less is known about the impact of CMS's most recent strategy: tying payments to performance under the Value-Based Purchasing (VBP) program. We examined trends in multiple measures of patient satisfaction in the period 2008-14. We found that patient experience has improved modestly at US hospitals-both those participating in the VBP program and others-with the majority of improvement concentrated in the period before the program was implemented. While certain subsets of hospitals improved more than others, we found no evidence that the program has had a beneficial effect. As policy makers continue to promote value-based payment as a way to improve patient experience, it will be critical to ensure that payment is structured in ways that actually drive improvement.
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Affiliation(s)
- Irene Papanicolas
- Irene Papanicolas is an assistant professor of health economics in the Department of Social Policy at the London School of Economics, in London, England. At the time of this writing, she was a 2015-16 Harkness Fellow in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - José F Figueroa
- José F. Figueroa is a physician in the Department of Medicine at Brigham and Women's Hospital and an instructor of medicine at Harvard Medical School, both in Boston
| | - E John Orav
- E. John Orav is an associate professor of biostatistics at the Harvard T. H. Chan School of Public Health
| | - Ashish K Jha
- Ashish K. Jha is the K. T. Li Professor of International Health at the Harvard T. H. Chan School of Public Health and director of the Harvard Global Health Institute, in Cambridge, Massachusetts
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Association of Magnet Status and Nurse Staffing With Improvements in Patient Experience With Hospital Care, 2008–2015. Med Care 2018; 56:111-120. [DOI: 10.1097/mlr.0000000000000854] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wallace S, Hanson KT, Dowdy SC, Habermann EB. Impact of surgical approach and patient factors on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scoring in gynecologic surgery. Gynecol Oncol 2018; 148:28-35. [DOI: 10.1016/j.ygyno.2017.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/05/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
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Engaging Survivors of Critical Illness in Health Care Assessment and Policy Development. Ethical and Practical Complexities. Ann Am Thorac Soc 2017; 13:1871-1876. [PMID: 27574861 DOI: 10.1513/annalsats.201606-497oi] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Health systems, granting agencies, and professional societies are increasingly involving patients and their family members in the delivery of health care and the improvement of health sciences. This is a laudable advance toward fully patient-centered medicine. However, patient engagement is not a simple matter, either practically or ethically. The complexities include (1) the physical limitations that patients and their family members may have, from traveling to meetings to special dietary needs; (2) the emotional sensitivities patients and their families might experience-from distress at discussions of disease prognosis, outcomes, and therapies to being inexperienced at public speaking; and (3) the fact that advocacy efforts by patients and family members, which may be encouraged at the national level, may threaten individual professionals providing care to individual patients and may result in risk to patients. In this article, a patient-physician and patient-bioethicist set out the obstacles, including ones that they have encountered in their own advocacy efforts. The aim is to survey the practical and ethical landscape so that solutions to various problems may be identified and solved as we move forward in our efforts to involve patients and their families in research, policy, and quality improvement in critical care medicine.
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Impact of Cross-level Measurement Noninvariance on Hospital Rankings Based on Patient Experiences With Care in 7 European Countries. Med Care 2017; 55:e150-e157. [PMID: 29135779 DOI: 10.1097/mlr.0000000000000580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospital-level findings on patient experiences with care are increasingly reported publicly. A critical aspect left unexamined is the commonality of composite measures of patient experiences across different groups of patients, nursing units, hospitals, and countries. Absence of commonality is termed measurement noninvariance and is hypothesized to have a strong impact on performance assessment. AIM The aim of this study is to examine measurement invariance across groups and levels under study (patients, nursing units, hospitals, and countries) and illustrate the degree to which this method of analysis impacts hospital rankings. RESEARCH DESIGN Data were collected from 11,289 patients in 7 European countries, 186 hospitals, and 824 nursing units. Multilevel factor analytic models were applied to evaluate measurement invariance across the hierarchical levels of the study and across groups at specific levels (self-perceived health at patient level; unit speciality at nursing unit level). Hospital rankings for the final multilevel model were compared with those from a single-level factor model that is unsuspecting of measurement invariance. RESULTS Cross-group invariance was shown for levels of self-perceived health and to a large degree also for nursing unit speciality. Patient experience composite measures were, however, not invariant across patient, unit, and hospital levels. Hospital rankings were largely impacted when accounted for this cross-level invariance. The percentage of hospitals with discordant ranks by >10 percentile points varied from 26.7% in Spain to 70% in Poland. CONCLUSIONS Leaving unexamined possible noninvariance across groups and hierarchical levels may have far reaching consequences for how the public perceives hospitals' position relative to other hospitals.
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Financial Performance of Hospitals in the Mississippi Delta Region Under the Hospital Readmissions Reduction Program and Hospital Value-based Purchasing Program. Med Care 2017; 55:924-930. [DOI: 10.1097/mlr.0000000000000808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van Huy N, Dung NN, Thang CD, Hanh LT. Patient satisfaction with health care services at a national institute of ophthalmology. Int J Health Plann Manage 2017; 33:e251-e262. [PMID: 28892187 DOI: 10.1002/hpm.2449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/10/2022] Open
Abstract
Little is known about how patients in developing countries, such as Vietnam, are satisfied with eye care services. The purpose of this study was to assess the satisfaction with health services and its associated factors among patients attending a national institute of ophthalmology in Vietnam. In a cross-sectional study utilizing quantitative methods, 500 inpatients and their relatives attending a national institute of ophthalmology in Vietnam were approached for data collection. The results indicated that under 50% of the patients were satisfied with eye care services. However, when classified by level of satisfaction, only 6.8% were very satisfied with all domains of care. There was no significant difference in satisfaction by gender and income, while significant differences by department, residence, and education were found. Patients who were from rural areas, were better educated, and used the services of the glaucoma department, were more satisfied with eye care than those from urban areas, were less educated, and used the services of treatment-on-demand department. Multivariable regression detected 2 main factors, gender and location, associated with patient satisfaction. Patients who were female and came from rural and remote areas were more likely to be satisfied than patients who were male and living in urban areas. The study suggests that to continue to improve health care quality, it is important to eliminate differences in providing eye care services regardless of whether patients are male or female, and whether they come from a rural or urban area.
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Affiliation(s)
- Nguyen Van Huy
- Department of Health Management and Organization, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Ngoc Dung
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Cao Duc Thang
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Le Thuy Hanh
- Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
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Fos EB. The unintended consequences of The Centers for Medicare and Medicaid Services pay-for-performance structures on safety-net hospitals and the low-income, medically vulnerable population. Health Serv Manage Res 2017; 30:10-15. [PMID: 28166671 DOI: 10.1177/0951484816678011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Safety-net hospitals are hospitals with patient mix that is substantially composed of the uninsured, underinsured, and low-income, medically vulnerable patient populations. They are the hospitals of last resort for poor patients. This article examined the impact of The Centers for Medicare and Medicaid Services pay-for-performance reimbursement policies on the financial viability of safety-net hospitals. Studies showed that these policies, which are based on the principle of reward and punishment, might have unintentionally placed safety-net hospitals on financial disadvantage compared to other hospital organizations. Several studies implied that these payment structures might have resulted in a situation where safety-net hospitals that are serving poor patient populations become more susceptible to penalties than hospitals that are serving affluent patients.
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Affiliation(s)
- Elmer B Fos
- College of Health and Human Services, The University of North Carolina at Charlotte, NC, USA
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Mullings L, Sankaranarayanan J. Quality of communication about medicines in United States hospitals: A national retrospective study. Res Social Adm Pharm 2016; 13:849-856. [PMID: 27913084 DOI: 10.1016/j.sapharm.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/22/2016] [Accepted: 09/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the benefits of improving transitions across care, literature is very limited on inpatient "Communication about Medicines" (ComMed) by staff across United States (U.S.) hospitals. OBJECTIVES To evaluate ComMed quality variations by hospital characteristics. METHODS In a cross-sectional, retrospective study of publicly available U.S. Medicare's Hospital Consumer Assessment of Health Care Plans Survey (HCAHPS) data (January 2013-September 2014), ComMed quality (high = above average/excellent vs. low = average/below average/poor star ratings) of 3125 hospitals were compared across region, rural-urban location, and health information technology (HIT) infrastructure giving providers access to patients' electronic medical records. Multivariate logistic regression analysis was conducted with adjusting for confounders (hospital - bed size, ownership, type, ED services, the number of completed HCAHPS surveys). RESULTS After adjusting for other characteristics, Midwest versus Western region hospitals (OR = 1.55, 95% CI: 1.21-1.98, p=<0.0001), hospitals with HIT infrastructure (OR = 1.29, 95% CI: 1.05-1.59, p = 0.02) were more likely while Northeast vs. Western region hospitals (OR = 0.67, 95% CI: 0.50-0.89, p=<0.0001) and hospitals in metropolitan areas with 1 million or more population vs. Nonmetro area with less than 2500 population were less likely (OR = 0.68, 95% CI: 0.48-0.95, p=<0.0001), to be associated with high ComMed quality. Hospitals' small bed-size, physician/non-profit ownership, critical-access type, absent ED services, and 100-299 HCAHPS completed surveys were more likely to be associated with high ComMed quality. CONCLUSIONS One of the first national studies found significant variations in ComMed quality across U.S. hospitals by location (high in Midwest and low in Northeast regions and urban areas) and by access to HIT infrastructure (high) after controlling for other hospital characteristics. With this baseline data, hospital providers and policymakers can design, implement, and evaluate service programs with pharmacists and HIT to enhance ComMed quality in the future delivery of patient-centered care.
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Affiliation(s)
- Lauren Mullings
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT, USA
| | - Jayashri Sankaranarayanan
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT, USA; Department of Pharmacy Services, Hartford Hospital, Harford, CT, USA.
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