Impact of Hospitalist Team Structure on Patient-Reported Satisfaction with Physician Performance

Patients' Experience with Received Healthcare in Internal Medicine and Surgery Wards of Slovenian Hospitals-A Cross-Sectional Survey

Aim

The aim of the study was to explore the experiences of patients with delivered healthcare in selected Slovenian hospitals.

Methods

A cross-sectional study was employed. A total of 1,748 patients participated. A shortened version of the Consumer Assessment of Healthcare Providers and Systems survey was used. Permission to conduct the study was obtained from the Slovenian Medical Ethics Committee. Data were collected between February and March 2020. Univariate, bivariate and multivariate analyses were conducted.

Results

The average hospital rating was 8.86 (SD=1.47; p<0.001) out of 10. The hospital would be definitely recommended to others by 1,290 (75.7%) respondents. The regression model "patients' experience with care" was explained in 18%, mostly by "patients' general health status" (-0.267), "provision of written and oral information about symptoms or health problems post discharge" (-0.200), and "talking to patients about care post discharge" (-0.175). The model "hospital rate" was explained in 30.4% by "patients' experience with care" (0.576), "new medication was explained" (-0.242) and "patient age" (0.132).

Conclusion

The hospital rates are good and mostly explained by patient experience. The results revealed that tasks connected to comprehensive preparation of patients for healthcare treatment including communication, health education and appropriate discharge are only partially fulfilled. Improvements and holistic data capture are needed to make the measurement of patient experience a greater contribution to the improvement and efficiency of hospital care.

Peer feedback: A tool to improve PA, NP, and physician collaboration and clinical practice

ABSTRACT

The increasing use of physician associates/assistants (PAs) and NPs on clinical teams creates an opportunity for colleagues to provide feedback that can drive growth and improvement in PA and NP clinical skills. Through a needs assessment, month-long pilot, and buy-in from our academic hospital medicine group, we initiated a peer feedback platform that sought to highlight individual faculty strengths, facilitate thoughtful and constructive feedback, and create effective collaboration among colleagues. Three months after implementation, results indicated that the platform provided important information on clinical skills and identified areas for growth and opportunities for additional training. Peer feedback can also improve working relationships among PAs, NPs, and physicians by highlighting the clinical skill sets and value of all team members.

The Impact of Dynamic Real-Time Feedback on Patient Satisfaction Scores

INTRODUCTION

Providers' communication skills have a significant impact on patients' satisfaction. Improved patients' satisfaction has been positively correlated with various healthcare and financial outcomes. Patients' satisfaction in the inpatient setting is measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In this study, we evaluated the impact of dynamic real-time feedback to the providers on the HCAHPS scores.

METHODS

This was a randomized study conducted at our 550-bed level-1 tertiary care center. Twenty-six out of 27 hospitalists staffing our 12 medicine teams (including teams containing advanced practice providers (APPs) and house-staff teams) were randomized into intervention and control groups. Our research assistant interviewed 1110 patients over a period of 7 months and asked them the three provider communication-specific questions from the HCAHPS survey. Our intervention was a daily computer-generated email which alerted providers to their performance on HCAHPS questions (proportions of "always" responses) along with the performance of their peers and Medicare benchmarks.

RESULTS

The intervention and control groups were similar with regard to baseline HCAHPS scores and clinical experience. The proportion of "always" responses to the three questions related to provider communication was statistically significantly higher in the intervention group compared to the control group (86% vs 80.5%, p-value 0.00001). It was also noted that the HCAHPS scores were overall lower on the house-staff teams and higher on the teams with APPs.

CONCLUSION

Real-time patients' feedback to inpatient providers with peer comparison via email has a positive impact on the provider-specific HCAHPS scores.

The Hospital Value-Based Purchasing Program: Do hospitalists improve health care value

INTRODUCTION

As healthcare organizations examine the associated benefits of employing a larger hospitalist workforce, there is a need to better understand the association with patients' quality, experience, and efficiency. However, there is a lack of information regarding how hospital use of hospitalists over time influences hospital scoring on quality programs, such as the Center for Medicare and Medicaid Services (CMS) Hospital Inpatient Value-Based Purchasing (HVBP) Program. This study examines the association between hospitalist staffing between 2014 and 2019 and HVBP scores.

METHODS

We used a cross-sectional panel study design. Total Performance Score (TPS) and its domains were obtained from CMS from 2014 to 2019 and merged with the American Hospital Association Annual Survey Database. We utilized random-effects multivariable panel regression models and zero-inflated negative binomial regression to examine the association between the hospitalist-staffing ratio and the HVBP Program. All models were adjusted for hospital characteristics.

RESULTS

A total of 2126 hospitals were included in the study. The average ratio of hospitalists per staffed bed was 0.06, with a standard deviation of 0.15. This study suggests that hospitals that employ a higher percentage of hospitalists see improvement in their overall TPS (β = 5.40; p < .001), Patient Experience (β = 2.49; p <.05), and Efficiency (incidence-rate ratio= 1.41; p < .001) domain. However, the Clinical Care domain was no different in organizations employing more hospitalists.

CONCLUSION

There are benefits associated with TPS, Patient Experience, and Efficiency from employing hospitalists. Managers should seek opportunities to leverage hospitalists' expertise in providing care, particularly in improving care processes.

The Impact of a New Internal Medicine Residency Program on Patient Satisfaction Scores for Teaching Hospitalist Faculty Compared to Non-teaching Hospitalist

Introduction: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national survey sent to patients to measure their inpatient experience. Graduate medical education programs may affect a sponsoring institution in various ways, but there has been little research into the effect of teaching hospitalist faculty on HCAHPS scores in a community-based hospital. The aim of the current study is to evaluate if the introduction of internal medicine resident physicians would affect the HCAHPS scores of patients admitted by hospitalist faculty physicians.

Methods: This was a retrospective analysis of anonymous patient satisfaction survey data for internal medicine hospitalist teams from January 2019 to December 2019. Data were retrieved from the Press Ganey database. We compared two groups: teaching hospitalists (N = 12) and non-teaching hospitalists (N = 34). Data were divided into two time periods: January to June (pre-residents) and July to December (post-residents).

Results: From January to June (pre-residents), 646 HCAHPS surveys were returned. For the post-resident cohort (July to December), a total of 487 surveys were returned. The “Recommend” domain, showed a significant improvement in the mean pre-resident to post-resident (57% to 69%; p = 0.0351).

Conclusion: There was a significant increase in the mean rating of the “Recommend” hospital domain for the teaching hospitalists when compared to the non-teaching after the addition of a new internal medicine residency program.

Comparison of Patient Satisfaction in Inpatient Care Provided by Hospitalists and Nonhospitalists in South Korea

Background: A Korean hospitalist is a medical doctor in charge of inpatient care during hospital stays. The purpose of this study is to examine the patient satisfaction of hospitalist patients compared to non-hospitalist patients. Patient satisfaction is closely related to the outcome, quality, safety, and cost of care. Thus, seeking to achieve high patient satisfaction is essential in the inpatient care setting. Design, setting, and participants: This is a case-control study based on patient satisfaction survey by the Korean Health Insurance Review and Assessment Service. We measured patients’ satisfaction in physician accessibility, consultation and care service skills, and overall satisfaction through logistic regression analyses. A total of 3871 patients from 18 facilities responded to 18 questionnaires and had health insurance claim data. Results: Hospitalist patients presented higher satisfaction during the hospital stay compared to non-hospitalist patients. For example, as per accessibility, hospitalist patients could meet their attending physician more than twice a day (OR: 3.46, 95% CI: 2.82–4.24). Concerning consultation and care service skills, hospitalists’ explanations on the condition and care plans were easy to understand (OR: 2.33, 95% CI: 1.89–2.88). Moreover, overall satisfaction was significantly higher (β: 0.431, p < 0.0001). Subgroup analyses were conducted by medical division and region. Hospitalist patients in the surgical department and the rural area had greater patient satisfaction in all aspects of the survey than non-hospitalist patients. Conclusions: Hospitalists’ patients showed higher satisfaction during the hospital stay. Our study discovered that hospitalists could provide high-quality care as they provide onsite care continuously from admission to discharge.

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

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