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Pandit AA, Halpern MT, Gressler LE, Kamel M, Payakachat N, Li C. Association of race/ethnicity and patient care experiences with healthcare utilization and healthcare costs among prostate cancer survivors: A SEER-CAHPS study. J Geriatr Oncol 2024; 15:101748. [PMID: 38493533 PMCID: PMC11017784 DOI: 10.1016/j.jgo.2024.101748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION This study aimed to evaluate the association of race/ethnicity and patient care experiences (PCEs) with healthcare utilization and costs among US older adults with prostate cancer (PCa). MATERIALS AND METHODS The study used data from 2007 to 2015 Surveillance, Epidemiology, and End Results dataset linked to Medicare Consumer Assessment of Healthcare Providers and Systems survey and Medicare claims (SEER-CAHPS). We identified males aged ≥65 years who completed a CAHPS survey within 6-60 months post-PCa diagnosis. Covariate-adjusted associations of six CAHPS PCE composite measures with any emergency department visit and any inpatient stay (using logistic regressions), and with total part A and part B Medicare costs (using generalized linear models) were examined by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian, and other). RESULTS Among 1834 PCa survivors, a 1-point higher score for getting care quickly was associated with higher odds (odds ratio 1.08; 95% confidence interval [CI]: 1.02-1.15; p = 0.009) of any inpatient stay in Hispanic patients. Higher total costs were associated with a 1-point higher score for getting needed care among Hispanic patients ($590.84; 95% CI: $262.15, $919.53; p < 0.001); a 1-point higher score for getting care quickly among Hispanic patients ($405.26; 95% CI: $215.83, $594.69; p < 0.001); and a 1-point higher score for customer service among patients belonging to other races ($361.69; 95% CI: $15.68, $707.69; p = 0.04). DISCUSSION We observed differential associations by race/ethnicity between PCEs and healthcare utilization and costs. Further research is needed to explore the causes of these associations.
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Affiliation(s)
- Ambrish A Pandit
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
| | - Michael T Halpern
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E342, Bethesda, MD 20892-9762, United States.
| | - Laura E Gressler
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
| | - Mohamed Kamel
- Department of Surgery, College of Medicine, University of Cincinnati, Medical Sciences Building Room 2519, 231 Albert Sabin Way Suite 2501, 45267 Cincinnati, OH, United States; Department of Urology, Ain Shams University, Cairo 11566, Egypt
| | - Nalin Payakachat
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
| | - Chenghui Li
- Department of Pharmacy Practice, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, United States.
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Lung Cancer Mortality Racial/Ethnic Disparities in Patient Experiences with Care: a SEER-CAHPS Study. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01358-8. [PMID: 35767217 DOI: 10.1007/s40615-022-01358-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND To determine whether there are racial/ethnic disparities in patient experiences with care among lung cancer survivors, whether they are associated with mortality. METHODS A retrospective cohort study of lung cancer survivors > 65 years old who completed a CAHPS survey > 6 months after the date of diagnosis. We used data from the SEER-Consumer Assessment of Healthcare Providers Systems (SEER-CAHPS®) database from 2000 to 2013 to assess racial/ethnic differences in patient experiences with care multivariable Cox proportional hazards models to assess the association between patient experience with care scores mortality in each racial/ethnic group. RESULTS Within our cohort of 2603 lung cancer patients, Hispanic patients reported lower adjusted mean score with their ability to get needed care compared to white patients (B: - 5.21, 95% CI: - 9.03, - 1.39). Asian patients reported lower adjusted mean scores with their ability to get care quickly (- 4.25 (- 8.19, - 0.31)), get needed care (- 7.06 (- 10.51, - 3.61)), get needed drugs (- 9.06 (- 13.04, - 5.08)). For Hispanic patients, a 1-unit score increase in their ability to get all needed care (HR: 1.02, 1.00-1.03) care coordination (1.06, 1.02-1.09) was associated with higher risk of mortality. Among black patients, a 1-unit score increase in their ability to get needed care (HR: 0.99, 95% CI 0.98-0.99) care coordination (0.97, 0.94-0.99) was associated with lower risk mortality. CONCLUSIONS There are racial/ethnic disparities in lung cancer patient experiences with care that may impact mortality. Patient experiences with care are important risk factors of mortality for certain racial/ethnic groups.
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Sanghavi P, McWilliams JM, Schwartz AL, Zaslavsky AM. Association of Low-Value Care Exposure With Health Care Experience Ratings Among Patient Panels. JAMA Intern Med 2021; 181:941-948. [PMID: 34047761 PMCID: PMC8261613 DOI: 10.1001/jamainternmed.2021.1974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Patient reviews of health care experiences are increasingly used for public reporting and alternative payment models. Critics have argued that this incentivizes physicians to provide more care, including low-value care, undermining efforts to reduce wasteful practices. OBJECTIVE To assess associations between rates of low-value service provision to a primary care professional (PCP) patient panel and patients' ratings of their health care experiences. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used Medicare fee-for-service claims from January 1, 2007, to December 31, 2014, for a random 20% sample of beneficiaries to identify beneficiaries for whom each of 8 low-value services could be ordered but would be considered unnecessary. The study also used health care experience reports from independently sampled beneficiaries who responded to the 2010-2015 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare fee-for-service survey. Statistical analysis was performed from January 1, 2019, to December 9, 2020. MAIN OUTCOMES AND MEASURES The main outcomes were health care experience ratings from Medicare beneficiaries who responded to the CAHPS survey from 2 domains, namely "Your Health Care in the Last 6 Months" (overall health care, office wait time, timely access to nonurgent care, and timely access to urgent care) and "Your Personal Doctor" (overall personal physician and a composite score for interactions with personal physician). Beneficiaries in both samples were attributed to the PCP with whom they had the most spending. For each PCP, a composite score of low-value service exposure was constructed using the 20% sample; this score represented the adjusted relative propensity of the PCP patient panel to receive low-value care. The association between low-value service exposure and health care experience ratings reported by the CAHPS respondents in the PCP patient panel was estimated using regression analysis. RESULTS The final sample had 100 743 PCPs, with a mean of approximately 258 patients per PCP. Only 1 notable association was found; more low-value care exposure was associated with more frequent reports of having to wait more than 15 minutes after the scheduled time of an appointment (a mean of 0.448 points lower CAHPS score on a 10-point scale for PCP patient panels who received the most low-value care vs the least low-value care). Although some other associations were statistically significant, their magnitudes were substantially smaller than those typically considered meaningful in other CAHPS literature and were inconsistent in direction across levels of low-value service exposure. CONCLUSIONS AND RELEVANCE This quality improvement study found that more low-value care exposure for a PCP patient panel was not associated with more favorable patient ratings of their health care experiences.
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Affiliation(s)
- Prachi Sanghavi
- Biological Sciences Division, Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - J Michael McWilliams
- Department of Health Care Policy, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Aaron L Schwartz
- Division of General Internal Medicine, Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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DiMartino LD, Kirschner J, Jackson GL, Mollica MA, Lines LM. Are care experiences associated with survival among cancer patients? An analysis of the SEER-CAHPS data resource. Cancer Causes Control 2021; 32:977-987. [PMID: 34046807 DOI: 10.1007/s10552-021-01451-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer patients' care experiences encompass the range of interactions with the health care system and are an important indicator of care quality, which may influence survival outcomes. This study evaluates relationships between care experiences and survival using a large, nationally representative sample of cancer patients. METHODS We used linked SEER (Surveillance Epidemiology and End Results)-CAHPS (Consumer Assessment of Healthcare Providers and Systems) data to identify people diagnosed 8/2006-12/2013, focusing on 10 solid tumor cancer sites with the highest mortality rates among those > 65. CAHPS measures included 5 global ratings and 3 composite scores. We used survey-weighted Cox proportional hazard models comparing survival time for those who had lower (0-8) vs higher ratings (9-10) and lower (0-89) vs higher (90-100) composite scores, adjusting for case-mix and additional covariates. RESULTS We identified 2,263 eligible people; 26% died by 5-year post-survey completion or end of follow-up (12/31/2017). We found lower Prescription Drug Plan (PDP) ratings were significantly associated with lower mortality (adjusted HR = 0.67, p = 0.03). Lower Getting Needed Care scores were also significantly associated with lower mortality (adjusted HR = 0.79, p = 0.04). For other care experience measures, general health status, cancer stage, and comorbidities were more predictive of survival (p < .05). CONCLUSIONS Except for PDP and Getting Needed Care, survival was similar for those with worse versus better care experiences. Patients with poorer cancer prognoses may perceive better services from their drug plan and more responsive care from clinical providers compared to those with better prognoses. Further research is needed examining processes underlying perceptions of care experiences and survival.
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Affiliation(s)
| | | | - George L Jackson
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Duke University, Durham, NC, USA
| | | | - Lisa M Lines
- RTI International, Research Triangle Park, NC, USA
- University of Massachusetts Medical School, Worcester, MA, USA
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Olaisen RH, Schluchter MD, Flocke SA, Smyth KA, Koroukian SM, Stange KC. Assessing the Longitudinal Impact of Physician-Patient Relationship on Functional Health. Ann Fam Med 2020; 18:422-429. [PMID: 32928758 PMCID: PMC7489969 DOI: 10.1370/afm.2554] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/25/2019] [Accepted: 01/27/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Access to a usual source of care is associated with improved health outcomes, but research on how the physician-patient relationship affects a patient's health, particularly long-term, is limited. The aim of this study was to investigate the longitudinal effect of changes in the physician-patient relationship on functional health. METHODS We conducted a prospective cohort study using the Medical Expenditure Panel Survey (MEPS, 2015-2016). The outcome was 1-year change in functional health (12-Item Short-Form Survey). The predictors were quality of physician-patient relationship, and changes in this relationship, operationalized with the MEPS Primary Care (MEPS-PC) Relationship subscale, a composite measure with preliminary evidence of reliability and validity. Confounders included age, sex, race/ethnicity, educational attainment, insurance status, US region, and multimorbidity. We conducted analyses with survey-weighted, covariate-adjusted, predicted marginal means, used to calculate Cohen effect estimates. We tested differences in trajectories with multiple pairwise comparisons with Tukey contrasts. RESULTS Improved physician-patient relationships were associated with improved functional health, whereas worsened physician-patient relationships were associated with worsened functional health, with 1-year effect estimates ranging from 0.05 (95% CI, 0-0.10) to 0.08 (95% CI, 0.02-0.13) compared with -0.16 (95% CI, -0.35 to -0.03) to -0.33 (95% CI, -0.47 to -0.02), respectively. CONCLUSION The quality of the physician-patient relationship is positively associated with functional health. These findings could inform health care strategies and health policy aimed at improving patient-centered health outcomes.
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Affiliation(s)
- R Henry Olaisen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio .,Center for Community Health Integration, Departments of Family Medicine & Community Health, Population and Quantitative Health Sciences, Sociology, and the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Mark D Schluchter
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Susan A Flocke
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kathleen A Smyth
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.,Center for Community Health Integration, Departments of Family Medicine & Community Health, Population and Quantitative Health Sciences, Sociology, and the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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Chen JG, Lee S, Khallouq BB. Association of Demographics and Hospital Stay Characteristics With Patient Experience in Hospitalized Pediatric Patients. J Patient Exp 2020; 7:1077-1085. [PMID: 33457548 PMCID: PMC7786789 DOI: 10.1177/2374373520925251] [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] [Indexed: 11/15/2022] Open
Abstract
There is limited research on patient experience in hospitalized pediatric patients. Our aim was to investigate the association of patient demographics and hospital stay characteristics with experience in a tertiary-care, freestanding children's hospital. We conducted a retrospective cross-sectional study of patient experience surveys. We designated the highest rating as "top-box" and examined data across 8 domains, including overall assessment (OA). A total of 4602 surveys were analyzed. Top-box percentages were lower for younger patients in 6 domains, including OA (0-<1 year old: 57.6%; 1-<4 years old: 61.3%; 4-<12 years old: 68.4%; ≥12 years old: 70.2%; P < .001), and were lower for patients with private insurance in 5 domains, including OA (private 63.2%, public 68.9%; P < .001). There was no association between other demographics (gender, race/ethnicity, primary language) and OA. Overall assessment was also not associated with length of stay (P = .071) and number of consulting services (P = .703). The most important domain predictor of OA was personal issues (odds ratio = 4.79), which assessed concern, sensitivity, and communication from staff. In conclusion, patient experience was associated with age and insurance status but not hospital stay characteristics.
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Affiliation(s)
- Jerome Gene Chen
- Pediatric Critical Care Medicine, Arnold Palmer Hospital for Children, Orlando, FL, USA
- University of Florida Pediatric Residency Program at Orlando Health, Orlando, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
- Jerome Gene Chen, Pediatric Critical Care Medicine, Arnold Palmer Hospital for Children, 86 W. Underwood St, Ste 202, MP 336 Orlando, FL 32806, USA.
| | - Stacey Lee
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Bertha Ben Khallouq
- Pediatric Critical Care Medicine, Arnold Palmer Hospital for Children, Orlando, FL, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
- University of Central Florida College of Sciences, Orlando, FL, USA
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Association of Patient-reported Experiences and Surgical Outcomes Among Group Practices: Retrospective Cohort Study. Ann Surg 2020; 271:475-483. [PMID: 30188401 DOI: 10.1097/sla.0000000000003034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of the study was to determine the association of patient-reported experiences (PREs) and risk-adjusted surgical outcomes among group practices. BACKGROUND The Centers for Medicare and Medicaid Services required large group practices to submit PREs data for successful participation in the Physician Quality Reporting System (PQRS) using the Consumer Assessment of Healthcare Providers and Systems for PQRS survey. Whether these PREs data correlate with perioperative outcomes remains ill defined. METHODS Operations between January 1, 2014 and December 31, 2016 in the American College of Surgeons' National Surgical Quality Improvement Program registry were merged with 2015 Consumer Assessment of Healthcare Providers and Systems for PQRS survey data. Hierarchical logistic models were constructed to estimate associations between 7 subscales and 1 composite score of PREs and 30-day morbidity, unplanned readmission, and unplanned reoperation, separately, while adjusting for patient- and procedure mix. RESULTS Among 328 group practices identified, patients reported their experiences with clinician communication the highest (mean ± standard deviation, 82.66 ± 3.10), and with attention to medication cost the lowest (25.96 ± 5.14). The mean composite score was 61.08 (±6.66). On multivariable analyses, better PREs scores regarding medication cost, between-visit communication, and the composite score of experience were each associated with 4% decreased odds of morbidity [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92-0.99], readmission (OR 0.96, 95% CI 0.93-0.99), and reoperation (OR 0.96, 95% CI 0.93-0.99), respectively. In sensitivity analyses, better between-visit communication remained significantly associated with fewer readmissions. CONCLUSIONS In these data, patients' report of better between-visit communication was associated with fewer readmissions. More sensitive, surgery-specific PRE assessments may reveal additional unique insights for improving the quality of surgical care.
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Liu JB, Pusic AL, Hall BL, Glasgow RE, Ko CY, Temple LK. Combining Surgical Outcomes and Patient Experiences to Evaluate Hospital Gastrointestinal Cancer Surgery Quality. J Gastrointest Surg 2019; 23:1900-1910. [PMID: 30374815 DOI: 10.1007/s11605-018-4015-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/12/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Assessments of surgical quality should consider both surgeon and patient perspectives simultaneously. Focusing on patients undergoing major gastrointestinal cancer surgery, we sought to characterize hospitals, and their patients, on both these axes of quality. METHODS Using the American College of Surgeons' National Surgical Quality Improvement Program registry, hospitals were profiled on a risk-adjusted composite measure of death or serious morbidity (DSM) generated from patients who underwent colectomy, esophagectomy, hepatectomy, pancreatectomy, or proctectomy for cancer between January 1, 2015 and December 31, 2016. These hospitals were also profiled using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Highest-performing hospitals on both quality axes, and their respective patients, were compared to the lowest-performing hospitals. RESULTS Overall, 60,526 patients underwent their cancer operation at 530 hospitals. There were 38 highest- and 48 lowest-performing hospitals. The correlation between quality axes was poor (ρ = 0.10). Compared to the lowest-performing hospitals, the highest-performing hospitals were more often NCI-designated cancer centers (29.0% vs. 4.2%, p = 0.002) and cared for a lower proportion of Medicaid patients (0.14 vs. 0.23, p < 0.001). Patients who had their operations at the lowest- versus highest-performing hospitals were more often black (17.2% vs. 8.4%, p < 0.001), Hispanic (8.3% vs. 3.5%, p < 0.001), functionally dependent (3.8% vs. 0.9%, p < 0.001), and not admitted from home (4.4% vs. 2.4%, p < 0.001). CONCLUSIONS Hospital performance varied when assessed by both risk-adjusted surgical outcomes and patient experiences. In this study, poor-performing hospitals appeared to be disproportionately serving disadvantaged and minority cancer patients.
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Affiliation(s)
- Jason B Liu
- American College of Surgeons, 633 N. St. Clair St., 22nd floor, Chicago, IL, 60611, USA.
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | - Andrea L Pusic
- Division of Plastic Surgery, Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Bruce L Hall
- American College of Surgeons, 633 N. St. Clair St., 22nd floor, Chicago, IL, 60611, USA
- Department of Surgery, Washington University in St. Louis, Saint Louis Veterans Affairs Medical Center, St. Louis, MO, USA
- Center for Health Policy and the Olin Business School, Washington University in St. Louis, St. Louis, MO, USA
- BJC Healthcare, St. Louis, MO, USA
| | - Robert E Glasgow
- Department of Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Clifford Y Ko
- American College of Surgeons, 633 N. St. Clair St., 22nd floor, Chicago, IL, 60611, USA
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Larissa K Temple
- Division of Colorectal Surgery, University of Rochester Medical Center, Rochester, NY, USA
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Patient Satisfaction with Clinicians and Short-Term Mortality in a US National Sample: the Roles of Morbidity and Gender. J Gen Intern Med 2019; 34:1459-1466. [PMID: 31144280 PMCID: PMC6667580 DOI: 10.1007/s11606-019-05058-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/20/2018] [Accepted: 04/02/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND In a prior study, we found patient satisfaction was associated with mortality. However, that study included few deaths, yielding wide confidence intervals, was criticized for possible morbidity under-adjustment, and lacked power to explore sociodemographic moderation. OBJECTIVE To revisit the satisfaction-mortality association in a larger national sample, allowing more precise risk estimates, sequential morbidity adjustment, and exploration of sociodemographic moderation. DESIGN Prospective cohort study. PARTICIPANTS 2000-2015 Adult Medical Expenditures Panel Surveys (MEPS) respondents (N = 92,952), each enrolled for 2 consecutive years. MAIN MEASURES We used five Consumer Assessment of Health Plans Survey (CAHPS) items to assess patients' year 1 satisfaction with their clinicians. Death during the 2 years of MEPS participation was determined by proxy report. We modeled the satisfaction-mortality association in sequential regressions: model 1 included sociodemographics, model 2 added health status (approximating recommended CAHPS adjustment), and model 3 added smoking status, disease burden, and healthcare utilization. KEY RESULTS Satisfaction was not associated with mortality in model 1. In model 2, higher satisfaction was associated with higher mortality (hazard ratios [95% CIs] for 2nd, 3rd, and 4th (top) quartiles vs. 1st quartile: 1.28 (1.01, 1.62), P = 0.04; 1.43 (1.12, 1.82), P = 0.004; and 1.57 (1.25, 1.98), P < 0.001, respectively). The associations were not attenuated in model 3. There was a significant interaction between gender and satisfaction (F[3, 443] = 3.62, P = 0.01). The association between satisfaction and mortality was significant in women only, such that their mortality advantage over men was eliminated in the highest satisfaction quartile. CONCLUSIONS The association of higher patient satisfaction with clinicians with higher short-term mortality was evident only after CAHPS-recommended adjustment, was not attenuated by further morbidity adjustment, and was evident in women but not men. The findings suggest that characteristics among women who are more satisfied with their clinicians may be associated with increased mortality risk.
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Congiusta S, Solomon P, Conigliaro J, O'Gara-Shubinsky R, Kohn N, Nash IS. Clinical Quality and Patient Experience in the Adult Ambulatory Setting. Am J Med Qual 2018; 34:87-91. [PMID: 29790371 DOI: 10.1177/1062860618777878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Quality and patient experience are important dimensions of care delivery. The extent to which they are related in the adult outpatient setting is unknown. This brief study utilized data from a large integrated health system over a 1-year period in 2015 and measured the degree of correlation between physicians' patient experience scores and 8 standardized quality metrics. These quality measures were paired into similar groups to create 4 composite measures: outcome, screening, vaccination, and adherence. Measures of outcome ( r = 0.20, P = .06), vaccination ( r = 0.12, P = .26), and adherence ( r = -0.04, P = .75) were not significantly correlated with patient experience; screening ( r = 0.29, P = .006) was minimally correlated with patient experience. Overall, this study found minimal correlation between measures of patient experience and clinical quality in the outpatient setting. Measurement of both of these domains is essential to understanding patterns of care.
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Affiliation(s)
| | - Philip Solomon
- 1 Northwell Health, Manhasset, NY.,2 Donald and Barbara School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Joseph Conigliaro
- 1 Northwell Health, Manhasset, NY.,2 Donald and Barbara School of Medicine at Hofstra/Northwell, Hempstead, NY
| | | | | | - Ira S Nash
- 1 Northwell Health, Manhasset, NY.,2 Donald and Barbara School of Medicine at Hofstra/Northwell, Hempstead, NY
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Relationship Between Adolescent Report of Patient-Centered Care and of Quality of Primary Care. Acad Pediatr 2016; 16:770-776. [PMID: 26802684 PMCID: PMC4958046 DOI: 10.1016/j.acap.2016.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Few studies have examined adolescent self-report of patient-centered care (PCC). We investigated whether adolescent self-report of PCC varied by patient characteristics and whether receipt of PCC is associated with measures of adolescent primary care quality. METHODS We analyzed cross-sectional data from Healthy Passages, a population-based survey of 4105 10th graders and their parents. Adolescent report of PCC was derived from 4 items. Adolescent primary care quality was assessed by measuring access to confidential care, screening for important adolescent health topics, unmet need, and overall rating of health care. We conducted weighted bivariate analyses and multivariate logistic regression models of the association of PCC with adolescent characteristics and primary care quality. RESULTS Forty-seven percent of adolescents reported that they received PCC. Report of receiving PCC was associated with high quality for other measures, such as having a private conversation with a clinician (adjusted odds ratio [aOR] 2.2; 95% confidence interval [CI] [1.9, 2.6]) and having talked about health behaviors (aOR 1.6; 95% CI 1.4, 1.8); it was also associated with lower likelihood for self-reported unmet need for care (aOR 0.8; 95% CI 0.7, 0.9) and having a serious untreated health problem (aOR 0.4; 95% CI 0.3, 0.5). CONCLUSIONS Many adolescents do not report receiving PCC. Adolescent-reported PCC positively correlates with measures of high-quality adolescent primary care. Our study provides support for using adolescent-report of PCC as a measure of adolescent primary care quality.
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Toomey SL, Zaslavsky AM, Elliott MN, Gallagher PM, Fowler FJ, Klein DJ, Shulman S, Ratner J, McGovern C, LeBlanc JL, Schuster MA. The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS. Pediatrics 2015; 136. [PMID: 26195542 PMCID: PMC5036167 DOI: 10.1542/peds.2015-0966] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Centers for Medicare and Medicaid Services (CMS) uses Adult Hospital Consumer Assessment of Healthcare Providers and Systems (Adult HCAHPS) scores for public reporting and pay-for-performance for most US hospitals, but no publicly available standardized survey of inpatient experience of care exists for pediatrics. To fill the gap, CMS and the Agency for Healthcare Research and Quality commissioned the development of a pediatric version (Child HCAHPS), a survey of parents/guardians of pediatric patients (<18 years old) who were recently hospitalized. This article describes the development of Child HCAHPS, which included an extensive review of the literature and quality measures, expert interviews, focus groups, cognitive testing, pilot testing of the draft survey, a national field test with 69 hospitals in 34 states, psychometric analysis, and end-user testing of the final survey. We conducted extensive validity and reliability testing to determine which items would be included in the final survey instrument and develop composite measures. We analyzed national field test data of 17,727 surveys collected in November 2012 to January 2014 from parents of recently hospitalized children. The final Child HCAHPS instrument has 62 items, including 39 patient experience items, 10 screeners, 12 demographic/descriptive items, and 1 open-ended item. The 39 experience items are categorized based on testing into 18 composite and single-item measures. Our composite and single-item measures demonstrated good to excellent hospital-level reliability at 300 responses per hospital. Child HCAHPS was developed to be a publicly available standardized survey of pediatric inpatient experience of care. It can be used to benchmark pediatric inpatient experience across hospitals and assist in efforts to improve the quality of inpatient care.
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Affiliation(s)
- Sara L. Toomey
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts;,Address correspondence Sara L. Toomey, MD, MPhil, MPH, MSc, Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail:
| | - Alan M. Zaslavsky
- Harvard Medical School, Boston, Massachusetts;,Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | | | - Floyd J. Fowler
- Center for Survey Research, University of Massachusetts Boston, Massachusetts
| | - David J. Klein
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Shanna Shulman
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Jessica Ratner
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Caitriona McGovern
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
| | - Jessica L. LeBlanc
- Center for Survey Research, University of Massachusetts Boston, Massachusetts
| | - Mark A. Schuster
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
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14
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Anhang Price R, Elliott MN, Cleary PD, Zaslavsky AM, Hays RD. Should health care providers be accountable for patients' care experiences? J Gen Intern Med 2015; 30:253-6. [PMID: 25416601 PMCID: PMC4314483 DOI: 10.1007/s11606-014-3111-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/14/2014] [Accepted: 10/27/2014] [Indexed: 11/27/2022]
Abstract
Measures of patients' care experiences are increasingly used as quality measures in accountability initiatives. As the prominence and financial impact of patient experience measures have increased, so too have concerns about the relevance and fairness of including them as indicators of health care quality. Using evidence from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, the most widely used patient experience measures in the United States, we address seven common critiques of patient experience measures: (1) consumers do not have the expertise needed to evaluate care quality; (2) patient "satisfaction" is subjective and thus not valid or actionable; (3) increasing emphasis on improving patient experiences encourages health care providers and plans to fulfill patient desires, leading to care that is inappropriate, ineffective, and/or inefficient; (4) there is a trade-off between providing good patient experiences and providing high-quality clinical care; (5) patient scores cannot be fairly compared across health care providers or plans due to factors beyond providers' control; (6) response rates to patient experience surveys are low, or responses reflect only patients with extreme experiences; and (7) there are faster, cheaper, and more customized ways to survey patients than the standardized approaches mandated by federal accountability initiatives.
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15
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Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, Edgman-Levitan S, Cleary PD. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014; 71:522-54. [PMID: 25027409 DOI: 10.1177/1077558714541480] [Citation(s) in RCA: 505] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs.
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Affiliation(s)
| | | | | | - Ron D Hays
- UCLA Department of Medicine, Los Angeles, CA, USA
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