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Burke HM, Carter J. Integration of patient experience factors improves readmission prediction. Medicine (Baltimore) 2023; 102:e32632. [PMID: 36701722 PMCID: PMC9857268 DOI: 10.1097/md.0000000000032632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Many readmission prediction models have marginal accuracy and are based on clinical and demographic data that exclude patient response data. The objective of this study was to evaluate the accuracy of a 30-day hospital readmission prediction model that incorporates patient response data capturing the patient experience. This was a prospective cohort study of 30-day hospital readmissions. A logistic regression model to predict readmission risk was created using patient responses obtained during interviewer-administered questionnaires as well as demographic and clinical data. Participants (N = 846) were admitted to 2 inpatient adult medicine units at Massachusetts General Hospital from 2012 to 2016. The primary outcome was the accuracy (measured by receiver operating characteristic) of a 30-day readmission risk prediction model. Secondary analyses included a readmission-focused factor analysis of individual versus collective patient experience questions. Of 1754 eligible participants, 846 (48%) were enrolled and 201 (23.8%) had a 30-day readmission. Demographic factors had an accuracy of 0.56 (confidence interval [CI], 0.50-0.62), clinical disease factors had an accuracy of 0.59 (CI, 0.54-0.65), and the patient experience factors had an accuracy of 0.60 (CI, 0.56-0.64). Taken together, their combined accuracy of receiver operating characteristic = 0.78 (CI, 0.74-0.82) was significantly more accurate than these factors were individually. The individual accuracy of patient experience, demographic, and clinical data was relatively poor and consistent with other risk prediction models. The combination of the 3 types of data significantly improved the ability to predict 30-day readmissions. This study suggests that more accurate 30-day readmission risk prediction models can be generated by including information about the patient experience.
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Affiliation(s)
| | - Jocelyn Carter
- Harvard Medical School, Boston, United States
- Massachusetts General Hospital, Boston, United States
- * Correspondence: Jocelyn Carter, Massachusetts General Hospital, 55 Fruit Street, Blake 15, Boston, MA 02114, United States (e-mail: )
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2
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Cuizon SGG, Fry-Bowers EK. The Patient Care Experience as Perceived by Hispanic Patients With Chronic Illness Undergoing Transplant: A Grounded Theory. ANS Adv Nurs Sci 2022; 45:335-350. [PMID: 35708484 DOI: 10.1097/ans.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hispanics are one of the largest-growing minorities, yet little is understood of the patient experience from their perspective. Patient experience is the current federally mandated hospital quality indicator that is measured via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Minority representation in the HCAHPS survey development however was not robust. This study used a constructivist grounded theory method to explore how English- and Spanish-speaking Hispanic patients seeking kidney and liver transplant care at a safety-net hospital perceive and interpret the care experience. A grounded theory process model emerged finding comfort, communication, connection, and care to be interdependent factors crucial for a positive hospital admission. Furthermore, "cultural context" was found to influence perception of each of these concepts. This research provides key insights into how Hispanics may perceive their needs when seeking care. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A50 .
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Affiliation(s)
- Silvinia Gamilia González Cuizon
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, California (Drs Cuizon and Fry-Bowers); and Loma Linda University Health, Loma Linda, California (Dr Cuizon)
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3
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Seltzer EK, Guntuku SC, Lanza AL, Tufts C, Srinivas SK, Klinger EV, Asch DA, Fausti N, Ungar LH, Merchant RM. Patient Experience and Satisfaction in Online Reviews of Obstetric Care: Observational Study. JMIR Form Res 2022; 6:e28379. [PMID: 35357310 PMCID: PMC9015735 DOI: 10.2196/28379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/29/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background The quality of care in labor and delivery is traditionally measured through the Hospital Consumer Assessment of Healthcare Providers and Systems but less is known about the experiences of care reported by patients and caregivers on online sites that are more easily accessed by the public. Objective The aim of this study was to generate insight into the labor and delivery experience using hospital reviews on Yelp. Methods We identified all Yelp reviews of US hospitals posted online from May 2005 to March 2017. We used a machine learning tool, latent Dirichlet allocation, to identify 100 topics or themes within these reviews and used Pearson r to identify statistically significant correlations between topics and high (5-star) and low (1-star) ratings. Results A total of 1569 hospitals listed in the American Hospital Association directory had at least one Yelp posting, contributing a total of 41,095 Yelp reviews. Among those hospitals, 919 (59%) had at least one Yelp rating for labor and delivery services (median of 9 reviews), contributing a total of 6523 labor and delivery reviews. Reviews concentrated among 5-star (n=2643, 41%) and 1-star reviews (n=1934, 30%). Themes strongly associated with favorable ratings included the following: top-notch care (r=0.45, P<.001), describing staff as comforting (r=0.52, P<.001), the delivery experience (r=0.46, P<.001), modern and clean facilities (r=0.44, P<.001), and hospital food (r=0.38, P<.001). Themes strongly correlated with 1-star labor and delivery reviews included complaints to management (r=0.30, P<.001), a lack of agency among patients (r=0.47, P<.001), and issues with discharging from the hospital (r=0.32, P<.001). Conclusions Online review content about labor and delivery can provide meaningful information about patient satisfaction and experiences. Narratives from these reviews that are not otherwise captured in traditional surveys can direct efforts to improve the experience of obstetrical care.
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Affiliation(s)
- Emily K Seltzer
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States
| | - Sharath Chandra Guntuku
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States.,Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Amy L Lanza
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States
| | - Christopher Tufts
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States
| | - Sindhu K Srinivas
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, United States
| | - Elissa V Klinger
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States
| | - David A Asch
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Nick Fausti
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States
| | - Lyle H Ungar
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Raina M Merchant
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States
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4
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Clarke‐Deelder E, Eliakimu E, Mbatia R, Bohren MA, Mashasi I, Larson E. Measuring user experience of care among caregivers of sick children: validation and descriptive analysis in a sample of 75 health facilities in rural Tanzania. Trop Med Int Health 2022; 27:317-329. [DOI: 10.1111/tmi.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emma Clarke‐Deelder
- Department of Epidemiology and Public Health Swiss Tropical and Public Health Institute Basel Switzerland
| | - Eliudi Eliakimu
- Health Quality Assurance Unit Ministry of Health, Community Development Gender, Elderly and Children Dodoma Tanzania
| | | | - Meghan A. Bohren
- Gender and Women’s Health Unit Centre for Health Equity School of Population and Global Health University of Melbourne Melbourne Australia
| | - Irene Mashasi
- Management and Development for Health Dar es Salaam Tanzania
| | - Elysia Larson
- Department of Obstetrics and Gynecology Beth Israel Deaconess Medical Center and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School Boston USA
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5
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Gomez‐Cano M, Lyratzopoulos G, Campbell JL, N. Elliott M, A. Abel G. The underlying structure of the English Cancer Patient Experience Survey: Factor analysis to support survey reporting and design. Cancer Med 2022; 11:3-20. [PMID: 34866346 PMCID: PMC8704178 DOI: 10.1002/cam4.4325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The English Cancer Patient Experience Survey (CPES) is a regularly conducted survey measuring the experience of cancer patients. We studied the survey's underlying structure using factor analysis to identify potential for improvements in reporting or questionnaire design. METHODS Cancer Patient Experience Survey 2015 respondents (n = 71,186, response rate 66%) were split into two random subgroups. Using exploratory factor analysis (EFA) on the first subgroup, we identified the survey's latent structure. EFA was then applied to 12 sets of items. A first ("core") set was formed by questions that applied to all participants. The subsequent sets contained the "core set" plus questions corresponding to specific care pathways/patient groups. We used confirmatory factor analysis (CFA) on the second data subgroup for cross-validation. RESULTS The EFA suggested that five latent factors underlie the survey's core questions. Analysis on the remaining 11 care pathway/patient group items also indicated the same five latent factors, although additional factors were present for questions applicable to patients with an overnight stay or those accessing specialist nursing. The five factors models had an excellent fit (comparative fit index = 0.95, root mean square error of approximation = 0.045 for core set of questions). Items loading on each factor generally corresponded to a specific section or subsection of the questionnaire. CFA findings were concordant with the EFA patterns. CONCLUSION The findings suggest five coherent underlying sub-constructs relating to different aspects of cancer health care. The findings support the construction of evidence-based composite indicators for different domains of experience and provide options for survey re-design.
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Affiliation(s)
- Mayam Gomez‐Cano
- University of Exeter Medical School (Primary Care)University of ExeterExeterUK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) GroupDepartment of Behavioural Science and HealthUniversity College LondonLondonUK
| | - John L. Campbell
- University of Exeter Medical School (Primary Care)University of ExeterExeterUK
| | | | - Gary A. Abel
- University of Exeter Medical School (Primary Care)University of ExeterExeterUK
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Fowler FJ, Brenner PS, Hargraves JL, Cleary PD. Comparing Web and Mail Protocols for Administering Hospital Consumer Assessment of Healthcare Providers and Systems Surveys. Med Care 2021; 59:907-912. [PMID: 34334736 PMCID: PMC8570265 DOI: 10.1097/mlr.0000000000001627] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to compare results of using web-based and mail (postal) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data collection protocols. RESEARCH DESIGN Patients who had been hospitalized in a New England Hospital were surveyed about their hospital experience. Patients who provided email addresses were randomized to 1 of 3 data collection protocols: web-alone, web with postal mail follow-up, and postal mail only. Those who did not provide email addresses were surveyed using postal mail only. Analyses compared response rates, respondent characteristics, and patient-reported experiences. SUBJECTS For an 8-week period, patients were discharged from the study hospital to home. MEASURES Measures included response rates, characteristics of respondents, 6 composite measures of their patient experiences, and 2 ratings of the hospital. RESULTS Response rates were significantly lower for the web-only protocol than the mail or combined protocols, and those who had not provided email addresses had lower response rates. Those over 65 were more likely than others to respond to all protocols, especially for the mail-only protocols. Respondents without email addresses were older, less educated, and reported worse health than those who provided email addresses. After adjusting for respondent differences, those in the combined protocol differed significantly from the mail (postal) only respondents on 2 measures of patient experience; those in the web-only protocol differed on one. Those not providing an email address differed from those who did on one measure. CONCLUSION If web-based protocols are used for HCAHPS surveys, adjustments for a mode of data collection are needed to make results comparable.
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Affiliation(s)
| | - Philip S Brenner
- Department of Sociology, University of Massachusetts Boston, Boston, MA
| | | | - Paul D Cleary
- Anna M.R. Lauder Professor of Public Health, Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
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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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8
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Results of mapping patients expectation using SERVQUAL. J Healthc Qual Res 2020; 35:381-390. [PMID: 33169680 DOI: 10.1016/j.jhqr.2019.11.008] [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] [Received: 05/23/2019] [Revised: 10/14/2019] [Accepted: 11/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Understanding expectations of the patients towards the quality of services that hospitals providing is very important in quality in healthcare. With every health care organization claiming its services to be the best, benchmarking and comparing them to ascertain the real best is very difficult but much required in this competitive world. Patients have a varied need depending upon the resources and criticality of disease. The aim of the study was to identify the factors linked with patient's expectations contributing to the quality of the service delivered by the hospital. MATERIALS AND METHODS Multi-speciality hospitals were visited to survey indoor and outdoor patients of different age groups. Omega coefficient and Cronbach α test were used to test the questionnaire's validity and reliability. The factor analysis technique was used to identify factors determining patient expectations. The SERVQUAL framework was used to categorize evaluation criteria. RESULTS The resultant factors show variations in prioritizing service demands by the patients. Such a system would enable the patients to select a hospital capable of delivering best quality services. CONCLUSION This study identifies the factors that contribute in delivering high quality service by the hospital. It gives a futuristic view to design a framework for evaluating the quality of the service delivered by a hospital.
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9
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Otani K, Deng Y, Herrmann PA, Kurz RS. Patient Satisfaction, Quality Attributes, and Organizational Characteristics: A Hierarchical Linear Model Approach. J Patient Exp 2019; 7:801-806. [PMID: 33294618 PMCID: PMC7705829 DOI: 10.1177/2374373519892410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Patient satisfaction studies have gained more and more attention, and there are many patient satisfaction studies. These studies assume that patients were selected randomly and independently, but patient satisfaction surveys are described as a multistage or hierarchically structured sample. Thus, there is a need to conduct a hierarchical linear model (HLM) analysis with a large number of hospitals. This study utilized an HLM to investigate both the individual patient-level effect on the overall satisfaction rating and the effect of hospital characteristics on the combining process of patient’s overall satisfaction rating. This study used patient satisfaction data collected from 100 hospitals with the sample size of 85 766. The hospital-level characteristics include total expense per personnel, payroll expense per personnel, number of staffed beds per personnel, and number of admission per personnel. This study found that hospital characteristics influence overall rating of the hospital through the doctor, staff, and room attributes. When considering the complex nature of the overall patient rating process of hospitals, it makes more sense to analyze hospital characteristics that are interacting with attributes rather than treat hospital characteristics as independent of these factors.
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Affiliation(s)
- Koichiro Otani
- Department of Public Policy, Purdue University Fort Wayne, Fort Wayne, IN, USA
| | - Yihao Deng
- Department of Mathematical Sciences, Purdue University Fort Wayne, Fort Wayne, IN, USA
| | | | - Richard S Kurz
- School of Public Health, University of North Texas, Fort Worth, TX, USA
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Radwin LE, Cabral H, Bokhour BG, Seibert MN, Stolzmann K, Annis A, Mohr DC. A scale to measure nurses' and providers' patient centered care in primary care settings. PATIENT EDUCATION AND COUNSELING 2019; 102:2302-2309. [PMID: 31351786 DOI: 10.1016/j.pec.2019.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/26/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES 1) Refine pilot scale measuring patients' experiences of outpatient nurses' and providers' care; 2) Determine variance explained by (a) pilot scale items and (b) "Survey of Health Experiences of Patients" (SHEP)/"Consumer Assessment of Health Care Providers and Systems" (CAHPS) scale items. METHODS Randomly selected Veteran patients with recent visits with primary care outpatient nurses and providers (n = 1192) completed scales: pilot "PCC in Primary Care: Nurses and Providers Scale" and SHEP/CAHPS scale items. Factor analyses conducted using structural equation modeling (SEM), variance measurement using regression strategies. RESULTS SEM generated scale comprised 17 items in 3 factors; 2 operationalized nurses' care; 1 providers' care. Fit statistics were acceptable. Variance explained for total PCC: nurses = 42%, providers = 56%. Combined pilot and SHEP/CAHPS item analyses yielded similarly structured scale. 70% of provider care variance explained by single item. CONCLUSION Appraisal of team, value-based care requires accrediting care to the appropriate clinician. The "PCC in Primary Care: Nurses and Providers Scale (PC2:NaPS)" provides a psychometrically sound measure for this purpose. PRACTICE IMPLICATIONS PC2:NaPS use would improve primary care leaders' and clinicians' analyses of patient centered care and associated outcomes in their settings, and thus enhance success of quality improvement and organizational projects.
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Affiliation(s)
- Laurel E Radwin
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Howard Cabral
- Boston University School of Public Health, Boston, MA, USA.
| | - Barbara G Bokhour
- Boston University School of Public Health, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, Bedford, MA, USA.
| | - Marjory Nealon Seibert
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Kelly Stolzmann
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Ann Annis
- Michigan State University, East Lansing, MI, USA.
| | - David C Mohr
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA.
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Sustained Hospital Performance on Hospital Consumer Assessment of Healthcare Providers and Systems Survey Measures: What Are the Determinants? J Healthc Manag 2019; 63:15-28. [PMID: 29303821 DOI: 10.1097/jhm-d-16-00006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY This study examines hospital characteristics associated with sustained superior performance on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures. We classified hospitals as sustainers if they remained in the top 25th percentile of overall patient ratings of inpatient experience from 2009 through 2013. We classified hospital characteristics as modifiable or unmodifiable. Modifiable characteristics are operational measures that hospitals can change to improve performance; these characteristics include registered nurse (RN) staffing levels, presence of hospitalists, and level of physician integration. Unmodifiable characteristics are core structural dimensions, such as hospital size and teaching status, that require substantial investment to change, as well as market-level factors such as competition and unemployment rates. Using logistic regression analysis, we found that RN staffing levels, Medicare share of inpatient days, teaching status, and market competition were significant predictors of the likelihood that a given hospital sustained high levels of patient ratings over time (i.e., the likelihood of a hospital being classified as a sustainer). Hospitals with a higher ratio of inpatient days to RN staffing and higher Medicare share of inpatient days had lower odds of being classified as sustainers.
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12
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Contribution of HCAHPS Specific Care Experiences to Global Ratings Varies Across 7 Countries. Med Care 2019; 57:e65-e72. [DOI: 10.1097/mlr.0000000000001077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bull C, Byrnes J, Hettiarachchi R, Downes M. A systematic review of the validity and reliability of patient-reported experience measures. Health Serv Res 2019; 54:1023-1035. [PMID: 31218671 PMCID: PMC6736915 DOI: 10.1111/1475-6773.13187] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To identify patient-reported experience measures (PREMs), assess their validity and reliability, and assess any bias in the study design of PREM validity and reliability testing. DATA SOURCES/STUDY SETTING Articles reporting on PREM development and testing sourced from MEDLINE, CINAHL and Scopus databases up to March 13, 2018. STUDY DESIGN Systematic review. DATA COLLECTION/EXTRACTION METHODS Critical appraisal of PREM study design was undertaken using the Appraisal tool for Cross-Sectional Studies (AXIS). Critical appraisal of PREM validity and reliability was undertaken using a revised version of the COSMIN checklist. PRINCIPAL FINDINGS Eighty-eight PREMs were identified, spanning across four main health care contexts. PREM validity and reliability was supported by appropriate study designs. Internal consistency (n = 58, 65.2 percent), structural validity (n = 49, 55.1 percent), and content validity (n = 34, 38.2 percent) were the most frequently reported validity and reliability tests. CONCLUSIONS Careful consideration should be given when selecting PREMs, particularly as seven of the 10 validity and reliability criteria were not undertaken in ≥50 percent of the PREMs. Testing PREM responsiveness should be prioritized for the application of PREMs where the end user is measuring change over time. Assessing measurement error/agreement of PREMs is important to understand the clinical relevancy of PREM scores used in a health care evaluation capacity.
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Affiliation(s)
- Claudia Bull
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Joshua Byrnes
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Ruvini Hettiarachchi
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
| | - Martin Downes
- Centre for Applied Health Economics (CAHE)Griffith UniversityBrisbaneQueenslandAustralia
- Menzies Health Institute Queensland (MHIQ)BrisbaneQueenslandAustralia
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Zun AB, Ibrahim MI, Mokhtar AM, Halim AS, Wan Mansor WNA. Translation, Cross-Cultural Adaptation, and Validation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) into the Malay Language. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112054. [PMID: 31185665 PMCID: PMC6604016 DOI: 10.3390/ijerph16112054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient feedback is an important tool in assessing health system quality. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was developed in 2006 as a standardized instrument to assess patient perceptions in the United States of America. This study aimed to translate and validate the HCAHPS questionnaire into the Malay language in order to assess patient perceptions of health services in Malaysia. METHODS The original HCAPHS in English was translated into Malay based on the established guideline. The content validation involved an expert panel of 10 members, including patients. The face validation pilot testing of the HCAHPS-Malay version was conducted among 10 discharged patients. The exploratory factor analysis (EFA) used principal axis factor, and varimax rotation was established based on a cross-sectional study conducted among 200 discharged patients from Hospital Universiti Sains Malaysia (Hospital USM). RESULTS The overall content validity index was 0.87, and the universal face validity index was 0.82. From the EFA, the factor loading value ranged from 0.652 to 0.961 within nine domains. The internal consistency reliability with Cronbach's alpha was 0.844. CONCLUSION The HCAHPS-Malay is a reliable and valid tool to determine patients' perception of healthcare services among inpatients in Hospital USM based on the content and face validation result together with a good construct validity and excellent absolute reliability. Further testing on HCAHPS-Malay version in other settings in Malaysia needs to be done for cross-validation.
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Affiliation(s)
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia.
| | - Ariffin Marzuki Mokhtar
- Hospital Universiti Sains Malaysia Management Unit, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia.
| | - Ahmad Sukari Halim
- Hospital Universiti Sains Malaysia Management Unit, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia.
| | - Wan Nor Arifin Wan Mansor
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia.
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Engelhardt KE, Matulewicz RS, DeLancey JO, Merkow RP, Quinn CM, Kreutzer L, Bilimoria KY. Physician characteristics associated with patient experience scores: implications for adjusting public reporting of individual physician scores. BMJ Qual Saf 2018; 28:412-415. [PMID: 30487182 DOI: 10.1136/bmjqs-2018-008346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/05/2018] [Accepted: 11/05/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Kathryn Elizabeth Engelhardt
- Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Surgery, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
| | - Richard S Matulewicz
- Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John O DeLancey
- Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christopher M Quinn
- Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lindsey Kreutzer
- Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Perry SJ, Richter JP, Beauvais B. The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health Serv Res 2018; 53:4943-4969. [PMID: 29957888 DOI: 10.1111/1475-6773.12997] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore antecedents and outcomes of nurse self-reported job satisfaction and dissatisfaction-based turnover cognitions, theorizing (using Self-Determination Theory) that leaders can foster work conditions that help fulfill innate needs, thereby fostering satisfaction of nurses and patients, and reducing adverse events. DATA SOURCES/STUDY SETTING Primary and secondary data were collected within a 4-month period in 2015, from 2,596 nurses in 110 Army treatment facilities (hospitals and clinics) across 35 health care systems. DATA COLLECTION/EXTRACTION We collected individual nurse responses to the Practice Environment Scale-Nursing Work Index, in addition to aggregated archival data from the same timeframe, including both facility-level patient satisfaction records (the Army Provider Level Satisfaction Survey) and health care system-level adverse events records (provided by the Army Programming, Analysis, and Evaluation office). PRINCIPAL FINDINGS Five predictors of nurse satisfaction and turnover cognitions emerged-supportive leadership, staffing levels, nurse-physician teamwork, adoption of nursing care practice, and advancement opportunities. Aggregated nurse satisfaction was the most consistent predictor of both patient satisfaction and adverse events. CONCLUSION These findings provide evidence of the importance of nurse attitudes in improving perceived and actual performance across facilities and health care systems; in addition to practical steps, managers can take to improve satisfaction and retention.
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Affiliation(s)
| | - Jason P Richter
- 4th Medical Support Squadron, Seymour Johnson AFB, Goldsboro, NC
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17
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Hatfield LA, Zaslavsky AM. Separable covariance models for health care quality measures across years and topics. Stat Med 2018; 37:2053-2066. [PMID: 29609196 DOI: 10.1002/sim.7656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/17/2018] [Accepted: 02/05/2018] [Indexed: 11/10/2022]
Abstract
Public quality reports for Medicare Advantage health plans include 11 measures of patient experiences reported in the annual Consumer Assessment of Healthcare Providers and Systems surveys. Computing summaries at the health plan level (of multiple measures in multiple years) yields an array-structured random variable. To summarize associations among measures and years, we model the variance-covariance matrix governing the plan-level vectors of yearly quality measures as a Kronecker product of an across-measure matrix and an across-year matrix, or a sum of such Kronecker products. This approach extends separable covariance structure to Fay-Herriot models. In addition, we develop linear combinations of Kronecker products similar to principal components for array random variables. To each Kronecker-product term, we apply post hoc analyses suited to the corresponding dimension of the cross-classification: 1-way factor analysis for the across-measure factor and time-series analysis to the across-year factor. These methods draw out key patterns of variation in the quality measures over time and suggest new strategies for reporting quality information to consumers.
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Affiliation(s)
- Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
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18
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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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Brant JM, Mohr C, Coombs NC, Finn S, Wilmarth E. Nurses’ Knowledge and Attitudes about Pain: Personal and Professional Characteristics and Patient Reported Pain Satisfaction. Pain Manag Nurs 2017; 18:214-223. [DOI: 10.1016/j.pmn.2017.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 11/22/2016] [Accepted: 04/06/2017] [Indexed: 11/15/2022]
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21
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Validation of the Child HCAHPS survey to measure pediatric inpatient experience of care in Flanders. Eur J Pediatr 2017; 176:935-945. [PMID: 28540435 DOI: 10.1007/s00431-017-2919-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/30/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED The recently developed Child HCAHPS provides a standard to measure US hospitals' performance on pediatric inpatient experiences of care. We field-tested Child HCAHPS in Belgium to instigate international comparison. In the development stage, forward/backward translation was conducted and patients assessed content validity index as excellent. The draft Flemish Child HCAHPS included 63 items: 38 items for five topics hypothesized to be similar to those proposed in the US (communication with parent, communication with child, attention to safety and comfort, hospital environment, and global rating), 10 screeners, a 14-item demographic and descriptive section, and one open-ended item. A 6-week pilot test was subsequently performed in three pediatric wards (general ward, hematology and oncology ward, infant and toddler ward) at a JCI-accredited university hospital. An overall response rate of 90.99% (303/333) was achieved and was consistent across wards. Confirmatory factor analysis largely confirmed the configuration of the proposed composites. Composite and single-item measures related well to patients' global rating of the hospital. Interpretation of different patient experiences across types of wards merits further investigation. CONCLUSION Child HCAHPS provides an opportunity for systematic and cross-national assessment of pediatric inpatient experiences. Sharing and implementing international best practices are the next logical step. What is Known: • Patient experience surveys are increasingly used to reflect on the quality, safety, and centeredness of patient care. • While adult inpatient experience surveys are routinely used across countries around the world, the measurement of pediatric inpatient experiences is a young field of research that is essential to reflect on family-centered care. What is New: • We demonstrate that the US-developed Child HCAHPS provides an opportunity for international benchmarking of pediatric inpatient experiences with care through parents and guardians. • Our study findings show considerable variation in experiences for types of pediatric services. Support to share good practices and launch quality improvement initiatives can be obtained by organizing regular two-way feedback sessions with clinicians to place the findings in context.
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22
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Velez VJ, Kaw R, Hu B, Frankel RM, Windover AK, Bokar D, Rish JM, Rothberg MB. Do HCAHPS Doctor Communication Scores Reflect the Communication Skills of the Attending on Record? A Cautionary Tale from a Tertiary-Care Medical Service. J Hosp Med 2017; 12:421-427. [PMID: 28574531 DOI: 10.12788/jhm.2743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores measure patient satisfaction with hospital care. It is not known if these reflect the communication skills of the attending physician on record. The Four Habits Coding Scheme (4HCS) is a validated instrument that measures bedside physician communication skills according to 4 habits, namely: investing in the beginning, eliciting the patient's perspective, demonstrating empathy, and investing in the end. OBJECTIVE To investigate whether the 4HCS correlates with provider HCAHPS scores. METHODS Using a cross-sectional design, consenting hospitalist physicians (n = 28), were observed on inpatient rounds during 3 separate encounters. We compared hospitalists' 4HCS scores with their doctor communication HCAHPS scores to assess the degree to which these correlated with inpatient physician communication skills. We performed sensitivity analysis excluding scores returned by patients cared for by more than 1 hospitalist. RESULTS A total of 1003 HCAHPS survey responses were available. Pearson correlation between 4HCS and doctor communication scores was not significant, at 0.098 (-0.285, 0.455; P = 0.619). Also, no significant correlations were found between each habit and HCAHPS. When including only scores attributable to 1 hospitalist, Pearson correlation between the empathy habit and the HCAHPS respect score was 0.515 (0.176, 0.745; P = 0.005). Between empathy and overall doctor communication, it was 0.442 (0.082, 0.7; P = 0.019). CONCLUSION Attending-of-record HCAHPS scores do not correlate with 4HCS. After excluding patients cared for by more than 1 hospitalist, demonstrating empathy did correlate with the doctor communication and respect HCAHPS scores. Journal of Hospital Medicine 2017;12:421-427.
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Affiliation(s)
- Vicente J Velez
- Department of Hospital Medicine, Medicine Institute, Center for Excellence in Healthcare Communication, Office of Patient Experience, Cleveland Clinic, Cleveland, Ohio
| | - Roop Kaw
- Department of Hospital Medicine, Medicine Institute, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bo Hu
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Richard M Frankel
- Indiana University School of Medicine, Cleveland Clinic Education Institute, Cleveland, Ohio
| | - Amy K Windover
- Center for Excellence in Healthcare Communication, Office of Patient Experience, Cleveland Clinic, Cleveland, Ohio
| | - Dan Bokar
- Office of Patient Experience, Cleveland Clinic, Cleveland, Ohio
| | - Julie M Rish
- Office of Patient Experience, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Michael B Rothberg
- Center for Value-based Care Research, Cleveland Clinic Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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23
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Shippee ND, Shippee TP, Mobley PD, Fernstrom KM, Britt HR. Effect of a Whole-Person Model of Care on Patient Experience in Patients With Complex Chronic Illness in Late Life. Am J Hosp Palliat Care 2017; 35:104-109. [PMID: 28133973 PMCID: PMC5704566 DOI: 10.1177/1049909117690710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Patients with serious chronic illness are at a greater risk of depersonalized, overmedicalized care as they move into later life. Existing intervention research on person-focused care for persons in this transitional period is limited. Objective: To test the effects of LifeCourse, a team-based, whole-person intervention emphasizing listening to and knowing patients, on patient experience at 6 months. Design: This is a quasi-experimental study with patients allocated to LifeCourse and comparison groups based on 2 geographic locations. Robust change-score regression models adjusted for baseline differences and confounding. Setting/Participants: Patients (113 intervention, 99 comparison in analyses) were individuals with heart failure or other serious chronic illness, cancer, or dementia who had visits to hospitals at a large multipractice health system in the United States Midwest. Measurements: Primary outcome was 6-month change in patient experience measured via a novel, validated 21-item patient experience tool developed specifically for this intervention. Covariates included demographics, comorbidity score, and primary diagnosis. Results: At 6 months, LifeCourse was associated with a moderate improvement in overall patient experience versus usual care. Individual domain subscales for care team, communication, and patient goals were not individually significant but trended positively in the direction of effect. Conclusion: Person-focused, team-based interventions can improve patient experience with care at a stage fraught with overmedicalization and many care needs. Improvement in patient experience in LifeCourse represents the sum effect of small improvements across different domains/aspects of care such as relationships with and work by the care team.
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Affiliation(s)
- Nathan D Shippee
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Tetyana P Shippee
- 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Patrick D Mobley
- 2 Division of Applied Research, Allina Health, Minneapolis, MN, USA
| | - Karl M Fernstrom
- 2 Division of Applied Research, Allina Health, Minneapolis, MN, USA
| | - Heather R Britt
- 2 Division of Applied Research, Allina Health, Minneapolis, MN, USA
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Fernstrom KM, Shippee ND, Jones AL, Britt HR. Development and validation of a new patient experience tool in patients with serious illness. BMC Palliat Care 2016; 15:99. [PMID: 28038669 PMCID: PMC5203706 DOI: 10.1186/s12904-016-0172-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/01/2016] [Indexed: 01/08/2023] Open
Abstract
Background Patients with serious chronic illnesses face increasingly complex care and are at risk of poor experience due to a fragmented health system. Most current patient experience tools are not designed to address the unique care aspects of this population and the few that exist are delivered too late in the disease trajectory and are not administered longitudinally which makes them less useful across settings. Methods We developed a new tool designed to address these gaps. The 25 item scale was tested and refined using randomly cross-validated exploratory and confirmatory factor analyses. Participants were not yet hospice eligible but sick enough to receive benefits of a supportive care approach in the last 2 to 3 years of life. Full information maximum likelihood models were run to confirm the factor structure developed in exploratory analyses. Goodness-of-fit was assessed with the Comparative Fit Index, the Tucker-Lewis Index, and the Root Mean Square Error of Approximation. Test-retest reliability was assessed with the intraclass correlation coefficient and internal consistency of the final scale was examined using Cronbach’s alpha. Results Exploratory factor analysis revealed three domains — Care Team, Communication, and Care Goals — after removing weak loading and cross loading items. The initial three domain measurement model suggested in the development cohort was tested in the validation cohort and exhibited poor fit X2 (206) = 565.37, p < 0.001; CFI = 0.879; TLI = 0.864; RMSEA = 0.076. After model respecification, including removing one additional item and allowing paths between theoretically plausible error terms, the final 21 item tool exhibited good fit X2 (173) = 295.63, p < 0.001; CFI = 0.958; TLI = 0.949; RMSEA = 0.048. Cronbach’s alpha revealed high reliability of each domain (Care Team = 0.92, Communication = 0.83, Care Goals = 0.77) and the entire scale (α = 0.91). ICC showed adequate test-retest validity (ICC = 0.58; 95% CI: 0.52–0.65) of the full scale. Conclusions When administered earlier in the chronic illness trajectory, a new patient experience scale focused on care teams across settings, communication, and care goals, displayed strong reliability and performed well psychometrically. Trial registrations This trial (NCT01746446) was registered at ClinicalTrials.gov on November 27, 2012 (retrospectively registered). Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0172-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karl M Fernstrom
- Division of Applied Research, Allina Health, 2925 Chicago Avenue, Mail Stop #10039, Minneapolis, MN, 55407, USA.
| | - Nathan D Shippee
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, D375 Mayo MMC 729, Minneapolis, MN, 55455, USA
| | - Alissa L Jones
- Division of Applied Research, Allina Health, 2925 Chicago Avenue, Mail Stop #10039, Minneapolis, MN, 55407, USA
| | - Heather R Britt
- Division of Applied Research, Allina Health, 2925 Chicago Avenue, Mail Stop #10039, Minneapolis, MN, 55407, USA
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25
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Kim ES, Dedrick RF, Cao C, Ferron JM. Multilevel Factor Analysis: Reporting Guidelines and a Review of Reporting Practices. MULTIVARIATE BEHAVIORAL RESEARCH 2016; 51:881-898. [PMID: 27754708 DOI: 10.1080/00273171.2016.1228042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We provide reporting guidelines for multilevel factor analysis (MFA) and use these guidelines to systematically review 72 MFA applications in journals across a range of disciplines (e.g., education, health/nursing, management, and psychology) published between 1994 and 2014. Results are organized in terms of the (a) characteristics of the MFA application (e.g., construct measured), (b) purpose (e.g., measurement validation), (c) data source (e.g., number of cases at Level 1 and Level 2), (d) statistical approach (e.g., maximum likelihood), and (e) results reported (e.g., intraclass correlations for indicators and latent variables, standardized factor loadings, fit indices). Results from this review have implications for applied researchers interested in expanding their approaches to psychometric analyses and construct validation within a multilevel framework and for methodologists using Monte Carlo methods to explore technical and methodological issues grounded in realistic research design conditions.
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Esdar M, Hübner U, Liebe JD, Hüsers J, Thye J. Understanding latent structures of clinical information logistics: A bottom-up approach for model building and validating the workflow composite score. Int J Med Inform 2016; 97:210-220. [PMID: 27919379 DOI: 10.1016/j.ijmedinf.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Clinical information logistics is a construct that aims to describe and explain various phenomena of information provision to drive clinical processes. It can be measured by the workflow composite score, an aggregated indicator of the degree of IT support in clinical processes. This study primarily aimed to investigate the yet unknown empirical patterns constituting this construct. The second goal was to derive a data-driven weighting scheme for the constituents of the workflow composite score and to contrast this scheme with a literature based, top-down procedure. This approach should finally test the validity and robustness of the workflow composite score. METHODS Based on secondary data from 183 German hospitals, a tiered factor analytic approach (confirmatory and subsequent exploratory factor analysis) was pursued. A weighting scheme, which was based on factor loadings obtained in the analyses, was put into practice. RESULTS We were able to identify five statistically significant factors of clinical information logistics that accounted for 63% of the overall variance. These factors were "flow of data and information", "mobility", "clinical decision support and patient safety", "electronic patient record" and "integration and distribution". The system of weights derived from the factor loadings resulted in values for the workflow composite score that differed only slightly from the score values that had been previously published based on a top-down approach. CONCLUSION Our findings give insight into the internal composition of clinical information logistics both in terms of factors and weights. They also allowed us to propose a coherent model of clinical information logistics from a technical perspective that joins empirical findings with theoretical knowledge. Despite the new scheme of weights applied to the calculation of the workflow composite score, the score behaved robustly, which is yet another hint of its validity and therefore its usefulness.
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Affiliation(s)
- Moritz Esdar
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Ursula Hübner
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Jan-David Liebe
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Jens Hüsers
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
| | - Johannes Thye
- Health Informatics Research Group, University of Applied Sciences Osnabrück, Faculty of Business Management and Social Sciences, Caprivistr. 30A, D-49076 Osnabrück, Germany.
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Abstract
Anesthesiologists are obligated to demonstrate the value of the care they provide. The Centers for Medicare and Medicaid Services has multiple performance-based payment programs to drive high-value care and motivate integrated care for surgical patients and hospitalized patients. These programs rely on diverse arrays of performance measures and complex reporting rules. Among all specialties, anesthesiology has tremendous potential to effect wide-ranging change on diverse measures. Performance measures deserve scrutiny by anesthesiologists as tools to improve care, the means by which payment is determined, and as a means to demonstrate the value of care to surgeons, hospitals, and patients.
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Affiliation(s)
- Joseph A Hyder
- Division of Critical Care Medicine, Department of Anesthesiology, Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - James R Hebl
- Department of Anesthesiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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28
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Cowen ME, Czerwinski J, Kabara J, Blumenthal DU, Kheder S, Simmons S. The risk-outcome-experience triad: Mortality risk and the hospital consumer assessment of healthcare providers and systems survey. J Hosp Med 2016; 11:628-35. [PMID: 27251217 DOI: 10.1002/jhm.2611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Studies have shown an association between the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) scores and clinical quality. The mortality risk on admission predicts adverse events. It is not known if this risk also portends a suboptimal patient experience. OBJECTIVE To determine if the admission mortality risk identifies an experience of care risk. DESIGN A retrospectively assembled cohort in which individual HCAHPS survey responses were linked to the admission risk of dying. SETTING Five community hospitals of various sizes in Michigan. PATIENTS There were 17,509 HCAHPS medical and surgical respondents; 2513 (14.4%) were at high risk of dying. MEASUREMENTS Odds ratio (OR) (high-risk patients to low-risk patients) for providing a top box score for HCAHPS dimensions, controlling for hospital and the standard HCAHPS patient mix adjustment factors. RESULTS High-risk respondents were less likely to provide the most favorable response (unadjusted) for all HCAHPS domains, although the difference was not significant (P = 0.09) for discharge information. Multivariable analyses indicated that high-risk patients were less likely to report a top box experience for doctor communication (OR: 0.85; 95% confidence interval [CI]: 0.77-0.94) and responsiveness of hospital staff (OR: 0.77; 95% CI: 0.69-0.85), but were more likely to have received adequate discharge information (OR: 1.30, 95% CI: 1.14-1.48). CONCLUSIONS Patients at high risk of dying who completed surveys were less likely to report favorable physician communication and staff responsiveness. Further understanding of these relationships may help design a care model to improve both outcomes and experience. Journal of Hospital Medicine 2016;11:628-635. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Mark E Cowen
- Department of Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan.
- Quality Institute, St. Joseph Mercy Hospital, Ann Arbor, Michigan.
| | | | - Jared Kabara
- Quality Institute, St. Joseph Mercy Hospital, Ann Arbor, Michigan
| | | | - Susan Kheder
- Department of Patient and Community Engagement, St. Joseph Mercy Hospital, Ann Arbor, Michigan
| | - Stefanie Simmons
- Department of Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, Michigan
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Hatfield LA, Zaslavsky AM. Implications of Variation in the Relationships between Beneficiary Characteristics and Medicare Advantage CAHPS Measures. Health Serv Res 2016; 52:1310-1329. [PMID: 27500888 DOI: 10.1111/1475-6773.12544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To study how differences in quality score adjustments across Medicare Advantage contracts change comparisons for individuals and contracts. DATA SOURCES Responses to the Medicare Advantage implementation of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) survey from 2010 to 2014. STUDY DESIGN We fit national-and state-level hierarchical models to predict CAHPS scores for individuals and contracts, adjusted for self-reported education, general health, and mental health. We allow the effects of these variables on quality measures to vary across contracts with a hierarchical model. DATA COLLECTION/EXTRACTION METHODS We perform secondary data analysis. PRINCIPAL FINDINGS For average consumers, standard adjustment is sufficient to represent variation in contract quality standardized to a common population. For people with characteristics far from average, personalized reporting using their characteristics and contract-specific coefficients can substantially change the expected quality measures across contracts. This effect is stronger when comparing among contracts within a state than across all contracts. CONCLUSIONS Customized reporting may help consumers select the best Medicare Advantage plan, but policies should protect against unintended consequences.
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Affiliation(s)
- Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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Beattie M, Shepherd A, Lauder W, Atherton I, Cowie J, Murphy DJ. Development and preliminary psychometric properties of the Care Experience Feedback Improvement Tool (CEFIT). BMJ Open 2016; 6:e010101. [PMID: 27301482 PMCID: PMC4916633 DOI: 10.1136/bmjopen-2015-010101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/07/2016] [Accepted: 04/26/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To develop a structurally valid and reliable, yet brief measure of patient experience of hospital quality of care, the Care Experience Feedback Improvement Tool (CEFIT). Also, to examine aspects of utility of CEFIT. BACKGROUND Measuring quality improvement at the clinical interface has become a necessary component of healthcare measurement and improvement plans, but the effectiveness of measuring such complexity is dependent on the purpose and utility of the instrument used. METHODS CEFIT was designed from a theoretical model, derived from the literature and a content validity index (CVI) procedure. A telephone population surveyed 802 eligible participants (healthcare experience within the previous 12 months) to complete CEFIT. Internal consistency reliability was tested using Cronbach's α. Principal component analysis was conducted to examine the factor structure and determine structural validity. Quality criteria were applied to judge aspects of utility. RESULTS CVI found a statistically significant proportion of agreement between patient and practitioner experts for CEFIT construction. 802 eligible participants answered the CEFIT questions. Cronbach's α coefficient for internal consistency indicated high reliability (0.78). Interitem (question) total correlations (0.28-0.73) were used to establish the final instrument. Principal component analysis identified one factor accounting for 57.3% variance. Quality critique rated CEFIT as fair for content validity, excellent for structural validity, good for cost, poor for acceptability and good for educational impact. CONCLUSIONS CEFIT offers a brief yet structurally sound measure of patient experience of quality of care. The briefness of the 5-item instrument arguably offers high utility in practice. Further studies are needed to explore the utility of CEFIT to provide a robust basis for feedback to local clinical teams and drive quality improvement in the provision of care experience for patients. Further development of aspects of utility is also required.
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Affiliation(s)
- Michelle Beattie
- School of Health Sciences, University of Stirling, Centre for Health Science, Inverness, UK
| | - Ashley Shepherd
- School of Health Sciences, University of Stirling, Stirling, UK
| | - William Lauder
- College of Nursing, University of South Florida, South Florida, Florida, USA
| | - Iain Atherton
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Julie Cowie
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Douglas J Murphy
- Quality, Safety and Informatics Research Group, University of Dundee, Dundee, UK
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Ziniel SI, Connor JA, Graham D, Kupiec JK, Rauscher NA, Growdon AS, Berger A, Jenkins KJ, Harris SK. Development and psychometric characteristics of the pediatric inpatient experience survey (PIES). Int J Qual Health Care 2016; 28:191-9. [PMID: 26796484 DOI: 10.1093/intqhc/mzv118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To study the psychometric properties of the Pediatric Inpatient Experience Survey (PIES), a mail and phone survey for parent reporting of family-centered aspects of inpatient care experiences. DESIGN Two waves of cross-sectional survey data were collected by mail and phone in 2009 to design a measurement instrument with good psychometric characteristics. Additional cross-sectional data from a mail administration in 2011 confirmed the measurement domains. SETTING Free-standing pediatric hospital in the northeastern USA. PARTICIPANTS A convenience sample of English-speaking parents of hospitalized children, stratified by patient type (medical versus surgical) and previous stays at this hospital (yes versus no), constituted the instrument design phase. Four hundred and seventy-nine (63%) of those approached agreed to participate and were randomly assigned to mail or phone survey administration. Four hundred and one of these respondents completed the first wave of the survey and 354 respondents completed the second wave. A shortened instrument was mailed to parents randomly selected from patient discharge records. Data from 929 parents (response rate: 36.2%) were used for confirmatory analysis of the created measurement domains. MAIN OUTCOME MEASURES The main outcome measures of this psychometric validation study were individual item performance, test-retest reliability, internal consistency, and construct validity. RESULTS The resulting survey includes 61 items with 35 rating items with satisfactory test-retest reliability loading on eight domains. The factor structure was supported by Cronbach's alpha and confirmatory factor analysis. The survey supported construct validity in distinguishing between medical versus surgical and first time versus previous hospital stay groups known to differ with regard to satisfaction. Comparing mail and phone administrations, differences in scores were exacerbated in domain scores and showed the need for mode adjustment. CONCLUSION PIES shows satisfactory test-retest reliability, internal consistency, and construct validity. A new domain measuring emotional connectedness to staff and the hospital is highly correlated with overall satisfaction.
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Affiliation(s)
- Sonja I Ziniel
- Program for Patient Safety and Quality, Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, MA, USA Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jean A Connor
- Program for Patient Safety and Quality, Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Dionne Graham
- Program for Patient Safety and Quality, Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Nina A Rauscher
- Program for Patient Safety and Quality, Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, MA, USA
| | - Amanda S Growdon
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | - Kathy J Jenkins
- Program for Patient Safety and Quality, Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Sion Kim Harris
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA Department of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
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Shwartz M, Restuccia JD, Rosen AK. Composite Measures of Health Care Provider Performance: A Description of Approaches. Milbank Q 2015; 93:788-825. [PMID: 26626986 PMCID: PMC4678940 DOI: 10.1111/1468-0009.12165] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Since the Institute of Medicine's 2001 report Crossing the Quality Chasm, there has been a rapid proliferation of quality measures used in quality-monitoring, provider-profiling, and pay-for-performance (P4P) programs. Al-though individual performance measures are useful for identifying specific processes and outcomes for improvement and tracking progress, they do not easily provide an accessible overview of performance. Composite measures aggregate individual performance measures into a summary score. By reducing the amount of data that must be processed, they facilitate (1) benchmarking of an organization's performance, encouraging quality improvement initiatives to match performance against high-performing organizations, and (2) profiling and P4P programs based on an organization's overall performance. METHODS We describe different approaches to creating composite measures,discuss their advantages and disadvantages, and provide examples of their use. FINDINGS The major issues in creating composite measures are (1) whether to aggregate measures at the patient level through all-or-none approaches or the facility level, using one of the several possible weighting schemes; (2) when combining measures on different scales, how to rescale measures (using z scores,range percentages, ranks, or 5-star categorizations); and (3) whether to use shrinkage estimators, which increase precision by smoothing rates from smaller facilities but also decrease transparency. CONCLUSIONS Because provider rankings and rewards under P4P programs may be sensitive to both context and the data, careful analysis is warranted before deciding to implement a particular method. A better understanding of both when and where to use composite measures and the incentives created by composite measures are likely to be important areas of research as the use of composite measures grows.
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Affiliation(s)
- Michael Shwartz
- Questrom School of
BusinessBoston University
- Center for Healthcare Organization and
Implementation ResearchBoston VA Healthcare System
| | - Joseph D Restuccia
- Questrom School of
BusinessBoston University
- Center for Healthcare Organization and
Implementation ResearchBoston VA Healthcare System
| | - Amy K Rosen
- Center for Healthcare Organization and
Implementation ResearchBoston VA Healthcare System
- Boston University School of
Medicine
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Otani K, Chumbler NR, Herrmann PA, Kurz RS. Impact of Pain on Patient Satisfaction Integration Process: How Patients With Pain Combine Their Health Care Attribute Reactions. Health Serv Res Manag Epidemiol 2015; 2:2333392815615103. [PMID: 28462270 PMCID: PMC5266431 DOI: 10.1177/2333392815615103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Context: Health care environments have been changing rapidly, and one of the changes is to emphasize patient satisfaction. However, most studies assume that all patients integrate their health care attribute reactions in the same way to arrive at their satisfaction. Objective: The objective of this study is to investigate how patients’ experience of pain influences their attribute reaction integration process and their overall rating of the hospital. Design: Patient satisfaction data were collected using a mailed questionnaire. Multiple linear regression analyses with a dichotomous (yes/no) pain variable and its interaction effects with nursing care, physician care, staff care, and hospital room were conducted with control variables. Main Outcome Measures: The pain variable was statistically significant and also revealed interaction effects with the physician care and the staff care variables in the model. Patients who needed medicine for pain showed lower overall rating of the hospitals than patients who did not need medicine. Results: The statistically significant interaction effects indicate that for patients who needed medicine for pain, staff care becomes more important and physician care becomes less important compared to patients who do not need medicine for pain. All 4 attributes (nursing care, physician care, staff care, and hospital room) are not equally influential. Conclusion: Implementing policies and procedures related to these interaction effects would lead to the most efficient and effective improvement outcomes. These findings suggest that future policies should be modified to enhance nursing and staff care to provide more direct care for patients with pain.
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Affiliation(s)
- Koichiro Otani
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Neale R Chumbler
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
| | | | - Richard S Kurz
- School of Public Health, University of North Texas, Health Science Center, Fort Worth, TX, USA
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Phillips NM, Street M, Haesler E. A systematic review of reliable and valid tools for the measurement of patient participation in healthcare. BMJ Qual Saf 2015; 25:110-7. [PMID: 26415751 DOI: 10.1136/bmjqs-2015-004357] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 08/31/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators. AIM This systematic review sought to identify strategies to measure patient participation in healthcare and to report their reliability and validity. In the context of this review, patient participation was constructed as shared decision-making, acknowledging the patient as having critical knowledge regarding their own health and care needs and promoting self-care/autonomy. METHODS Following a comprehensive search, studies reporting reliability or validity of an instrument used in a healthcare setting to measure patient participation, published in English between January 2004 and March 2014 were eligible for inclusion. RESULTS From an initial search, which identified 1582 studies, 156 studies were retrieved and screened against inclusion criteria. Thirty-three studies reporting 24 patient participation measurement tools met inclusion criteria, and were critically appraised. The majority of studies were descriptive psychometric studies using prospective, cross-sectional designs. Almost all the tools completed by patients, family caregivers, observers or more than one stakeholder focused on aspects of patient-professional communication. Few tools designed for completion by patients or family caregivers provided valid and reliable measures of patient participation. There was low correlation between many of the tools and other measures of patient satisfaction. CONCLUSION Few reliable and valid tools for measurement of patient participation in healthcare have been recently developed. Of those reported in this review, the dyadic Observing Patient Involvement in Decision Making (dyadic-OPTION) tool presents the most promise for measuring core components of patient participation. There remains a need for further study into valid, reliable and feasible strategies for measuring patient participation as part of continuous quality improvement.
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Affiliation(s)
- Nicole Margaret Phillips
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia Deakin University Centre for Quality and Patient Safety Research, Burwood, Victoria, Australia
| | - Maryann Street
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia Deakin University Centre for Quality and Patient Safety Research, Burwood, Victoria, Australia
| | - Emily Haesler
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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Beattie M, Murphy DJ, Atherton I, Lauder W. Instruments to measure patient experience of healthcare quality in hospitals: a systematic review. Syst Rev 2015; 4:97. [PMID: 26202326 PMCID: PMC4511995 DOI: 10.1186/s13643-015-0089-0] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving and sustaining the quality of hospital care is an international challenge. Patient experience data can be used to target improvement and research. However, the use of patient experience data has been hindered by confusion over multiple instruments (questionnaires) with unknown psychometric testing and utility. METHODS We conducted a systematic review and utility critique of questionnaires to measure patient experience of healthcare quality in hospitals. Databases (Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO) and Web of Knowledge until end of November 2013) and grey literature were scrutinised. Inclusion criteria were applied to all records with a 10 % sample independently checked. Critique included (1) application of COSMIN checklists to assess the quality of each psychometric study, (2) critique of psychometric results of each study using Terwee et al. criteria and (3) development and critique of additional aspects of utility for each instrument. Two independent reviewers completed each critique. Synthesis included combining findings in a utility matrix. RESULTS We obtained 1157 records. Of these, 26 papers measuring patient experience of hospital quality of care were identified examining 11 international instruments. We found evidence of extensive theoretical/development work. The quality of methods and results was variable but mostly of a high standard. Additional aspects of utility found that (1) cost efficiency was mostly poor, due to the resource necessary to obtain reliable samples; (2) acceptability of most instruments was good and (3) educational impact was variable, with evidence on the ease of use, for approximately half of the questionnaires. CONCLUSIONS Selecting the right patient experience instrument depends on a balanced consideration of aspects of utility, aided by the matrix. Data required for high stakes purposes requires a high degree of reliability and validity, while those used for quality improvement may tolerate lower levels of reliability in favour of other aspects of utility (educational impact, cost and acceptability). SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013006754.
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Affiliation(s)
- Michelle Beattie
- School of Health Sciences, Centre for Health Science, University of Stirling, Highland Campus, Old Perth Rd, Inverness, IV2 3JH, UK.
| | - Douglas J Murphy
- Quality, Safety and Informatics Research Group, University of Dundee, Dundee, UK.
| | - Iain Atherton
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK.
| | - William Lauder
- School of Health Sciences, University of Stirling, Stirling, UK.
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Racial/Ethnic disparities in patient experience with communication in hospitals: real differences or measurement errors? Med Care 2015; 53:446-54. [PMID: 25856567 DOI: 10.1097/mlr.0000000000000350] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An important aspect of medical care is clear and effective communication, which can be particularly challenging for individuals based on race/ethnicity. Quality of communication is measured systematically in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and analyzed frequently such as in the National Healthcare Disparities Report. Caution is needed to discern differences in communication quality from racial/ethnic differences in perceptions about concepts or expectations about their fulfillment. OBJECTIVES To examine assumptions about the degree of commonality across racial/ethnic groups in their perceptions and expectations, and to investigate the validity of conclusions regarding racial/ethnic differences in communication quality. METHODS We used 2007 HCAHPS data from the National CAHPS Benchmarking Database to construct racial/ethnic samples that controlled for other patient characteristics (828 per group). Using multiple-groups confirmatory factor analyses, we tested whether the factor structure and model parameters (ie, factor loadings, intercepts) differed across groups. RESULTS We identified support for basic tests of equivalence across 7 racial/ethnic groups in terms of equivalent factor structure and loadings. Even stronger support was found for Communication with Doctors and Nurses. However, potentially important nonequivalence was found for Communication about Medicines, including instances of statistically significant differences between non-Hispanic whites and non-Hispanic blacks, Asians, and Native Hawaiian/other Pacific Islanders. CONCLUSIONS Our results provide strongest support for racial/ethnic comparisons on Communication with Nurses and Doctors, and reason to caution against comparisons on Communication about Medicines due to significant differences in model parameters across groups; that is, a lack of invariance in the intercept.
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Brown SM, McBride G, Collingridge DS, Butler JM, Kuttler KG, Hirshberg EL, Jones JP, Hopkins RO, Talmor D, Orme J. Validation of the Intermountain patient perception of quality (PPQ) survey among survivors of an intensive care unit admission: a retrospective validation study. BMC Health Serv Res 2015; 15:155. [PMID: 25889073 PMCID: PMC4429340 DOI: 10.1186/s12913-015-0828-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Patients’ perceptions of the quality of their hospitalization have become important to the American healthcare system. Standard surveys of perceived quality of healthcare do not focus on the Intensive Care Unit (ICU) portion of the stay. Our objective was to evaluate the construct validity and internal consistency of the Intermountain Patient Perception of Quality (PPQ) survey among patients discharged from the ICU. Methods We analyzed prospectively collected results from the ICU PPQ survey of all inpatients at Intermountain Medical Center whose hospitalization included an ICU stay. We employed principal components analysis to determine the constructs present in the PPQ survey, and Cronbach’s alpha to evaluate the internal consistency (reliability) of the items representing each construct. Results We identified 5,680 patients who had completed the PPQ survey. There were three basic domains measured: nursing care, physician care, and overall perception of quality. Most of the variability was explained with the first two principal components. Constructs did not vary by type of respondent. Conclusions The Intermountain ICU PPQ survey demonstrated excellent construct validity across three distinct constructs. This, in addition to its previously established content validity, suggests the utility of the PPQ survey as an assay of the perceived quality of the ICU experience. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0828-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samuel M Brown
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, USA. .,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, 26 North 1900 East, Salt Lake City, UT, USA. .,Center for Humanizing Critical Care, Intermountain Healthcare, 5121 S Cottonwood St, Murray, UT, USA. .,Shock Trauma ICU, Intermountain Medical Center, 5121 S. Cottonwood Street, Murray, UT, 84107, USA.
| | - Glen McBride
- Strategic Planning and Research, Intermountain Healthcare, 36 S. State St., Salt Lake City, UT, USA.
| | - Dave S Collingridge
- Office of Research, Intermountain Healthcare, 5121 S Cottonwood St, Murray, UT, USA.
| | - Jorie M Butler
- Center for Humanizing Critical Care, Intermountain Healthcare, 5121 S Cottonwood St, Murray, UT, USA. .,Geriatrics Research Education and Clinical Center (GRECC), Veterans Affairs Medical Center, Salt Lake City, UT, USA. .,Department of Internal Medicine, Geriatrics Division, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, USA.
| | - Kathryn G Kuttler
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, USA. .,Center for Humanizing Critical Care, Intermountain Healthcare, 5121 S Cottonwood St, Murray, UT, USA. .,Homer Warner Center for Informatics Research, Intermountain Healthcare, 5171 South Cottonwood Street, Suite 220, Murray, UT, USA.
| | - Eliotte L Hirshberg
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, USA. .,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, 26 North 1900 East, Salt Lake City, UT, USA. .,Center for Humanizing Critical Care, Intermountain Healthcare, 5121 S Cottonwood St, Murray, UT, USA. .,Pediatric Critical Care, University of Utah, 26 North 1900 East, Salt Lake City, UT, USA.
| | - Jason P Jones
- Kaiser-Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, USA.
| | - Ramona O Hopkins
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, USA. .,Center for Humanizing Critical Care, Intermountain Healthcare, 5121 S Cottonwood St, Murray, UT, USA. .,Psychology Department and Neuroscience Center, Brigham Young University, 1022 SWKT, Provo, UT, USA.
| | - Daniel Talmor
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd, Boston, MA, USA.
| | - James Orme
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT, USA. .,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, 26 North 1900 East, Salt Lake City, UT, USA. .,Center for Humanizing Critical Care, Intermountain Healthcare, 5121 S Cottonwood St, Murray, UT, USA.
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Angst CM, Devaraj S, D'Arcy J. Dual Role of IT-Assisted Communication in Patient Care: A Validated Structure-Process-Outcome Framework. J MANAGE INFORM SYST 2014. [DOI: 10.2753/mis0742-1222290209] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Corey M. Angst
- a Management Department, Mendoza College of Business, University of Notre Dame
| | - Sarv Devaraj
- a Management Department, Mendoza College of Business, University of Notre Dame
| | - John D'Arcy
- b Lerner College of Business and Economics, University of Delaware
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Cleary PD, Meterko M, Wright SM, Zaslavsky AM. Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals. Med Care 2014; 52:619-25. [PMID: 24926709 PMCID: PMC4682878 DOI: 10.1097/mlr.0000000000000144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients. OBJECTIVES To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information. RESEARCH DESIGN We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI. RESULTS Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were >0.97 across 9 dimensions of inpatient experience. CONCLUSIONS This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics.
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Affiliation(s)
- Paul D. Cleary
- Yale School of Public Health, Yale School of Medicine, New Haven, CT
| | - Mark Meterko
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (152-M)
- Department of Health Policy & Management, Boston University School of Public Health, Boston, MA
| | - Steven M. Wright
- VA Office of Analytics and Business Intelligence, Washington, DC
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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Delavari M, Sønderlund AL, Mellor D, Mohebbi M, Swinburn B. Exploring obesogenic environments: the design and development of the migrant obesogenic perception of the environment questionnaire (MOPE-Q) using a sample of Iranian migrants in Australia. BMC Public Health 2014; 14:567. [PMID: 24906418 PMCID: PMC4068171 DOI: 10.1186/1471-2458-14-567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 06/02/2014] [Indexed: 12/05/2022] Open
Abstract
Background Although there are a number of studies examining the effect of migration on obesity, these studies tend to focus on the role of acculturation in this relationship. However, there are indications that the change in environment may also be an important factor. Indeed, there is a considerable lack of psychometric tools designed to assess the association between environment and migrant health behaviour. The current study aimed to assess the literature on the link between environment and health for migrants, and on the basis of this information, design and develop the Migrant Obesogenic Perception of the Environment questionnaire (MOPE-Q). The MOPE-Q is the first comprehensive measure of the impact of environmental factors on migrant health behaviour related to physical activity, food habits and body image concern, as well as weight change. Methods Using a systematic approach, an initial pool of items for the questionnaire was developed and refined on the basis of rigorous content and face validity assessments and factor analysis. Further, reliability tests and test re-test studies were undertaken. Differences between Iranian and Australian environmental factors as they relate to obesogenic behaviour were explored using the developed measure. Results A total of 36 items were developed for the MOPE-Q. Principal factor analysis identified three similar factor structures of environmental factors related to obesity (categorized in terms of facilitators, barriers and pressures) for each country. The final questionnaire consisted of four distinct subscales pertaining specifically to the Australian environment and five subscales pertaining to the Iranian environment, accounting for 59% and 63%, respectively, of the total variance in obesity rates. Data suggests that the MOPE-Q is a reliable and valid self-report measure for assessing the relationship between environmental factors linked to obesity and obesogenic behaviour for this particular migrant group. Conclusion The variations in environmental factors linked to obesity behaviour between home (Iran) and host (Australia) countries have been incorporated into the MOPE-Q instrument which has shown good psychometric properties. The MOPE-Q can be adapted and applied to other environments and populations to help explain changes in diet, physical activity patterns and body weight in migrant groups as they acculturate.
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Affiliation(s)
- Maryam Delavari
- WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne, Australia.
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Westbrook KW, Babakus E, Grant CC. Measuring patient-perceived hospital service quality: validity and managerial usefulness of HCAHPS scales. Health Mark Q 2014; 31:97-114. [PMID: 24878401 DOI: 10.1080/07359683.2014.907114] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study extends previous efforts to validate the Consumer Assessment of Healthcare Providers & Systems Hospital Survey (HCAHPS) instrument. Data from two non-profit hospitals are used to explore psychometric properties of the HCAHPS measures. The findings raise concerns that HCAHPS measures may not meet the standards for reliability and validity. The results are mixed in terms of the impact of HCAHPS dimensions on overall quality ratings of hospitals. Implications of the results are discussed and future research avenues are offered regarding the use and further refinement of the HCAHPS measures.
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Affiliation(s)
- Kevin W Westbrook
- a McAfee School of Business Administration , Union University-Germantown , Germantown , Tennessee
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Sipsma H, Liu Y, Wang H, Zhu Y, Xue L, Alpern R, Dale M, Bradley E. Patient experiences with inpatient care in rural China. Int J Qual Health Care 2013; 25:452-8. [DOI: 10.1093/intqhc/mzt046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Psychometric properties of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician and Group Adult Visit Survey. Med Care 2013; 50 Suppl:S28-34. [PMID: 23064274 DOI: 10.1097/mlr.0b013e31826cbc0d] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician and Group Adult Visit Survey enables patients to report their experiences with outpatient medical offices. OBJECTIVE To evaluate the factor structure and reliability of the CAHPS Clinician and Group (CG-CAHPS) Adult Visit Survey. DATA SOURCE Data from 21,318 patients receiving care in 450 clinical practice sites collected from March 2010 to December 2010 were analyzed from the CG-CAHPS Database. RESEARCH DESIGN AND PARTICIPANTS Individual level and multilevel confirmatory factor analyses were used to examine CAHPS survey responses at the patient and practice site levels. We also estimated internal consistency reliability and practice site level reliability. Correlations among multi-item composites and correlations between the composites and 2 global rating items were examined. MEASURES Scores on CG-CAHPS composites assessing Access to Care, Doctor Communication, Courteous/Helpful Staff, and 2 global ratings of whether one would Recommend their Doctor, and an Overall Doctor Rating. RESULTS Analyses provide support for the hypothesized 3-factor model assessing Access to Care, Doctor Communication, and Courteous/Helpful Staff. In addition, the internal consistency reliabilities were ≥ 0.77 and practice site level reliabilities for sites with >4 clinicians were ≥ 0.75. All composites were positively and significantly correlated with the 2 global rating items, with Doctor Communication having the strongest relationship with the global ratings. CONCLUSIONS The CG-CAHPS Adult Visit Survey has acceptable psychometric properties at the individual level and practice site level. The analyses suggest that the survey items are measuring their intended concepts and yield reliable information.
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Yeo HL, Temple LK. Can Patient-Reported Outcomes Data Be Used to Improve Quality of Care? SEMINARS IN COLON AND RECTAL SURGERY 2012. [DOI: 10.1053/j.scrs.2012.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Singer SJ, Friedberg MW, Kiang MV, Dunn T, Kuhn DM. Development and preliminary validation of the Patient Perceptions of Integrated Care survey. Med Care Res Rev 2012; 70:143-64. [PMID: 23161612 DOI: 10.1177/1077558712465654] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Valid measures of the integration of patient care could provide rapid and accurate feedback on the successfulness of current efforts to improve health care delivery systems. This article describes the development and pilot testing of a new survey, based on a novel conceptual model, which measures the integration of patient care as experienced by patients. We administered the survey to 1,289 patients with multiple chronic conditions from one health system and received responses from 527 patients (43%). Psychometric analysis of responses supported a six-dimension model of integration with satisfactory internal consistency, discriminant validity, and goodness of fit. The Patient Perceptions of Integrated Care survey can be used to measure the integration of care received by chronically ill patients for two main purposes: as a research tool to compare interventions intended to improve the integration of care and as a quality improvement tool intended to guide the refinement of delivery system innovations.
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Affiliation(s)
- Sara J Singer
- Harvard School of Public Health, Boston, MA 02115, USA.
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Squires A, Bruyneel L, Aiken LH, Van den Heede K, Brzostek T, Busse R, Ensio A, Schubert M, Zikos D, Sermeus W. Cross-cultural evaluation of the relevance of the HCAHPS survey in five European countries. Int J Qual Health Care 2012; 24:470-5. [PMID: 22807136 PMCID: PMC3441096 DOI: 10.1093/intqhc/mzs040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe the systematic language translation and cross-cultural evaluation process that assessed the relevance of the Hospital Consumer Assessment of Healthcare Providers and Systems survey in five European countries prior to national data collection efforts. DESIGN An approach involving a systematic translation process, expert review by experienced researchers and a review by 'patient' experts involving the use of content validity indexing techniques with chance correction. SETTING Five European countries where Dutch, Finnish, French, German, Greek, Italian and Polish are spoken. PARTICIPANTS 'Patient' experts who had recently experienced a hospitalization in the participating country. Main OutcomeMeasure(s) Content validity indexing with chance correction adjustment providing a quantifiable measure that evaluates the conceptual, contextual, content, semantic and technical equivalence of the instrument in relationship to the patient care experience. RESULTS All translations except two received 'excellent' ratings and no significant differences existed between scores for languages spoken in more than one country. Patient raters across all countries expressed different concerns about some of the demographic questions and their relevance for evaluating patient satisfaction. Removing demographic questions from the evaluation produced a significant improvement in the scale-level scores (P= .018). The cross-cultural evaluation process suggested that translations and content of the patient satisfaction survey were relevant across countries and languages. CONCLUSIONS The Hospital Consumer Assessment of Healthcare Providers and Systems survey is relevant to some European hospital systems and has the potential to produce internationally comparable patient satisfaction scores.
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Affiliation(s)
- Allison Squires
- New York University College of Nursing, New York, NY 10003, USA.
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Blalock SJ, Keller S, Nau D, Frentzel EM. Development of the Consumer Assessment of Pharmacy Services survey. J Am Pharm Assoc (2003) 2012; 52:324-32. [DOI: 10.1331/japha.2012.10149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Otani K, Herrmann PA, Kurz RS. Improving patient satisfaction in hospital care settings. Health Serv Manage Res 2012; 24:163-9. [PMID: 22040943 DOI: 10.1258/hsmr.2011.011008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Health-care managers have to address many aspects of the organization, and patient satisfaction is clearly one of the critical aspects for managers. To respond to the need of health-care managers, there have been many patient satisfaction studies. However, these studies focus on which attributes (factors such as nursing care and physician care) are more influential; they do not provide specific aspects for each attribute. In order to develop an effective intervention programme to improve patient satisfaction, more specific research outcomes are needed. This study utilized data collected between January 2007 and June 2008 from 32 hospitals representing a large, national private not-for-profit hospital system. The patient satisfaction survey included the Consumer Assessment of Healthcare Providers and Systems, Hospital version questionnaire items, and there are 31,471 cases. Two-stage multiple linear regression analyses were conducted with control variables (age, gender, perceived health, education and race). It was found that patients' highest priority is to be treated with courtesy and respect by nurses and physicians. An effective intervention programme to improve patient satisfaction would include a training programme, where care providers understand that patients want them to show courtesy and respect. Then, well-trained and empathetic nurses and staff members can comfort patients, and consequently improve patient satisfaction.
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Affiliation(s)
- Koichiro Otani
- Division of Public and Environmental Affairs, Indiana University-Purdue University Fort Wayne, Fort Wayne, IN 46805, USA.
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Abstract
BACKGROUND Efforts to reduce hospital readmissions have focused primarily on improving transitional care. Yet variation in readmission rates may more closely reflect variation in the underlying hospitalization rates than differences in the quality of care during and after discharge. METHODS We used national Medicare data to calculate, for each local hospital referral region (HRR), the 30-day, 60-day, and 90-day readmission rates among patients discharged with congestive heart failure or pneumonia. We also calculated population-based all-cause admission rates among Medicare enrollees in each HRR. We examined the variation in HRR readmission rates that was explained by overall hospitalization rates versus differences in patients' coexisting conditions, quality of discharge planning, physician supply, and bed supply. RESULTS HRR readmission rates ranged from 11 to 32% for congestive heart failure and from 8 to 27% for pneumonia. In univariate analyses, all-cause admission rates accounted for the highest proportion of regional variation in readmission rates for congestive heart failure (28%, 34%, and 37% at 30, 60, and 90 days, respectively); the next highest proportions were explained by case mix (11%, 15%, and 18%) and the number of cardiologists per capita (12%, 14%, and 15%). Results for pneumonia were similar, except that the number of pulmonologists per capita accounted for a lower proportion of the variation (6%, 8%, and 7%, respectively). In multivariate analyses, admission rates accounted for 16 to 24% of the variation for congestive heart failure and 11 to 20% for pneumonia; no other factor accounted for more than 6%. CONCLUSIONS We found a substantial association between regional rates of rehospitalization and overall admission rates. Programs directed at shared savings from lower utilization of hospital services might be more successful in reducing readmissions than programs initiated to date. (Funded by the Commonwealth Fund.).
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Affiliation(s)
- Arnold M Epstein
- Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA.
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