Content validity of patient-reported measures evaluating experiences of the quality of transitions in healthcare settings-a scoping review

No reviews so far have been conducted to define the constructs of patient-experienced quality in healthcare transitions or to identify existing generic measures of patients' experience of the quality within healthcare transitions. Our aim was to identify domains relevant for people experiencing healthcare transitions when evaluating the quality of care they have received, map the comprehensiveness of existing patient-reported experience measures (PREM), and evaluate the PREMs' content validity. The method was guided by the Joanna Briggs Institutes' guidance for scoping reviews. The search was performed on 07 December 2021 and updated 27 May 2024, in the electronic databases Medline (Ovid), Embase (Ovid), and Cinahl (EBSCO). The search identified 20,422 publications, and 190 studies were included for review. We identified 30 PREMs assessing at least one aspect of adults' experience of transitions in healthcare. Summarising the content, we consider a model with two domains, organisational and human-relational, likely to be adequate. However, a more comprehensive analysis and adequate definition of the construct is needed. None of the PREMs were considered content valid.

Trends in patient perceptions of care toward rural and urban hospitals in the United States: 2014-2019

PURPOSE

Understanding rural-urban disparities in patient satisfaction is critical to identify gaps for improvement in patient-centered care and tailor interventions to specific patient needs, especially those in the Frontier and Remote areas (FAR). This study aimed to examine disparities in patient perceptions of care between urban, rural non-FAR, and FAR hospitals between 2014 and 2019.

METHODS

This is a retrospective longitudinal study using 2014-2019 Hospital Consumer Assessment of Healthcare Providers and Systems data linked to American Hospital Annual Survey data (3,524 hospitals in 2014 and 3,440 hospitals in 2019). Multivariable linear regression models were used to identify differential trends in patient perceptions of care by hospital rurality over 2014-2019, adjusting hospital- and county-level characteristics.

FINDINGS

In 2014, patients at rural non-FAR and FAR hospitals had lower percentages of willingness to definitely recommend these hospitals than urban hospitals (average percentage difference, 95% CI: -4.0% [-4.5%, -3.5%]; -2.0% [-2.8%, -1.2%]); yet, over the study period, rural hospitals experienced steeper increases in patient willingness to recommend (0.2% [0.07%, 0.4%]; 0.4% [0.08%, 0.7%]). FAR hospitals also showed improvements in patient experience in a clean environment, communication with nurses, communication about medicines, and responsiveness of staff. Communication with doctors showed slight decreases across hospital locations.

CONCLUSIONS

Patient perceptions of care were generally improved in all US hospitals from 2014 to 2019, except communications with doctors. These findings highlight the potential for enhancing patient satisfaction and experience in urban hospitals and suggest the need to improve patient willingness to recommend in rural FAR hospitals.

Association of the Medicare Value-Based Purchasing Program With Changes in Patient Care Experience at Safety-net vs Non–Safety-net Hospitals

Question

Is the Centers for Medicare & Medicaid Services Hospital Value-Based Purchasing (VBP) program associated with changes in patient-reported experience in safety-net vs non–safety-net Hospitals?

Findings

In this cohort study of 2266 US hospitals, safety-net hospitals had lower performance than non–safety-net hospitals across all measures of patient experience and satisfaction from 2008 through 2019. The VBP program implementation was not associated with improvement in measures of patient experience in safety-net vs non–safety-net hospitals.

Meaning

Findings of this study suggest that the VBP program was not associated with improved patient experience at safety-net vs non–safety-net hospitals; policy makers may need to explore strategies beyond pay-for-performance programs to address the differences in patient-reported experience at these hospitals.

Importance

Safety-net hospitals, which have limited financial resources and care for disadvantaged populations, have lower performance on measures of patient experience than non–safety-net hospitals. In 2011, the Centers for Medicare & Medicaid Services Hospital Value-Based Purchasing (VBP) program began tying hospital payments to patient-reported experience scores, but whether implementation of this program narrowed differences in scores between safety-net and non–safety-net hospitals is unknown.

Objective

To evaluate whether the VBP program’s implementation was associated with changes in measures of patient-reported experience at safety-net hospitals compared with non–safety-net hospitals between 2008 and 2019.

Design, Setting, and Participants

This cohort study evaluated 2266 US hospitals that participated in the VBP program between 2008 and 2019. Safety-net hospitals were defined as those in the highest quartile of the disproportionate share hospital index. Data were analyzed from December 2021 to February 2022.

Main Outcomes and Measures

The primary outcomes were the Hospital Consumer Assessment of Healthcare Providers and Systems global measures of patient-reported experience and satisfaction, including a patient’s overall rating of a hospital and willingness to recommend a hospital. Secondary outcomes included the 7 other Hospital Consumer Assessment of Healthcare Providers and Systems measures encompassing communication ratings, clinical processes ratings, and hospital environment ratings. Piecewise linear mixed regression models were used to assess annual trends in performance on each patient experience measure by hospital safety-net status before (July 1, 2007-June 30, 2011) and after (July 1, 2011-June 30, 2019) implementation of the VBP program.

Results

Of 2266 US hospitals, 549 (24.2%) were safety-net hospitals. Safety-net hospitals were more likely than non–safety-net hospitals to be nonteaching (67.6% [371 of 549] vs 53.1% [912 of 1717]; P < .001) and urban (82.5% [453 of 549] vs 77.4% [1329 of 1717]; P = .01). Safety-net hospitals consistently had lower patient experience scores than non–safety-net hospitals across all measures from 2008 to 2019. The percentage of patients rating safety-net hospitals as a 9 or 10 out of 10 increased during the pre-VBP program period (annual percentage change, 1.84%; 95% CI, 1.73%-1.96%) and at a slower rate after VBP program implementation (annual percentage change, 0.49%; 95% CI, 0.45%-0.53%) at safety-net hospitals. Similar patterns were observed at non–safety-net hospitals (pre-VBP program annual percentage change, 1.84% [95% CI, 1.77%-1.90%] and post-VBP program annual percentage change, 0.42% [95% CI, 0.41%-0.45%]). There was no differential change in performance between these sites after the VBP program implementation (adjusted differential change, 0.07% [95% CI, −0.08% to 0.23%]; P = .36). These patterns were similar for the global measure that assessed whether patients would definitely recommend a hospital. There was also no differential change in performance between safety-net and non–safety-net hospitals under the VBP program across measures of communication, including doctor (adjusted differential change, −0.09% [95% CI, −0.19% to 0.01%]; P = .08) and nurse (adjusted differential change, −0.01% [95% CI, −0.12% to 0.10%]; P = .86) communication as well as clinical process measures (staff responsiveness adjusted differential change, 0.13% [95% CI, −0.03% to 0.29%]; P = .11; and discharge instructions adjusted differential change, −0.02% [95% CI, −0.12% to 0.07%]; P = .62).

Conclusions and Relevance

This cohort study of 2266 US hospitals found that the VBP program was not associated with improved patient experience at safety-net hospitals vs non–safety-net hospitals during an 8-year period. Policy makers may need to explore other strategies to address ongoing differences in patient experience and satisfaction, including additional support for safety-net hospitals.

Associations between Nurse Staffing Levels, Patient Experience, and Hospital Rating

The current study aimed to examine patient experience scores and differences in the scores based on the region and nurse staffing level of hospitals as well as to verify the effect of nurse-related patient experience scores on the overall rating of hospitals. Secondary data from the second Korean Patient Experience Survey-conducted using the cross-sectional design method-were analyzed, and 146 hospitals were included. Patient experience scores included six dimensions, and hospitals were categorized as: tertiary or general hospitals based on their type; capital and non-capital region hospitals based on regions; and beds-nurse or patients-nurse ratios were used based on nurse staffing levels. Pearson's correlation, simple regression, and multiple regression analysis methods were used. Among the six patient experience dimensions, the nurse-related patient experience score of 86.0 was the highest, whereas patient rights score of 78.4 was lowest. Moreover, the patient experience score for general hospitals with low nurse staffing grade was low, and the nurse experience score affected the overall hospital rating in general hospitals (p = 0.040). Policies to improve nurse staffing level are required to provide high-quality nursing care focused on communication with patients, which can enhance patient experience and satisfaction.