Usefulness of Child HCAHPS Survey Data for Improving Inpatient Pediatric Care Experiences

Narrative comments about pediatric inpatient experiences yield substantial information beyond answers to closed-ended CAHPS survey questions

PURPOSE

Adults' comments on patient experience surveys explain variation in provider ratings, with negative comments providing more actionable information than positive comments. We investigate if narrative comments on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey of inpatient pediatric care (Child HCAHPS) account for global perceptions of the hospital beyond that explained by reports about specific aspects of care.

METHODS

We analyzed 545 comments from 927 Child HCAHPS surveys completed by parents and guardians of hospitalized children with at least a 24-h hospital stay from July 2017 to December 2020 at an urban children's hospital. Comments were coded for valence (positive/negative/mixed) and actionability and used to predict Overall Hospital Rating and Willingness to Recommend the Hospital along with Child HCAHPS composite scores.

RESULTS

Comments were provided more often by White and more educated respondents. Negative comments and greater actionability of comments were significantly associated with Child HCAHPS global rating measures, controlling for responses to closed-ended questions, and child and respondent characteristics. Each explained an additional 8% of the variance in respondents' overall hospital ratings and an additional 5% in their willingness to recommend the hospital.

CONCLUSIONS

Child HCAHPS narrative comment data provide significant additional information about what is important to parents and guardians during inpatient pediatric care beyond closed-ended composites.

PRACTICE IMPLICATIONS

Quality improvement efforts should include a review of narrative comments alongside closed-ended responses to help identify ways to improve inpatient care experiences. To promote health equity, comments should be encouraged for racial-and-ethnic minority patients and those with less educational attainment.

Evaluation of a protocol for eliciting narrative accounts of pediatric inpatient experiences of care

OBJECTIVE

To evaluate the measurement properties of a set of six items designed to elicit narrative accounts of pediatric inpatient experience.

DATA SOURCES

Data came from 163 participants recruited from a probability-based online panel of U.S. adults. Participants were family members of a child who had an overnight hospital stay in the past 12 months.

STUDY DESIGN

Cross-sectional survey with follow-up phone interviews.

DATA COLLECTION/EXTRACTION METHODS

Participants completed an online (n = 129) or phone (n = 34) survey about their child's hospitalization experience. The survey contained closed-ended items from the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey, followed by the six narrative items. Approximately 2 weeks after completing the survey, 47 participants additionally completed a one-hour, semi-structured phone interview, the results of which served as a "gold standard" for evaluating the fidelity of narrative responses. Qualitative content analysis was used to code narrative and interview responses for domains of patient experience and actionability.

PRINCIPAL FINDINGS

The average narrative was 248 words (SD = 319). Seventy-nine percent of narratives mentioned a topic included in the Child HCAHPS survey; 89% mentioned a topic not covered by that survey; and 75% included at least one detailed description of an actionable event. Overall, there was 66% correspondence between narrative and interview responses. Correspondence was higher on the phone than in the online condition (75% vs. 59%).

CONCLUSIONS

Narratives elicited from rigorously designed multi-item sets can provide detailed, substantive information about pediatric inpatient experiences that hospitals could use to improve child and family experiences during pediatric hospitalization. They add context to closed-ended survey item responses and provide information about experiences of care important to children and families that are not included in quantitative surveys.

Parents Have More to Say: Comments From the Child HCAHPS Single Question Versus a Narrative Item Set

BACKGROUND AND OBJECTIVES

Narrative comments from the Child Hospital Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey from a single open-ended question are specific enough to make improvements (ie, actionable). A multiitem set might yield more insights. We compare comments from the single-item Child Hospital CAHPS and the 6-item beta version Narrative Item Set (NIS).

METHODS

The Child HCAHPS NIS was piloted 2021 to 2022 at an urban children's hospital that fielded the Child HCAHPS survey since 2017. We analyzed 382 NIS comments (n = 77 parents and guardians) and compared them to single-item comments.

RESULTS

NIS respondents wrote nearly 6 times the word count compared with respondents presented with a single item, with 75% of NIS respondents providing narrative to 5 or 6 NIS items. Single-item comments were more positive (57% vs 39% NIS), yet most (61%) NIS comments included at least 1 negative remark (vs 43% single-item). Eighty-two percent of NIS comments included content on the Child HCAHPS survey (vs 51% single-item). The most common Child HCAHPS topics in NIS narratives were about being kept informed of child's care and whether doctors treated respondents with courtesy and respect. More NIS comments were deemed actionable (69% vs 39% single-item), with 1 NIS item - what a parent wished had gone differently- eliciting the most-actionable narrative.

CONCLUSIONS

The multi-item NIS elicited high percentages of comments with sufficient detail to make improvements. A large NIS demonstration is needed to assess how quality leaders and frontline staff use NIS comments to improve inpatient pediatric care.

Improving Patient Experience Scores Using Simultaneous Interpretation on Family-Centered Rounds

OBJECTIVES

Patients speaking a primary language other than English face barriers to equitable care, particularly patient-provider communications. There is no gold standard for providing inpatient medical interpretation on family-centered rounds (FCR). We aimed to implement simultaneous, in-person interpretation of FCR for Spanish-speaking families and hypothesized improved satisfaction in care.

METHODS

In-person, Spanish Equipment-Assisted Simultaneous Medical Interpretation (EASMI) was implemented in March 2018 on FCR. Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) experience scores on communication domains were analyzed for Spanish and English-speaking families pre- (n = 118) and postimplementation (n = 552). Postimplementation, we conducted medical team surveys (n = 104) and semistructured interviews with Spanish-speaking families (n = 25) to determine satisfaction with interpretation modalities (phone, video, and EASMI).

RESULTS

Spanish-speaking families exhibited statistically significant improvements in Child HCAHPS top box scores compared to English-speaking families in multiple communication and informed care-related domains. For example, "How often did your child's doctors explain things to you in a way that was easy to understand?" top box scores improved from 58% to 95% for Spanish-speaking families, compared to 85% to 83% for English speakers, with the differential effect of the intervention showing statistical significance (P = .001). Medical team surveys demonstrated high satisfaction with EASMI. Qualitative themes from interviews and open-ended survey responses emphasized multiple care benefits with EASMI, including a perceived reduction of communication errors and increased family participation.

CONCLUSIONS

EASMI was associated with significant improvements in Child HCAHPS scores in communication domains and increased medical team and family members' satisfaction with interpretation. EASMI presents a novel method for equitable FCR for Spanish-speaking families.

Associations of pediatric nurse burnout with involvement in quality improvement

PURPOSE

Burnout among nurses negatively impacts patient care experiences and safety. Inpatient pediatric nurses are high-risk for burnout due to high patient volumes, inadequate staffing, and needing to balance the demands of patients, families and team members. We examined the associations of inpatient pediatric nurse burnout with their perspectives on the importance of quality at the hospital, patient experience measurement, quality improvement (QI), unit culture, and staffing.

METHODS

We conducted a cross-sectional study at an urban children's hospital. We surveyed pediatric nurses about their perspectives including the single-item Maslach Burnout Inventory. We fit separate regression models, controlling for role, location and unit, predicting outcome measures from the dichotomized burnout scale.

RESULTS

Twenty-seven percent of pediatric nurses reported burnout. Nurses who had more confidence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out (compared to those reporting burnout; all p-values<0.05). More open communication among nurses (e.g., about possible problems with care) and unit-level teamwork were also associated with not being burned out, whereas a larger QI workload was associated with burnout (p-values<0.05).

CONCLUSIONS

Open communication among nurses and nurses being more involved and valued in QI efforts were related to not being burned out. Research is needed to further examine aspects of QI involvement that reduce burnout.

PRACTICE IMPLICATIONS

Supporting open communication among pediatric nurses, engaging them in QI and integrating QI into patient care while minimizing QI workload may decrease burnout.

Summary of the 2020 AHRQ research meeting on 'advancing methods of implementing and evaluating patient experience improvement using consumer assessment of healthcare providers and systems (CAHPS®) surveys'

BACKGROUND

The Agency for Healthcare Research and Quality held a research meeting on using Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data for quality improvement (QI) and evaluating such efforts.

TOPICS COVERED.

Meeting addressed: 1)What has been learned about organizational factors/environment needed to improve patient experience? 2)How have organizations used data to improve patient experience? 3)What can evaluations using CAHPS data teach us about implementing successful programs to improve patient experience?

KEY THEMES

Providers and stakeholders need to be engaged early and often, standardize QI processes, complement CAHPS data with other data, and compile dashboards of CAHPS scores to identify and track improvement. Rigorous study designs are valuable, but much can be learned and accomplished through practical organization-level studies.

What Parents have to Say: Content and Actionability of Narrative Comments from Child HCAHPS Survey

OBJECTIVE

To examine the content and actionability of written comments from parents and guardians on the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey.

METHODS

We coded 548 narrative text comments linked to demographic information from the Child HCAHPS survey from July 2017 to December 2020 about inpatient pediatric care at an urban children's hospital-within-a-hospital at an academic medical center. We developed initial codes based on research findings and the content of the Child HCAHPS survey, and also added codes that emerged from the comments. We performed directed and conventional content analysis.

RESULTS

Most comments were positive and provided by the child's mother. About half referred to content on the Child HCAHPS survey, primarily on being treated with courtesy and respect or explaining care at discharge. Comments about other topics most frequently provided a narrative rating of the provider or described whether providers were caring and friendly. Thirty-nine percent of comments were deemed sufficiently specific to make improvements (ie, actionable) in inpatient pediatric care; negative comments or comments about care for sicker patients were more often actionable.

CONCLUSIONS

Child HCAHPS comments provided rich detail and a large portion were deemed actionable. Comments also provided insights into topics both on the survey itself and on many other inpatient pediatric issues raised by parents and guardians. More research is needed on the value of Child HCAHPS comments, the association between Child HCAHPS open-ended and closed-ended responses, and how quality leaders and frontline staff use comments to improve inpatient pediatric care.