Factors associated with Medicare beneficiary complaints about quality of care

Inpatient heart failure treatment from the patient's perspective

OBJECTIVE

The objective of this study was 2-fold: (1) to identify particular opportunities for improvement in patient-centered care of heart failure patients and (2) to suggest strategies for service quality improvement focusing on those areas.

SAMPLE

A national cross-sectional sample of survey data from diagnostic-related group 127 patients was collected between December 1, 2001, and November 30, 2003. Data were split into two 12-month samples to compare results over time. The 2002 sample included 5224 patients treated at 220 hospitals; the 2003 sample included 6531 patients treated at 269 hospitals.

METHOD

A standardized mail-out/mail-back methodology was used to collect data from random samples of patients within 5 days of discharge.

RESULTS

For both samples, the ranking of service issues was highly similar, with the same 4 areas emerging as the foremost priorities: patient involvement in decision making, staff response to concerns voiced during the hospital stay, staff sensitivity to the inconvenience of heart failure and hospitalization, and emotional/spiritual support. Improvement in these 4 service areas should be associated with the greatest increases in patient satisfaction and quality of care for heart failure patients.

CONCLUSIONS

Adequately addressing these patient needs should increase patient satisfaction and quality of care for heart failure patients.

Consumers: from perceptions to participation

As Winston Churchill once said, "Personally, I am always ready to learn, although I don't always like being taught." In behavioral health, consumers can make important contributions to the design and evaluation of programs and services. As demonstrated by this case study, progress can be made in incremental steps, over several years. Another reason for BABH's success was progression from very concrete projects to an ongoing organizational structure that consumers could identify as providing a role in policy and procedure development, program evaluation, strategic planning, and programmatic changes. Performance improvement professionals, through their contributions to the organizational design of committees and communication structures, are in ideal positions to promote the full participation of consumers across all healthcare settings. Just imagine what could be achieved in understanding how to design systems if current issues and recent research results were routinely explored--such as those by Harrington et al. regarding Medicare beneficiary complaints (2001) and Gines et al. (2001) on chronic care and satisfaction with managed care--with a consistent group of consumers. Consider adding consumer participation as a new exciting goal in the next edition of your performance improvement and strategic plans!