1
|
Ernecoff NC, Anhang Price R, Klein DJ, Haviland AM, Saliba D, Orr N, Gildner J, Gaillot S, Elliott MN. Which medicare advantage enrollees are at highest one-year mortality risk? Arch Gerontol Geriatr 2024; 124:105454. [PMID: 38703702 DOI: 10.1016/j.archger.2024.105454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND While a number of tools exist to predict mortality among older adults, less research has described the characteristics of Medicare Advantage (MA) enrollees at higher risk for 1 year mortality. OBJECTIVES To describe the characteristics of MA enrollees at higher mortality risk using patient survey data. RESEARCH DESIGN Retrospective cohort. SUBJECTS MA enrollees completing the 2019 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. MEASURES Linked demographic, health, and mortality data from a sample of MA enrollees were used to predict 1-year mortality risk and describe enrollee characteristics across levels of predicted mortality risk. RESULTS The mortality model had a 0.80 c-statistic. Mortality risks were skewed: 6 % of enrollees had a ≥ 10 % 1-year mortality risk, while 45 % of enrollees had 1 % to < 5 % 1-year mortality risk. Among the high-risk (≥10 %) group, 47 % were age 85+ versus 12 % among those with mortality risk <5 %. 79 % were in fair or poor self-rated health versus 29 % among those with mortality risk of <5 %. 71 % reported needing urgent care in the prior 6 months versus 40 % among those with a mortality risk of 1 to<5 %. CONCLUSIONS Relatively few older adults enrolled in MA are at high 1-year mortality risk. Nonetheless, MA enrollees over age 85, in fair or poor health, or with recent urgent care needs are far more likely to be in a high mortality risk group.
Collapse
Affiliation(s)
- Natalie C Ernecoff
- RAND Corporation, 4570 Fifth Avenue Suite 600, Pittsburgh, PA 15213, United States
| | | | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Amelia M Haviland
- RAND Corporation and Carnegie Mellon University, 4800 Forbes Avenue, Hamburg Hall 2214, Pittsburgh, PA 15213, United States
| | - Debra Saliba
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; University of California Los Angeles Borun Center, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095, United States; Los Angeles Veterans Administration GRECC, Los Angeles, CA, United States
| | - Nate Orr
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Jennifer Gildner
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, United States
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States.
| |
Collapse
|
2
|
Shunmuga Sundaram C, Campbell R, Ju A, King MT, Rutherford C. Patient and healthcare provider perceptions on using patient-reported experience measures (PREMs) in routine clinical care: a systematic review of qualitative studies. J Patient Rep Outcomes 2022; 6:122. [PMID: 36459251 PMCID: PMC9718906 DOI: 10.1186/s41687-022-00524-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patient-reported experience measures (PREMs) assess quality-of-care from patients' perspectives. PREMs can be used to enhance patient-centered care and facilitate patient engagement in care. With increasing quality improvement studies in clinical practice, the use of PREMs has surged. As a result, knowledge about stakeholder experiences of using PREMs to assess quality of care across diverse clinical settings is needed to inform PREM implementation efforts. To address this, this review examines the qualitative literature on patient and healthcare provider experiences of using PREMs in clinical practice. METHODS Medline, Embase and PsycInfo were systematically searched from inception to May 2021. Additional searching of reference lists for all included articles and relevant review articles were performed. Retrieved articles were screened for eligibility by one reviewer and 25% cross-checked by a second reviewer across all stages of the review. Full texts meeting eligibility criteria were appraised against the COREQ checklist for quality assessment and thematic analysis was used to analyze textual data extracted from the results. RESULTS Electronic searches identified 2683 records, of which 20 studies met eligibility criteria. Extracted data were synthesized into six themes: facilitators to PREM implementation; barriers to PREM implementation; healthcare providers' perspectives towards using PREMs; patients' perspectives towards using PREMs; advantages of using PREMs in clinical practice; limitations and practical considerations to reduce resistance of PREM usage. The primary factors facilitating and impeding the use of PREMs include organizational-, staff- and patient-related factors. CONCLUSION Results can be used to guide the usage and implementation of PREMs in clinical settings by addressing the identified barriers and building on the perceived benefits to encourage adoption of PREMs. Results around facilitators to PREM implementation and practical considerations could also promote appropriate use of PREMs by healthcare providers, helping to improve practice and the quality of care based on patient feedback.
Collapse
Affiliation(s)
- Chindhu Shunmuga Sundaram
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Rachel Campbell
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Angela Ju
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Madeleine T King
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia. .,Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney, Sydney, Australia. .,The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.
| |
Collapse
|
3
|
Ananth P, Wolfe J, Johnston EE. Charting a path to high-quality end-of-life care for children with cancer. Cancer 2022; 128:3586-3592. [PMID: 36006762 PMCID: PMC9530011 DOI: 10.1002/cncr.34419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022]
Abstract
There are currently no quality measures for end-of-life (EOL) care for children with cancer. In this commentary, we address why it is essential that we develop quality measures for EOL care for children with cancer, review the progress made to date, and chart the course for future work in this area.
Collapse
Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, CT
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA
| | - Emily E. Johnston
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
4
|
Ananth P, Mun S, Reffat N, Kang SJ, Pitafi S, Ma X, Gross CP, Wolfe J. Refining Patient-Centered Measures of End-of-Life Care Quality for Children With Cancer. JCO Oncol Pract 2022; 18:e372-e382. [PMID: 34613797 PMCID: PMC8932486 DOI: 10.1200/op.21.00447] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There are no existing quality measures (QMs) to optimize end-of-life care for children with cancer. Previously, we developed a set of 26 candidate QMs. Our primary objective in this study was to achieve stakeholder consensus on priority measures. METHODS We conducted an iterative, cross-sectional electronic survey, using a modified Delphi method to build consensus among clinician and family stakeholders. In each of the two rounds of surveys, stakeholders were asked to rate QMs on a 9-point Likert scale, on the basis of perceived importance. Health care professionals were additionally asked to rate measures on perceived feasibility. After each round, we computed median scores on importance and feasibility of measurement, retaining QMs with median importance scores ≥ 8. RESULTS Twenty-five participants completed both rounds of the survey. In round 1, participants were asked to rate 26 QMs; nine QMs, including QMs pertaining to health care use, were removed because of median importance scores < 8. Two new measures were proposed for consideration in round 2, on the basis of participant feedback. Following round 2, 17 QMs were ultimately retained. QMs related to symptom screening and palliative care consultation were rated highly in importance and feasibility. QMs related to communication were rated highly important, yet less feasible. Measuring whether a patient's needs were heard by their health care team was rated among the least feasible. CONCLUSION Childhood cancer stakeholders prioritized QMs pertaining to patient-reported outcomes, deeming measures of health care resource use less important. Future research should seek to develop novel tools for quality assessment to enhance feasibility of implementing priority measures.
Collapse
Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, CT,Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT,Prasanna Ananth, MD, MPH, Department of Pediatrics, Section of Pediatric Hematology/Oncology, Yale School of Medicine, 330 Cedar St, LMP 2082C, New Haven, CT 06510; e-mail:
| | - Sophia Mun
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Noora Reffat
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Soo Jung Kang
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Sarah Pitafi
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT,Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Pediatrics, Boston Children's Hospital, Boston, MA,Harvard Medical School, Boston, MA
| |
Collapse
|
5
|
DiMartino LD, Kirschner J, Jackson GL, Mollica MA, Lines LM. Are care experiences associated with survival among cancer patients? An analysis of the SEER-CAHPS data resource. Cancer Causes Control 2021; 32:977-987. [PMID: 34046807 DOI: 10.1007/s10552-021-01451-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer patients' care experiences encompass the range of interactions with the health care system and are an important indicator of care quality, which may influence survival outcomes. This study evaluates relationships between care experiences and survival using a large, nationally representative sample of cancer patients. METHODS We used linked SEER (Surveillance Epidemiology and End Results)-CAHPS (Consumer Assessment of Healthcare Providers and Systems) data to identify people diagnosed 8/2006-12/2013, focusing on 10 solid tumor cancer sites with the highest mortality rates among those > 65. CAHPS measures included 5 global ratings and 3 composite scores. We used survey-weighted Cox proportional hazard models comparing survival time for those who had lower (0-8) vs higher ratings (9-10) and lower (0-89) vs higher (90-100) composite scores, adjusting for case-mix and additional covariates. RESULTS We identified 2,263 eligible people; 26% died by 5-year post-survey completion or end of follow-up (12/31/2017). We found lower Prescription Drug Plan (PDP) ratings were significantly associated with lower mortality (adjusted HR = 0.67, p = 0.03). Lower Getting Needed Care scores were also significantly associated with lower mortality (adjusted HR = 0.79, p = 0.04). For other care experience measures, general health status, cancer stage, and comorbidities were more predictive of survival (p < .05). CONCLUSIONS Except for PDP and Getting Needed Care, survival was similar for those with worse versus better care experiences. Patients with poorer cancer prognoses may perceive better services from their drug plan and more responsive care from clinical providers compared to those with better prognoses. Further research is needed examining processes underlying perceptions of care experiences and survival.
Collapse
Affiliation(s)
| | | | - George L Jackson
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Duke University, Durham, NC, USA
| | | | - Lisa M Lines
- RTI International, Research Triangle Park, NC, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
6
|
The association between patient experience and healthcare outcomes using SEER-CAHPS patient experience and outcomes among cancer survivors. J Geriatr Oncol 2020; 12:623-631. [PMID: 33277226 DOI: 10.1016/j.jgo.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To understand the relationship between patient experience, as measured by scores on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, and clinical and financial outcomes among older cancer survivors. MATERIALS AND METHODS We analyzed the records of all Fee-for-Service (FFS) Medicare beneficiaries 66 years and older who completed one CAHPS survey from 2001 to 2004 or 2007-2013 with one of the five following cancer types: breast, bladder, colorectal, lung, or prostate; and completed a CAHPS survey within 5 years of cancer diagnosis date. We conducted a multivariate analysis, controlling for clinical and demographic variables, to evaluate the association between excellent CAHPS scores and the following clinical and financial outcomes: mortality, emergency department visits, and total healthcare expenditures. RESULTS A total of 7395 individuals were present in our cohort, with 57% being male and 85.7% non-Hispanic White. Breakdown of the cohort by cancer site is as follows: prostate (40.4%), breast (28.6%), colorectal (14.0%), lung (9.4%), and bladder (7.6%). When looking at the relationship between CAHPS scores and clinical outcomes, there was no significant difference between excellent and non-excellent CAHPS score respondents in all three of the clinical outcomes studied. Furthermore, there was no association between ED utilization and patient experience scores when stratifying by cancer site and race/ethnicity among this cohort. CONCLUSION In this cohort, a highly rated patient experience, as measured by responses on the CAHPS survey, is not associated with improved clinical outcomes among older cancer survivors.
Collapse
|
7
|
Cefalu MS, Elliott MN, Setodji CM, Cleary PD, Hays RD. Hospital quality indicators are not unidimensional: A reanalysis of Lieberthal and Comer. Health Serv Res 2018; 54:502-508. [PMID: 30259508 DOI: 10.1111/1475-6773.13056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication. DATA SOURCE/STUDY DESIGN Pooled cross-sectional 2010-2011 Hospital Compare data (10/1/10 and 10/1/11 archives) and the 2012 American Hospital Association Annual Survey. DATA EXTRACTION We used 71 indicators of structure, process, and outcomes of hospital care in a principal component analysis of Ridit scores to evaluate the dimensionality of the indicators. We conducted an exploratory factor analysis using only the indicators in the Centers for Medicare & Medicaid Services' Hospital Value-Based Purchasing. PRINCIPAL FINDINGS There were four underlying dimensions of hospital quality: patient experience, mortality, and two clinical process dimensions. CONCLUSIONS Hospital quality should be measured using a variety of indicators reflecting different dimensions of quality. Treating hospital quality as unidimensional leads to erroneous conclusions about the performance of different hospitals.
Collapse
Affiliation(s)
| | | | | | - Paul D Cleary
- School of Public Health, Yale University, New Haven, Connecticut
| | - Ron D Hays
- Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, California
| |
Collapse
|
8
|
Quigley DD, Elliott MN, Setodji CM, Hays RD. Quantifying Magnitude of Group-Level Differences in Patient Experiences with Health Care. Health Serv Res 2018; 53 Suppl 1:3027-3051. [PMID: 29435975 DOI: 10.1111/1475-6773.12828] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Review approaches assessing magnitude of differences in patient experience scores between different providers. DATA SOURCES 1990-2016 literature. STUDY DESIGN Systematic literature review. DATA EXTRACTION METHODS Of 812 articles mentioning "CAHPS," "patient experience," "patient satisfaction," "important(ce)," "difference," or "significance," we identified 79 possible articles, yielding 35 for data abstraction. We included 22 articles measuring magnitude of differences in patient experiences. PRINCIPAL FINDINGS We identified three main ways of estimating magnitude of differences in patient experience scores: (1) by distribution/range of patient experience variable, (2) against external anchor, and (3) comparing a difference in patient experience on one covariate to differences in patient experience on other covariates. CONCLUSIONS We suggest routine estimation of magnitude in patient experience research. More work is needed documenting magnitude of differences between providers to make patient experience data more interpretable and usable.
Collapse
Affiliation(s)
| | | | | | - Ron D Hays
- Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA
| |
Collapse
|
9
|
Tevis SE, Kennedy GD, Kent KC. Is There a Relationship Between Patient Satisfaction and Favorable Surgical Outcomes? Adv Surg 2016; 49:221-33. [PMID: 26299501 DOI: 10.1016/j.yasu.2015.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sarah E Tevis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Highland Avenue, Madison, WI 53792, USA
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Highland Avenue, Madison, WI 53792, USA
| | - K Craig Kent
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Highland Avenue, Madison, WI 53792, USA.
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Xu X, Buta E, Anhang Price R, Elliott MN, Hays RD, Cleary PD. Methodological Considerations When Studying the Association between Patient-Reported Care Experiences and Mortality. Health Serv Res 2015; 50:1146-61. [PMID: 25483571 PMCID: PMC4545351 DOI: 10.1111/1475-6773.12264] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To illustrate methodological considerations when assessing the relationship between patient care experiences and mortality. DATA SOURCE Medical Expenditure Panel Survey data (2000-2005) linked to National Health Interview Survey and National Death Index mortality data through December 31, 2006. STUDY DESIGN We estimated Cox proportional hazards models with mortality as the dependent variable and patient experience measures as independent variables and assessed consistency of experiences over time. DATA EXTRACTION METHODS We used data from respondents age 18 or older with at least one doctor's office or clinic visit during the year prior to the round 2 interview. We excluded subjects who died in the baseline year. PRINCIPAL FINDINGS The association between overall care experiences and mortality was significant for deaths not amenable to medical care and all-cause mortality, but not for amenable deaths. More than half of respondents were in a different care experience quartile over a 1-year period. In the five individual experience questions we analyzed, only time spent with the patient was significantly associated with mortality. CONCLUSIONS Deaths not amenable to medical care and the time-varying and multifaceted nature of patient care experience are important issues to consider when assessing the relationship between care experience and mortality.
Collapse
Affiliation(s)
- Xiao Xu
- Xiao Xu, Ph.D., is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
- Eugenia Buta, Ph.D., is with the Department of Biostatistics and the Yale Center for Analytic Studies, Yale School of Public Health, New Haven, CT
- Rebecca Anhang Price, Ph.D., is with the RAND Corporation, Arlington, VA
- Marc N. Elliott, Ph.D., is with the RAND Corporation, Santa Monica, CA
- Ron D. Hays, Ph.D., is with the Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA
| | - Eugenia Buta
- Xiao Xu, Ph.D., is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
- Eugenia Buta, Ph.D., is with the Department of Biostatistics and the Yale Center for Analytic Studies, Yale School of Public Health, New Haven, CT
- Rebecca Anhang Price, Ph.D., is with the RAND Corporation, Arlington, VA
- Marc N. Elliott, Ph.D., is with the RAND Corporation, Santa Monica, CA
- Ron D. Hays, Ph.D., is with the Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA
| | - Rebecca Anhang Price
- Xiao Xu, Ph.D., is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
- Eugenia Buta, Ph.D., is with the Department of Biostatistics and the Yale Center for Analytic Studies, Yale School of Public Health, New Haven, CT
- Rebecca Anhang Price, Ph.D., is with the RAND Corporation, Arlington, VA
- Marc N. Elliott, Ph.D., is with the RAND Corporation, Santa Monica, CA
- Ron D. Hays, Ph.D., is with the Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA
| | - Marc N Elliott
- Xiao Xu, Ph.D., is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
- Eugenia Buta, Ph.D., is with the Department of Biostatistics and the Yale Center for Analytic Studies, Yale School of Public Health, New Haven, CT
- Rebecca Anhang Price, Ph.D., is with the RAND Corporation, Arlington, VA
- Marc N. Elliott, Ph.D., is with the RAND Corporation, Santa Monica, CA
- Ron D. Hays, Ph.D., is with the Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA
| | - Ron D Hays
- Xiao Xu, Ph.D., is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
- Eugenia Buta, Ph.D., is with the Department of Biostatistics and the Yale Center for Analytic Studies, Yale School of Public Health, New Haven, CT
- Rebecca Anhang Price, Ph.D., is with the RAND Corporation, Arlington, VA
- Marc N. Elliott, Ph.D., is with the RAND Corporation, Santa Monica, CA
- Ron D. Hays, Ph.D., is with the Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA
| | - Paul D Cleary
- Address correspondence to Paul D. Cleary, Ph.D., Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT 06520; e-mail:
| |
Collapse
|
12
|
Chawla N, Urato M, Ambs A, Schussler N, Hays RD, Clauser SB, Zaslavsky AM, Walsh K, Schwartz M, Halpern M, Gaillot S, Goldstein EH, Arora NK. Unveiling SEER-CAHPS®: a new data resource for quality of care research. J Gen Intern Med 2015; 30:641-50. [PMID: 25586868 PMCID: PMC4395616 DOI: 10.1007/s11606-014-3162-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/24/2014] [Accepted: 12/02/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Since 1990, the National Cancer Institute (NCI) and Centers for Medicare and Medicaid Services (CMS) have collaborated to create linked data resources to improve our understanding of patterns of care, health care costs, and trends in utilization. However, existing data linkages have not included measures of patient experiences with care. OBJECTIVE To describe a new resource for quality of care research based on a linkage between the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) patient surveys and the NCI's Surveillance, Epidemiology and End Results (SEER) data. DESIGN This is an observational study of CAHPS respondents and includes both fee-for-service and Medicare Advantage beneficiaries with and without cancer. The data linkage includes: CAHPS survey data collected between 1998 and 2010 to assess patient reports on multiple aspects of their care, such as access to needed and timely care, doctor communication, as well as patients' global ratings of their personal doctor, specialists, overall health care, and their health plan; SEER registry data (1973-2007) on cancer site, stage, treatment, death information, and patient demographics; and longitudinal Medicare claims data (2002-2011) for fee-for-service beneficiaries on utilization and costs of care. PARTICIPANTS In total, 150,750 respondents were in the cancer cohort and 571,318 were in the non-cancer cohort. MAIN MEASURES The data linkage includes SEER data on cancer site, stage, treatment, death information, and patient demographics, in addition to longitudinal data from Medicare claims and information on patient experiences from CAHPS surveys. KEY RESULTS Sizable proportions of cases from common cancers (e.g., breast, colorectal, prostate) and short-term survival cancers (e.g., pancreas) by time since diagnosis enable comparisons across the cancer care trajectory by MA vs. FFS coverage. CONCLUSIONS SEER-CAHPS is a valuable resource for information about Medicare beneficiaries' experiences of care across different diagnoses and treatment modalities, and enables comparisons by type of insurance.
Collapse
Affiliation(s)
- Neetu Chawla
- Division of Cancer Control and Population Sciences, Cancer Prevention Fellow, National Cancer Institute, 9609 Medical Center Drive, 3E450, Rockville, MD, 20892, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
OBJECTIVE Patient satisfaction with the health care experience has become a top priority for Centers for Medicare and Medicaid Services. With resources and efforts directed at patient satisfaction, we evaluated whether high patient satisfaction measured by HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys correlates with favorable outcomes. METHODS Medical centers were identified from the University HealthSystem Consortium database from 2011 to 2012. Variables included hospital characteristics, process measure compliance, and surgical outcomes. Chi-squared analysis was used to evaluate for variables associated with high patient satisfaction (defined as hospitals that scored above the 50th percentile of top box scores). RESULTS We identified 171 hospitals with complete data. The following variables were significantly associated with high overall patient satisfaction: large hospitals, high surgical volume, and low mortality (P < 0.001). Compliance with process measures and patient safety indicators, as well as length of stay, did not correlate with overall satisfaction. The presence of complications (P = 0.491) or increased rate of readmission (P = 0.056) were not found to affect patient satisfaction. Low mortality index was consistently found to be associated with high satisfaction across 9 of 10 HCAHPS domains. CONCLUSIONS We found that hospital size, surgical volume, and low mortality were associated with high overall patient satisfaction. However, with the exception of low mortality, favorable surgical outcomes were not consistently associated with high HCAHPS scores. With existing satisfaction surveys, we conclude that factors outside of surgical outcomes appear to influence patients' perceptions of their care.
Collapse
|
14
|
Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, Edgman-Levitan S, Cleary PD. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014; 71:522-54. [PMID: 25027409 DOI: 10.1177/1077558714541480] [Citation(s) in RCA: 485] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs.
Collapse
Affiliation(s)
| | | | | | - Ron D Hays
- UCLA Department of Medicine, Los Angeles, CA, USA
| | | | | | | | | |
Collapse
|
15
|
Tevis SE, Schmocker RK, Kennedy GD. Can patients reliably identify safe, high quality care? ACTA ACUST UNITED AC 2014; 3:150-160. [PMID: 26413179 DOI: 10.5430/jha.v3n5p150] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publicly reported tool that measures patient satisfaction. As both patients and Centers for Medicare & Medicaid Services (CMS) reimbursement rely on survey results as a metric of quality of care, we reviewed the current literature to determine if patient satisfaction correlates with quality, safety, or patient outcomes. We found varying associations between safety culture, process of care measure compliance, and patient outcomes with patient satisfaction on the HCAHPS survey. Some studies found inverse relationships between quality and safety metrics and patient satisfaction. The measure that most reliably correlated with high patient satisfaction was low readmission rate. Future studies using patient specific data are needed to better identify which factors most influence patient satisfaction and to determine if patient satisfaction is a marker of safer and better quality care. Furthermore, the HCAHPS survey should continue to undergo evaluations to assure it generates predictable results.
Collapse
Affiliation(s)
- Sarah E Tevis
- Department of Surgery, University of Wisconsin, Wisconsin, United States
| | - Ryan K Schmocker
- Department of Surgery, University of Wisconsin, Wisconsin, United States
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin, Wisconsin, United States
| |
Collapse
|
16
|
Goldberg SE, Harwood RH. Experience of general hospital care in older patients with cognitive impairment: are we measuring the most vulnerable patients' experience? BMJ Qual Saf 2013; 22:977-80. [PMID: 23868868 PMCID: PMC3888593 DOI: 10.1136/bmjqs-2013-001961] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sarah E Goldberg
- Division of Rehabilitation and Ageing, University of Nottingham, Queens Medical Centre, , Nottingham, UK
| | | |
Collapse
|