Do hospitals with lower mortality have higher patient satisfaction? A regional analysis of patients with medical diagnoses

After Primary Total Shoulder Arthroplasty, Factors Associated with Returning to the Same Surgeon for Subsequent Total Shoulder Arthroplasty

BACKGROUND

Total shoulder arthroplasty (TSA) is commonly done for degenerative conditions. Patients may need additional contralateral TSA or ipsilateral revision TSA. As a marker of patient satisfaction and practice integrity, factors associated with return to the same or different surgeon are of interest.

METHODS

Patients undergoing TSA were abstracted from the PearlDiver data set. Subsequent TSA within 2 years was identified. Factors analyzed included age, sex, comorbidity burden, prior depression diagnosis, insurance type, reverse versus anatomic TSA, ipsilateral versus contralateral surgery, and postoperative adverse events. Patients returning to the same surgeon versus different surgeon were compared with multivariable analysis.

RESULTS

98,048 TSA patients were identified, with 8483 patients (8.7%) undergoing subsequent TSA within 2 years. Of those, 1,237 (14.6%) chose a different surgeon. Factors associated with changing surgeons were revision surgery on the ipsilateral shoulder (OR:2.47), Medicaid insurance (OR:1.46), female sex (OR:1.36), any adverse events (OR:1.23), and higher Elixhauser Comorbidity Index (OR:1.07 per point), while prior depression diagnosis was associated with decreased odds (OR:0.74) of changing surgeon (P < 0.05 for all).

DISCUSSION

When pursuing a subsequent TSA, only a minority of patients changed to a different surgeon. Factors identified associated with changing to a different surgeon may help guide measures to improve patient satisfaction and practice integrity.

Are Patient Satisfaction Instruments Harming Both Patients and Physicians?

In this Viewpoint, Richman and Schulman argue that patient satisfaction surveys may not actually reflect clinical performance or assist efforts to improve patient experience and are not useful tools to measure physician performance.

Implementation of Daily Pharmacy Student New Medication Education During Hospitalization to Improve Patient Satisfaction

Introduction: Studies have shown that patients would like to receive more medication education while hospitalized. Higher patient satisfaction has been correlated with lower mortality and fewer hospital readmissions. Methods: This was a quasi-experimental study. Four Doctor of Pharmacy students were assigned 1 medicine inpatient unit to provide education on new medications during the study period, June to September. The primary endpoint was the change in HCAHPS scores for the medication communication domain composite for the intervention unit and a similar control unit that was not receiving the intervention from the pre-intervention to the intervention periods. Results: A total of 124 patients were educated during the intervention period, with an average age of 65 and 2.2 new medications. Average HCAHPS scores for the medication communication domain for the intervention unit increased from 68% pre-intervention to 91% during the intervention (P = .389) while the control unit remained unchanged at 78% both pre- and during the intervention (P = .13). Conclusion: An increase in the medication communication HCAHPS score for the intervention unit was observed, while the control unit remained stable. This study has the potential to drive change by implementing pharmacy students throughout inpatient units to educate patients on new medications thereby improving patient satisfaction.

Patient-Reported Care Coordination is Associated with Better Performance on Clinical Care Measures

BACKGROUND

Prior studies using aggregated data suggest that better care coordination is associated with higher performance on measures of clinical care process; it is unclear whether this relationship reflects care coordination activities of health plans or physician practices.

OBJECTIVE

Estimate within-plan relationships between beneficiary-reported care coordination measures and HEDIS measures of clinical process for the same individuals.

DESIGN

Mixed-effect regression models in cross-sectional data.

PARTICIPANTS

2013 Medicare Advantage CAHPS respondents (n=152,069) with care coordination items linked to independently collected HEDIS data on clinical processes.

MAIN MEASURES

Care coordination measures assessed follow-up, whether doctors had medical records during visits, whether doctors discussed medicines being taken, how informed doctors seemed about specialist care, and help received with managing care among different providers. HEDIS measures included mammography, colorectal cancer screening, cardiovascular LDL-C screening, controlling blood pressure, 5 diabetes care measures (LDL-C screening, retinal eye exam, nephropathy, blood sugar/HbA1c <9%, LCL-C<100 mg/dL), glaucoma screening in older adults, BMI assessment, osteoporosis management for women with a fracture, and rheumatoid arthritis therapy.

KEY RESULTS

For 9 of the 13 HEDIS measures, within health plans, beneficiaries who reported better care coordination also received better clinical care (p<0.05) and none of the associations went in the opposite direction; HEDIS differences between those with excellent and poor coordination exceeded 5 percentage points for 7 measures. Nine measures had positive associations (breast cancer screening, colorectal cancer screening, cardiovascular care LDL-C screening, 4 of 5 diabetes care measures, osteoporosis management, and rheumatoid arthritis therapy).

CONCLUSIONS

Within health plans, beneficiaries who report better care coordination also received higher-quality clinical care, particularly for care processes that entail organizing patient care activities and sharing information among different healthcare providers. These results extend prior research showing that health plans with better beneficiary-reported care coordination achieved higher HEDIS performance scores.

Does healthcare service quality affect outbound medical tourists’ satisfaction and loyalty? Experience from a developing country

Purpose

Poor quality of services in the health-care sector of the developing countries like Bangladesh forces affluent patients to seek advanced medical treatment from abroad. The purpose of this study is to explore the outbound medical tourists’ satisfaction and loyalty on the basis of the quality of the health-care service provided by foreign medical institutions.

Design/methodology/approach

The medical tourists from Bangladesh who have got medical services from Indian medical institutions were taken as a sample by applying a purposive sampling technique. For the measurement of outbound medical tourists’ satisfaction, the dimensions of the HEALTHQUAL model were adopted. A self-administrated questionnaire was the major tool for collecting data from the respondents. Using partial least square-structural equation model multivariate statistical technique and with the aid of SmartPLS software, primary data collected from 218 final respondents were analyzed.

Findings

The findings of this study reveal that four dimensions of the HEALTHQUAL model, namely, empathy, tangibility, efficiency, and safety have a significant positive impact on building medical tourists’ overall satisfaction, and then the overall satisfaction also has a positive level of significance on building loyalty towards foreign medical service providers.

Practical implications

The findings of this study can be a helpful instrument for the developing countries to rethink and reshuffle their own existing health-care system for providing quality medical services and at the same time, the medical tourists importing countries to sharpen their existing service quality as well as to attract more medical tourists in the future.

Originality/value

A handful of research has been carried out, especially focused on health-care service quality measurement and the relationship of health-care service quality with satisfaction and loyalty from the perspective of developing countries outbound medical tourists. Thus, this research work will give a flavor to think of health-care service quality in a different dimension.

Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective

The aim of this empirical research was to provide useful information for health system managers on the costs and investments involved in improving the quality of the National Health Service (NHS) based on patient assessments and from a gender perspective, i.e., without assuming that the perceived experience is identical for men and women. A cross-sectional study of 31 variables was applied using partial least squares structural equation modeling (PLS-SEM) as a research tool. The data were obtained from the Spanish Ministry of Health, Consumption, and Social Welfare for the entire Spanish territory between 2005 and 2018. The influence of expenditure, resource allocation, and mortality was hypothesized with regard to patient satisfaction according to disconfirmation theory. Patient satisfaction reflects clinical effectiveness, and therefore is a measure of health system quality. The results show that women are more sensitive to public investment in health than men, i.e., an increase in the level of spending and resources increases satisfaction more in women. In both sexes, the level of expenditure has a direct influence on patient satisfaction, and therefore on the quality of the healthcare system. It is important to increase spending on primary care, especially on specialized medical care and diagnostic equipment. However, reducing the use of drugs in favor of alternative treatments or therapies is considered to be positive. Likewise, spending has an impact on available resources, and these, in turn, have a positive influence on the level of use and a negative impact on mortality. Resources, especially healthcare staff, nuclear magnetic resonance equipment, and the number of posts in day hospitals, increase patients’ positive perception of the NHS.

Investigating the Potential Contribution of Patient Rating Sites to Hospital Supervision: Exploratory Results From an Interview Study in the Netherlands

Background

Over the last decades, the patient perspective on health care quality has been unconditionally integrated into quality management. For several years now, patient rating sites have been rapidly gaining attention. These offer a new approach toward hearing the patient’s perspective on the quality of health care.

Objective

The aim of our study was to explore whether and how patient reviews of hospitals, as reported on rating sites, have the potential to contribute to health care inspector’s daily supervision of hospital care.

Methods

Given the unexplored nature of the topic, an interview study among hospital inspectors was designed in the Netherlands. We performed 2 rounds of interviews with 10 senior inspectors, addressing their use and their judgment on the relevance of review data from a rating site.

Results

All 10 Dutch senior hospital inspectors participated in this research. The inspectors initially showed some reluctance to use the major patient rating site in their daily supervision. This was mainly because of objections such as worries about how representative they are, subjectivity, and doubts about the relevance of patient reviews for supervision. However, confrontation with, and assessment of, negative reviews by the inspectors resulted in 23% of the reviews being deemed relevant for risk identification. Most inspectors were cautiously positive about the contribution of the reviews to their risk identification.

Conclusions

Patient rating sites may be of value to the risk-based supervision of hospital care carried out by the Health Care Inspectorate. Health care inspectors do have several objections against the use of patient rating sites for daily supervision. However, when they are presented with texts of negative reviews from a hospital under their supervision, it appears that most inspectors consider it as an additional source of information to detect poor quality of care. Still, it should always be accompanied and verified by other quality and safety indicators. More research on the value and usability of patient rating sites in daily hospital supervision and other health settings is needed.

Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

Background

Nurse-sensitive indicators and nurses’ satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care.

Methods

To calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the publicly reported nurse-sensitive indicators: screening of delirium, screening of malnutrition, and pain assessments, were averaged (2011). Nurse-perceived quality ratings were obtained from staff nurses working in the same hospitals by the Dutch Essentials of Magnetism II survey (2010). Concordance between the quality measures was analyzed using Spearman’s rank correlation.

Results

The mean screening performances ranged from 63 % to 93 % across the six hospitals. Nurse-perceived quality of care differed significantly between the hospitals, also after adjusting for nursing experience, educational level, and regularity of shifts. The hospitals with high-levels of nurse-perceived quality were also high-performing hospitals according to nurse-sensitive indicators. The relationship was true for high-performing as well as lower-performing hospitals, with strong correlations between the two quality measures (r_S = 0.943, p = 0.005).

Conclusions

Our findings showed that there is a significant positive association between objectively measured nurse-sensitive screening indicators and subjectively measured perception of quality. Moreover, the two indicators of quality of nursing care provide corresponding quality rankings. This implies that improving factors that are associated with nurses’ perception of what they believe to be quality of care may also lead to better screening processes. Although convergent validity seems to be established, we emphasize that different kinds of quality measures could be used to complement each other, because various stakeholders may assign different values to the quality of nursing care.

Relationship Between Adolescent Report of Patient-Centered Care and of Quality of Primary Care

OBJECTIVE

Few studies have examined adolescent self-report of patient-centered care (PCC). We investigated whether adolescent self-report of PCC varied by patient characteristics and whether receipt of PCC is associated with measures of adolescent primary care quality.

METHODS

We analyzed cross-sectional data from Healthy Passages, a population-based survey of 4105 10th graders and their parents. Adolescent report of PCC was derived from 4 items. Adolescent primary care quality was assessed by measuring access to confidential care, screening for important adolescent health topics, unmet need, and overall rating of health care. We conducted weighted bivariate analyses and multivariate logistic regression models of the association of PCC with adolescent characteristics and primary care quality.

RESULTS

Forty-seven percent of adolescents reported that they received PCC. Report of receiving PCC was associated with high quality for other measures, such as having a private conversation with a clinician (adjusted odds ratio [aOR] 2.2; 95% confidence interval [CI] [1.9, 2.6]) and having talked about health behaviors (aOR 1.6; 95% CI 1.4, 1.8); it was also associated with lower likelihood for self-reported unmet need for care (aOR 0.8; 95% CI 0.7, 0.9) and having a serious untreated health problem (aOR 0.4; 95% CI 0.3, 0.5).

CONCLUSIONS

Many adolescents do not report receiving PCC. Adolescent-reported PCC positively correlates with measures of high-quality adolescent primary care. Our study provides support for using adolescent-report of PCC as a measure of adolescent primary care quality.

Pharmacy-Initiated Transitions of Care Services: An Opportunity to Impact Patient Satisfaction

PURPOSE

A transitions of care program at an academic teaching hospital was designed to reengineer the fragmented discharge process. The team included a pharmacy technician, called a transition specialist, who coordinated the medication needs of discharging patients. This study intends to assess the impact of the transitions of care program on patient satisfaction scores.

METHODS

Two datasets of Press Ganey and Hospital Consumer Assessment of Healthcare Providers (HCAHPS) were analyzed. Patients eligible for inclusion were age 18 years or older and successfully discharged from the study facility. All participants received usual care by a servicebased pharmacist, medication counseling by a nurse prior to discharge, and other standard of care services by the inpatient medical team. The intervention group received the previously stated usual care plus services by the transitions of care program.

RESULTS

The results from HCAHPS scores proved inconclusive. The results from the Press Ganey dataset found that the surgery transplant service demonstrated statistically significant improvement for satisfaction scores, and they warrant further review.

CONCLUSIONS

Results demonstrate that HCAHPS metrics do not correlate with the successes or lack thereof of the transitions of care program. Press Ganey might be a potential surrogate marker for assessing the impact of this program. This study is the first to qualitatively evaluate pharmacy transitions of care service using patient satisfaction scores.

The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS

The Centers for Medicare and Medicaid Services (CMS) uses Adult Hospital Consumer Assessment of Healthcare Providers and Systems (Adult HCAHPS) scores for public reporting and pay-for-performance for most US hospitals, but no publicly available standardized survey of inpatient experience of care exists for pediatrics. To fill the gap, CMS and the Agency for Healthcare Research and Quality commissioned the development of a pediatric version (Child HCAHPS), a survey of parents/guardians of pediatric patients (<18 years old) who were recently hospitalized. This article describes the development of Child HCAHPS, which included an extensive review of the literature and quality measures, expert interviews, focus groups, cognitive testing, pilot testing of the draft survey, a national field test with 69 hospitals in 34 states, psychometric analysis, and end-user testing of the final survey. We conducted extensive validity and reliability testing to determine which items would be included in the final survey instrument and develop composite measures. We analyzed national field test data of 17,727 surveys collected in November 2012 to January 2014 from parents of recently hospitalized children. The final Child HCAHPS instrument has 62 items, including 39 patient experience items, 10 screeners, 12 demographic/descriptive items, and 1 open-ended item. The 39 experience items are categorized based on testing into 18 composite and single-item measures. Our composite and single-item measures demonstrated good to excellent hospital-level reliability at 300 responses per hospital. Child HCAHPS was developed to be a publicly available standardized survey of pediatric inpatient experience of care. It can be used to benchmark pediatric inpatient experience across hospitals and assist in efforts to improve the quality of inpatient care.

Examining the role of patient experience surveys in measuring health care quality

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.

Patient satisfaction surveys and quality of care: an information paper

With passage of the Patient Protection and Affordable Care Act of 2010, payment incentives were created to improve the "value" of health care delivery. Because physicians and physician practices aim to deliver care that is both clinically effective and patient centered, it is important to understand the association between the patient experience and quality health outcomes. Surveys have become a tool with which to quantify the consumer experience. In addition, results of these surveys are playing an increasingly important role in determining hospital payment. Given that the patient experience is being used as a surrogate marker for quality and value of health care delivery, we will review the patient experience-related pay-for-performance programs and effect on emergency medicine, discuss the literature describing the association between quality and the patient-reported experience, and discuss future opportunities for emergency medicine.

Inpatients' willingness to recommend: a multilevel analysis

BACKGROUND

Satisfaction with health care is one of the most widely assessed measures of hospital care quality, yet studies that account for clustering effects are uncommon. We constructed a multilevel model to identify predictors of willingness to recommend while controlling for clustering effects due to hospital and care unit. We also examined differences in predictors by care unit.

PURPOSE

The aim of this study was to identify factors that both influence patient perceptions of care and are potentially modifiable by the hospital delivering care.

METHODOLOGY

Our sample includes Hospital Consumer Assessment of Healthcare Providers and Systems survey data collected between July 1, 2007, and June 30, 2008, for 131 hospitals and 33,445 patients. The primary outcome was willingness to recommend the hospital to family and friends. Variables were collected at three levels: patient (Hospital Consumer Assessment of Healthcare Providers and Systems survey item responses and demographics), care unit, and hospital. Data were analyzed using multilevel modeling. We also ran a series of two-level models to explore differences in predictors by care type.

FINDINGS

The strongest predictors of willingness to recommend, controlling for clustering effects, were items that generally reflected interpersonal aspects of care such as nursing and physician behaviors. In the two-level models, predictors of willingness to recommend overlapped across care units, but important differences were noted.

PRACTICE IMPLICATIONS

Our results suggest that hospitals that wish to improve their performance would benefit most from focusing on interpersonal aspects of care. Hospitals that focus resources on improving in these areas, that assess care units separately, and that investigate the meaning and context of survey responses will be most likely to see improvements in satisfaction scores.

Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction

BACKGROUND

Hospitals use patient satisfaction surveys to assess their quality of care. A key question is whether these data provide valid information about the medically related quality of hospital care. The objective of this study was to determine whether patient satisfaction is associated with adherence to practice guidelines and outcomes for acute myocardial infarction and to identify the key drivers of patient satisfaction.

METHODS AND RESULTS

We examined clinical data on 6467 patients with acute myocardial infarction treated at 25 US hospitals participating in the CRUSADE initiative from 2001 to 2006. Press Ganey patient satisfaction surveys for cardiac admissions were also available from 3562 patients treated at these same 25 centers over this period. Patient satisfaction was positively correlated with 13 of 14 acute myocardial infarction performance measures. After controlling for a hospital's overall guideline adherence score, higher patient satisfaction scores were associated with lower risk-adjusted inpatient mortality (P=0.025). One-quartile changes in both patient satisfaction and guideline adherence scores produced similar changes in predicted survival. For example, a 1-quartile change (75th to 100th) in either the patient satisfaction score or the guideline adherence score yielded the same change in predicted survival (odds ratio, 1.24; 95% CI, 1.02 to 1.49; and odds ratio, 1.24; 95% CI, 1.08 to 1.41, respectively). Satisfaction with nursing care was the most important determinant of overall patient satisfaction (P<0.001).

CONCLUSIONS

Higher patient satisfaction is associated with improved guideline adherence and lower inpatient mortality rates, suggesting that patients are good discriminators of the type of care they receive. Thus, patients' satisfaction with their care provides important incremental information on the quality of acute myocardial infarction care.

The association between GP and patient ratings of quality of care at outpatient clinics

BACKGROUND

GPs and patients are frequently asked to evaluate mental health care, but studies including evaluations from both groups are rare.

OBJECTIVE

To assess the association between GPs' and patients' assessment of mental health outpatient clinic in Norway and identify important health care predictors for patient and GP satisfaction with the clinics.

METHODS

Two cross-sectional national surveys were carried out: survey of GPs in 2006 and patients in 2007 evaluating outpatient clinics at 69 community mental health centres in Norway. A total of 2009 GPs and 9001 outpatients assessed the clinics by means of a postal questionnaire. Main outcome measures were correlations between GP and patient ratings of the outpatient clinics at the clinic level and health care predictors for patient satisfaction and GP satisfaction with the clinics.

RESULTS

Clinic scores for GPs' and patients' assessment of waiting time were moderate to highly correlated (0.65), while clinic scores for GP and patient satisfaction had a lower but significant positive association (0.37). Significant positive correlations between clinic scores for GP and patients ratings were found for 38 of the 48 associations tested. The most important predictors for patient satisfaction with the clinics were interaction with the clinician (beta: 0.23) and being met with politeness and respect at the clinic (beta: 0.19), while the most important predictors for GP satisfaction with the clinics were perceived competence (beta: 0.25), rejection of referrals (beta: -0.17) and waiting time for patients (beta: -0.16).

CONCLUSIONS

A consistent positive association between GP and patient ratings at the clinic level was identified. Mental health services aiming at improving GP and patient satisfaction should be sensitive to the fact that the two groups prioritize different health care factors.

Patient Satisfaction: Evaluating the Success of Hospital Ward Redesign

Patients who were moved from a traditional medical ward to a new state-of-the-art medical ward were surveyed regarding their perceptions of quality during their hospitalization. Respondents rated the environment of the state-of-the-art facility, as well as the overall quality of their hospital stay, more positively. However, fewer differences in perceptions of the quality of the broader hospital environment and little difference in the perceived quality of staff-patient interactions were found. Findings indicated that enhancing the facilities of the patient care environment improved patients' overall perceptions of the quality of their hospital stay.

How can the principles of complexity science be applied to improve the coordination of care for complex pediatric patients?

Clinical and technological advances in medicine have resulted in more patients requiring multidisciplinary care and coordination of services. This is particularly challenging in pediatrics, given the dependency of children. Coordination of care is a key ingredient of quality care; when suboptimal, clinical outcomes and satisfaction can suffer. In this article we view coordination of care through the lens of complexity science in an effort to find new solutions to this healthcare challenge.

A Psychometric Analysis of the Patient Satisfaction With Nursing Care Quality Questionnaire

Patient satisfaction with nursing care quality is an important indicator of the quality of care provided in hospitals. This study tested a newly developed patient-centered measure of patient satisfaction with nursing care quality within a random sample of 14 hospitals in Ontario, Canada. Results of this study revealed that the newly developed instrument had excellent psychometric properties. Total scores on satisfaction with nursing care were strongly related to overall satisfaction with the quality of care received during hospitalization. The results of this study yielded actionable, patient-focused results that can be used by managers to address areas requiring improvement.

Patient, provider, and clinic characteristics associated with public STD clinic patient satisfaction

OBJECTIVES

There is a lack of information describing levels of patient satisfaction among patients seeking sexually transmitted diseases (STD) care in a public clinic setting. We sought to identify patient, provider, and clinic characteristics associated with patient satisfaction within public STD clinics.

METHODS

A cross sectional survey with random sampling was conducted among patients attending two public STD clinics. Satisfaction was assessed using questions from validated national surveys. Outcomes for multivariate logistic regression analysis were ratings of overall health care and clinician.

RESULTS

499/605 (82%) patients were enrolled. Patients were mean age 29 years, 51% male, 94% black. Lower rating of clinician technical skills (OR = 15.6 clinic A, OR = 7.9 clinic B) and clinic environment (OR = 3.9 clinic A, OR = 9.6 clinic B) were associated with lower healthcare rating, as was lower rating of television/video in waiting room (OR = 10.2, clinic A) and dysuria (OR = 4.2, clinic B). Higher clinician rating (OR = 0.58, clinic A) and receiving written materials (OR = 0.44, clinic B) were protective of lower healthcare rating. Risks for lower clinician rating at clinic A were greater pain, problems getting care, lower rating of clinician technical skill, and overall health care, while receiving written materials was protective. At clinic B, lower rating of clinician technical skill and clinic environment were risks for lower clinician rating.

CONCLUSIONS

Patient satisfaction was associated with modifiable provider and clinic characteristics. Results from our study indicate a need to examine whether health outcomes of STD management vary by patient satisfaction.