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.

Perspektif Pasien Terhadap Kualitas Pelayanan Kesehatan di Rawat Inap Puskesmas Arjasa Menggunakan Hospital Consumer Assessment of Healthcare Providers and Systems

Public Health Center (Puskesmas) as a first-level service facility should always prioritize quality in its services. Assessment of service quality from the patients’ perspectives serves as a way to obtain an overview of the quality of health services that will be utilized as a reference in improving the quality of health services. This study aimed to obtain an overview of service quality based on the inpatients’ perspectives at Arjasa Public Health Center using the Hospital Consumer Assessment of Healthcare Providers and Systems. The type of this study was a descriptive survey with a quantitative approach. The research population was all patients who were receiving inpatient services at the Arjasa Public Health Center. The sampling technique used was accidental sampling and was adjusted to the time of the study. Data analysis was performed using univariate analysis, aiming to describe the characteristics of the research variables. Based on the results of the study, the quality of health services according to the inpatients’ perceptions at Arjasa Public Health Center shows that nurse communication was in the very good category, doctor communication was in the very good category, responsive dimension was in the very good category, physical comfort dimension was in the good category, pain control dimension was in the very good category, drug communication dimension was in the good category, and information return dimension was in the good category. Overall, the quality of health services based on the inpatients’ perceptions at Arjasa Public Health Center was good.. Abstrak: Puskesmas sebagai fasilitas pelayanan tingkat pertama harus selalu menerapkan kualitas dalam pelayanannya. Penilaian kualitas pelayanan dari perspektif pasien merupakan salah satu cara untuk mendapatkan gambaran kualitas pelayanan kesehatan yang akan dijadikan acuan dalam meningkatkan kualitas pelayanan kesehatan. Penelitian ini bertujuan untuk mendapatkan gambaran kualitas pelayanan berdasarkan perspektif pasien rawat inap di Puskesmas Arjasa menggunakan Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Jenis penelitian yang dilakukan adalah survei deskriptif dengan pendekatan kuantitatif. Populasi penelitian ini adalah seluruh pasien yang sedang menerima pelayanan rawat inap Puskesmas Arjasa. Teknik pengambilan sampel menggunakan pengambilan sampel yang tidak disengaja, dan disesuaikan dengan waktu penelitian. Analisis data dilakukan dengan analisis univariat yang bertujuan untuk menggambarkan karakteristik variabel penelitian. Berdasarkan hasil penelitian, kualitas pelayanan kesehatan sesuai persepsi rawat inap Puskesmas Arjasa tentang komunikasi perawat sangat baik, terhadap komunikasi dokter dalam kategori sangat baik, pada dimensi responsif memiliki kriteria yang sangat baik, pada dimensi kenyamanan fisik berada dalam kategori baik, dimensi kontrol rasa sakit termasuk dalam kategori sangat baik, dimensi komunikasi obat berada dalam kategori baik, dimensi pengembalian informasi dalam kategori baik. Secara keseluruhan, kualitas pelayanan kesehatan sesuai persepsi rawat inap Puskesmas Arjasa baik.

Hospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty

Introduction The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients’ satisfaction of their hospital experience. A minority of discharged patients return the survey. Underlying bias among who ultimately returns the survey (non-response bias) after total knee arthroplasty (TKA) may affect results of the survey. Thus, the objective of the current study is to assess the relationship between patient characteristics and postoperative outcomes on HCAHPS survey nonresponse. Methods All adult patients at a single institution undergoing inpatient, elective, primary TKA between February 2013 and May 2020 were selected for analysis. Following discharge, all patients had been mailed the HCAHPS survey. The primary outcome analyzed in the current study is survey return. Patient characteristics, surgical variables, and 30-day postoperative outcomes were analyzed. Univariate and multivariate analyses were performed to identify factors independently associated with return of the HCAHPS survey. Results Of 4,804 TKA patients identified, 1,498 (31.22%) returned HCAHPS surveys. On multivariate regression analyses controlling for patient factors, patients who did not return the survey were more likely to have a higher American Society of Anesthesia score (ASA score of 4 or higher, OR = 2.37; P<0.001), and be partially or totally dependent (OR = 2.37; P = 0.037). Similarly, patients who did not return the survey were more likely to have had a readmission (OR = 1.94; P<0.001), be discharged to a place other than home (OR = 1.52; P<0.001), or stay in the hospital for longer than 3 days (OR = 1.43; P = 0.004). Discussion Following TKA, HCAHPS survey response rate was only 31.22% and completion of the survey was associated with several demographic and postoperative variables. These findings suggest that HCAHPS survey results capture a non-representative fraction of the true TKA patient population. This bias is necessary to consider when using HCAHPS survey results as a metric for quality of healthcare and federal reimbursement rates.

Patient satisfaction in China: a national survey of inpatients and outpatients

ObjectivesPatient satisfaction is an important indicator of hospital healthcare quality. Little up-to-date information of patient satisfaction in China is available. This study attempts to gain a holistic understanding of patient satisfaction in China and identify the key antecedents of patient satisfaction.DesignA cross-sectional national survey was conducted in 2018.SettingHospitals in 27 provinces and 4 municipalities in 4 regions of China.ParticipantsA random sample of 15 699 patients who visited 1304 hospitals were surveyed, with around 500 from each of the 27 provinces and 4 municipalities.Primary and secondary outcome measuresThe Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire was used to measure patients’ overall satisfaction and willingness to recommend the hospital.ResultsWe found significant variation in overall patient satisfaction but little variation in hospital recommendation across the four broad regions. Moreover, we examined determinants of patient satisfaction and their likelihood to recommend the hospital. The overall satisfaction for inpatients and outpatients is commonly influenced by communication with doctors (inpatient: β=0.524, p<0.001; outpatient: β=0.541, p<0.001), hospital cleanness (inpatient: β=0.165, p<0.05; outpatient: β=0.144, p<0.001) and acceptable charges (inpatient: β=1.481, p<0.001; outpatient: β=1.045, p<0.001). Both inpatients and outpatients are more likely to recommend the hospital if there are communication with doctors (inpatient: OR=1.743, p<0.001; outpatient: OR=1.647, p<0.001), acceptable charges (inpatient: OR=2.660, p<0.001; outpatient: OR=2.433, p<0.001). Outpatient satisfaction and hospital recommendation are also influenced by time spent with doctors (satisfaction: β=0.301, p<0.001; recommend: OR=1.430, p<0.001) and waiting time (satisfaction: β=−0.318, p<0.001; recommend: OR=0.844, p<0.001).ConclusionsThere are regional differences of patient satisfaction in China. Patient satisfaction is influenced by a variety of hospital factors and province/municipality factors. The influencing factors of patient satisfaction may not motivate patients to recommend the hospital.

Demographics matter: the potentially disproportionate effect of COVID-19 on hospital ratings

Objective To identify how features of the community in which a hospital serves differentially relate to its patients' experiences based on the quality of that hospital. Design A Finite Mixture Model (FMM) is used to uncover a mix of two latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in either group. A multiple linear regression relates the characteristics of communities served by hospitals to the patients' expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. The analysis was conducted via Stata. Setting Hospital ratings are measured by Hospital Compare using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services for hospitals in the USA. Participants 2,816 Medicare-certified acute care hospitals across all US states. Intervention None. Main Outcome Measure Differences in the marginal impacts of key community demographics on patient experiences between the two groups of hospitals. Results We provide evidence that low-rated hospitals have much more variability in patient experience ratings than high-rated ones. Moreover, the experiences at low-rated hospitals are more sensitive to county demographic factors, which means exogenous shocks, like coronavirus disease-2019 (COVID-19), will likely affect these hospitals differently, as such shocks are known to disproportionately affect their communities. Conclusions Our results imply that low-rated hospitals with more variability in their HCAHPS responses are more likely to face adverse patient experiences due to COVID-19 than high-rated hospitals. Pandemics like COVID-19 create conditions that intensify the already high demands placed on hospitals and care providers and make it even more challenging to deliver quality care.

An approach to exploring associations between hospital structural measures and patient satisfaction by distance‐based analysis

Background Patient satisfaction studies have explored domains of patient satisfaction, the determinants of domains, and score differences of domains by patient/hospital structural measures but reports on the structure of patient satisfaction with respect to similarities among domains are scarce. This study is to explore by distance-based analysis whether similarities among patient-satisfaction domains are influenced by hospital structural measures, and to design a model evaluating relationships between the structure of patient satisfaction and hospital structural measures. Methods The Hospital Consumer Assessment of Healthcare Providers and Systems 2012 survey scores and their structural measures from the Hospital Compare website reported adjusted percentages of scale for each hospital. Contingency tables of nine measures and their ratings were designed based on hospital structural measures, followed by three different distance-based analyses - clustering, correspondence analysis, and ordinal multidimensional scaling – for robustness to identify homogenous groups with respect to similarities. Results Of 4,677 hospitals, 3,711 (79.3%) met the inclusion criteria and were analyzed. The measures were divided into three groups plus cleanliness. Certain combinations of these groups were shown to be dependent on hospital structural measures. High value ratings for communication and low value ratings for medication explanation, quietness and staff responsiveness were not influenced by hospital structural measures, but the varied-ratings domain group similarities, including items such as global evaluation and pain management, were affected by hospital structural measures. Conclusions Distance-based analysis can reveal the hidden structure of patient satisfaction. This study suggests that hospital structural measures including hospital size, the ability to provide acute surgical treatment, and hospital interest in improving medical care quality are factors which may influence the structure of patient satisfaction.