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.

Microbiological Safety and Organoleptic Quality of Homogenized Sausages Manufactured with Commercial Functional Additives

The aim of the study was to compare the microbiological safety and sensory quality of meat products manufactured with commercial functional additives. Four functional additives (AFX, AE100, PANA4, FPRX) were used in industrial conditions in the production of homogenized meat products (thick wiener). In order to determine the microbiological safety of final products, the total number of aerobic mesophilic bacteria and the number of Listeria monocytogenes were measured. Consumer assessment and quantitative flavor profiling (QFP) were used for analysis of organoleptic quality. After 7 days of storage, it was found that the effectiveness of the selected additives against the growth of aerobic mesophilic bacteria was unsatisfactory. Only after application of PANA4 did the product not show undesirable changes that would disqualify it from consumption. Each of the functional additives used had a high level of efficacy in inhibiting the growth of Listeria monocytogenes. Meat products with PANA4 addition had the highest consumer acceptance of the overall appearance. The best intensity of flavor bouquet, meat aroma and color, assessed by QFP method, was characterized by the samples with AFX and PANA4 in their recipe.

Construction and Performance of the Hospice Care Index Claims-Based Quality Measure

As part of the Medicare Hospice Benefit (MHB), hospices submit claims containing information that allows policy makers to assess hospice quality, help policy makers improve the MHB, and increase patients’ experiences of care. We examine ten different hospice quality indicators related to the provision of services and patterns of live discharge. We calculated indicators using 100% Medicare fee-for-service (FFS) claims from October 1, 2018 through September 30, 2019. A hospice’s total score among all ten indicators is referred to as their Hospice Care Index (HCI), with a possible high score of 10. We examined all hospices with at least 20 discharges. After exclusion, we examined 4,155 hospices representing 1,562,003 beneficiaries. Most hospices earn a high HCI score: over 85% of hospices had scores of eight or more. At the same time, there were some lower scoring hospices: one in ten hospices scored seven on the index, and the remaining 4.9% scored six or lower. We find that on average hospices with higher HCI scores have better Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice ratings. Among hospices with a score of ten, 85.1% of caregivers reported they would definitely recommend the hospice vs. 82.9% of caregivers of patients receiving treatment from hospices with a score of seven or less. Using the HCI, the Centers for Medicare and Medicaid Services and hospice patient caregivers can assess hospices across a broad set of indicators. Policymakers and hospices should monitor these ten indicators to understand their performance relative to peers.

Connecticut’s Veterans-Directed Care Program Outcomes Compared to HCBS Waiver Participants: HCBS CAHPS Results

Connecticut (CT) Veterans Directed Home and Community Based Services Program (VDC) is an innovative Veterans Administration (VA) services option providing veterans at risk of institutionalization with person-centered consumer-directed long-term services and supports at home. Funded by an Administration for Community Living grant, the CT Department of Aging and Disability Services partnered with the VA, the five CT Area Agencies on Aging, and UConn Health Center on Aging (UConn). UConn researchers conducted the Consumer Assessment of Healthcare Providers and Systems in Home and Community Based Services (HCBS CAHPS) survey with VDC participants (n=36) from October 2019 through March 2020. The standardized, validated HCBS CAHPS survey, which Connecticut administers to individuals in most CT Medicaid HCBS programs, is a universal, cross-disability tool to assess/improve the quality of HCBS programs. Analyses compared VDC participants’ program experiences to survey results from individuals in the Connecticut Home Care Program (CHCP) (for older adults) (n=629), Personal Care Assistance (PCA) (n=282), and Acquired Brain Injury (ABI) (n=327) waiver programs. Notably, more VDC participants (91%) knew who their support broker was, compared to CHCP, ABI, and PCA (82%, 79%, and 72%, respectively) who knew their case manager; 91% of VDC participants gave their support broker the highest rating, compared to 66% to 74% of participants in other programs who rated their case manager. This study provides strong evidence that the CT VDC program is positively impacting veterans and that the AAAs and support brokers are effectively helping them receive the HCBS they need in a consumer-directed way.

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.

How Do Consumers Perceive Sensory Attributes of Apple?

Pomological characteristics and consumer acceptability of four scab-resistant apple cultivars (‘Topaz’, ‘Florina’, ‘Goldstar’ and ‘Golden Orange’) and standard commercial cultivar ‘Golden Delicious’ were investigated. Consumer acceptability consisted of rating fruit samples on Likert scales measuring appearance, flavour, size, sweetness, acidity, crispiness, juiciness, skin texture and general impression. Consumers better evaluated the cultivar ‘Topaz’ sensory characteristics of flavour, juiciness, taste and general impression than other evaluated scab-resistant apple cultivars and the cultivar ‘Golden Delicious’. ‘Golden Delicious’ got good grades for appearance, size and sweetness. ‘Topaz’ also had the best pomological characteristic related to measured fruit firmness, contents of soluble solids and organic acids. It can be concluded that only the cultivar ‘Topaz’ among the scab-resistant apple cultivars achieved a good consumer assessment.

INNV-31. NEURO-ONCOLOGY OUTPATIENT SATISFACTION IS MAINTAINED IN THE ERA OF COVID-19 TELEMEDICINE

INTRODUCTION The use of telemedicine increased during the COVID-19 pandemic. However, the impact on patient satisfaction in the Neuro-oncology population is unknown. This quality improvement project compares outpatient satisfaction before and during the COVID-19 pandemic as well as in-person versus telemedicine platforms during the pandemic. METHODS We performed an IRB-exempt retrospective analysis of aggregate de-identified outpatient satisfaction scores among Neuro-oncology patients seen at The Preston Robert Tisch Brain Tumor Center (PRTBTC) at Duke University. The Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) is a survey developed and distributed by Press Ganey Associates, and is the most widely used outpatient satisfaction survey in the United States. We compared pre-COVID-19 CG-CAHPS scores from patients who received in-person care at the PRBTC between April 2019 and March 2020 to COVID-19 pandemic CG-CAHPS scores (i.e. those who received either telemedicine or in-person care at the PRTBTC) from April 2020 to March 2021. RESULTS Approximately 1448 surveys were completed for both in-person and telemedicine visits. During the pandemic, 48.6% of surveys represented telemedicine, with monthly variations from 84.6% (April 2020) to 21.4% (March 2021). Patient satisfaction scores pre-COVID-19 were similar to those during the pandemic: overall provider rating from 0-10 (9.28 v 9.36), knowledge of medical history (96.9% v 95.4%), listens carefully (96.6% v 96.9%), shows respect (97.2% v 98.1%), and time spent (93.2% v 95.5%). During the COVID-19 pandemic, in-person and telemedicine demonstrate similar levels of satisfaction: overall provider rating from 0-10 (9.29 v 9.48), knowledge of medical history (94.9% v 96.1%), listens carefully (95.4% v 99.0%), shows respect (97.5% v 99.0%), and time spent (94.7% v 96.7%). CONCLUSION Outpatient satisfaction prior to and during the COVID-19 pandemic was similar. Patients reported similar satisfaction between in-person and telemedicine platforms. We support the ongoing use of telemedicine for outpatient Neuro-oncology.

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.