Summary and Review: Reporting Hospital Patient Experience

1
Summary and ReviewReporting Hospital Patient
Experience

• Christine Crofton, PhD
• Agency for Healthcare Research and Quality
• Hospital Public Reporting Summit
• May 26, 2004

2
AHRQ Interest in Hospital Patient Experience

• Request from CMS to design a standardized survey
  to allow meaningful comparisons across hospitals
• Recognition of the importance of the patients
  perspective on the quality of health care

3
Goals of HCAHPS

• Provide reliable data for public reporting on
  quality of care in hospitals from the patients
  perspective
• Provide an incentive for hospitals to improve the
  quality of care

4
Patient Perspective on Experience of Hospital
Care

• Literature search including
• Instrument validation,
• Sampling,
• Reporting and
• Quality improvement/quality assurance issues
• IOM Report, Crossing the Quality Chasm.

5
Patient Perspective on Experience of Hospital
Care

• Call for measures (and reports),
• Web chat,
• Mulitple meetings with stakeholders,
• Meetings with vendors and
• Ongoing opportunities for public comment.

6
Additional Sources of Input

• Qualitative research
• Cognitive testing of the instrument (English and
  Spanish) and
• Conduct of 16 focus groups

7
Focus Group Composition

• 10 of 16 groups, Medicare recipients
• 14 groups, recently hospitalized or loved one
  hospitalized
• 6 groups focused on emergency/urgent care
• 6 on planned/elective care
• 2 groups, new mothers
• Mix of ethnic background, education level

8
Format of group discussion

• Free response how one identifies high/low
  quality hospitals
• Prompted response Usefulness of seven categories
  of information
• Preference for level of detail in hospital
  quality reports

9
Topics--Free Response

• Concern about staffing shortages, particularly
  nurses
• Concern about coordination of care
• Concern about hospital-acquired illness
• Dislike of care from students

10
Prompted Discussionof Seven Categories

• Doctor communication skills
• Responsiveness of hospital staff
• Comfort and cleanliness of hospital
• Nurse/staff communication skills
• Pain management
• Avoiding problems with medication
• Avoiding problems after discharge

11
Doctor Communication Skills

• When you dont understand something about your
  health, its really terrible.
• Theyre only there once a day for five minutes.
  How hard is it to treat you with courtesy and
  respect? I mean, youre the paying customer.

12
Responsiveness of Nurses, Staff

• If they are not listening carefully, they might
  miss something. I might mention some little
  symptom that means nothing to me but is very
  important. They could miss it if they are not
  listening to me.
• When I push the call button, Im not asking for
  the TV guide. I need help.

13
Comfort, Cleanliness of Hospital Environment

• Most germs you cant see. If you have dirt in
  your room or bathroom that you CAN see, imagine
  what you cant see.
• If the bathroom is dirty, how clean are your
  caretakers?
• You have a baby in the hospital, you dont
  want him picking up germs.

14
Overall Rating Questions

• Using any number from 0 to 10 where 0 is the
  worst possible care and 10 is the best possible
  care, what number would you give the care you
  received
• ?From all the nurses who treated you?
• ?From all the doctors who treated you?
• What number would you use to rate this
  hospital?

15
Preference for Detail

• Two thirds of participants preferred detailed
  information from the seven categories.
• Many of the remaining one third wanted overall
  ratings for a first cut, then detailed
  information to make a final decision.
• Almost all said they would like both kinds of
  information if both were available.

16
Usefulness of Hospital Quality Ratings to
Consumers

• It would certainly be great if hospitals were
  rated with stars like hotels.
• It would really be nice if hospitals, doctors
  and nurses were rated before you had to choose a
  hospital. Finding the right one is very
  time-consuming and confusing.
• Participant A Where is this information? I
  want to know
• Participant B Theyre going to create it.
  Thats why theyre spending big bucks to figure
  out what to say in it.

17
Barriers, Risks, Challenges

• Zoomerang comments
• Quality performance is a complicated,multi-facete
  d issue.
• Must be clear, simple, to minimize confusion.
• It will be a challenge to get consumers to
  understand how they can use this information in
  conjunction with physicians.