The relationships between HCAHPS communication and discharge satisfaction items and hospital readmissions

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1 Patie nt E rie nce J our nal xpe | Issue 2 Volume 1 Article 12 2014 ps between HC The relationshi AHPS comm unication and discharge satisfaction items and ho spital readmissions Fadi Hachem en t of H Dep ystem s M anagem en t, R ush , [email protected] ail.com artm ealth S Jeff Canar artm en t of H ealth S ystem s M anagem en Dep ush , jeff_ca [email protected] t, R Francis Fullam MA t, R artm ealth S ystem s M anagem en t of H ush , [email protected] ush.edu Dep en Andrew S. Gallan PhD Ke aduate Co lle ge of B usi ness, D eP aul U niversit y , [email protected] paul.edu llstadt Gr Samuel H ohmann Dep artm en t of H ealth S ystem s M anagem en t, R ush; UH C , [email protected] .edu Se e ne ition al a uthor s xt p age for add http://p s and additional works at: xjournal.org/journal Follow thi nd M edical Admini stration C ommon Part of the , Health P olicy Common s , Health Health a s stration C ommon s , and the Health S ervices Research C ommon s Services Admini Recomme nded Citation amuel; and Johnson, C Hachem, F adi; Canar, Jeff; Fullam, F rancis MA; Gallan, Andrew S. PhD; Hohmann, S atherine (2014) " The ital readmissions," ems and hosp ce perien ischarge satisfaction it t Ex Patien relationships be tween HC AHPS comm unica tion a nd d ss. 2, A Journal : Vol. 1: I rticle 12. Available at: xjournal.org/journal/vol1/iss2/12 http://p atient Experience Journal by en accepted for inclusion in P n access by Patient Experience Journal. It has be s brought to you for f This Article i ree and ope atient Experience Journal. strator of P ized admini an author

2 The relationshi AHPS comm unication and discharge ps between HC satisfaction items and ho spital readmissions Auth ors Fadi Hachem, Jeff C anar, Francis Fullam M A, Andrew S. Gallan PhD, Samuel Hohmann, a nd C atherine Johnson This article i s available in P atient Experience Journal: http://p xjournal.org/journal/vol1/iss2/12

3 Patient Experience Journal Fall 2014, pp. Fall 2014, pp. 71-77 Volume 1, Issue 2 – Measurement The relationships between HCAHPS communication and discharge The relationships between HCAHPS communication and discharge discharge The relationships between HCAHPS communication and satisfaction items and hospital readmissions satisfaction items and hospital readmissions ersity, , Department of Health Systems Management, Rush Univ , Department of Health Systems Management, Rush Univ ersity, [email protected] [email protected] Fadi Hachem, MS Department of Health Systems Management, Rush Univer sity Department of Health Systems Management, Rush Univer sity Jeff Canar, PhD, , [email protected] , f [email protected] sity [email protected] Francis Fullam, MA, Department of Health Systems Management, Rush Univer Department of Health Systems Management, Rush Univer sity Kellstadt Graduate College of Business, DePaul Unive Kellstadt Graduate College of Business, DePaul Unive rsity rsity Andrew S. Gallan, PhD, [email protected] , [email protected] sity Department of Health Systems Management, Rush Univer ; University HealthSystem ; University HealthSystem Samuel F. Hohmann, PhD, Department of Health Systems Management, Rush Univer sity Consortium, [email protected] sit [email protected] Department of Health Systems Management, Rush Univer y, c Department of Health Systems Management, Rush Univer sit [email protected] Cathy Johnson, MS, Abstract The Hospital Consumer Assessment of Healthcare Prov metric iders and Systems (HCAHPS) survey has become a key The Hospital Consumer Assessment of Healthcare Prov metric iders and Systems (HCAHPS) survey has become a key The Hospital Consumer Assessment of Healthcare Prov iders and Systems (HCAHPS) survey has become a key metric used by organizations and patients to evaluate pati used by organizations and patients to evaluate pati ent experience. Readmissions also continue to be a metric used to metric used to ent experience. Readmissions also continue to be a used by organizations and patients to evaluate pati ent experience. Readmissions also continue to be a metric used to of the added cost to both healthcare systems and pa of the added cost to both healthcare systems and pa evaluate performance because tients. Both measures are also seen in tients. Both measures are also seen in of the added cost to both healthcare systems and pa tients. Both measures are also seen in n effect on hospital reimbursements. Previous stud programs such as Value Based Purchasing that have a n effect on hospital reimbursements. Previous stud ies have ies have ies have n effect on hospital reimbursements. Previous stud programs such as Value Based Purchasing that have a programs such as Value Based Purchasing that have a ion ion demonstrated a relationship between patient percept s and quality of care, and have found patients to b e reliable e reliable s and quality of care, and have found patients to b demonstrated a relationship between patient percept ted to higher evaluators of their care. While good communication and positive provider relationships have been rela evaluators of their care. While good communication ted to higher evaluators of their care. While good communication and positive provider relationships have been rela ted to higher and positive provider relationships have been rela limited to evaluating the relationship limited to evaluating the relationship compliance, past research has been satisfaction and higher rates of treatment satisfaction and higher rates of treatment between readmissions and satisfaction at an organiz between readmissions and satisfaction at an organiz ational level. This retrospective, cross - sectional study will examine ational level. This retrospective, cross sectional study will examine e HCAHPS questions and readmissions at 30 da e HCAHPS questions and readmissions at 30 da the relationship between communication and discharg ys, specifically at the relationship between communication and discharg the relationship between communication and discharg e HCAHPS questions and readmissions at 30 da the patient level. Of the eight HCAHPS questions a nalyzed, higher scores on questions regarding “nurs es listening” and the patient level. Of the eight HCAHPS questions a nalyzed, higher scores on questions regarding “nurs es listening” and the patient level. Of the eight HCAHPS questions a nalyzed, higher scores on questions regarding “nurs es listening” and egarding “help egarding “help ecreased risk of readmission, while higher scores r “doctors explaining information” were linked to a d egarding “help ecreased risk of readmission, while higher scores r “doctors explaining information” were linked to a d “doctors explaining information” were linked to a d ecreased risk of readmission, while higher scores r the importance that a patient’s after discharge” were linked to an increased risk after discharge” were linked to an increased risk for readmission. These results show the importance that a patient’s explaining HCAHPS results. This study’s seemingly severity of illness and hospital procedures have on explaining HCAHPS results. This study’s seemingly severity of illness and hospital procedures have on severity of illness and hospital procedures have on explaining HCAHPS results. This study’s seemingly paradoxical ve when reviewing HCAHPS results and using them to dri findings suggest the need to ve recognize potential trad recognize potential trad e-offs when reviewing HCAHPS results and using them to dri patient experience initiatives. Keywords Patient experience, patient satisfaction, HCAHPS, q rge uality of care, communication, readmissions, discha rge Patient experience, patient satisfaction, HCAHPS, q uality of care, communication, readmissions, discha rge uality of care, communication, readmissions, discha Patient experience, patient satisfaction, HCAHPS, q have received VBP scores based on quality performan have received VBP scores based on quality performan ce. ce. Introduction VBP scores will affect up to 2% of financial VBP scores will affect up to 2% of financial izations receive, and will be izations receive, and will be reimbursements that organ Patient satisfaction is an important issue in healt hcare, as it Patient satisfaction is an important issue in healt hcare, as it based on how hospitals perform on each measure, and the based on how hospitals perform on each measure, and the functions as a measure of success and quality. The functions as a measure of success and quality. The level of improvement for each measure. HCAHPS score level of improvement for each measure. HCAHPS score s s Hospital Consumer Assessment of Healthcare Provider s Hospital Consumer Assessment of Healthcare Provider ls will account for 30% of the total VBP score hospita will account for 30% of the total VBP score hospita ls and Systems (HCAHPS) survey serves as a standard and Systems (HCAHPS) survey serves as a standard receive, while clinical, outcome, and efficiency me asures asures receive, while clinical, outcome, and efficiency me enters for Medicare measure of patient experience by the C enters for Medicare 3 will account for the other 70%. (CMS). HCAHPS survey data have and Medicaid Services (CMS). HCAHPS survey data have h have been publically available since March of 2008, whic h been publically available since March of 2008, whic sions is In addition to patient experience, reducing readmis In addition to patient experience, reducing readmis sions is facilitated standardized comparisons across organiz ations. facilitated standardized comparisons across organiz ations. ant a focus for hospitals. Readmissions are a signific ant a focus for hospitals. Readmissions are a signific set Not only has the HCAHPS survey served as a standard Not only has the HCAHPS survey served as a standard set on burden not only on the healthcare system, but also on burden not only on the healthcare system, but also res for reporting, but it has also served as an res for reporting, but it has also served as an of measu charged individual patients. Estimates are that 20% of dis charged individual patients. Estimates are that 20% of dis parency parency incentive for improving scores and increasing trans incentive for improving scores and increasing trans 1 s, s, Medicare beneficiaries are readmitted within 30 day Medicare beneficiaries are readmitted within 30 day Patient satisfaction scores serve as a key among providers. Patient satisfaction scores serve as a key 2 s in which accounted for over $15 billion in excess cost which accounted for over $15 billion in excess cost s in quality metric to guide quality improvement initiat quality metric to guide quality improvement initiat ives. ives. 4 The Readmission Reductions Program instituted by The Readmission Reductions Program instituted by 2009. CMS in 2012 will now adjust payments based on CMS in 2012 will now adjust payments based on Along with public reporting , HCAHPS scores are now , HCAHPS scores are now 5 readmissions. Preventable readmissions serve as a Preventable readmissions serve as a Based Purchasing being used by CMS for the Value- Based Purchasing itals itals Program (VBP). Beginning in fiscal year 2013, hosp Program (VBP). Beginning in fiscal year 2013, hosp Fall 2014 Patient Experience Journal, Volume 1, Issue 2 - Fall 2014 © The Author(s), 2014. Published in association wit nd Patient Experience Institute h The Beryl Institute a © The Author(s), 2014. Published in association wit h The Beryl Institute a 71 Downloaded from www.pxjournal.org

4 HCAHPS Communication/Discharge Satisfaction Items & Readmissions, Hachem et al. e significant indicator of the quality of a healthcar information regarding discharge HCAHPS domains and interaction. 30-day readmissions at an individual patient level. ith Higher satisfaction with care has been associated w This current study expands on the existing literatu re by 6,7,8 , better adherence to practice lower inpatient mortality focusing on patient-level HCAHPS and readmission 7,9,10 11 , improved , lower healthcare utilization guidelines l data. information, as opposed to high-level organizationa 12 9 , and , reduced readmissions health status at discharge are not Data that link patient experience to clinical data 13 . Patients with a self- lower risk of physician lawsuits use in widely available, and provide a unique dataset for reported poor care experience measure had twice the risk o it is this study. Patients have unique encounters, and s ed in of an adverse event or medical error being document s a important to assess them individually. Secondly, a 14 Work by Press Ganey has shown that the chart. relationship exists between good communication and er organizations with lower HCAHPS VBP scores and high quality care, this study specifically investigated a patient’s readmission penalties are also more likely to have lower perception of provider communication and discharge 15 These results VBP scores related to clinical measures. es. information and its relationship to readmission rat indicate that technical aspects of care and quality may only Good provider communication is essential to a patie nt- explain part of the patient experience, and that pa tient patient provider relationship and should have an effect on care satisfaction scores are another indicator of their is compliance and health outcomes after discharge. Th quality. study hypothesizes that patients who report higher scores r for communication HCAHPS questions will have a lowe Patients with higher “willingness to recommend” sco res risk for readmission within 30 days. are more likely to provide positive ratings for the ir experience with interpersonal interactions and Methods 16 communication with medical staff. Physician-patient communication has an impact on emotional health, y of This study is a retrospective, cross-sectional stud ing, decreased symptom manifestation, increased function ent patients (n = 30,968) who were treated at 10 differ 17 and decreased pain. A patient who feels he or she is d returned hospitals. All patients in this sample received an “known as a person” by his/her physician is more li kely to an HCAHPS survey. An HCAHPS survey is administered 18 In complete and comply with a treatment regimen. by hospitals and is sent to a random sample of disc harged several studies, where patient satisfaction (measur ed by an inpatients age 18 or older anytime between 2 days t o 6 related, overall satisfaction question) and quality were cor luded weeks after discharge. There were 877 patients exc and individual survey questions regarding communication from our dataset: patients who were classified as he staff behavior had the strongest association with t observation patients, and patients who were transit ioned 8,9 overall satisfaction. to a different level of care by being discharged an d readmitted on the same day. A 2011 study by Boulding, et al. showed that an organization’s overall satisfaction rating has a ne gative HCAHPS and discharge data came from 10 different 9 correlation to its readmission rate. The study was organizations sharing information with University conducted using hospital level data, which provides a high f HealthSystem Consortium (UHC), a non-profit group o level perspective on the care experience. The inve stigators academic medical centers across the United States. Data e study found that patient satisfaction measures used in th lection were obtained from the UHC clinical database, a col the were actually more predictive of readmissions than of quality measures reported to UHC by member the clinical variables used and that communication was s and institutions from across the country. HCAHPS score strongest predictor of patient outcomes. The study quality measures were matched by UHC using medical measure focused on the general reliability of CMS data as a d record number, encounter number, and readmission an tion data of hospital performance. The clinical and satisfac discharge dates. Institutional Review Board approv al was being compared were publically available and not obtained for this study from Rush University Medica l necessarily linked to the same time period, preclud ing an Center IRB Committee. assessment of causality. HPS Variables analyzed in this study were the eight HCA With CMS introducing VBP and the Readmissions questions about nurse communication, physician ve Reduction Program, there is an opportunity to impro communication, and discharge communication. These ovements both quality and patient satisfaction, and tie impr Table 1 questions are shown in . Responses to each of these to direct financial benefit. This serves to justif y and lead questions were coded into two categories: top-box Thus, an organization’s efforts to improve care quality. sponses responses, and all other responses. The top-box re n nurse this study will investigate the relationship betwee included patients who answered either “always” or “ yes”, communication, physician communication, and depending on the type of question. Patient Experience Journal, Volume 1, Issue 2 - Fa ll 2014 72

5 HCAHPS Communication/Discharge Satisfaction Items & Readmissions, Hachem et al. The APR-DRG Grouper, developed by 3M Health n shows the results of the binary logistic regressio Table 3 . Information Systems, is used by UHC to determine th e Because of the exploratory nature of the study and severity of illness (SOI) variable. The patient DR Gs were inclusion of all variables, a corrected p-value of p<0.01 grouped into a binomial variable and classified as either the was used to reduce the type-I error rate. Three of ength of medical or surgical in nature. Initial admission l eight HCAHPS questions analyzed in this study were stay (LOS) was also considered. Socio-demographic found to be significant predictors of readmission i n 30 factors included patient age, patient gender, and p atient tal stay, days. For two of the questions, “During this hospi payer (Medicare, Medicaid, Commercial, and Other). how often did the nurses listen carefully to you?” (OR spital 0.821, p=.003, CI 0.721-0.935), and “During this ho ement SPSS Statistical Package 18 was used for data manag you stay, how often did doctors explain things in a way and analysis. 1), could understand?” (OR 0.819, p=.002, CI 0.721-0.93 patients who responded with a higher top-box score were likely to be readmitted within 30 days. For one The relationship between LOS and 30 day readmission less nurses or question: “During this hospital stay, did doctors, was analyzed using an independent t-test. The rela tionship u would other hospital staff talk with you about whether yo between the HCAHPS question scores, severity of ill ness, have the help you needed when you left the hospital ?” DRG, age, gender, and payer variables and readmissi on (OR 1.289, p<.001, CI 1.120-1.484), patients who were analyzed using a chi square test. A binary log istic to responded with a higher top-box response were found n each regression was used to test the relationship betwee likely to be readmitted within 30 days. be more or HCAHPS question and readmission while controlling f the clinical and socio-demographic variables. Discussion Results This study hypothesized that patients who reported higher scores on HCAHPS communication questions would have et varied Readmission rates for the 10 hospitals in the datas esults a lower risk for readmission within 30 days. Our r from 7.6% to 10.6%, with an average readmission rat e of show a mixed association between readmission and 9.3%. r of HCAHPS items. Of the eight questions analyzed, fou the questions were significantly associated with Table 2 also . Table 2 Descriptive data are summarized in spital readmission. Two of the questions (“During this ho shows the results of the bivariate analysis. All c linical and you?” and stay, how often did the nurses listen carefully to demographic variables included in this study were f ound “During this hospital stay, how often did doctors e xplain to be significantly associated with readmission at 30 days. things in a way you could understand?”) showed that those The majority of both readmitted and non-readmitted lower odds patients who responded with “always” had 18% patients were female. More than a third (34.8%) of both e for readmission within 30 days. However, one of th readmitted and non-admitted patients were aged 55 – 69 nurses questions (“During this hospital stay, did doctors, years. Medicare patients accounted for the majorit y of you or other hospital staff talk with you about whether nts non-readmitted and readmitted patients. Most patie would have the help you needed when you left the who were readmitted had a medically classified DRG. nse of hospital?”) showed that those patients with a respo for Moderate severity of illness at admission accounted “Yes” actually had 30% odds for readmission within higher most readmitted and non-readmitted patients. The 30 days. - average length of stay on initial admission for non 4.9 days and 5.81 + 6.9 readmitted patients was 4.14 + significant In the analysis, it was found that a statistically days for readmitted patients. I) and association existed between severity of illness (SO 30-day readmission. In the sample, as expected, pa tients , the Of the eight HCAHPS questions analyzed in the study with a higher severity of illness at admission had a per percentage of top box responses ranged from 70-89% significantly higher risk of being readmitted in 30 days. item. The study had predicted that higher HCAHPS For the discharge question assessing “help after 30- communication scores would be associated with lower discharge,” more patients with extreme severity of illness yzed in day readmission rates. Six of the eight items anal answered “yes” to this question than expected, and more this study were found to be significantly associate d with patients than expected with mild severity of illnes s 30-day readmission. Two of the HCAHPS questions eral answered “no” to this question. This brings up sev (relating to “help after discharge” and “receiving written admitted interesting possibilities. Those patients who are information after discharge”) had higher top box use with a higher SOI are likely to need more help beca ed responses for readmitted patients than non-readmitt these they are starting off in a worse condition. Thus, patients. All HCAHPS questions were subsequently patients may receive more attention from nurses and included in the multivariate analysis. therefore perceive a better nurse relationship and kely to be treatment. Also, a patient with a higher SOI is li Patient Experience Journal, Volume 1, Issue 2 - Fal l 2014 73

6 HCAHPS Communication/Discharge Satisfaction Items & Readmissions, Hachem et al. e more more alert to his or her situation and needs, and b se or negative effects on HCAHPS scores. Although the willing to listen and interact with staff. Patient s with high relationships exist within the dataset, it is criti cal to explore are more SOI are identified as high risk by staff, and again organization specific results and whether these res ults While likely to be the focus of extra discharge planning. pertain to an organization before making any change s. ecial identifying patients as high risk and in need of sp n Administrators should recognize that providers ofte attention is important, extra attention may explain the recognize individual patient characteristics and ad just their higher HCAHPS scores being tied to higher readmissi on. communication style and content to address risks. These relationships require additional exploration. Allocating additional resources to patients who are ions. recognized to be at risk may reduce future readmiss There were several limitations to this study. Firs t, there ytics to Also, this study highlights the ability to use anal ing are many factors that impact a patient’s risk of be drive patient experience initiatives. study. readmitted that have not been accounted for in this These include other socio-demographic factors and Finally, future research may consider exploring the did not previous admissions in the year. Also, the dataset relationship that exists between communication as differentiate between scheduled or emergency surger ies or measured by the HCAHPS and readmissions. Using admissions. Moreover, this dataset only includes patient experience data highlights important relati onships readmission information if a patient was readmitted to the atient with clinical data that can be used to help drive p ategorized same facility. It is possible that some patients c satisfaction initiatives to improve patient quality and ally, as not readmitted were readmitted elsewhere. Gener experiences. HCAHPS surveys have a low response rate. Thus, the sample used in this study may represent a specific segment References of the population and results may not be generaliza ble. Finally, because of the survey process, there may b e 1. Centers for Medicare & Medicaid Services. HCAHPS r patients who returned HCAHPS surveys regarding thei Fact Sheet . initial admission after their second discharge. Th us they http://www.hcahpsonline.org/files/August%202013 may have been filling out the survey regarding thei r %20HCAHPS%20Fact%20Sheet2.pdf. Accessed readmission experience rather than their initial ad mission. October 1, 2013. survey This potential effect is a result of the timing of 2. Barr JK, Giannotti TE, Sofaer S, Duquette CE, administration across all institutions, and thus no t specific Waters WJ, Petrillo MK. Using public reports of to our sample. patient satisfaction for hospital quality improveme nt. 2006;41(3):663-682. Health Services Research. This study points to several areas for future resea rch. Centers for Medicare & Medicaid Services. Hospital 3. Although CMS creates domains from specific question s, Value-Based Purchasing Program . differences exist among questions, indicating value in http://www.cms.gov/Outreach-and- looking at individual questions. More research nee ds to be Education/Medicare-Learning-Network- done to explore what influences a patient’s respons e to MLN/MLNProducts/downloads/Hospital_VBPurch HCAHPS questions based on their interpretation of t he asing_Fact_Sheet_ICN907664.pdf. Accessed questions. Also, it is important to explore why di fferences October 1, 2013. exist between nurse and physician questions, and wh at that Jencks SF, Williams MV, Coleman EA. 4. might indicate about those patient/provider relatio nships. Rehospitalizations among patients in the medicare fee-for-service program. The New England Journal of While there are limitations to the HCAHPS survey, i t 2009;360:1418-1428. Medicine. nonetheless provides valuable data regarding aspect s of 5. Centers for Medicare & Medicaid Services. an organizational performance. It should be used with Readmissions Reduction Program . a understanding that HCAHPS scores are influenced by http://www.cms.gov/Medicare/Medicare-Fee-for- atient’s number of factors and are only one indicator of a p Service-Payment/AcuteInpatientPPS/Readmissions- 19 It is also important to note that the doctor experience. Reduction-Program.html. Accessed October 1, 2013. and nurse questions do not ask specifically about o ne d 6. Baptist Leadership Group. Achieving patient-centere provider or care team member, but rather of all the excellence: Identifying drivers of patient mortalit y and members of those groups (i.e., all doctors or all n urses readmission. r the who cared for patient). Thus, it is unclear whethe http://secure.bhclg.com/contentdocuments/Webinar patient is rating the best provider, worst provider , or an 082611.pdf. Accessed October 1, 2013. average. 7. Glickman SW, Boulding W, Manary M, Staelin R, Roe MT, Wolosin RJ, et al. Patient satisfaction and its ital This study raises important considerations for hosp relationship with clinical quality and inpatient administrators. It is important to remember that m any mortality in acute myocardial infarction. Circulation: specific hospital processes may have unintended pos itive 2010;3(2):188-195. Cardiovascular Quality and Outcomes. 74 Patient Experience Journal, Volume 1, Issue 2 - Fa ll 2014

7 HCAHPS Communication/Discharge Satisfaction Items & Readmissions, Hachem et al. Jaipaul CK, Rosenthal GE. Do hospitals with lower 8. 14. Taylor BB, Marcantonio ER, Pagovich O, et al. Do mortality have higher patient satisfaction? A regio nal medical inpatients who report poor service quality analysis of patients with medical diagnoses. American experience more adverse events and medical 2003;18(2):59-65. Journal of Medical Quality. errors? 2008;46(2):224-228. Medical Care. Boulding W, Glickman SW, Manary MP, Schulman 9. 15. Press Ganey. The relationship between HCAHPS KA, & Staelin R. Relationship between patient performance and readmission penalties White Paper. satisfaction with inpatient care and hospital http://www.pressganey.com/newsLanding/12-12- readmission within 30 days. American Journal of 12/the_relationship_between_hcahps_performance_a Managed Care. 2011;17(1):41-48. nd_readmission_penalties.aspx. Accessed October 1, 10. Jha AK, Orav EJ, Zheng J, Epstein AM. Patients' 2013. perception of hospital care in the united states. N Engl Klinkenberg WD, Boslaugh S, Waterman BM, Otani 16. J Med. 2008;359(18):1921-1931. K, Inguanzo JM, Gnida JC, et al. Inpatients' Fenton JJ, Jerant AF, Bertakis KD, & Franks P. The 11. willingness to recommend: A multilevel analysis. cost of satisfaction: A national study of patient 2011;36(4):349-358. Health Care Management Review. satisfaction, health care utilization, expenditures , and Stewart M. Effective physician-patient 17. Archives of Internal Medicine. 2012;172(5):405- mortality. communication and health outcomes: A review. 411. Canadian Medical Association Journal. 1995;152(9):1423- 12. Covinsky KE, Rosenthal GE, Chren M, Justice AC, 1433. n Fortinsky RH, Palmer RM, et al. The relation betwee Beach MC, Keruly J, Moore RD. Is the quality of the 18. lder health status changes and patient satisfaction in o patient-provider relationship associated with bette r Journal of Geriatric Internal hospitalized medical patients. adherence and health outcomes for patients with 1998;13:223-229. Medicine. Journal of General Internal Medicine. HIV? 13. Fullam F, Garman AN, Johnson TJ, Hedberg EC. 2006;21(6):661-665. tive The use of patient satisfaction surveys and alterna 19. LaVela SL and AS Gallan. Evaluation and Medical coding procedures to predict malpractice risk. measurement of patient experience. Patient Experience Care . 2009;47(5):553-559. Journal . 2014; 1(1): 28-36. Table 1: HCAHPS Questions Regarding Communication and Dis charge Satisfaction Top Box Question Label HCAHPS Survey Question Response Nurse Communication treat you with courtesy During this hospital stay, how often did the nurses Nurse Courtesy and Respect and respect? listen carefully to you? During this hospital stay, how often did the nurses Nurses Listen ”Always” During this hospital stay, how often did nurses exp lain things in a way you Nurses Explain could understand? Physician Communication Doctors Courtesy During this hospital stay, how often did the doctors treat you with and Respect courtesy and respect? During this hospital stay, how often did the doctor s listen carefully to you? Doctors Listen During this hospital stay, how often did doctors ex plain things in a way Doctors Explain you could understand? Discharge Communication Talk about Help after During this hospital stay, did doctors, nurses or o ther hospital staff talk “Yes” needed when you Discharge? with you about whether you would have the help you left the hospital? During this hospital stay, did you get information in writing about what Receive Information ou left the hospital? symptoms or health problems to look out for after y in Writing? 75 l 2014 Patient Experience Journal, Volume 1, Issue 2 - Fal

8 HCAHPS Communication/Discharge Satisfaction Items & Readmissions, Hachem et al. riables by Readmission Status Table 2 – Summary of Clinical, Demographic, and HCAHPS Va Readmitted No p - value Readmitted Yes (N) % (N) % 2 X (2, 30,091) = 9.829, p = .007 Age 9003 33.0% 850 30.4% < 54 972 - < 70 9493 34.8% 55 34.8% > 8803 32.2% > 970 34.7% 70 2 X (1, 30,091) = 13.639, p< .001 Gender 48.9% 12339 1364 45.2% Male 14960 54.8% 1428 51.1% Female 2 X (3, 30,091) =110.477, p< .001 Payer 9763 35.9% 781 28.0% Commercial 12977 47.5% 1561 Medicare 55.9% Medicaid 2491 9.1% 307 11.0% 2038 7.5% 143 5.1% Other 2 X (1, 30,091) =229.477, p<0.001 DRG 13600 49.8% Medical 64.9% 1811 50.2% 981 13699 35.1% Surgical 2 X (3, 30,091) =592.327, p<0.001 SOI at Admit 34.5% Mild 467 16.7% 9406 10822 39.6% 1081 38.7% Moderate 22.8% 1040 37.2% Major 6233 838 3.1% 204 Extreme 7.3% 2 X Nurse Courtesy and Respect (1, 28411) = 0.299, p = 0.584 - 3950 15.3% 3 411 15.7% Score 1 84.3% Score 4 21846 84.7% 2204 2 Nurses Listen X (1, 28473) = 15.960, p<.001 3 24.6% 740 6371 28.2% - Score 1 19477 75.4% 1885 71.8% Score 4 2 X (1, 28450) = 9.975, p = .002 Nurses Explain 732 3 6472 25.1% 27.9% Score 1 - 19352 74.9% 1894 72.1% Score 4 2 X Doctors Courtesy and Respect (1, 28421) = 17.262, p < .001 - 3498 13.5% 423 16.1% Score 1 3 86.5% 2200 Score 4 83.9% 22326 2 Doctors Listen X (1, 28421) = 17.262, p< .001 Score 1 - 3 5410 21.0% 643 24.5% 1986 Score 4 20382 79.0% 75.5% 2 Doctors Explain X (1, 28454) = 43.229, p<.001 782 - 6195 24.0% 29.8% Score 1 3 19633 76.0% 1844 70.2% Score 4 2 X Talk about help after (1, 27024) = 13.223, p<.001 Discharge? No 3494 14.2% 11.6% 286 Yes 21058 85.8% 2186 88.4% 2 X Receive Information In (1, 26992) = 0.372, p = 0.542 Writing? 11.0% 280 2686 11.4% No Readmitted Readmitted Yes No (N) Mean + SD (N) Mean + SD - t (3083) = 12.400, p < .001 LOS (days) 27299 4.14 + 4.9 2792 5.81 + 6.9 Patient Experience Journal, Volume 1, Issue 2 - Fa 76 ll 2014

9 HCAHPS Communication/Discharge Satisfaction Items & Readmissions, Hachem et al. Table 3 – Multivariate Relationship between Clinical, D emographic, and HCAHPS variables and Readmission (* = Significant P-Value) Readmitted No/Yes (Yes=1) B Exp (B) 95% CI for Exp (B) (Lower - value p - Explanatory Variable Upper) *<0.001 1.030 1.023 - 1.037 0.030 LOS Age (Years) 54 < > 55 - < 70 - 0.043 0.958 .853 - 1.076 0.472 - > 0.846 .731 - .979 0.025 70 0.167 Gender Male Female - 0.116 0.891 .815 - .973 *0.010 Payer Commercial 1.500 0.280 1.323 1.166 - *<0.001 Medicare 0.204 Medicaid 1.045 - 1.438 *0.012 1.226 Other - 0.225 0.799 - .983 0.034 .649 DRG Medical .555 0.492 Surgical 0.612 - - .674 *<0.001 SOI at Admit Mild Moderate 0.533 1.704 1.506 - 1.927 *<0.001 2.755 - *<0.001 Major 0.880 2.412 2.111 Extreme 3.109 2.511 - 3.848 *<0.001 1.134 Courtesy and Nurse Respect - 3 Score 1 0.031 1.182 1.016 - 1.376 0.167 Score 4 Nurses Listen - 3 Score 1 Score 4 0.197 0.821 .721 - .935 - *0.003 Nurses Explain Score 1 - 3 Score 4 0.016 1.016 .896 - 1.1522 0.808 Doctors Courtesy and Respect Score 1 - 3 Score 4 0.611 - 1.126 0.041 0.959 .818 - Doctors Listen - Score 1 3 Score 4 0.021 1.021 .882 - 1.182 0.779 Doctors Explain Score 1 - 3 0.199 Score 4 - 0.819 .721 - .931 *0.002 Talk about help after Discharge? No Yes 0.254 1.289 1.120 - 1.484 *0.000 Receive Information In Writing? No 1.192 0.679 Yes 0.031 1.031 .892 - l 2014 Patient Experience Journal, Volume 1, Issue 2 - Fal 77

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