OBJECTIVE:The aim of the study was to determine the association of patient-reported experiences (PREs) and risk-adjusted surgical outcomes among group practices.
BACKGROUND:The Centers for Medicare ...and Medicaid Services required large group practices to submit PREs data for successful participation in the Physician Quality Reporting System (PQRS) using the Consumer Assessment of Healthcare Providers and Systems for PQRS survey. Whether these PREs data correlate with perioperative outcomes remains ill defined.
METHODS:Operations between January 1, 2014 and December 31, 2016 in the American College of Surgeons’ National Surgical Quality Improvement Program registry were merged with 2015 Consumer Assessment of Healthcare Providers and Systems for PQRS survey data. Hierarchical logistic models were constructed to estimate associations between 7 subscales and 1 composite score of PREs and 30-day morbidity, unplanned readmission, and unplanned reoperation, separately, while adjusting for patient- and procedure mix.
RESULTS:Among 328 group practices identified, patients reported their experiences with clinician communication the highest (mean ± standard deviation, 82.66 ± 3.10), and with attention to medication cost the lowest (25.96 ± 5.14). The mean composite score was 61.08 (±6.66). On multivariable analyses, better PREs scores regarding medication cost, between-visit communication, and the composite score of experience were each associated with 4% decreased odds of morbidity odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92–0.99, readmission (OR 0.96, 95% CI 0.93–0.99), and reoperation (OR 0.96, 95% CI 0.93–0.99), respectively. In sensitivity analyses, better between-visit communication remained significantly associated with fewer readmissions.
CONCLUSIONS:In these data, patients’ report of better between-visit communication was associated with fewer readmissions. More sensitive, surgery-specific PRE assessments may reveal additional unique insights for improving the quality of surgical care.
Reducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported ...prevalence and identified factors associated with children's dental care use, including the association with children's oral health.
A cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means.
The 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33).
It was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship.
Oral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children's oral health.
Clinical neurosurgery is a complex specialty with multiple participants, including a variety of providers, patients, family members, and administrators, who interact in complex fashions. Modern-day ...patient care requires near-constant team communication of vital, detailed clinical information; any breakdown in this process can result in patient harm. Medical communication practices with patients impact mutual rapport as well as the overall physician–patient relationship. Enhanced relationship-centered communication techniques have been shown to improve patient compliance and may positively influence malpractice litigation rates. Neurosurgeons frequently interact with other health care providers and members of the hospital administration on matters relating to billing, compliance, and quality. Communication among the stakeholders is complicated, however, by the fact that the participants may be speaking a variety of different, mutually unintelligible “languages.” We discuss the details of the various types of information exchanges in neurosurgery, the key players involved, and the vulnerabilities to breakdowns in the system. In addition, we review the multifaceted, systems-level issues in neurosurgical communication and related weaknesses.
Background
Oncology settings increasingly use patient experience data to evaluate clinical performance. Given that older patients with hematologic malignancies are a high-risk population, this study ...examined factors associated with patient-reported health care experiences during the first year of their cancer diagnosis.
Methods
Cross-sectional study using the 2000–2015 SEER-CAHPS® data to examine patient experiences of Medicare enrollees with a primary diagnosis of leukemia or lymphoma. The primary outcomes were three CAHPS assessments: overall care, personal doctor, and health plan overall. We estimated case-mix adjusted and fully adjusted associations between factors (i.e., clinical and sociodemographic) and the CAHPS outcomes using bivariate statistical tests and multiple linear regression.
Results
The final sample included 1,151 patients, with 431 diagnosed with leukemia and 720 diagnosed with lymphoma (median time from diagnosis to survey 6 months). Patients who completed the survey further apart from the diagnosis date reported significantly higher adjusted ratings of care overall (
β
.39,
p
= .008) than those closer to diagnosis. American Indian/Alaska Native, Asian, and Pacific Islander patients had lower adjusted ratings of care overall (
β
− .73,
p
= .003) than Non-Hispanic white patients. Multimorbidity was significantly associated with higher adjusted personal doctor ratings (
β
.26,
p
= .003).
Conclusions
Unfavorable patient experiences among older adults diagnosed with hematologic malignancies warrant targeted efforts to measure and improve care quality. Future measurement of experiences of cancer care soon after diagnosis, coupled with careful sampling of high-priority populations, will inform oncology leaders and clinicians on strategies to improve care for high-risk, high-cost populations.
Optimal beef meat colour is associated with increased consumer acceptance, whereas dark or pale meat has a reduced desirability. Dark beef also has a variable eating quality and reduced shelf-life. ...We hypothesised that a poor meat colour at carcass grading would generate an unacceptable eating quality after vacuum-packed chilled storage for up to 20 weeks, due to the unfavourable pH conditions commonly associated with light and dark muscles. At three beef processing plants, beef longissimus muscles from 81 pasture- and grain-fed cattle (mix of Bos taurus and Bos indicus × Bos taurus) were graded at ~24 h post-slaughter for meat colour. The carcasses were allocated to light, medium and dark colour groups, with n = 27 carcasses per colour group. From the 81 carcasses, a total of 162 longissimus lumborum (LL) muscles was collected and half LLs were randomly allocated to three ageing times (2, 12, 20 weeks) within colour group and six half LLs were used per colour group within storage period and plant. Vacuum-packed muscles were stored at –1.0 ± 0.5°C for the designated period and sampled for biochemical and sensory assessments. The effects of colour group, storage week and carcass traits were analysed. Dark muscles had higher pH than the lighter ones (P < 0.05). The carcass trait dentition, feed type and fat depth did not influence the eating quality (P > 0.05). After 2, 12 and 20 weeks of vacuum-packed chilled storage; eating quality was similar for all 3 meat-colour groups (P > 0.05). With increasing storage time, all eating-quality attributes improved (P < 0.001 for all). Lipid oxidation increased with storage time and although values at 20 weeks were slightly above accepted levels for rancidity detection, MQ4 scores indicated that the meat would still be categorised as a three-star product, indicative of the opportunity to store the longissimus lumborum (LL) for this length of time, while maintaining an acceptable eating quality, regardless of meat colour at carcass grading.
Background Patients with end-stage renal disease (ESRD) have special health needs; little is known about their care experiences. Study Design Secondary analysis of 2009-2010 Medicare Consumer ...Assessment of Healthcare Providers and Systems (CAHPS) data, using representative random samples of Medicare beneficiaries. Description of Medicare beneficiaries with ESRD and investigation of differences in patient experiences by sociodemographic characteristics and coverage type. Setting & Participants Data were collected from 823,564 Medicare beneficiaries (3,794 with ESRD) as part of the Medicare CAHPS survey, administered by mail with telephone follow-up of nonrespondents. Predictor ESRD status, age, education, self-reported general and mental health status, race/ethnicity, sex, Medicare coverage type, state of residence, and other demographic measures. Outcomes 6 composite measures of patient experience in 4 care domains (access to care, physician communication, customer service, and access to prescription drugs and drug information) and 4 ratings (overall care, personal physician, specialist physician, and prescription drug plan). Results Patients with ESRD reported better care experiences than non-ESRD beneficiaries for 7 of 10 measures ( P < 0.05) after adjustment for patient characteristics, geography, and coverage type, although to only a small extent (adjusted mean difference, <3 points scale, 0-100). Black patients with ESRD and less educated patients were more likely than other patients with ESRD to report poor experiences. Limitations Inability to distinguish patient experiences of care for different treatment modalities. Conclusions On average, beneficiaries with ESRD report patient experiences that are at least as positive as non-ESRD beneficiaries. However, black and less educated patients with ESRD reported worse experiences than other ESRD patients. Stratified reporting of patient experience by race/ethnicity or education in patients with ESRD can be used to monitor this disparity. Physician choice and confidence and trust in physicians may be particularly important for patients with ESRD.
Patients’ experience of care (PEC) is as an important dimension in quality of care. As a distinct entity from patient satisfaction and patient health-related quality of life, PEC is defined as ...patients’ perceptions of the range of interactions they have with the health care system, including care from providers, facilities, and health plans. While traditionally PEC may be ascertained via informal assessments, in recent years, especially in the United States, there has been a shift towards standardized surveillance of PEC amongst dialysis patients in order to: (1) set a normative expectation regarding the importance of PEC; (2) standardize the components of patients’ experience that are assessed to minimize potential “blind spots”; (3) provide a direct “voice” to the patient in communicating perceptions of their care; (4) facilitate comparisons of quality across facilities; and (5) broaden accountability for PEC to the entire multidisciplinary dialysis care team. In this review, we will discuss the significance of PEC as a quality of care metric in dialysis patients; the history of PEC assessment across other health care arenas; the development of the In-Center Hemodialysis Consumer Assessment of Healthcare Provider and Systems survey as a means to standardize PEC assessment among US dialysis patients; experiences in PEC assessment across international dialysis populations; and future areas of research needed to refine the ascertainment of PEC and its impact upon patient outcomes.
Does Hospital Size Affect Patient Satisfaction? McFarland, Daniel C; Shen, Megan Johnson; Parker, Patricia ...
Quality management in health care,
10/2017, Letnik:
26, Številka:
4
Journal Article
Recenzirano
Centers for Medicare & Medicaid Services reimbursement is now contingent on quality measures such as patient satisfaction as determined by Hospital Consumer Assessment of Healthcare Providers and ...Systems (HCAHPS). In providing patient-centered care that is guided by patient satisfaction measures, it is critical to understand system-level factors that may influence how patients assess their care experiences. One important system-level influence to consider is hospital size.
HCAHPS scores, number of hospital beds, and nursing magnet status were obtained from publically available Hospital Compare, American Hospital Directory, and Magnet Hospitals Web sites, respectively. An aggregate score for patient satisfaction was created across all domains of the HCAHPS. Multilevel regression modeling was performed to examine the associations between hospital size and HCAHPS aggregate and individual dimensions.
Hospital size was significantly associated with patient satisfaction such that larger size was associated with lower satisfaction (β = -.312, P < .001). Hospital size was most strongly associated with less patient satisfaction on the following HCAHPS items: "receiving help as soon as needed" (β = -.441, P < .001), "room and bathroom cleanliness" (β = -.286, P < .001), and doctor communication (β = -.213, P < .001), whereas nurse communication (β = .194, P < .001) was the one modifiable dimension that was associated with more favorable ratings in larger hospitals. Magnet nursing designation was significantly associated with larger hospital size (P < .001).
Patient satisfaction scores may be lower in large hospitals because of patients' perceptions of hospital cleanliness, receiving help on time, and doctor communication. Focusing on improving these factors may improve patient satisfaction scores for larger hospitals.
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