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    Patient experience correlates with clinical quality

    Measure your HCAHPS


    Once Considered An afterthought by harried clinicians and hospital workers, patient satisfaction—or "patient experience" as it is increasingly called—is now taking center stage thanks to some new data points.

    While patient satisfaction has been attracting increased attention since the mid-1980s, two recent developments have furthered the movement. First, the Centers for Medicare and Medicaid Services (CMS) began publishing patient satisfaction from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey on its HospitalCompare Web site in March 2008. Although most patients still don't know the information is available and even fewer are using it to make hospital choices, the availability of publicly reported data is forcing hospitals to take a long, hard look in the mirror.

    Second, there's growing evidence that patient satisfaction correlates with better quality of care. A study published in the October 30, 2008 issue of the New England Journal of Medicine analyzed data collected from the HCAHPS survey. Among the study's findings: hospitals with more satisfied patients generally provided higher quality of care as measured by standard quality metrics. Hospitals that earned high marks from patients satisfied with their care were more likely to provide appropriate care for heart attack, congestive heart failure, pneumonia and prevention of surgical complications.

    "For the first time we can see there's a pretty linear relationship between clinical quality and the patient experience," says Anne-Marie Audet, MD, vice president of quality improvement and efficiency for the Commonwealth Fund, which sponsored the study. "The pushback in the industry was always that satisfaction was just a touchy-feely thing, but the literature is increasingly showing the relationship between the patient experience and quality. It's intuitive to some, but we need the data to convince the rest."

    It's not a stretch to see how satisfaction might relate to better quality—and ultimately better outcomes. For example, the patient whose attentive caregiver has placed a personal item in easy reach will not only appreciate the courtesy, she'll be less likely to get out of bed, thus less likely to fall and thus less likely to develop a hospital-acquired infection.

    But the question of how exactly to measure the customer experience presents challenges. Consider the overarching HCAHPS satisfaction question, "Would you recommend this hospital to your friends and family?" While some find the question a useful, big-picture assessment, others say responses reflect a hospital's reputation and brand equity as much as the patient's actual experience.

    What's more, there are regional and cultural nuances that are difficult to capture. For example, patients in the South often report higher satisfaction than those in the North, says Dr. Audet.

    What's more, satisfaction is highly subjective. What matters a great deal to one patient may not be as relevant to another.

    HCAHPS doesn't go far enough with some measures, such as language access, says Maribeth Shannon, director of the California Healthcare Foundation's Market and Policy Monitory Program. The foundation used a patient satisfaction survey from 2003 until 2007, which was a precursor to HCAHPS in California.

    "In coming up with a national standard for HCAHPS there was obviously a lot of negotiation back and forth," Shannon says. "Hospitals didn't want the survey to be unwieldy. We're down to 27 questions in the HCAHPS model, but those don't capture everything I would like to see hospitals focus on."

    Although HCAHPS may not be comprehensive, hospitals are gathering a lot of patient experience information on their own, says Deirdre Mylod, vice president of the acute business division for Press Ganey Associates Inc., which surveys more than 40% of U.S. hospitals. Roughly 96% of Press Ganey's clients augment the HCAHPS survey with questions relevant to their particular patient base.

    "HCAHPS by itself doesn't ask about privacy, emotional support, shared decision making or coordination of care," Mylod says. "But it fulfills CMS's vision to be a short set of measures to make comparisons between hospitals. It wasn't designed to be a quality improvement tool by itself."

    The Commonwealth Fund study did identify some concrete areas where hospitals can focus their attention. Nearly a third of patients did not give their hospital a high rating in the area of pain management, and about a fifth of patients did not highly rate communication of discharge instructions.


    Shelly Reese
    Shelly Reese is a freelance writer based in Cincinnati, Ohio. She is a frequent contributor to Managed Healthcare Executive.


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