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What The Evidence Shows About Patient Activation: Better Health Outcomes and Care Experiences; Fewer Data On Costs

Emerging evidence indicates that interventions that tailor support to the individual’s level of activation, and that build skills and confidence, are effective in increasing patient activation. Furthermore, patients who start at the lowest activation levels tend to increase the most. We conclude that policies and interventions aimed at strengthening patients’ role in managing their health care can contribute to improved outcomes and that patient activation can-and should-be measured as an intermediate outcome of care that is linked to improved outcomes.

Abstract

Patient engagement is an increasingly important component of strategies to reform health care. In this article we review the available evidence of the contribution that patient activation-the skills and confidence that equip patients to become actively engaged in their health care-makes to health outcomes, costs, and patient experience. There is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences, but there is limited evidence to date about the impact on costs. Emerging evidence indicates that interventions that tailor support to the individual’s level of activation, and that build skills and confidence, are effective in increasing patient activation. Furthermore, patients who start at the lowest activation levels tend to increase the most. We conclude that policies and interventions aimed at strengthening patients’ role in managing their health care can contribute to improved outcomes and that patient activation can-and should-be measured as an intermediate outcome of care that is linked to improved outcomes.

Health Affairs, 32(7):1299-1305 – 2013

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Using Evidence to Improve Satisfaction With Medication Side-Effects Education on a Neuro-Medical Surgical Unit

Improving patient satisfaction related to communication about medications and potential side effects can improve healthcare outcomes

Abstract

Patient satisfaction is viewed as a significant indicator of quality of care. More specifically, improving patient satisfaction related to communication about medications and potential side effects can improve healthcare outcomes. Patient satisfaction scores related to medication side effects on a neuro-medical surgical unit were monitored following a quality improvement program. These patients frequently experience cognitive impairment and functional difficulties that can affect the way they understand and handle medications. The purpose of this quality improvement practice change was to (a) develop an educational approach for post-acute neurosurgical patients and (b) evaluate whether the use of the approach is successful in improving patient satisfaction scores related to medication education on side effects. The quality improvement program interventions included (a) patient informational handouts inserted into admission folders, (b) nurse education about the importance of providing education on side effects to patient and discussion of their involvement with the program, (c) unit flyers with nurse education, and (d) various communications with bedside nurses through personal work mail and emails. The primary focus was for nurses to employ the teach-back method to review and reinforce the medication side-effect teaching with patients. Evaluation of the data showed an increase in patient satisfaction after the implementation of the Always Ask program.

Journal of Neuroscience Nursing, 32(7):1299-1305 – 2013

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Improving the Patient Experience: Real-World Strategies for Engaging Nurses

Hospital performance on the communication with nurses’ domain within HCAHPS predicts performance on several other domains. In addition, nurses at the bedside have significantly lower engagement scores than nurses who are not involved in direct patient care.

Abstract

Patients spend more time with nurses during an admission than with any other profession in the hospital. Nurses and their interactions with patients are central to shaping and improving the patient’s experience. Patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, drives 30% of value-based purchasing (VBP) scores and incentive payments, as prescribed under the Patient Protection and Affordable Care Act. Hospital performance on the communication with nurses’ domain within HCAHPS predicts performance on several other domains. In addition, nurses at the bedside have significantly lower engagement scores than nurses who are not involved in direct patient care. Considering the relationship between nurse engagement and patient experience and the relationship between patient experience and hospital success under VBP, pursuing strategies and tactics that will foster and sustain nurse engagement is critical for nurse executives.

Journal of Nursing Administration, 32(7):1299-1305 – 2014

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Reducing Patient Suffering Through Compassionate Connected Care

Caregivers learn to better express empathy and compassion to patients, and nurse leaders are better equipped to engage nurses at the bedside.

Abstract

Patient experience continues to play an increasingly critical role in quality outcomes and reimbursement. Nurse executives are tasked with helping direct-care nurses connect with patients to improve care experiences. Connecting with patients in compassionate ways to alleviate inherent patient suffering and prevent avoidable suffering is key to improving the patient experience. The Compassionate Connected Care framework identifies strategies for meeting the challenges of connecting with patients and reducing suffering. Methods integrate clinical, operational, cultural, and behavioral aspects of care to target patient needs based on condition. Caregivers learn to better express empathy and compassion to patients, and nurse leaders are better equipped to engage nurses at the bedside.

Journal of Nursing Administration, 32(7):1299-1305 – 2014

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Association Between Patient Satisfaction and Outcomes in Kidney Transplant

The results demonstrate that there is a positive and statistically significant correlation between a patient’s perceived quality of care, as measured by HCAHPS data, and quantified clinical outcomes for graft loss and patient death in kidney transplant recipients.

Abstract

This was a cross-sectional cohort study analyzing aggregate publicly reported data integrated from 2 primary sources and included all US accredited kidney transplant programs that report data within the Scientific Registry of Transplant Recipients and Hospital Compare; 188 kidney transplant programs, representing 15 710 transplants were included in this study. In general, the scores for patient satisfaction questions were higher for higher-performing transplant programs; 5 questions reached statistically significant associations (P < .05). A composite of these 5 questions demonstrated a strong association with a center’s performance indices for both 1-month and 1-year graft and patient outcomes (69% vs 40%, P < .001, and 60% vs 44%, P = .035, respectively), which remained significant after controlling for baseline demographics. The results demonstrate that there is a positive and statistically significant correlation between a patient’s perceived quality of care, as measured by HCAHPS data, and quantified clinical outcomes for graft loss and patient death in kidney transplant recipients.

American Journal of Medical Quality, 32(7):1299-1305 – 2015

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The Impact of Patient-Centered Care on Outcomes

Patient-centered communication influences patients’ health through perceptions that their visit was patient centered, and especially through perceptions that common ground was achieved with the physician. Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals.

Background

We designed this observational cohort study to assess the association between patient-centered communication in primary care visits and subsequent health and medical care utilization.

Methods

We selected 39 family physicians at random, and 315 of their patients participated Office visits were audiotaped and scored for patient-centered communication. In addition, patients were asked for their perceptions of the patient-centeredness of the visit. The outcomes were: (1) patients’ health, assessed by 3 visual analogue scale on symptom discomfort and concern; (2) self-report of health, using the Medical Outcomes Study Short Form-36; and (3) medical care utilization variables of diagnostic tests, referrals, and visits to the family physician, assessed by chart review. The 2 measures of patient-centeredness were correlated with the outcomes of visits, adjusting fur the clustering of patients by physician and controlling for confounding variables.

Results

Patient-centered communication was correlated with the patients’ perceptions of finding common ground. In addition, positive perceptions (both the total score and the subscore on finding common ground) were associated with better recovery from their discomfort and concern, better emotional health 2 months later, and fewer diagnostic tests and referrals.

Conclusions

Patient-centered communication influences patients’ health through perceptions that their visit was patient centered, and especially through perceptions that common ground was achieved with the physician. Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals.

Journal of Family Practice, 32(7):1299-1305 – 2000

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Risk Factors for Early Hospital Readmission in Low-Income Elderly Adults

The independent risk factors for early readmission identified according to regression analysis were living alone (odds ratio (OR)=1.71, 95% confidence interval (CI)=1.02-2.87), fair or poor satisfaction with primary care physician.

Objectives

To identify risk factors for early hospital readmission in low-income community-dwelling older adults.

Design

Prospective cohort study.

Setting

University-affiliated urban safety-net healthcare system in Indianapolis, Indiana

Participants

Community-dwelling adults aged 65 and older with annual income less than 200% of the federal poverty level and enrolled in the Geriatric Resources for Assessment and Care of Elders (GRACE) randomized controlled trial (N=951).

Measurements

Participant health and functional status at baseline and 6, 12, 18, and 24months. Early readmission was defined as a repeat hospitalization occurring within 30days of a prior hospital discharge. Candidate risk factors included sociodemographic characteristics, health and functional status, prior care, lifestyle, and satisfaction with care.

Results

Of 457 index admissions in 328 participants, 85 (19%) were followed by an early readmission. The independent risk factors for early readmission identified according to regression analysis were living alone (odds ratio (OR)=1.71, 95% confidence interval (CI)=1.02-2.87), fair or poor satisfaction with primary care physician (OR=2.12, 95% CI=1.01-4.46), not having Medicaid (OR=1.80, 95% CI=1.05-3.11), receiving a new assistive device in the past 6months (OR=2.26, 95% CI=1.26-4.05), and staying in a nursing home in the past 6months (OR=5.08, 95% CI=1.56-16.53). Age, race, sex, education, and chronic diseases were not associated with early readmission.

Conclusions

A broad range of nonmedical risk factors played a greater role than previously recognized in early hospital readmission of low-income seniors.

Journal of the American Geriatrics Society, 32(7):1299-1305 – 2014

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Is There a Relationship Between Patient Satisfaction and Favorable Outcomes?

Low mortality index was consistently found to be associated with high satisfaction across 9 of 10 HCAHPS domains.

Objective

Patient satisfaction with the health care experience has become a top priority for Centers for Medicare and Medicaid Services. With resources and efforts directed at patient satisfaction, we evaluated whether high patient satisfaction measured by HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys correlates with favorable outcomes.

Methods

Medical centers were identified from the University Health-System Consortium database from 2011 to 2012. Variables included hospiratl characteristics, process measure compliance, and surgical outcomes. Chi-squared analysis was used to evaluate for variables associated with high patient satisfaction (defined as hospitals that scored above the 50th percentile of top box scores).

Results

We identified 171 hospitals with complete data. The following variables were significantly associated with high overall patient satisfaction: large hospitals, high surgical volume, and low mortality (P < 0.001). Compliance with process measures and patient safety indicators, as well as length of stay, did not correlate with overall satisfaction. The presence of complications (P = 0.491) or increased rate of readmission (P = 0.056) were not found to affect patient satisfaction. Low mortality index was consistently found to be associated with high satisfaction across 9 of 10 HCAHPS domains.

Conclusions

We found that hospital size, surgical volume, and low mortality were associated with high overall patient satisfaction. However, with the exception of low mortality, favorable surgical outcomes were not consistently associated with high HCAHPS scores. With existing satisfaction surveys, we conclude that factors outside of surgical outcomes appear to influence patients’ perceptions of their care.

Annals of Surgery, 32(7):1299-1305 – 2014

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Examining the Role of Patient Experience Surveys in Measuring Health Care Quality

Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization.

Abstract

Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs.

Medical Care Research and Review, 32(7):1299-1305 – 2014

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Patient Satisfaction and Quality of Surgical Care in US Hospitals

Length of stay was shorter in hospitals with the highest levels of patient satisfaction (7.1 days vs 7.7 days, P < 0.001). Adjusting for procedural volume and structural characteristics, institutions in the highest quartile of patient satisfaction had the higher process of care performance (96.5 vs 95.5, P < 0.001), lower readmission rates (12.3% vs 13.6%, P < 0.001), and lower mortality (3.1% vs 3.6%) than those in the lowest quartile. Hospitals with high patient satisfaction also had a higher composite score for quality across all measures (P < 0.001).

Objective

The relationship between patient satisfaction and surgical quality is unclear for US hospitals. Using national data, we examined if hospitals with high patient satisfaction have lower levels of performance on accepted measures of the quality and efficiency of surgical care.

Background

Federal policymakers have made patient satisfaction a core measure for the way hospitals are evaluated and paid through the value-based purchasing program. There is broad concern that performance on patient satisfaction may have little or even a negative correlation with the quality of surgical care, leading to potential trade-offs in efforts to improve patient experience with other surgical quality measures.

Methods

We used the Hospital Consumer Assessment of Healthcare Providers and Systems survey data from 2010 and 2011 to assess performance on patient experience. We used national Medicare data on 6 common surgical procedures to calculate measures of surgical efficiency and quality: risk-adjusted length of stay, process score, risk-adjusted mortality rate, risk-adjusted readmission rate, and a composite z score across all 4 metrics. Multivariate models adjusting for hospital characteristics were used to assess the independent relationships between patient satisfaction and measures of surgical efficiency and quality.

Results

Of the 2953 US hospitals that perform one of these 6 procedures, the median patient satisfaction score was 69.5% (interquartile range, 63% 75.5%). Length of stay was shorter in hospitals with the highest levels of patient satisfaction (7.1 days vs 7.7 days, P < 0.001). Adjusting for procedural volume and structural characteristics, institutions in the highest quartile of patient satisfaction had the higher process of care performance (96.5 vs 95.5, P < 0.001), lower readmission rates (12.3% vs 13.6%, P < 0.001), and lower mortality (3.1% vs 3.6%) than those in the lowest quartile. Hospitals with high patient satisfaction also had a higher composite score for quality across all measures (P < 0.001).

Conclusions

Among US hospitals that perform major surgical procedures, hospitals with high patient satisfaction provided more efficient care and were associated with higher surgical quality. Our findings suggest there need not be a trade-off between good quality of care for surgical patients and ensuring a positive patient experience.

Annals of Surgery, 32(7):1299-1305 – 2015