MedStatix

Readmissions in the Era of Patient Engagement

Improved patient satisfaction is associated with decreased 30-day readmission rates and that patient-centered communication may improve health outcomes and reduce expenditures.

Abstract

The patient perspective on readmissions is lacking in the literature despite evidence that improved patient satisfaction is associated with decreased 30-day readmission rates and that patient-centered communication may improve health outcomes and reduce expenditures. In the emerging era of patient engagement in which patients increasingly desire to participate in their medical care, patient perspectives on readmissions warrant further investigation. We aimed to illuminate the patient voice on readmissions, focusing on factors that patients associate with preventable readmissions and the extent to which patients and physicians agree on readmission preventability.

JAMA Internal Medicine, 32(7):1299-1305 – 2014

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Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days

Higher overall patient satisfaction and satisfaction with discharge planning are associated with lower 30-day risk-standardized hospital readmission rates after adjusting for clinical quality. This finding suggests that patient-centered information can have an important role in the evaluation and management of hospital performance.

Objectives

To determine whether hospitals where patients report higher overall satisfaction with their interactions among the hospital and staff and specifically their experience with the discharge process are more likely to have lower 30-day readmission rates after adjustment for hospital clinical performance.

Study Design

Among patients 18 years or older, an observational analysis was conducted using Hospital Compare data on clinical performance, patient satisfaction, and 30-day risk-standardized readmission rates for acute myocardial infarction, heart failure, and pneumonia for the period July 2005 through June 2008.

Methods

A hospital-level multivariable logistic regression analysis was performed for each of 3 clinical conditions to determine the relationship between patient-reported measures of their satisfaction with the hospital stay and staff and the discharge process and 30-day readmission rates, while controlling for clinical performance.

Results

In samples ranging from 1798 hospitals for acute myocardial infarction to 2562 hospitals for pneumonia, higher hospital-level patient satisfaction scores ( overall and for discharge planning) were independently associated with lower 30-day readmission rates for acute myocardial infarction ( odds ratio [ OR] for readmission per interquartile improvement in hospital score, 0.97; 95% confidence interval [CI], 0.94-0.99), heart failure ( OR, 0.96; 95% CI, 0.95-0.97), and pneumonia ( OR, 0.97; 95% CI, 0.96-0.99). These improvements were between 1.6 and 4.9 times higher than those for the 3 clinical performance measures.

Conclusions

Higher overall patient satisfaction and satisfaction with discharge planning are associated with lower 30-day risk-standardized hospital readmission rates after adjusting for clinical quality. This finding suggests that patient-centered information can have an important role in the evaluation and management of hospital performance. ( Am J Manag Care. 2011; 17(1):41-48).

American Journal of Managed Care, 32(7):1299-1305 – 2011

MedStatix

An Agenda For Improving Compassionate Care: A Survey Shows About Half Of Patients Say Such Care Is Missing

Our survey of 800 recently hospitalized patients and 510 physicians found broad agreement that compassionate care is “very important” to successful medical treatment. However, only 53 percent of patients and 58 percent of physicians said that the health care system generally provides compassionate care. Given strong evidence that such care improves health outcomes and patients’ care experiences, we recommend that national quality standards include measures of compassionate care.

Abstract

As the US health care system undergoes restructuring and pressure to reduce costs intensifies, patients worry that they will receive less compassionate care. So do health care providers. Our survey of 800 recently hospitalized patients and 510 physicians found broad agreement that compassionate care is “very important” to successful medical treatment. However, only 53 percent of patients and 58 percent of physicians said that the health care system generally provides compassionate care. Given strong evidence that such care improves health outcomes and patients’ care experiences, we recommend that national quality standards include measures of compassionate care; that such care be a priority for comparative effectiveness research to determine which aspects have the most influence on patients’ care experiences, health outcomes, and perceptions of health-related quality of life; and that payers reward the provision of such care. We also recommend the development of systematic approaches to help health care professionals improve the skills required for compassionate care.

Health Affairs, 32(7):1299-1305 – 2011

MedStatix

Patient Satisfaction Surveys and Quality of Care: An Information Paper

Because physicians and physician practices aim to deliver care that is both clinically effective and patient centered, it is important to understand the association between the patient experience and quality health outcomes.

Abstract

With passage of the Patient Protection and Affordable Care Act of 2010, payment incentives were created to improve the “value” of health care delivery. Because physicians and physician practices aim to deliver care that is both clinically effective and patient centered, it is important to understand the association between the patient experience and quality health outcomes. Surveys have become a tool with which to quantify the consumer experience. In addition, results of these surveys are playing an increasingly important role in determining hospital payment. Given that the patient experience is being used as a surrogate marker for quality and value of health care delivery, we will review the patient experience-related pay-for-performance programs and effect on emergency medicine, discuss the literature describing the association between quality and the patient-reported experience, and discuss future opportunities for emergency medicine.

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

MedStatix

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