MedStatix

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

MedStatix

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

MedStatix

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

MedStatix

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

MedStatix

An evidence base for patient-centered cancer care: A meta-analysis of studies of observed communication between cancer specialists and their patients

Both patient-centered- and instrumental behavior are significantly, positively associated with satisfaction, with patient-centered communication having a relatively stronger association.

Objective

In the context of patients visiting cancer specialists, the objective is to test the association between both patient-centered communication (including Affective Behavior and Participation Behavior) and Instrumental Behavior and patients’ post-visit satisfaction with a variety of visit phenomena.

Methods

Meta-analysis of 25 articles representing 10 distinct data sets.

Results

Both patient-centered- and instrumental behavior are significantly, positively associated with satisfaction, with patient-centered communication having a relatively stronger association.

Conclusions

There is an evidence base for the efficacy of patient-centered care.

Patient Education and Counseling, 32(7):1299-1305 – 2009

MedStatix

The impact of patients’ participation on physicians’ patient-centered communication

When interacting with high participation patients, physicians engaged in significantly more patient-centered communication overall than when interacting with low participation patients.

Objective

The goal of this study is to add to a small, but growing body of research exploring how patients’ communication style affects physicians’ communication. In particular, we examine how patients’ active participation (e.g., asking questions, providing information) affects physicians’ use of patient-centered communication.

Methods

The same 25 physicians were observed interacting with high and low participation patients. High participation was defined as the frequency of information seeking/verifying, information provision, assertive utterances, and expressing concerns. On average, physicians interviewed 2.56 high participation patients and 3.44 low participation patients. Transcripts of the interviews were coded for physicians’ patient-centered communication. High and low patient participation interviews were then compared using nested ANOVAs.

Results

When interacting with high participation patients, physicians engaged in significantly more patient-centered communication overall than when interacting with low participation patients. Analyses on separate components of patient-centeredness indicated that physicians engaged in significantly more exploring of patients’ disease and illness, but did not engage in significantly more understanding of the whole person or finding of common ground.

Conclusions

Patients who actively participate in medical interviews influence physicians to adopt a more patient-centered style of communication. (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Patient Education and Counseling, 32(7):1299-1305 – 2009

MedStatix

Enhancing Patient-Centered Communication and Collaboration by Using the Electronic Health Record in the Examination Room

Dialogue is an important component of this process: “If you don’t mind, I am going to be typing as you speak. I’m happy to show you what I’m writing”; “I’m going to look up your test results, would you like to look at them together?”; “Let’s look at the trends in your blood pressure readings”; “Now that we’ve seen how you’re doing, let’s talk about how you can continue to improve. . . .” These verbal and nonverbal cues could potentiate collaboration by facilitating a joint assessment of the patient’s current health status and highlighting opportunities for active patient involvement.

Abstract

Introducing the HER with a verbal explanation and patient-centered body language, by positioning the screen as a bridge rather than a divider, could enhance the relationship and jumpstart the process of activation. Dialogue is an important component of this process. “If you don’t mind, I am going to be typing as you speak. I’m happy to show you what I’m writing”; “I’m going to look up your test results, would you like to look at them together”; “Let’s look at the trends in your blood pressure readings”;”Now that we’ve seen how you’re doing, let’s talk about how you can continue to improve…” These verbal and nonverbal cues could potentiate collaboration by facilitating a joint assessment of the patient’s current health status and highlighting opportunitites for active patient involvement.

Jama-Journal of the American Medical Association, 32(7):1299-1305 – 2013

MedStatix

Closing the loop – Physician communication with diabetic patients who have low health literacy

Primary care physicians caring for patients with diabetes mellitus and low functional health literacy rarely assessed patient recall or comprehension of new concepts. Overlooking this step in communication reflects a missed opportunity that may have important clinical implications.

Background

Patients recall or comprehend as little as half of what physicians convey during an outpatient encounter. To enhance recall, comprehension, and adherence, it is recommended that physicians elicit patients’ comprehension of new concepts and tailor subsequent information, particularly for patients with low functional health literacy. It is not known how frequently physicians apply this interactive educational strategy, or whether it is associated with improved health outcomes.

Methods

We used direct observation to measure the extent to which primary care physicians working in a public hospital assess patient recall and comprehension of new concepts during outpatient encounters, using audiotapes of visits between 38 physicians and 74 English-speaking patients with diabetes mellitus and low functional health literacy. We then examined whether there was an association between physicians’ application of this interactive communication strategy and patients’ glycemic control using information from clinical and administrative databases.

Results

Physicians assessed recall and comprehension of any new concept in 12 (20%) of 61 visits and for 15 (12%) of 124 new concepts. Patients whose physicians assessed recall or comprehension were more likely to have hemoglobin A levels below the mean (less than or equal to58.6%) vs patients whose physicians did not (odds ratio, 8.96; 95% confidence interval, 1.1-74.9) (P =.02). After multivariate logistic regression, the 2 variables independently associated with good glycemic control were higher health literacy levels (odds ratio, 3.97; 95% confidence interval, 1.09-14.47) (P=.04) and physicians’ application of the interactive communication strategy (odds ratio, 15.15; 95% confidence interval, 2.07-110.78) (P<.01).

Conclusions

Primary care physicians caring for patients with diabetes mellitus and low functional health literacy rarely assessed patient recall or comprehension of new concepts. Overlooking this step in communication reflects a missed opportunity that may have important clinical implications.

Archives of Internal Medicine, 32(7):1299-1305 – 2003

MedStatix

Patient-centered communicated is associated with positive therapeutic alliance: a systematic review

The limited evidence suggests patient-centered interaction styles related to the provision of emotional support and allowing patient involvement in the consultation process enhance the therapeutic alliance.

Question

During the patient-therapist encounter, which communication factors correlate with constructs of therapeutic alliance?

Participants

Clinicians and patients in primary, secondary or tertiary care settings. Measures: Studies had to investigate the association between communication factors (interaction styles, verbal factors or non-verbal factors) and constructs of the therapeutic alliance (collaboration, affective bond, agreement, trust, or empathy), measured during encounters between health practitioners and patients.

Results

Among the twelve studies that met the inclusion criteria, 67 communication factors were identified (36 interaction styles, 17 verbal factors and 14 non-verbal factors). The constructs of therapeutic alliance in the included studies were rapport, trust, communicative success and agreement. Interaction styles that showed positive large correlations with therapeutic alliance were those factors that help clinicians to engage more with patients by listening to what they have to say, asking questions and showing sensitivity to their emotional concerns. Studies of verbal and non-verbal factors were scarce and inconclusive.

Conclusions

The limited evidence suggests patient-centered interaction styles related to the provision of emotional support and allowing patient involvement in the consultation process enhance the therapeutic alliance. Clinicians can use this evidence to adjust their interactions with patients to include communication strategies that strengthen the therapeutic alliance. [Pinto RZ, Ferreira ML, Oliveira VC, Franco MR, Adams R, Maher CG, Ferreira PH (2012) Patient-centred communication is associated with positive therapeutic alliance: a systematic review.

Journal of Physiotherapy, 32(7):1299-1305 – 2012

MedStatix

When Seeing The Same Physician, Highly Activated Patients Have Better Care Experiences Than Less Activated Patients

We found that patients at higher levels of activation had more positive experiences than patients at lower levels seeing the same clinician. The findings suggest that the care experience is transactional, shaped by both providers and patients. Strategies to improve the patient experience, therefore, should focus not only on providers but also on improving patients’ ability to elicit what they need from their providers.

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