Psychometric Testing of a Measure of Patient Experience in an Ambulatory Surgery Setting.

The purpose of this research was to develop a psychometrically sound survey for use with the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Services (OAS CAHPS) survey. Both an exploratory pilot and a confirmatory pilot were conducted in hospital outpatient departments and freestanding ambulatory surgery centers eligible for participation in the OAS CAHPS program. Analyses indicated an internally consistent and valid 18-item survey with 6 measures, including Access, Moving Through the Visit, Nurses, Anesthesiologist, Doctor, and Coordinated Care. The measures are small, maximizing the number that can be used along with the OAS CAHPS survey, given Centers for Medicare & Medicaid Services restrictions.

The Relationship Between Nurse-Reported Safety Culture and the Patient Experience.

OBJECTIVE: The purpose of this study was to better understand the relationship between nurse-reported safety culture and the patient experience in a multistate sample of nurses and patients, matched by hospital unit/service line and timeframe of care delivery. BACKGROUND: Nurses play a key role in the patient experience and patient safety. A strong safety culture may produce positive spillover effects throughout the nurse caregiving experience, resulting in patient perception of a high-quality experience. METHODS: Multivariate mixed-effects regression models were specified using data from a multistate sample of hospital units that administered both the Agency for Healthcare Research and Quality (AHRQ) staff safety culture survey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey over a 12-month period. Survey response variables are measured at the unit (service line) and hospital level. RESULTS: Key variables in the HCAHPS and AHRQ surveys were significantly correlated. Findings highlight the relationship between 3 safety culture domains: teamwork, adequate staffing, and organizational learning on the achievement of a positive patient experience. CONCLUSION: Modifiable aspects of hospital culture can influence the likelihood of achieving high HCAHPS top box percentages in the nursing and global domains, which directly impact hospital reimbursement.

Nursing care, inpatient satisfaction, and value-based purchasing: vital connections.

OBJECTIVE: The objective of this study was to investigate how domains of patient satisfaction in hospitals predict Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) global rating scores to support hospital administrators in dealing with reimbursement changes. BACKGROUND: Medicare's inpatient value-based purchasing program ties a portion of hospital payments to scores on the HCAHPS survey. METHODS: Logistical regression analysis of patient-level satisfaction domain scores from a standard, commercially available survey and HCAHPS top-box scores controlled for potential confounding variables. RESULTS: Each 1-point increase in the nursing domain score increased the odds of achieving an HCAHPS top-box score by 4.9%. Increases in other domain scores also affected top-box odds, although to a smaller extent. CONCLUSIONS: Hospital administrators wishing to maximize Medicare reimbursement will realize the greatest impact by improving patient satisfaction with nursing care.

Patient satisfaction with hospitalists: facility-level analyses.

Despite concerns and disagreements about the impact of hospitalist models on health care, hospitalists are becoming the dominant means of providing inpatient care, and models continue to diversify. Understanding their impact and the factors that influence their adoption is essential. This study examined hospitalists' impact on patient satisfaction, considering a host of characteristics. Cross-sectional data received in calendar year 2008, aggregated to the facility level, represent 1777 hospitals (41% of which employed hospitalists) and 2 648 275 patients. Press Ganey's psychometrically sound inpatient satisfaction survey consists of 38 items (10 sections) rated on a 5-point Likert-type scale. Findings suggest that facilities with hospitalists may have an advantage regarding satisfaction with nursing and personal issues (eg, privacy, emotional needs, response to complaints), both of which may be related to broader communication issues. Moreover, teaching (overall satisfaction) and large facilities (satisfaction with admissions, nursing, and tests/treatments) might especially benefit from the presence of hospitalists. Exploring how specific hospitalist functions influence patient satisfaction may reap rewards.

Award-winning outpatient service: finding the common thread.

With the considerable number of quality improvement options available, it is difficult to determine which are right for your organization. As the award-winning outpatient organizations and the research literature cited in this article demonstrate, improving the quality of communication both directly and indirectly increases a patient's opinion of an organization. Specifically, the extent and quality of communication with the patient and among healthcare team members, both during and after the patient's visit, are key drivers of the patient's increased likelihood to recommend the organization. Better communication increases not only patient satisfaction, but also the patient's adherence to post-visit guidelines and medication, which is associated with increased quality of life. Thus, communication-type initiatives are central to improving service quality. Rather than offering a guide to implementing one of the many communication-focused initiatives available, this article offers an empirically based conceptual framework to help the reader consider the broader effects of these initiatives.

Dementia care mapping as a research tool.

INTRODUCTION: Dementia Care Mapping (DCM) was originally developed as a clinical tool but has attracted interest as a potential observational measure of quality of life (QOL) and well-being of long-term care residents with dementia. DCM coding involves continuous observation over a 6-h period, with observers recording a Behavior Category Code (BCC, a recording of activity/interaction) and a Well/Ill Being (WIB) score at 5 min intervals. METHOD: Descriptive data from several different research teams on the distribution and psychometric properties of DCM data were compiled and summarized. RESULTS: Issues and problems identified include: complex scoring algorithms, inter-rater reliability of the BCCs, limited variability of WIB values, associations between resident characteristics and DCM assessments, rater time burden, and comparability of results across study settings. CONCLUSIONS: Despite the identified limitations, DCM has promise as a research measure, as it may come closer to rating QOL from the perspective of persons with dementia than other available measures. Its utility will depend on the manner in which it is applied and an appreciation of the measure's strength and limitations. Possible changes that might improve the reliability, validity, and practicality of DCM as a research tool include coding the predominant event (rather than the 'best' event), shortening the observation period, and adding '0' as a neutral WIB coding option.

Information and service needs of persons with Alzheimer's disease and their family caregivers living in rural communities.

This study aimed to identify the information and service needs of persons with Alzheimer's disease (AD) and their family caregivers living in rural communities and to assess differences and similarities in each partner's perspective. In an outpatient clinic setting, a self-report survey was completed by 100 caregivers, while a similar survey was used to interview 100 persons with mild to moderate AD. The survey assessed respondents' interest in information or services related to 22 topics about AD and various aspects of coping with the disease. Although more caregivers than persons with AD reported interest in each topic, 8 of the top 10 topics endorsed by each group of respondents were the same. However, analysis of responses by dyads revealed substantial disagreement in terms of each partner's interest in information and services. Patient and family education, as well as referrals for services, must take into account each partner's unique perspective and needs.

A comparison of three methods of measuring dementia-specific quality of life: perspectives of residents, staff, and observers.

PURPOSE: This exploratory study compared three methods of assessing dementia specific quality of life, corresponding to the perspectives of residents, staff members, and trained observers. DESIGN AND METHODS: We collected data on 172 residents with dementia in four special care nursing facilities and three assisted living facilities. Analyses assessed the relationship of each quality-of-life method or perspective to the others and to resident characteristics such as cognitive and functional status. RESULTS: The relationship of staff quality-of-life measures to resident characteristics varied by care setting while no significant relationships were found for resident quality-of-life measures. Staff and observational measures were moderately correlated in both settings. Moderate correlations of resident measures with staff and observational measures were found in the assisted living sample. IMPLICATIONS: Each perspective is relatively independent and somewhat unique. Measures that focus on specific aspects of quality of life may be more appropriate to use with assisted living residents than with residents of special care facilities.

Development of the knowledge about memory loss and care (KAML-C) test.

The purpose of this study was to develop a test to assess the knowledge of family caregivers concerning memory loss, the early stages of Alzheimer's disease (AD), and related care issues. A total of 31 multiple-choice items were generated in three domains: medical information, caregiving, and legal/financial planning. The test was administered to experts in the field of dementia research and care, medical students, and family caregivers. Item analysis procedures were then used to reduce the test to 15 items. Results suggest that the Knowledge about Memory Loss and Care (KAML-C) test is a reliable and valid test for examining the knowledge level of family caregivers with a relative in the early stages of dementia.

Comparison of dementia-specific quality of life measures in adult day centers.

This study evaluated five dementia-specific quality of life (DQOL) measures including client interviews, staff proxies, and observations with 54 clients in three adult day centers. Also, the relationship of cognitive and functional status to each of the DQOL measures was assessed. Client interviews correlated well with each other, but not with other measures. Staff proxies were strongly correlated with each other and moderately correlated with the observational measure. On average, clients rated their DQOL higher than staff. Analyses suggest that functional impairment is associated with poorer DQOL as indicated by staff and observer measures. Possible explanations and implications are explored.

Comparison of two home care protocols for total joint replacement.

OBJECTIVES: To examine the effect of a more-efficient home care protocol to manage total joint replacement (TJR) patients after surgery. DESIGN: A randomized trial of two home care protocols for TJR management. SETTING: A hospital-affiliated home healthcare agency in a large midwestern city. PARTICIPANTS: Medicare-eligible individuals undergoing elective total hip or knee replacement surgery (N = 136). INTERVENTION: A home care protocol that included preoperative home visits by a nurse and a physical therapist and fewer postoperative visits (range of 9-12 visits) to the home than an existing protocol (range of 11-47 visits). MEASUREMENTS: Functional status, lower extremity functioning, health-related quality of life, satisfaction with care, and use and cost of healthcare services for 6 months postsurgery. RESULTS: There were no differences in functional status, health-related quality of life, or lower extremity functioning by group at 6 months. A marginally significant gain in satisfaction with access to care (P =.059) was found in the intervention group at 6 months. Home healthcare costs were 55% lower for the streamlined group (P <.001). Other costs did not differ significantly by group. CONCLUSION: TJR patients who received the more-efficient home care protocol experienced comparable outcomes to those who received the existing protocol. An abbreviated set of home care visits resulted in more-efficient delivery of care without compromising patient outcomes.

Evaluation of the managed community care demonstration project.

The purpose of this article is to describe the impact of a capitated community-care demonstration in Illinois that attempted to increase the range of services provided while constraining overall costs. The authors examined the implementation and outcomes, using pretest and posttest measures of client satisfaction, range of services, agency costs, and nursing home admissions. Demonstration clients (n = 752) had a mean age of 80, and an average of two activities of daily living impairments. The number of covered services increased from 3 at baseline to 14 during the demonstration, whereas the mean number of services used increased from 1 to 2.5. Satisfaction with care remained stable and agency average costs declined. The capitation rate more closely approximated agency costs than customary fee-for-service (FFS) and provided a fixed deductible for clients. No difference was seen in nursing home admissions compared to clients served under FFS in the same geographic location. These results imply that capitation increased the range of covered services, maintained client satisfaction, increased efficiency, and did not affect rate of nursing home admissions. Capitated home- and community-based services needs to be tested in other locations and with other providers.