McFarland Daniel C, Ornstein Katherine A, Holcombe Randall F
Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York.
Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, New York.
J Hosp Med. 2015 Aug;10(8):503-9. doi: 10.1002/jhm.2371. Epub 2015 May 4.
Hospital Value-Based Purchasing (HVBP) incentivizes quality performance-based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population-dense areas and could bias Centers for Medicare & Medicaid Services (CMS) reimbursement.
Assess nonrandom variation in patient satisfaction as determined by HCAHPS.
Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized 4 highly predictive variables, and hospitals were reranked accordingly.
A total of 3907 HVBP-participating hospitals.
There were 934,800 patient surveys by the most conservative estimate.
A total of 3144 county demographics (US Census) and HCAHPS surveys.
Hospital size and primary language (non-English speaking) most strongly predicted unfavorable HCAHPS scores, whereas education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals' locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas.
Demographic and structural factors (eg, hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct.
医院基于价值的采购（HVBP）通过将支付直接与从医院医疗服务提供者和系统消费者评估（HCAHPS）调查中获得的患者满意度得分挂钩，激励基于质量绩效的医疗保健。较低的HCAHPS得分似乎集中在人口密集的异质地区，可能会使医疗保险和医疗补助服务中心（CMS）的报销产生偏差。
评估HCAHPS所确定的患者满意度的非随机差异。
对HCAHPS的各个维度和综合得分进行多变量回归建模。标准化偏回归系数评估预测因素的强度。加权个体（医院）患者满意度调整得分（WIPSAS）使用4个高度预测性变量，并据此对医院重新排名。
共有3907家参与HVBP的医院。
最保守估计有934,800份患者调查问卷。
共有3144个县的人口统计数据（美国人口普查）和HCAHPS调查。
医院规模和主要语言（非英语）最强烈地预测了不利的HCAHPS得分，而教育程度和白人种族最强烈地预测了有利的HCAHPS得分。WIPSAS计算的平均调整后患者满意度得分接近HCAHPS得分的全国平均水平。然而，WIPSAS根据医院所在位置预测变量的强度，以不同程度改变了医院排名。预测得分较低的结构和人口特征由WIPSAS进行了考量，这也提高了许多安全网医院和不同地区学术医疗中心的排名。
即使在CMS进行调整后，人口和结构因素（如医院床位）仍可预测患者满意度得分。CMS应考虑WIPSAS或类似调整，以考虑医院可能努力纠正的患者满意度不平等的严重程度。
