McFarland Daniel C, Shen Megan Johnson, Parker Patricia, Meyerson Sandra, Holcombe Randall F
Departments of Medicine (Dr McFarland) and Psychiatry and Behavioral Sciences (Dr Parker), Memorial Sloan-Kettering Cancer Center, New York, New York; Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York (Dr Johnson Shen); Icahn School of Medicine at Mount Sinai, New York, New York (Ms Meyerson); and University of Hawaii Cancer Center, Honolulu, Hawaii (Dr Holcombe).
Qual Manag Health Care. 2017 Oct/Dec;26(4):205-209. doi: 10.1097/QMH.0000000000000149.
Centers for Medicare & Medicaid Services reimbursement is now contingent on quality measures such as patient satisfaction as determined by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). In providing patient-centered care that is guided by patient satisfaction measures, it is critical to understand system-level factors that may influence how patients assess their care experiences. One important system-level influence to consider is hospital size.
HCAHPS scores, number of hospital beds, and nursing magnet status were obtained from publically available Hospital Compare, American Hospital Directory, and Magnet Hospitals Web sites, respectively. An aggregate score for patient satisfaction was created across all domains of the HCAHPS. Multilevel regression modeling was performed to examine the associations between hospital size and HCAHPS aggregate and individual dimensions.
Hospital size was significantly associated with patient satisfaction such that larger size was associated with lower satisfaction (β = -.312, P < .001). Hospital size was most strongly associated with less patient satisfaction on the following HCAHPS items: "receiving help as soon as needed" (β = -.441, P < .001), "room and bathroom cleanliness" (β = -.286, P < .001), and doctor communication (β = -.213, P < .001), whereas nurse communication (β = .194, P < .001) was the one modifiable dimension that was associated with more favorable ratings in larger hospitals. Magnet nursing designation was significantly associated with larger hospital size (P < .001).
Patient satisfaction scores may be lower in large hospitals because of patients' perceptions of hospital cleanliness, receiving help on time, and doctor communication. Focusing on improving these factors may improve patient satisfaction scores for larger hospitals.
医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）的报销现在取决于诸如患者满意度等质量指标，患者满意度由医疗服务提供者和系统消费者评估（Hospital Consumer Assessment of Healthcare Providers and Systems，HCAHPS）来确定。在提供以患者满意度指标为导向的以患者为中心的护理时，了解可能影响患者评估其护理体验方式的系统层面因素至关重要。一个需要考虑的重要系统层面影响因素是医院规模。
分别从公开的医院比较（Hospital Compare）、美国医院名录（American Hospital Directory）和磁铁医院网站（Magnet Hospitals Web sites）获取HCAHPS评分、医院床位数和护理磁铁地位。在HCAHPS的所有领域创建了一个患者满意度综合评分。进行多水平回归建模以检查医院规模与HCAHPS综合评分及各个维度之间的关联。
医院规模与患者满意度显著相关，规模越大满意度越低（β = -0.312，P < 0.001）。医院规模与患者在以下HCAHPS项目上的满意度关联最为强烈：“尽快得到所需帮助”（β = -0.441，P < 0.001）、“病房和浴室清洁度”（β = -0.286，P < 0.001）以及医生沟通（β = -0.213，P < 0.001），而护士沟通（β = 0.194，P < 0.001）是在大型医院中与更有利评分相关的一个可改变维度。磁铁护理指定与更大的医院规模显著相关（P < 0.001）。
大型医院的患者满意度得分可能较低，原因是患者对医院清洁度、及时获得帮助和医生沟通的看法。关注改善这些因素可能会提高大型医院的患者满意度得分。
