Health Policy and Management, Harvard T H Chan School of Public Health, Cambridge, Massachusetts, USA.
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
BMJ Qual Saf. 2018 Oct;27(10):844-851. doi: 10.1136/bmjqs-2017-007597. Epub 2018 Apr 4.
Patient experience is a key measure of hospital quality and is increasingly contained in value-based payment programmes. Understanding whether strategies aimed at improving care transitions are associated with better patient experience could help clinical leaders and policymakers seeking to improve care across multiple dimensions.
To determine the association of specific hospital care coordination and transition strategies with patient experience.
We surveyed leadership at 1600 acute care hospitals and categorised respondents into three groups based on the strategies used: low-strategy (bottom quartile of number of strategies), mid-strategy (quartiles 2 and 3) and high-strategy (highest quartile). We used linear regression models to examine the association between use of these strategies and performance on measures of patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems survey.
We achieved a 62% response rate. High-strategy hospitals reported using 7.7 strategies on average usually or always on their patient populations, while mid-strategy and low-strategy hospitals reported using 5.0 and 2.3 strategies, respectively. Compared with low-strategy hospitals, high-strategy hospitals had a higher overall rating (+2.23 percentage points (pp), P<0.001), higher recommendation score (+2.5 pp, P<0.001), and higher satisfaction with discharge process (+1.35 pp, P=0.01) and medication communication (+1.44 pp, P=0.002). Mid-strategy hospitals had higher scores than low-strategy hospitals except for discharge satisfaction. Patient-facing strategies, like sharing discharge summaries with patients prior to discharge, using discharge coordinators and calling patients 48 hours after discharge, were each individually associated with a higher overall hospital rating, and higher satisfaction with discharge process and medication communication.
Hospitals with greater reported use of care coordination and transition strategies have better patient experience than hospitals with fewer reported strategies. Strategies that most directly involve patients have the strongest association with better experience.
患者体验是医院质量的关键衡量标准，并且越来越多地包含在基于价值的支付计划中。了解旨在改善护理过渡的策略是否与更好的患者体验相关，可能有助于寻求改善多个维度护理的临床领导者和政策制定者。
确定特定的医院护理协调和过渡策略与患者体验之间的关联。
我们调查了 1600 家急症护理医院的领导层，并根据使用的策略将受访者分为三组：低策略组（使用策略数量处于最低四分位）、中策略组（第二和第三四分位）和高策略组（最高四分位）。我们使用线性回归模型来检查这些策略的使用与医院医疗保健提供者和系统评估调查的患者体验措施之间的关联。
我们的回应率达到了 62%。高策略医院报告称，其患者群体平均通常或总是使用 7.7 种策略，而中策略和低策略医院分别报告使用 5.0 和 2.3 种策略。与低策略医院相比，高策略医院的整体评分更高（+2.23 个百分点（pp），P<0.001），推荐评分更高（+2.5 pp，P<0.001），出院流程满意度更高（+1.35 pp，P=0.01）和药物沟通满意度更高（+1.44 pp，P=0.002）。中策略医院的评分高于低策略医院，但出院满意度除外。面向患者的策略，如在出院前与患者共享出院总结、使用出院协调员以及在出院后 48 小时内致电患者，每项策略都与医院整体评分的提高和对出院流程以及药物沟通的满意度提高相关。
报告使用更多护理协调和过渡策略的医院比报告使用较少策略的医院有更好的患者体验。与患者最直接相关的策略与更好的体验关联最强。
