Dai Andrea, Moore Megan, Polyakovsky Anna, Gooding Tracy, Lerew Tara, Carrougher Gretchen J, Gibran Nicole S, Pham Tam N
Department of Surgery, University of Washington Medicine, UW Medicine Regional Burn Center, Seattle, Washington.
J Burn Care Res. 2019 Feb 20;40(2):202-210. doi: 10.1093/jbcr/iry018.
Little is understood about the inpatient experience from the burn patients' perspectives. Rather, hospitals emphasize quantitative feedback as part of the ongoing process improvement. Comments returned with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) administrative survey may provide important patient perspectives. They analyzed quantitative and qualitative HCAHPS data to identify areas for care improvement. They reviewed our burn center HCAHPS results over 2 years. They analyzed "top-box" result in each defined HCAHPS category, which is the most frequently reported best result in each composite, including survey scores ≥9 (out of 10). They performed qualitative content analysis of open-text responses via a HIPAA-compliant analysis software. They developed a hierarchy of major expressed themes and organized them using HCAHPS-validated satisfaction domains. A total of 610 inpatient HCAHPS surveys (21% response rate) were returned. Seventy-five percent of respondents ranked their burn center as ≥9 (out of 10) in care scores. Content analysis identified three main components of the inpatient experience: 1) provider/nurse communication, 2) hospital environment, and 3) the discharge experience. Caring, respect, handoff coordination, explanations, listening, and confidence in provider constituted the six key communication themes. Patients generally reported that burn providers listened to their concerns, but others requested clearer explanations of their condition and care. Responses about hospital environment highlighted excessive noise and disrupted sleep, and variable responses related to cleanliness. Challenges in the discharge experience included difficulties procuring wound care supplies and discharge medications. Qualitative data from HCAHPS helped identify major target areas for burn center performance improvement. Analysis of HCAHPS direct patient feedback is useful in process improvement, whereas numerical data alone do not provide sufficient actionable information.
从烧伤患者的角度来看，人们对住院体验了解甚少。相反，医院强调将定量反馈作为持续质量改进过程的一部分。随《医疗服务提供者和系统消费者评估》（HCAHPS）行政调查返回的评论可能提供重要的患者观点。他们分析了HCAHPS的定量和定性数据，以确定护理改进的领域。他们回顾了我们烧伤中心两年多的HCAHPS结果。他们分析了每个定义的HCAHPS类别中的“顶级”结果，这是每个综合指标中最常报告的最佳结果，包括调查得分≥9（满分10分）。他们通过符合《健康保险流通与责任法案》（HIPAA）的分析软件对开放文本回复进行了定性内容分析。他们制定了主要表达主题的层次结构，并使用经HCAHPS验证的满意度领域对其进行了组织。共返回了610份住院患者HCAHPS调查问卷（回复率为21%）。75%的受访者将他们的烧伤中心护理评分评为≥9（满分10分）。内容分析确定了住院体验的三个主要组成部分：1）医护人员/护士沟通，2）医院环境，3）出院体验。关怀、尊重、交接协调、解释、倾听以及对医护人员的信任构成了六个关键沟通主题。患者普遍表示烧伤医护人员倾听了他们的担忧，但也有人要求对他们的病情和护理进行更清晰的解释。关于医院环境的回复突出了噪音过大和睡眠受到干扰，以及与清洁程度相关的不同回复。出院体验中的挑战包括获取伤口护理用品和出院药物方面的困难。HCAHPS的定性数据有助于确定烧伤中心绩效改进的主要目标领域。对HCAHPS直接患者反馈的分析有助于质量改进，而仅靠数字数据并不能提供足够的可操作信息。
