Siddiqui Zishan, Berry Stephen, Bertram Amanda, Allen Lisa, Hoyer Erik, Durkin Nowella, Qayyum Rehan, Wick Elizabeth, Pronovost Peter, Brotman Daniel J
Division of General Internal Medicine, Johns Hopkins Medicine Baltimore, Maryland, USA.
Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA.
J Hosp Med. 2018 Sep;13(10):681-687. doi: 10.12788/jhm.3037. Epub 2018 Jul 25.
Hospital-level studies have found an inverse relationship between patient experience and readmissions. However, based on typical survey response time, it is unclear if patients are able to respond to surveys before they get readmitted and whether being readmitted might be a driver of poor experience scores (reverse causation).
Using patient-level Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) and Press Ganey data to examine the relationship between readmissions and experience scores and to distinguish between patients who responded before or after a subsequent readmission.
Retrospective analysis of 10-year HCAHPS data.
Single tertiary care academic hospital.
Patients readmitted within 30 days of an index hospitalization who received an HCAHPS survey linked to index admission comprised the exposure group. This group was divided into those who responded prior to readmission and those who responded after readmission. Nonreadmitted patients comprised the control group.
Multivariable-logistic regression to analyze the association between HCHAPS and Press Ganey scores and 30-readmission status, adjusted for patient factors.
Only 15.8% of the readmitted patients responded to the survey prior to readmission, and their scores were not significantly different from the nonreadmitted patients. The patients who responded after readmission were significantly more dissatisfied with physicians (doctors listened 73.0% vs 79.2%, aOR 0.75, P < .0001), staff responsiveness, (call button 50.0% vs 59.1%, aOR 0.71, P < .0001) pain control, discharge plan, noise, and cleanliness of the hospital.
Our findings suggest that poor patient experience may be due to being readmitted, rather than being predictive of readmission.
医院层面的研究发现患者体验与再入院之间存在负相关关系。然而，基于典型的调查响应时间，尚不清楚患者在再次入院之前是否能够对调查做出回应，以及再次入院是否可能是体验得分不佳的一个驱动因素（反向因果关系）。
使用患者层面的医疗服务提供者与系统消费者评估（HCHAPS）以及Press Ganey数据，来研究再入院与体验得分之间的关系，并区分在随后再次入院之前或之后做出回应的患者。
对10年的HCAHPS数据进行回顾性分析。
一家三级医疗学术医院。
在首次住院后30天内再次入院且收到与首次入院相关的HCAHPS调查的患者组成暴露组。该组被分为在再次入院之前做出回应的患者和在再次入院之后做出回应的患者。未再次入院的患者组成对照组。
多变量逻辑回归分析，以分析HCHAPS和Press Ganey得分与30天再入院状态之间的关联，并对患者因素进行调整。
只有15.8%的再次入院患者在再次入院之前对调查做出了回应，他们的得分与未再次入院的患者没有显著差异。在再次入院之后做出回应的患者对医生（医生倾听情况：73.0%对79.2%，调整后比值比0.75，P <.0001）、工作人员响应能力（呼叫按钮：50.0%对59.1%，调整后比值比0.71，P <.0001）、疼痛控制、出院计划、噪音和医院清洁度的不满程度明显更高。
我们的研究结果表明，患者体验不佳可能是由于再次入院，而不是再次入院的预测因素。
