School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Medical Statistics, Peking University First Hospital, Beijing, China.
Pediatr Res. 2023 Oct;94(4):1562-1569. doi: 10.1038/s41390-023-02488-3. Epub 2023 Jan 23.
The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China.
This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment.
A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7-15%. The child's global health status and the respondent being the child's mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall's τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00.
Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China.
Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings. Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients' experience measures in a Chinese population. This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China.
本研究旨在确定中文版儿童医院消费者评估医疗保健提供者和系统（Child-HCAHPS）的病例组合调整因素，并评估病例组合调整对中国患者体验测量的影响。
本研究回顾性分析了来自中国六个国家区域儿科中心的数据。参与者为年龄≤17 岁的儿童及其监护人，他们完成了调查。使用中文版儿童 HCAHPS 测量儿科住院患者的护理体验。使用解释能力综合指标评估候选病例组合调整因素。量化六个中心的评分和排名变化，以评估调整的影响。
共有 2708 名受访者于 2021 年 1 月至 3 月完成了调查，应答率为 7%-15%。儿童的总体健康状况和受访者是儿童的母亲被确定为病例组合调整因素，并构建了 18 项患者体验项目的病例组合调整模型。调整前后医院排名的 Kendall's τ 相关系数范围为 0.73 至 1.00。
尽管在我们的样本中，病例组合调整的影响可能看起来不大，但它证明了在中国儿科医疗机构进一步开发病例组合调整模型的可行性、必要性和方法学。
病例组合调整模型可调整可能影响患者体验评分的不可由医疗保健提供者改变的因素，从而提高机构级评分的可比性。需要在不同环境中修改质量措施的标准化病例组合调整协议。这是第一项确定调整变量以及病例组合调整对中国人群儿科住院患者体验测量可能影响的研究。本研究为在中国开发儿科医疗机构的病例组合调整模型提供了可行性和必要性的证据。
