HCAHPS: Background and Significance Evidenced Based Recommendations Susan T. Bionat, APRN, CNS, ACNP-BC, CCRN Education Leader, Nurse Practitioner Program
Objectives Discuss the background of HCAHPS. Discuss the significance of HCAHPS to the patient, provider, and the institution Review the global domains that are being monitored. Review some of the recommendations based on evidences to improve communication with patient, provider, and medications.
HCAHPS Background Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) It is a 32 item, national, standardized hospital survey based on the patients perspective Hospital scores are reported by the Center for Medicare and Medicaid by hospitalcompare.com.
HCAHPS Background Three Broad Goals The survey and implementation protocol allows objective and meaningful comparison of the hospitals Public reporting of the HCAHPS results create new incentives for the hospital to improve quality of care. Public reporting enhances accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment
HCAHPS Content and Administration It is administered to a random sample of adult inpatients between 48 hours and six weeks after discharge Patients admitted in the medical, surgical and maternity care service lines are eligible for the survey Administered by mail, phone, mail with phone follow up, or interactive voice recognition The IPPS should achieve at least 300 completed surveys over 4 calendar quarters
HCAHPS Measures Ten HCAHPS measures are reported in the hospital comparison website Six composites summarize how well the nurses and doctors communicate with patients and how responsive the staff are to the patient s needs How well the hospital staff help manage patient s pain How well the staff communicates with patients on new medications Key information is provided at discharge
HCAHPS If your hospital receives high scores on the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS), 30-day readmission rates are likely to be low, according to a study by Press Ganey, a South Bend, IN, health care performance improvement organization.
Why is HCAHPS so important? Medicare/ Medicaid monitor rehospitalizations and the financial incentives depend on quality outcomes, The impact of the problem escalates from patient satisfaction to 30-day readmissions that Medicare can potentially penalize. FY 2014 Hospital Value Based Purchasing Program links a portion of the IPPS hospital s payment from CMS to performance on a set of quality measures
Communication Factors affecting the patient satisfaction scores Patients Caregivers
Evidenced Based Findings CAREGIVERS/PROVIDERS Zwarenstein, M. (2009). Interprofessional Collaboration : Effects of Practice Based Interventions on Professional Practice and Healthcare Outcomes. Cochrane Library Five studies met the inclusion criteria; two studies examined interprofessional rounds, two studies examined interprofessional meetings, and one study examined externally facilitated interprofessional audit. One study on daily interdisciplinary rounds in inpatient medical wards at an acute care hospital showed a positive impact on length of stay and total charges.
Results CAREGIVERS/PROVIDERS IPC interventions can improve healthcare processes and outcomes IPC interventions include: Interprofessional rounds interprofessional meetings, and externally facilitated interprofessional audit. Three of these studies found that these interventions led to improvements in patient care, such as drug use, length of hospital stay and total hospital charges
Evidenced Based Findings Elie, K. (2011), Framing of Health Information Messages. Cochrane Library 35 Studies, N= 16, 345 health consumers It was found that both attribute and goal framing may have little if any effect on health consumers' behavior. In one study of attribute framing, participants understood the message better when it was framed negatively than when it was framed positively. Positively-framed messages may have led to more positive perception of effectiveness than negatively-framed messages. There was little or no difference in persuasiveness in the context of attribute framing.
Evidenced Based Findings Ryan, R. (2011). Consumer oriented interventions for evidence based prescribing and medicine use: an overview of systematic reviews. Cochrane Library Objectives: To determine effects of interventions which target health consumers to promote evidence based prescribing and medicine use by consumers Total 37 review articles Promising interventions to improve adherence and other key medicines use outcomes (e.g. adverse events, knowledge) included self-monitoring and self-management, simplified dosing and interventions directly involving pharmacists.
Evidenced Based Findings CAREGIVERS/PROVIDERS Other strategies showed promise in relation to adherence but their effects were less consistent. These included reminders; education combined with self-management skills training, counseling or support; financial incentives; and lay health worker interventions. No interventions were effective to improve all medicine use outcomes across all diseases, populations or settings. For some interventions, such as information or education provided alone, the evidence suggests ineffectiveness; for many others there is insufficient evidence to determine effects on medicine use outcomes.
Evidenced Based Findings CAREGIVERS/PROVIDERS Kripalani et al. (2007) recommended simplification of dosing to improve medication adherence. More emphasis is placed on those new medications on discharge during medication reconciliation. Interventions that include monitoring and feedback, as well as informational interventions repeated at multiple sessions are also effective (Kripalani, 2007).
Evidenced Based Findings PATIENT FACTORS Elliot, MN.et al (2012). Gender Differences in Patients Perceptions of Inpatient Care Objectives: to examine gender difference in inpatient experience and how they vary by dimension of care and other characteristics N=1,971,632 patients from medical/ surgical units discharged in 3830 hospitals, July 2007-2008 Findings: less positive experience for women than men especially in the areas of Communication with Medications, Discharge Information and Cleanliness. Gender gap is larger for older patients with worse reported health status and in for profit hospital.
Evidenced Based Findings Mosher et al. (2012) studied older veterans with mean age group of 74 and showed that the patient knew 56.4% of medication names and 78.5% of medication purposes. Percentages in the low literacy group are down to 32.2% with medication names compared to 54.6% with marginal literacy.
Evidenced Based Findings The older population 65 years or older numbered 39.6 million in 2009 represented12.9% of the U.S. population. By 2030, there will be about 72.1 million older persons, more than twice their number in 2000 (aoa.org, 2013). Patients 65 years and older represented 40 percent of hospitalized adults
Health Literacy Health Literacy is important for older adults in understanding their medications and health information as well as accessing and using health care services (Zamora and Cingerman, 2011).
Health Literacy Low health literacy is considered a risk factor. Low health literacy is a significant, independent, and modifiable risk factor for 30-day hospital reutilization post discharge (Mitchell, 2012)
Health Literacy Current review of the literatures refers to health literacy in three contexts: (a) skills and health knowledge, (b) functional health literacy and (c) health behaviors and health outcomes (Zamora & Cingerman, 2011). Skills and health knowledge represent the cognitive and social skills that determine motivation, and ability to gain access to health information.
Summary HCAHPS is linked to patient satisfaction, quality care and financial reimbursement Communication is vital among patients and caregivers for quality, safety and patient satisfaction Effective providers interventions include interprofessional collaboration, rounds and meetings
Summary Framing messages whether positive or negative have little or no effect on health consumers behavior Effective medication education should include outcomes such as a side effects and knowledge of medications, self monitoring, self management, simplified dosing and pharmacy involvement Plain information or education alone are ineffective interventions
Summary Dose simplification, monitoring, feedback repeated at multiple sessions are effective Patient factors, include to pay particular attention to female gender as they have less positive experience especially in the areas of communication with medications, discharge information and cleanliness. With the aging consumers, health literacy is an important consideration and linked to 30 day readmissions.
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