Accelerating Improvement and Narrowing Gaps

Trends in Patients' Experiences with Hospital Care Reflected in HCAHPS Public Reporting

Published in: HSR, Health Services Research, v. 24, no. 6, Dec. 2015, p. 1850-1867

Posted on RAND.org on April 24, 2015

by Marc N. Elliott, Christopher W Cohea, William Lehrman, Elizabeth Goldstein, Paul Cleary, Laura Giordano, Megan K. Beckett, Alan M. Zaslavsky

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OBJECTIVE: Measure HCAHPS improvement in hospitals participating in the second and fifth years of HCAHPS public reporting; determine whether change is greater for some hospital types. DATA: Surveys from 4,822,960 adult inpatients discharged July 2007–June 2008 or July 2010–June 2011 from 3,541 U.S. hospitals. STUDY DESIGN: Linear mixed-effect regression models with fixed effects for time, patient mix, and hospital characteristics (bedsize, ownership, Census division, teaching status, Critical Access status); random effects for hospitals and hospital-time interactions; fixed-effect interactions of hospital characteristics and patient characteristics (gender, health, education) with time predicted HCAHPS measures correcting for regression-to-the-mean biases. DATA COLLECTION METHODS: National probability sample of adult inpatients in any of four approved survey modes. PRINCIPAL FINDINGS: HCAHPS scores increased by 2.8 percentage points from 2008 to 2011 in the most positive response category. Among the middle 95 percent of hospitals, changes ranged from a 5.1 percent decrease to a 10.2 percent gain overall. The greatest improvement was in for-profit and larger (200 or more beds) hospitals. CONCLUSIONS: Five years after HCAHPS public reporting began, meaningful improvement of patients' hospital care experiences continues, especially among initially low-scoring hospitals, reducing some gaps among hospitals.

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