Cover: Trends in HCAHPS Survey Scores, 2008–2019

Trends in HCAHPS Survey Scores, 2008–2019

A Quality Improvement Perspective

Published in: Medical Care, Volume 62, Number 6 (June 2024), pages 416-422. DOI: 10.1097/MLR.0000000000002001

Posted on rand.org May 15, 2024

by Megan K. Beckett, Denise D. Quigley, Christopher W. Cohea, William Lehrman, Chelsea Russ, Laura Giordano, Marc N. Elliott

Background

HCAHPS' 2008 initial public reporting, 2012 inclusion in the Hospital Value-Based Purchasing Program (HVBP), and 2015 inclusion in Hospital Star Ratings were intended to improve patient experiences.

Objectives

Characterize pre-COVID-19 (2008–2019) trends in hospital consumer assessment of healthcare providers and systems (HCAHPS) scores.

Research Design

Describe HCAHPS score trends overall, by phase: (1) initial public reporting period (2008–2013), (2) first 2 years of HVBP (2013–2015), and (3) initial HCAHPS Star Ratings reporting (2015–2019); and by hospital characteristics (HCAHPS decile, ownership, size, teaching affiliation, and urban/rural).

Subjects

A total of 3909 HCAHPS-participating US hospitals.

Measures

HCAHPS summary score (HCAHPS-SS) and 9 measures.

Results

The mean 2007–2019 HCAHPS-SS improvement in most-positive-category ("top-box") responses was +5.2 percentage points/pp across all hospitals (where differences of 5pp, 3pp, and 1pp are "large," "medium," and "small"). Improvement rate was largest in phase 1 (+0.8/pp/year vs. +0.2pp/year and +0.1pp/year for phases 2 and 3, respectively). Improvement was largest for Overall Rating of Hospital (+8.5pp), Discharge Information (+7.3pp), and Nurse Communication (+6.5pp), smallest for Doctor Communication (+0.8pp). Some measures improved notably through phases 2 and 3 (Nurse Communication, Staff Responsiveness, Overall Rating of Hospital), but others slowed or reversed in Phase 3 (Communication about Medicines, Quietness). Bottom-decile hospitals improved more than other hospitals for all measures.

Conclusions

All HCAHPS measures improved rapidly 2008–2013, especially among low-performing (bottom-decile) hospitals, narrowing the range of performance and improving scores overall. This initial improvement may reflect widespread, general quality improvement (QI) efforts in lower-performing hospitals. Subsequent slower improvement following the introduction of HVBP and Star Ratings may have reflected targeted, resource-intensive QI in higher-performing hospitals.

Research conducted by

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