Does patient experience predict 30-day readmission? A patient-level analysis of HCAHPS data

Zishan Siddiqui, Stephen Berry, Amanda Bertram, Lisa Allen, Erik Hans Hoyer, Nowella Durkin, Rehan Qayyum, Elizabeth Wick, Peter Pronovost, Daniel Brotman

Research output: Contribution to journalArticle

Abstract

BACKGROUND: 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). OBJECTIVE: 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. DESIGN: Retrospective analysis of 10-year HCAHPS data. SETTING: Single tertiary care academic hospital. PARTICIPANTS: 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. ANALYSIS: Multivariable-logistic regression to analyze the association between HCHAPS and Press Ganey scores and 30-readmission status, adjusted for patient factors. RESULTS: 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% versus 79.2%, adjusted odds ratio [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. CONCLUSION: Our findings suggest that poor patient experience may be due to being readmitted, rather than being predictive of readmission.

Original languageEnglish (US)
Pages (from-to)681-687
Number of pages7
JournalJournal of Hospital Medicine
Volume13
Issue number10
DOIs
StatePublished - Oct 1 2018

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Health Personnel
Odds Ratio
Delivery of Health Care
Patient Readmission
Tertiary Healthcare
Causality
Reaction Time
Noise
Hospitalization
Logistic Models
Regression Analysis
Physicians
Pain
Control Groups
Surveys and Questionnaires

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

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Does patient experience predict 30-day readmission? A patient-level analysis of HCAHPS data. / Siddiqui, Zishan; Berry, Stephen; Bertram, Amanda; Allen, Lisa; Hoyer, Erik Hans; Durkin, Nowella; Qayyum, Rehan; Wick, Elizabeth; Pronovost, Peter; Brotman, Daniel.

In: Journal of Hospital Medicine, Vol. 13, No. 10, 01.10.2018, p. 681-687.

Research output: Contribution to journalArticle

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AU - Durkin, Nowella

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N2 - BACKGROUND: 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). OBJECTIVE: 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. DESIGN: Retrospective analysis of 10-year HCAHPS data. SETTING: Single tertiary care academic hospital. PARTICIPANTS: 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. ANALYSIS: Multivariable-logistic regression to analyze the association between HCHAPS and Press Ganey scores and 30-readmission status, adjusted for patient factors. RESULTS: 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% versus 79.2%, adjusted odds ratio [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. CONCLUSION: Our findings suggest that poor patient experience may be due to being readmitted, rather than being predictive of readmission.

AB - BACKGROUND: 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). OBJECTIVE: 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. DESIGN: Retrospective analysis of 10-year HCAHPS data. SETTING: Single tertiary care academic hospital. PARTICIPANTS: 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. ANALYSIS: Multivariable-logistic regression to analyze the association between HCHAPS and Press Ganey scores and 30-readmission status, adjusted for patient factors. RESULTS: 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% versus 79.2%, adjusted odds ratio [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. CONCLUSION: Our findings suggest that poor patient experience may be due to being readmitted, rather than being predictive of readmission.

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