Dissertation/Thesis Abstract

Examining the relationship between perceived quality of care and actual quality of care as measured by 30 day readmission rates: Examining the relationship among shared risk, capitation, physician employment, hospitalists, and medical homes with patient experience and overall hospital quality
by Salinas, Stanley, D.H.A., Central Michigan University, 2015, 86; 3723146
Abstract (Summary)

Background

Medicare’s Value Based Purchasing program has linked outcomes and patient experience to reimbursement. Most clinicians and administrators have been amenable to linking outcomes with reimbursements; however, linking patient experience with reimbursement has been contentious. There is a concern among some clinicians and administrators that patient experience is not only difficult or impossible to accurately measure but also that it may have little or no relationship with actual quality. The goals of this study are to add to the body of knowledge surrounding the relationship between patient satisfaction and actual hospital quality and to provide useful information to healthcare administrators and policy makers regarding how specific payment, delivery and staffing models may be related to patient satisfaction and actual hospital quality.

Methods

A correlation analysis was used to test the relationship between hospital quality as measured by 30-day readmission rates and patient experience as measured by HCAHPS question #22; Would you recommend this hospital to your friends and family? were used as the measure of patient experience.

Regression analyses were used to measure whether the percent of net revenue from capitation, the percent of net revenue from shared risk, the number of employed physicians per bed, the number of hospitalists per bed or the presence of a medical home were predictors of hospital quality and patient experience.

Results

A statistically significant relationship was found between hospital quality and patient experience. Neither the percent of revenue from capitation or shared risk were found to be predictors of patient experience or quality, however the number of hospitalists per bed was found to be a predictor of both. The number of employed physicians per bed and the presence of an established patient centered medical home were found to the statistically significant predictors of patient experience but not quality.

Discussion

The findings from this study confirm that hospitals with higher patient experience scores have lower rates of readmission and therefore have higher levels of overall quality and along with other large studies, such as those by Isaac et al. (n = 927) in 2010 and Jha et al. (n = 4032) in 2008, supports the use of patient experience as an element of VBP.

In healthcare, we often think of clinical quality and patient experience as the results of education, training and even organizational culture. While all of these factors are important, this study reminds us that, how we structure our delivery or how our workforce is staffed may be just as important.

Conclusion

Patient experience is correlated with hospital quality and this finding; along with similar findings from other studies shows that it is a reliable and valid factor in value based purchasing. As administrators adapt to a system increasingly focused on value, strategic decision making surrounding delivery and employment models, ought to be influenced, at least in part, by studies like this.

Indexing (document details)
Advisor: Berkshire, Steven
Commitee: Lamarine, Roland, Narad, Richard
School: Central Michigan University
Department: Health Administration
School Location: United States -- Michigan
Source: DAI-B 77/02(E), Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Health sciences, Health care management
Keywords: Hcahps, Health quality, Hospital quality, Patient experience, Perception, Readmission
Publication Number: 3723146
ISBN: 9781339058030
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