Patients find pain management, discharge instructions lacking

[cougarnurse]

Thought this would be of interest:

The quality of hospitals across the U.S. is inconsistent. To address this issue, the federal government and private organizations have begun to publicly report data, such as how well hospitals treat certain conditions. But until now, there has been no data on how patients themselves feel about the care they received. A new study by Harvard School of Public Health (HSPH) researchers analyzed the first national data on patients' experiences in hospital settings and found that though patients are generally satisfied with their care, there is substantial room for improvement in a number of key areas, including pain management and discharge instructions.

The study appears in the October 30, 2008 issue of The New England Journal of Medicine.

"These data really represent a sea change for the health care system. Patient-centered care is at the heart of a high-performing system and until now, we have lacked information on how patients feel about their care. With this information now freely available, providers and policymakers can begin to focus on improving patients' experiences in the hospital," said lead author Ashish K. Jha, MD, MPH, and assistant professor of health policy at HSPH.

The researchers analyzed data collected in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which asked patients questions about their hospital experiences and their demographic characteristics. Responses were grouped into six areas: communication with doctors, communication with nurses, communication about medications, quality of nursing services, how well hospitals prepared patients for discharge and pain management. More than 2,400 hospitals (about 60% of U.S. hospitals) reported data.

To view data on individual hospitals, go to the U.S. Department of Health & Human Services Hospital Compare website (Medicare.gov - Hospital Compare) and click on the "Find and Compare Hospitals" button. The site provides data on patient experiences as well as other quality-of-care measures.

The results showed that, on average, about 67% of patients would definitely recommend the hospital at which they were treated. Patients were more satisfied with hospitals that had a greater ratio of nurses to patients, which wasn't surprising to the researchers. However, the HCAHPS survey provides the first national data to show the important role that nurses can play in providing patient-centered care.

Another important finding of the study was that hospitals with more satisfied patients generally provided higher quality of care as measured by standard quality metrics. Hospitals in which patients rated their care highly were more likely to provide the appropriate care for heart attack, congestive heart failure, pneumonia and prevention of surgical complications.

"Our study confirms that there need be no tradeoff between ensuring that care is technically superb and addressing the needs of the patients," said senior author Arnold Epstein, MD, MA, and chair of the Department of Health Policy and Management at HSPH.

There were large variations in patient-satisfaction performance across the country. For example, 71.9% of hospital patients in Birmingham, AL, gave their care a high rating (9 or 10 on a 10-point scale); hospitals in Knoxville, TN (69.9%) and Charlotte, NC (69.4%) received the next-highest scores. Patients gave hospitals in East Long Island, NY (49.9%), Fort Lauderdale, FL (51.9%) and New York City (52.3%) the lowest marks.

The researchers were surprised by some results. Pain management has been the target of both accreditation and quality-improvement initiatives for many years, but nearly a third of patients did not give high ratings in that area. Discharge instructions have similarly been targeted for quality initiatives, but about a fifth of patients did not rate communications in that area highly. "Given that we spend more than $2 trillion annually for health care in our country, we should expect that the basics are addressed, like always treating pain adequately," Jha added.

Jha and his colleagues are hopeful that the public reporting of patient experience data will lead to improvements in patient-centered care. "As medicine becomes increasingly high-tech, sometimes the basic needs of patients have gotten lost. Our hope is that by systematically measuring and publicly reporting on how patients experience their care, hospitals will be inspired to better meet the needs of their patients," he said.

[cougarnurse]

This, too: Many hospitals fail to please: survey - Yahoo! News

New survey data ranking patients' experiences in U.S. hospitals find many institutions fall short, particularly when it comes to managing pain, researchers said on Wednesday.

The data come from newly available customer satisfaction surveys on 2,400 institutions or 60 percent of U.S. hospitals.

While customer satisfaction surveys are commonplace in service industries, patients in the United States rarely have had the chance to see how their hospital fares compared with the competition.

"It's shocking that given the $2.1 trillion spent on health care that we have not had this kind of information before," said Dr. Ashish Jha, a Harvard health policy researcher whose study appears in the New England Journal of Medicine.

"Every other industry does it," he said in a telephone interview.

The data were collected as part of the Hospital Consumer Assessment of Healthcare Providers and Systems survey and are available to the public at www.hospitalcompare.hhs.gov.

Hospitals must participate in the survey if they want to get increases in payment rates from Medicare, the federal insurance program for the elderly, Jha said.

Jha and colleagues analyzed the data, which included questions on communication with doctors and nurses, communication about drugs, quality of nursing, how well hospitals prepared patients for discharge and pain management.

"Patients in general were satisfied with the care they received, but boy there is a lot of room for improvement," Jha said.

He said patients especially found fault with pain management and hospital discharge instructions, two areas that have already been the target of quality improvement initiatives for several years.

Nearly a third of patients gave hospitals low marks in pain management, and about a fifth of patients said discharge instructions were not clearly communicated.

The survey also uncovered wide swings in satisfaction by region, with 72 percent of patients in Birmingham, Alabama, giving their hospitals high marks. Hospitals in Knoxville, Tennessee, and Charlotte, North Carolina, got high marks from nearly 70 percent of patients.

But only about half of patients at hospitals in East Long Island, New York, Fort Lauderdale, Florida and New York City ranking their performance a 9 or 10 on a 10-point scale.

Jha hopes the rankings will lead to improvements in patient care.