Background: CMS launched the Hospital Value-Based Purchasing (VBP) Program in 2010 as part of their initiatives to incorporate healthcare quality into Medicare payment structures. Participating hospitals are assessed according to four domains: Clinical Care, Person and Community Engagement, Safety, and Efficiency and Cost Reduction. Interventions to improve patient safety such as hand hygiene, contact precautions, and reducing unnecessary catheter use may lead to better patient experience. However, prior literature examining the association between patient safety measures and patient experience has shown conflicting findings. In this study, we aim to assess the correlation between Safety and Person and Community Engagement measures to improve our understanding of how hospitals are performing under this payment structure and the relationship between patient safety and experience.
Methods: Patient safety measures were identified using the 2022 Healthcare Associated Infections (HAI) dataset created by the CDC. The predictor variables involved four HAIs under the Safety domain: Central Line-Associated Bloodstream Infection, Catheter Associated Urinary Tract Infection (CAUTI), Clostridium difficile Infection (C. diff), and Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia. HAI measures were logarithmically transformed due to their skewed distributions. We used Pearson’s correlation coefficients to examine the cross-sectional association between HAI measures and HCAHPS responses for five Person and Community Engagement measures’ performance rates: Communication with Nurses, Communication with Doctors, Responsiveness of Hospital Staff, Cleanliness and Quietness of Hospital, and Overall Hospital Rating. Coefficients with r > 0.1 and p < 0.05 were considered statistically and clinically significant.
Results: Among 1,698 hospitals, CAUTI (r = 0.1135) and C. diff (r = 0.1443) were slightly positively correlated with Communication with Nurses performance rates. Similarly, CAUTI (r = 0.1094) and C. diff (r = 0.1395) scores were weakly associated with Communication with Doctors performance rates. For Responsiveness of Hospital Staff performance rates, CAUTI (r = 0.1332) and C. diff (r = 0.1741) were the only safety measures that demonstrated a slight positive correlation with the patient experience measure. No patient safety measures were significantly correlated with Hospital Cleanliness and Quietness (r < 0.1 or p > 0.05). MRSA bacteremia scores (r = -0.1326) were negatively correlated with Overall Hospital Ratings.
Conclusions: CAUTI and C. diff patient safety measures were correlated with responsiveness of staff and communication with doctors and nurses. Our findings differ from previously reported literature that did not find significant relationships between patient safety and patient experience as measured by HCAHPS responses. The study’s limitations include missing patient safety or experience scores for over half of hospitals, decreasing the power of our analysis and contributing to potential selection bias. Future research can assess multilevel factors that may affect patient experience, such as patient demographics, hospital characteristics, and market structure. Investigating how hospital safety measures can positively impact patient experience will be integral to improving healthcare quality in hospitals.