Background: Patients’ satisfaction has been shown to be associated with improved health outcomes and reduced health care utilization. The Center for Medicare Services (CMS) has linked patient satisfaction to financial incentives as part of the value-based purchasing program. Patient satisfaction in the inpatient setting is measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. There is a lag between patient’s index hospitalization and HCHAPS score availability to hospitalists.
Methods: We conducted a randomized controlled trial to evaluate the impact of daily computer-generated emails (our intervention) on patient satisfaction. Section of hospital medicine comprised of 12 General Internal Medicine (GIM) ward teams at our 600-bed, level 1 tertiary care center. 3 GIM care teams were composed as follows: Hospitalist only, Hospitalist with APP and Hospitalist with housestaff. 26 hospitalists (out of 27) were randomized to intervention or control groups. A research assistant interviewed a random sample of 1110 patients in their room each day over a period of 7 months. Patients were asked the three-provider communication specific questions from the HCAHPS survey:● During this hospital stay, how often did doctors treat you with courtesy and respect?● During this hospital stay, how often did doctors listen carefully to you? ● During this hospital stay, how often did doctors explain things in a way you could understand?Patient responses were recorded as: Never, sometimes, usually and always and subsequently entered into a website. The website then pushed out an email with the proportion of “top-box” or “always” responses with peer comparison to each hospitalist in the intervention group at 7 am every morning except Sundays and Mondays. No emails were sent to hospitalists in the control group.
Results: The intervention and control groups were similar with regards to baseline HCAHPS scores and clinical experience (table 1). The proportion of “always” responses to the 3 survey questions was statistically significantly higher in the intervention group (86%, 1290/1500) compared to the control group (80.5%, 1239/1539), with a p-value of less than 0.00001. This difference persisted when results were analyzed for individual questions (table 2).We also compared the proportion of “always” responses to the 3 survey questions based on attending hospitalist’s role on the ward team In the control group, the proportion of “always” responses to the 3 survey questions was the lowest on house-staff teams and highest for patients seen by attendings in collaboration with Advanced Practice Providers (APPs) on direct care teams (85.6%) compared to house-staff teams (77%) and attendings seeing patients on their own (80.8%). Top box scores by role showed the greatest increase for patients seen by attendings on house-staff teams (85%, p<0.05) and on their own (86.6%, p<0.05).
Conclusions: We did not provide coaching to improve communication skills and instead relied on self-directed improvement based on reflection and peer comparison. Dynamic real-time feedback improves the provider specific HCAHPS scores. Our intervention required a research assistant to administer the questionnaire every day but was otherwise automated. Interestingly, it was noted that the HCAHPS scores were overall lower on the house staff teams and higher on the teams with APPs. However, daily feedback increased patient satisfaction scores to a similar level irrespective of the role of the provider on the inpatient team.
