SUMMARY Goal: We examined the relationship of nine hospital environment measures (room cleanliness, room quietness, food temperature, food variety, mattress comfort, room temperature, room privacy, hospital signage, adequate parking) to two patient outcome measures (likelihood of recommending hospital, overall satisfaction with hospital) by type of services received (medical, obstetric, surgical) at all military medical treatment facilities globally. Our aim was to understand the impact of various hospital environment measures on the patient experience. Methods: We analyzed six logistic regression models, one for each patient satisfaction measure and each service line (medical, obstetric, surgical). The patient characteristic variables were gender, patient age group, and beneficiary category (active duty, active duty family member, retiree, retiree dependents). Results are based on 20,534 completed surveys representing inpatient care delivered October 2019 to March 2020. Data are from the Military Health System TRICARE Inpatient Satisfaction Survey, which is based on the Hospital Consumer Assessment of Healthcare Providers and Systems survey with additional Department of Defense questions. Principal Findings: Across all models, nearly all hospital environment measures were found to be significantly related to patient satisfaction outcomes, aside from food variety in two models and room privacy and temperature in one model. The strongest environment impact factor was room cleanliness for both outcomes with odds ratios ranging from 2.1 to 2.7, p < .01 in all cases. The order of impact for the other eight environment factors varied across service lines with some playing dominant roles dependent on the type of care being received. Significant odds ratios (p < .05) ranged from 1.3 to 2.0 for room quietness, 1.5 to 1.9 for hospital signage, 1.3 to 1.5 for both food variety and food temperature, 1.3 to 1.8 for mattress comfort, 1.3 to 1.6 for room temperature, and 1.3 to 1.8 for adequate parking. Hospital environment measures represented a breadth of the patient experience and were significantly related to a patient’s overall satisfaction and likelihood to recommend military inpatient facilities. Applications to Practice: Healthcare leaders continuously focus on improving the overall patient experience. Fostering a positive experience includes many factors such as provider and nurse interactions and communications with patients. Moreover, the hospital environment should not be overlooked as also having an impact on patient satisfaction, and hospital leaders—both military and civilian—should continue to emphasize hospital amenities as well.

Introduction: Access to care (ATC) is an important component of providing quality healthcare. Clinics need to be able to accurately measure access; however, patients’ reports of access may be different from performance-based data gathered using administrative measures. The purpose of this research is to examine the relationship between ATC administrative data and patient survey results. Materials and Methods: This is a retrospective study performed in military medical treatment facilities. Survey data were obtained from the Joint Outpatient Experience Survey (JOES), and administrative data were collected from the Military Health System Data Repository. The data period was from May 2016 through March 2017 for 135 parent Military Treatment Facilities. This study was approved under the Defense Health Agency Internal Review Board (IRB number: CDO-15-2025). The analyses compare JOES ATC measures to administrative ATC measures. Overall correlation analyses and multivariate regression analyses were performed in order to generate observable correlations between access and healthcare measures (both administrative measures and patient survey items). Results: Results show moderate correlations between the facilities’ ATC survey items and administrative measures. These correlations were affected by the composition of the facility patient mix. The patient-based ATC measures from the JOES survey are related to administrative ATC measures collected and monitored by the facilities. In each final regression model, the coefficients for the ATC administrative variables were significant and negative which indicates that as the wait time for an appointment increases, patients’ ratings of the time between scheduling and appointment dates declines and patients’ assessments of being able to see a provider declines as well. Conclusions: Measuring ATC is a vital step in ensuring the health of patients and the provision of high quality care. Both patient surveys and administrative data are widely used for measuring ATC. This study found statistically significant moderate associations between survey and administrative ATC measures, which remained significant even after controlling for patient characteristics of the facilities. These study results suggest that administrative data can provide an accurate assessment of access; however, survey items can be useful for diagnosing potential issues with access, such as call center scheduling and provider availability. Future studies should explore the gaps in research surrounding best practices at facilities which have high patient experience with access, and look at other survey measures related to access, such as telephone resources and web-based communication programs.

Introduction This study examines the care experience of obstetric patients within the Military Health System and compares them to those of medical and surgical care patients. Specifically, the study seeks to (1) examine how obstetric inpatient experience ratings differ from medical and surgical inpatient experience ratings, (2) understand specific aspects of care that drive overall experience ratings within this population, (3) test whether adherence to nursing practices such as hourly rounding and nurse leader visits affect experience ratings, and (4) describe ways that patient experience information can be presented to healthcare providers to improve performance. Materials and Methods Data for this study include Military Health System patient experience survey data (based on the Hospital Consumer Assessment of Healthcare Providers and Systems) collected from 2011 through 2019. Analysis includes data collected from 338,124 patients aged 18 years and older. Our analysis involved z-test comparisons of patient experience measure scores, trend analysis, logistic regression-based driver analysis, and correlations. Results Obstetric ratings are generally lower than those of medical and surgical patients; however, they have been improving at a slightly faster rate year over year. Effective nurse communications with patients are a particularly strong driver for improving their overall care experiences, and practices like hourly nurse rounding, nurse leader visits, and nurse–patient shift change conversations are positively correlated with obstetric patient experience ratings. Conclusions This study contextualizes how obstetric inpatient experience ratings differ from those of medical and surgical care patients. Healthcare administrators and policymakers should be aware that obstetric patients may have unique needs and expectations that lead to patient experience ratings differing from those of medical and surgical patients. Effective nurse–patient communications, hourly rounding, nurse leader visits, and nurse–patient shift change conversations could be strategies used to improve obstetric experience ratings.

Research has consistently found a link between hourly nurse rounding and patient outcomes, including reduced falls, reduced pressure ulcers, reduced call light usage, and improved patient experience; however, little research exists specific to patient falls and nurse rounding in acute care settings. This study adds to the body of knowledge by statistically quantifying and providing linkages between nurse rounding frequency and patient fall rates using data from 31 military treatment facilities comprehensively over a period from fiscal year (FY) 2017 through FY2019. Poisson regression results indicated that hourly nurse rounding was associated with a reduction of more than 21% in fall rates (incidence rate ratio = 0.79, P < .01) relative to infrequent rounding, and poorly rated nurse communication was associated with an 8.6-fold increase in patient fall rates relative to highly rated nurse communication (incidence rate ratio = 8.6, P < .01).

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