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BACKGROUND Studies have shown an association between the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) scores and clinical quality. The mortality risk on admission predicts adverse events. It is not known if this risk also portends a suboptimal patient experience. OBJECTIVE To determine if the admission mortality risk identifies an experience of care risk. DESIGN A retrospectively assembled cohort in which individual HCAHPS survey responses were linked to the admission risk of dying. SETTING Five community hospitals of various sizes in Michigan. PATIENTS There were 17,509 HCAHPS medical and surgical respondents; 2513 (14.4%) were at high risk of dying. MEASUREMENTS Odds ratio (OR) (high‐risk patients to low‐risk patients) for providing a top box score for HCAHPS dimensions, controlling for hospital and the standard HCAHPS patient mix adjustment factors. RESULTS High‐risk respondents were less likely to provide the most favorable response (unadjusted) for all HCAHPS domains, although the difference was not significant (P = 0.09) for discharge information. Multivariable analyses indicated that high‐risk patients were less likely to report a top box experience for doctor communication (OR: 0.85; 95% confidence interval [CI]: 0.77‐0.94) and responsiveness of hospital staff (OR: 0.77; 95% CI: 0.69‐0.85), but were more likely to have received adequate discharge information (OR: 1.30, 95% CI: 1.14‐1.48). CONCLUSIONS Patients at high risk of dying who completed surveys were less likely to report favorable physician communication and staff responsiveness. Further understanding of these relationships may help design a care model to improve both outcomes and experience. Journal of Hospital Medicine 2016;11:628–635. © 2016 Society of Hospital Medicine

Objectives: The hypothesis was that a reminder about recommended primary care physician (PCP) follow-up, sent via e-mail to patients discharged from the emergency department (ED), would increase the proportion of patients who followed up with their PCPs within the recommended time frame. Patient receptiveness to e-mail follow-up reminders was also assessed.Methods: This was a mixed methods clinical intervention study with subjects randomized either to receive the usual care discharge instructions only or to also receive a reminder e-mail message the day after the ED visit. The reminder e-mail contained the subject's PCP's name and address and the recommended PCP follow-up time interval. A blinded review of outpatient PCP medical records was conducted to determine whether and when follow-up occurred. Researchers attempted to contact patients with a telephone survey 2 weeks after their ED visits. The primary outcomes between groups were compared using chi-square tests and relative risks (RRs) with 95% confidence intervals (CIs).Results: Thirty-three percent of the intervention group and 32% of the control group followed-up as recommended (RR = 1.04, 95% CI = 0.81 to 1.33); 52% of the intervention group and 48% of the control group followed-up within 10 days of the recommended time (RR = 1.08, 95% CI = 0.91 to 1.29). The 334 patients (57%) successfully contacted via telephone demonstrated a high interest in receiving future e-mail reminders (75%), with the group that received e-mail reminders more likely to want one in the future than those who did not receive e-mail reminders (82.5% vs. 69.76%; p = 0.04).Conclusions: E-mail reminders sent after ED visits did not improve patients' adherence to the recommended timing of primary care follow-up contained in discharge instructions. Subjects in both the control and the intervention groups favorably viewed the concept of e-mail reminders, suggesting that the value of e-mail reminders after ED discharge may be in areas such as patient satisfaction that were not specifically targeted for measurement in this study.ACADEMIC EMERGENCY MEDICINE 2015;22:47-53 © 2014 by the Society for Academic Emergency Medicine O utpatient follow-up care of patients discharged from the emergency department (ED) is critical to ensuring continuity of care and optimal patient outcomes. Primary care physician (PCP) followup rates after ED care as low as 24% to 50% have been demonstrated in both urban and suburban hospitals. 1,2Prior studies have demonstrated that ED patients have difficulty understanding their discharge instructions, with 34 and 31.5% of patients in separate studies demonstrating confusion regarding their ED follow-up care. 3,4 Multiple approaches to improve follow-up rates after ED care have been attempted. [5][6][7] In one of the first attempts to improve patient compliance with follow-up appointments after ED visits, a 1970s study noted an increase from 58% to 80% when patients were telephoned with appointment reminders the day after their

IntroductionFeedback on patient satisfaction (PS) as a means to monitor and improve performance in patient communication is lacking in residency training. A physician’s promotion, compensation and job satisfaction may be impacted by his individual PS scores, once he is in practice. Many communication and satisfaction surveys exist but none focus on the emergency department setting for educational purposes. The goal of this project was to create an emergency medicine-based educational PS survey with strong evidence for content validity.MethodsWe used the Delphi Method (DM) to obtain expert opinion via an iterative process of surveying. Questions were mined from four PS surveys as well as from group suggestion. The DM analysis determined the structure, content and appropriate use of the tool. The group used four-point Likert-type scales and Lynn’s criteria for content validity to determine relevant questions from the stated goals.ResultsTwelve recruited experts participated in a series of seven surveys to achieve consensus. A 10-question, single-page survey with an additional page of qualitative questions and demographic questions was selected. Thirty one questions were judged to be relevant from an original 48-question list. Of these, the final 10 questions were chosen. Response rates for individual survey items was 99.5%.ConclusionThe DM produced a consensus survey with content validity evidence. Future work will be needed to obtain evidence for response process, internal structure and construct validity.