Variation in Family Experience of Pediatric Inpatient Care As Measured by Child HCAHPS

Abstract

BACKGROUND Making national comparisons of family experience of inpatient pediatric care has been limited by the lack of a publicly available survey. The Agency for Healthcare Research and Quality and Centers for Medicare & Medicaid Services commissioned development of the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey to address this gap. Using Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey we measured performance of hospitals in a national field test. METHODS We analyzed 17 727 surveys completed from December 2012 to February 2014 by parents of children (<18 years) hospitalized at 69 hospitals in 34 states. For each of 18 survey measures, we calculated a case-mix-adjusted hospital “top-box” score (ie, percentage of respondents selecting the most positive response option). We quantified variation across hospitals by estimating hospital-level SDs for each item with a hierarchical linear probability model. We examined associations of family experience with patient, parent, and hospital characteristics. We compared aggregate performance on each measure across participating hospitals. RESULTS Mean hospital top-box scores ranged from 55% (“Preventing mistakes and helping you report concerns”) to 84% (“Keeping you informed about your child's care in the emergency department”). The mean for overall rating of hospital stay was 73% (SD 7%). “Quietness of hospital room” scores varied most across hospitals (SD 8%). Overall top-box scores were higher for freestanding childrens hospitals (74%) and childrens hospitals within a hospital (73%) than for pediatric wards within hospitals (68%, P = .007). CONCLUSIONS Family experience of pediatric inpatient care shows substantial room for improvement and varies considerably across hospitals and measures.

Are Caregivers Who Respond to the Child HCAHPS Survey Reflective of All Hospitalized Pediatric Patients?

“…Surveys were not sent to patients whose admissions were classified as observations, who died during hospitalization, were labeled as restricted by their caregivers, or were admitted with a primary psychiatric diagnosis or to an inpatient psychiatry bed, which is standard practice and consistent with how the tool was validated. 32,33 Surveys were sent only in English. The C-HCAHPS is a 62-question, pediatric version of the HCAPHS, created in 2015 with 39 patient-experience questions, which includes 10 screening questions, 12 questions regarding demographics, and 1 open-ended question.…”

A Review of Best Practices for Monitoring and Improving Inpatient Pediatric Patient Experiences

“…Nine (75%) of the 12 quantitative articles included pediatric patient experience surveys. The resulting survey data were used for identifying and targeting new QI initiatives (eg, aiming to improve customer service, staff courtesy, discharge workflow, physician-family communication, patient education, or patient engagement) 28,33,34,[36][37][38][39]42 and motivating cultural change (eg, setting expectations and educating staff on discipline-specific best practice and standards of care). 36 The authors of 1 study noted that although pediatric patient experience data allow organizations to prioritize improvements, they yield limited tactical insights on how to effect change.…”

Hospital-to-Home Interventions, Use, and Satisfaction: A Meta-analysis

“…The Agency for Healthcare Research and Quality's Pediatric Quality Measures Program has funded 6 Centers of Excellence for ongoing work in this area. 6,7,108,109 Future work should also be focused on understanding variability in outcomes. Much of this variability may be due to differences in the interventions themselves.…”

“…5 The Child Hospital Consumer Assessment of Hospital Providers and Systems survey was recently developed for use in the pediatric population and was also endorsed by the Agency for Healthcare Research and Quality as a quality measure. 6,7 Parental or caregiver satisfaction with the hospital discharge process is one of the key composite measures assessed in the Child Hospital Consumer Assessment of Hospital Providers and Systems survey 7 and has also been correlated with a decrease in postdischarge use. 8 -11 Use rates and parental satisfaction are therefore increasingly employed as key indicators of hospital discharge quality and serve as important outcomes for attempts to improve discharge processes.…”

“…The rise of parental satisfaction as an important quality indicator provides the opportunity to evaluate interventions that may not have had a statistically significant impact on postdischarge use. 6,7 Finally, a metaanalysis of the effect of pediatric discharge interventions on use has not previously been performed. We therefore undertook this updated systematic review and meta-analysis of the literature to determine which pediatric hospital discharge process interventions are associated with decreased use and/or improved patient and/or caregiver satisfaction compared with typical local discharge processes.…”