ISQUA17-1752THE EFFECT OF ADVERSE EVENTS ON PATIENT EXPERIENCE AMONG HOSPITAL INPATIENTS

Abstract

Objectives: The focus on patient reported experience, one of the multiple dimensions of health care quality, has intensified. It is not fully understood how patient reported experience intersects with the other dimensions of health care quality. This study examines the relationship, if any, that reported adverse events in the hospital, have on patient reported experience. Methods: Cross-sectional assessment of one year experience of adult hospital discharges from Mayo Clinic Rochester hospitals from fourth quarter 2012 through 2014 with follow-up patient satisfaction surveys. All provider-reported events with and without harm were linked to all hospital discharges with follow-up HCAHPS patient satisfaction surveys. Univariate analysis was conducted across events with harm vs: events without harm, nonevents, and a combined non-harm event and non-event cohort. Categorical comparisons of survey response rates and composite measures were conducted using chi-square test of proportions and continuous variables using Wilcoxon rank sum test. All statistical analyses were conducted using SAS v9.3. Results: A total of 8734 reported patient events occurred during the study period; 6682 (6.4%) adult hospital discharges had a provider reported event which reached the patient (C or higher), of which 3191 (3.1%) had adverse events with harm or required intervention (D or higher). HCAHPS surveys were obtained on 20,935 (20.1%) of all discharges. The survey rate was significantly lower among those with reported events with and without harm than those without events (16.4% and 15.4% vs. 20.5%, p < 0.001) Among survey responders, those with events reaching the patient scored lower on Communication with Nurses (63.1% vs 70.0%), Communication with Doctors (67.3% vs 72.7%), Responsiveness of Hospital Staff (59.2% vs 67.1%), Pain Management (56.5% vs 62.3%), Communication about Medicines (45.8% vs 52.8%), Environment (50.1% vs 54.7%), Global Rating (80.4% vs 83.6%), and Overall Summary Score (92.4 vs 93.8) than the others (all p < 0.01). No differences were seen on Discharge Information or Care Transition (both p > 0.05). Conclusion: Patients experiencing adverse events are less likely to be surveyed about their hospital experience, and when they are surveyed, they report less satisfaction with most aspects of their care. The biggest differences between those with harm and those without events appeared to be in staff responsiveness and communications with both doctors and nurses. Understanding how patient reported experience impacts other dimensions of quality will provide insight into what patients' value, improve patient care and also has the potential to improve hospital reimbursement. As a component of CMS value based purchasing, the patient reported experience dimension accounts for 25% of the score.