Does type of hospitalization determine which components of care drive patient-reported experience in the HCAHPS survey?

Research Objective: To determine whether the contributions of composite measures of patient experience to overall hospital ratings on the HCAHPS Survey (also known as the CAHPS Hospital Survey) vary by hospitalization type. Study Design: We defined 24 hospitalization types using a combination of major diagnostic category and service line (medical, surgical, or obstetrical). We examined 7 composite measures of patient experience: Doctor Communication, Nurse Communication , Staff Responsiveness, Room Clean and Quiet, New Medicines Explained, Pain Control, and Post-Discharge Information. To assess the importance of each composite for each type of hospitalization, we calculated simultaneous partial correlations between composite scores and an overall hospital rating, controlling for patient demographics. Population Studied: 49,812 English- or Spanish-speaking adult patients with non-psychiatric primary diagnoses discharged to home between December 2002 and January 2003 after an inpatient admission lasting at least one day in any of 132 general acute care hospitals in 3 states. Principal Findings: Nurse communication was the most important composite overall, with an average partial correlation of 0.34 (range 0.17-0.49); it was statistically significant (p<0.005) and among the three largest partial correlations for all hospitalization types. Discharge information was the least important overall, with an average partial correlation of 0.05 that was statistically significant for only 10 of 24 types (p<0.05) and among the three most important for only one (r=0.16). Partial F-tests of interactions found significant (p<0.05) variation in partial correlations by hospitalization type for 5 of 7 composites (all but Responsiveness and Clean/Quiet), with the largest variations observed for Nurse Communication, Doctor Communication, and Pain Control (F >2, p<0.005). Conclusions: Nurse Communication is important to overall patient experience for all types of hospitalizations, but especially for some types; Responsiveness and Cleanliness/Quiet are uniformly moderately important; Doctor Communication and Pain matter for most types and are especially important for at least 6 of 24 hospitalization types; Medications and Discharge matter for about half of 24 hospitalization types and are important only for a few. Implications for Policy, Delivery or Practice: Because some aspects of patient experience are relevant only for certain hospitalization types, measuring those aspects for all types adds noise; quality measures might be improved by restricting administration or scoring to relevant hospitalizations. Web-based reporting could highlight the most important composites for consumers who anticipate a particular hospitalization type. Finally, quality improvement efforts can target those aspects of patient experience that matter most for each hospitalization type.