Online Program

Vulnerable Patients are Linked to Poorer Experience and Higher Readmission

Tuesday, November 3, 2015 : 5:30 p.m. - 5:50 p.m.

Alice Li, MS, Decision Analytic & Research, Press Ganey Associates, Inc., Chicago, IL
Jenhao (Jacob) Cheng, PhD, MS, Decision Analytic & Research, Press Ganey Associates, Inc., Elkridge, MD
Dennis Kaldenberg, PhD, Decision Analytics & Research, Press Ganey Associates, South Bend, IN
Background: Patient Experience is an important dimension of public reported hospital quality and Value-based Purchasing (VBP) program, and higher readmission rate is subject to penalty under Readmission Reduction Program. Vulnerable patients are more subject to receive poorer experience and higher readmission rate.

Research Objective: Identify key drivers associated with poorer experience and higher readmission rate, develop vulnerable index to predict patient experience.

Data: 3 million surveys with discharge date during 2013 from Press Ganey Associates’ survey data.

Methods: traditional definition of vulnerable population uses economic or financing terms and focus on patients with dual eligibility – low income seniors and younger persons with disabilities who are enrolled in both the Medicare and Medicaid programs.  However, there are patients who are vulnerable to poorer hospital experience that do not meet this classification. Therefore, in addition to the traditional economics, age, and medical conditions variables, our definition of vulnerability also include education, social support systems, health views, and psychological resilience.

Results: patients with higher vulnerable index score are associated with lower score in all HCAHPS domains except discharge domain. Correction of vulnerable index score with staff responsiveness, medication explanation, physician, nurse, pain management, environment, hospital rating and discharge instruction are -0.10194, -0.09556, -0.08994, -0.08186, -0.0803, -0.0703, -0.02257, 0.02409 respectively. Patients with higher vulnerable index score are associated with higher readmission rate (correlation is 0.1902), disregard if we include readmission visit as an index contributor. Acute care hospitals, hospitals in the South and Mid-West region, hospitals in public and not-for-profit sector, and in rural setting have more vulnerable population.

Conclusion: HCAHPS measures are part of VBP, and higher readmission rate are subject to penalties, vulnerable index is an important predictor for HCAHPS and readmission rate, understanding and controlling vulnerability can have economic value to health care provider.

Learning Areas:

Public health or related research

Learning Objectives:
Describe the vulnerable index method. Explain how vulnerable patients rate their experience. Explain the association between vulnerable patients and readmission rate Describe vulnerable population distribution by hospital characteristics.

Keyword(s): Quality of Care, Vulnerable Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a senior research analyst for over 7 years in the area of hospital quality improvement research, focusing on research in clinical process, patient satisfaction, outcome and efficiency quality measures. Among my scientific interests has been analysis of identifying key drivers of higher quality of care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.