Becker's Clinical Quality & Infection Control

14 PATIENT EXPERIENCE Hospitals With High Patient Experience Star Ratings Don't Have Better Outcomes, New Analysis Finds By Heather Punke C MS started awarding five-star ratings to hospitals based solely on HCAHPS scores in April of last year, and one year later, a research letter published in JAMA Internal Medicine claimed the patient satisfac- tion-based ratings are associated with patient outcomes. However, a recently released study from Quantros pro- duced contrary findings. According to Quantros's research, that letter's findings are "misleading and may actually steer patients to hospitals with poor clinical outcomes," a statement reads. Quantros used composite outcomes scores including mortality and complication rates as well as patient safety indicators from the Agency for Healthcare Research & Quality for all clinical conditions that carry a high risk of an adverse event — combined, it included more than 300 conditions. Quantros also risk adjusted the hospitals' out- comes for patient characteristics. It then used its CareChex percentile scoring methodology to distribute the hospitals into percentiles based on that score, and compared those to the hospitals' HCAHPS star rating from CMS. Instead of mirroring the JAMA Internal Medicine research findings, the Quantros study found one-star hospitals actually outperformed five-star hospitals on the composite score — 6 percent of one-star hospi- tals had outcome scores in the top 10 percent of the nation, while only 4 percent of five-star hospitals could say the same. Further, nearly half (47 percent) of all five-star rated hospitals performed below the national average composite score. Quantros believes its study differed so greatly from the 2015 study in JAMA Internal Medicine from Harvard re- searchers because of two main differences: 1. The Harvard study used HCAHPS data from the second quarter of 2014 through the first quarter of 2015 and linked it to Medicare patient safety outcomes from 2013, meaning patient experience scores were compared with outcomes from different patient populations. 2. The Harvard study used outcomes data from just three conditions (heart attack, pneumonia and heart failure). "These findings clearly confirm that consumers can- not safely assume that hospitals with a CMS five-star [HCAHPS] rating will provide better clinical quality than other star-rated hospitals," said Frank Mazza, MD, Quan- tros's CMO. "In fact, reliance on five-star rating will place them at a substantial risk of choosing a hospital that provides sub-standard care." This year, CMS released more comprehensive star ratings, which incorporate not only HCAHPS scores but also pa- tient outcomes. "More research will be needed to validate if these ratings provide a reasonable solution for measur- ing the quality of hospital care in an equitable manner," a Quantros statement reads. n 1. Patient shadowing: Following a patient and closely observing their experiences as they move through the care continuum can provide invaluable insights. Dr. Rosen references a program initiated by Anthony DiGioia, MD, an orthopedic surgeon, and his team at the Patient and Fami- ly Centered Care Innovation Center at UPMC in Pittsburgh, which followed hip replacement patients from arrival at the hospital through post-operative rehab. Shadowing led to the discovery of a new way to minimize the need for blood transfusion during surgery and revealed that some post-op hip replacement patients had to wait for rides in the rain. 2. Hassle mapping: This strategy involves developing a comprehensive understanding of where inconveniences, disappointments and complications can arise for patients as they move through the care cycle. This method can be applied to several disparate areas of care from the simple scheduling of an outpatient appointment to a visit to the emergency department to the experience of surgery and hospitalization, among others. Identifying frustrations present at different junctures throughout the process may allow certain elements of care to be streamlined and made more convenient. 3. Empathy mapping: Hospitals can employ this strat- egy while conducting emotional assessments during patient shadowing. The observer can perceive the patient's body language and facial expressions as they experience care. The observer can also ask how the patient is feeling at different intervals in the care expe- rience. The empathy map should include four quadrant layouts posted on a white board or paper. The quad- rants should consist of things the patient said and did, and a patient's thoughts and feelings inferred through observation of a patient as they move through care. In- sight into a patient's emotions and needs can influence care process redesigns which engage patients in a way that inspires positive emotions. n

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