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What is Patient Satisfaction Data – Really?

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Is it all about Subjectivity?

By Brent Mefesel MD

Patient Satisfaction data [PSD] is a subjective measure of what the patient perceives in terms of the level of service quality and care provided by the clinician.

Many health plans consider patient satisfaction an important measure of physician quality.  Although not a direct measure of clinical quality, many researchers link patient satisfaction to clinical outcomes.

Resource Intense

This PSD however, is also resource-intensive to collect and requires commitment on the part of the patient to fill out the forms and return them in the mail or on-line.  Selection bias may also occur in terms of patient satisfaction data, in that patients who choose to fill out and return the forms may in some cases not be representative of the overall patient population for a physician.

Recent Evolution

More recently, the field has been moving from measuring “satisfaction” to elucidating a more validated and specific “patient experience of care”.  The Consumer Assessment of Healthcare Providers and Systems (CAHPS®), funded and administered by the Agency for Healthcare Quality (AHRQ), is a part of a national initiative to measure, report on, and improve health care quality from the viewpoint of patients and other consumers.  Separate surveys are used for evaluating ambulatory care and facility or hospital care.

More CAHPS®

In addition, the National CAHPS Benchmarking Database contains over 10 years of CAHPS survey data from commercial and Medicaid plans and is designed to facilitate comparative analysis of individual CAHPS survey results with benchmarks, including national or regional averages.

Assessment

The CAHPS program works closely with other public and private research agencies, known collectively as the CAHPS Consortium, for continued review and enhancement of the survey tools.

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How Do Health Plans Measure Patient Satisfaction?

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[By Dr. Brent A. Metfessel MS]

Patient satisfaction is a subjective measure of what the patient perceives in terms of the level of service quality and care provided by the clinician. Many health plans consider patient satisfaction an important measure of physician quality.

Now, although not a direct measure of clinical quality, many researchers link patient satisfaction to clinical outcomes. This data, however, is also resource-intensive to collect and requires commitment on the part of the patient to fill out the forms and return them in the mail or on-line.

Selection Bias

However, selection bias may occur in terms of patient satisfaction data, in that patients who choose to fill out and return the forms may in some cases not be representative of the overall patient population for a physician.

Enter the CAHPS® Consortium

More recently, the field has been moving from measuring “satisfaction” to elucidating a more validated and specific “patient experience of care”.  The Consumer Assessment of Healthcare Providers and Systems (CAHPS®), funded and administered by the Agency for Healthcare Quality (AHRQ), is a part of a national initiative to measure, report on, and improve health care quality from the viewpoint of patients and other consumers. Separate surveys are used for evaluating ambulatory care and facility or hospital care.

In addition, the National CAHPS Benchmarking Database contains over 10 years of CAHPS survey data from commercial and Medicaid plans and is designed to facilitate comparative analysis of individual CAHPS survey results with benchmarks, including national or regional averages. The CAHPS program works closely with other public and private research agencies, known collectively as the CAHPS Consortium, for continued review and enhancement of the survey tools.

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About the Author

Brent A. Metfessel, MD MS is currently Senior Medical Informaticist in Clinical Analytics at UnitedHealthcare, where he designs physician measurement algorithms and statistical methods and leads the application of risk adjustment methodologies to various health care quality and cost-efficiency measurement initiatives. He also has a decade of experience in general computer science, statistical analysis, artificial intelligence, and computational biology. Dr. Metfessel received his Masters of Science Degree in health informatics from the Universityof Minnesota and his Medical Doctorate from the Universityof California, San Diego. 

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About the HCUPnet Data Base

An AHRQ Project

HCUPnet is a free, on-line query system based on data from the Healthcare Cost and Utilization Project (HCUP). It provides access to health statistics and information on hospital inpatient and emergency department utilization.

Link: http://hcupnet.ahrq.gov/HCUPnet.jsp

HCUPnet overview

HCUPnet is an on-line query system that gives you instant access to the largest set of all-payer health care databases that are publicly available. Using HCUPnet’s easy step-by-step query system, you can generate tables and graphs on national and regional statistics and trends for community hospitals in the U.S. In addition, community hospital data are available for those States that have agreed to participate in HCUPnet.

Community hospitals are defined as short-term, non-federal, general and other hospitals, excluding hospital units of other institutions (e.g., prisons). National and regional HCUP data include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals. They exclude long term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals, but these types of discharges are included if they are from community hospitals.

The HCUP Project

HCUPnet is part of the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ). HCUPnet generates statistics using data from HCUP’s Nationwide Inpatient Sample (NIS), the Kids’ Inpatient Database (KID), the State Inpatient Databases (SID) and the State Emergency Department Databases (SEDD). These databases and HCUPnet would not be possible without the statewide data collection projects that provide data to HCUP. You can purchase many HCUP databases to do more detailed analyses not possible through HCUPnet. For more information on purchasing HCUP data go to: HCUP Central Distributor Web site

HCUPnet also provides statistics based on the AHRQ Quality Indicators (QIs) which have been applied to the HCUP Nationwide Inpatient Sample. These statistics provide insight into potential quality of care problems. You can download software for the QIs from the Quality Indicators Web site and apply them to your own data.

Assessment

Data from the following statewide data organizations appear in HCUPnet as part of the Nationwide Inpatient Sample (NIS), the Kids’ Inpatient Database (KID), State Inpatient Databases (SID) or as State Emergency Department Databases (SEDD):

Conclusion

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AHRQ Report on Uninsured Hospitalizations

Differs from Insured Hospitalizations

By Staff Reportershorizontal-nurses

According to Tracey Walker, Senior Editor of Healthcare Executive News on March 13, 2009, the number of uninsured hospitalizations increased by 34%, over the last 10-year period, and the number of Medicaid hospitalizations increased by 36%. However, a newt report from the Agency for Healthcare Research and Quality (AHRQ) suggests the number of privately insured hospitalizations remained about the same.

AHRQ Report

According to the report, hospital charges increased for the uninsured faster than for overall hospital charges (76% for compared with 69% for all hospital stays). The average hospital charge for an uninsured stay in 2006 was $19,400 compared to $11,000 in 1997 (after adjusting for inflation). The average length of stay for the uninsured remained the same at about 4 days per hospital visit. Other findings included: 

  • Compared to all hospital stays, uninsured hospitalizations begin in the emergency department much more frequently (60% for the uninsured compared to 44% for all hospital stays).
  • The number of uninsured hospitalizations for skin infections rose sharply over the 10-year period, increasing from about 28,000 stays in 1997 to about 75,000 stays in 2006. Early appropriate outpatient treatment for skin infections can usually prevent the need for hospitalization.
  • There was a 36% increase in hospitalizations billed to Medicaid during the 10-year period.

Assessment

According to AHRQ, on average the costs (not charges) to provide hospital care to the uninsured are about $1,500 less expensive ($6,800 vs. $8,400 per hospital stay) than costs for all other hospital stays.

Assessment

Lack of health insurance has serious consequences on individuals and societies. For example, the uninsured may be more likely to delay or forgo necessary medical care until eventual hospitalization makes care much more expensive. And philosophically,

“As spending on Medicaid increases; the number of uninsured hospitalizations ought to decrease proportionally—adjusted for population increases”

So says, Hope Hetico; RN, MHA, CMP™ of www.HealthcareFinancials.com.

“But, this was not the case, and determining exactly why will require more studies.”

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Does a similar inverse relationship hold for public versus private education, housing and transportation?

Why or why not? Some pundits wonder if it is due to private entities having more “skin-in-the game?” Please opine?

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About ChainOnLine.org

A New AHRQ Web Site

By Staff Reportersradar1

A new educational Web site offering expert perspectives, advice and guidance on drugs, biological products and medical devices is now operational. The destination site, from the Agency for Healthcare Research and Quality’s [AHRQ] Centers for Education and Research on Therapeutics [CERTs], a federally sponsored network of more than a dozen leading research centers nationwide, was officially launched on January 8, 2009.

CHAIN

The Clinician-Consumer Health Advisory Information Network [CHAIN] http://www.chainonline.org connects clinicians and consumers with therapeutics information to assist in clinical practice and health care decision making in areas where evidence is undergoing significant and rapid changes.

CERTS

The site also provides access to educational and informational resources developed from research conducted by CERTs and intended for use in improving health care quality, safety and effectiveness. Clinical topics included on the CHAIN Web site address the management of blood clot prevention with drug-eluting stents and expert opinions about topics where evidence is uncertain, such as restarting anti-platelet therapy if it has been interrupted. The site’s educational section includes materials to assist consumers with clinician-patient conversations and decision-making as well as an online medication record. Resources for clinicians include a slide library that can be adapted to educate clinical audiences and used for continuing medical education credit.

Goal

The overarching goal is to serve as a trusted national resource for people seeking to improve health through the best use of medical therapies. The CERTs program includes partnerships of public and private organizations, a national steering committee involving multiple sectors and CERTs investigators, a coordinating center and 14 research centers. The CHAIN Web site was designed and developed collaboratively with input from all centers, working under the leadership of the Center for Collaborative and Interactive Technologies at Baylor College of Medicine, Houston.

Assessment

For more information, contact AHRQ Public Affairs: (301) 427-1246 or (301) 427-1998.

Internet Citation: Agency for Healthcare Research and Quality, Rockville, MD. Link: http://www.ahrq.gov/news/press/pr2009/chainpr.htm

From the Press Release: AHRQ Announces New Web Site on Emerging Issues in Medical Therapeutics.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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New Medical Informed Consent Dilemma

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Emerging Problems

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem21

According to the Dictionary of Health Insurance and Managed Care, informed consent is the oral and written communication process between a patient and physician that results in the agreement to undergo a particular procedure, surgical intervention or medical treatment.

Unfortunately, a lack of standardization surrounding this process represents a major risk for patients and surgeons, and may lead to inaccurate patient expectations, lost or incomplete consent forms, missing encounter documentation and delays in critical surgeries and procedures.

History: Render S. Davis of Emory University [2008 recipient of the Health Care Ethics Consortium’s Heroes in Healthcare Ethics Award] writes for us in the Business of Medical Practice www.MedicalBusinessAdvisors.com that the concept of informed consent is rooted in medical ethics and codified as a legal principle. It is based on the assertion that a competent person has the right to determine what is done to him or her [self-regulated autonomy].

Rationale: The American Medical Association recommends that its members disclose and discuss the following with their patients:  

  • The patient’s diagnosis, if known,
  • The nature and purpose of a proposed treatment or procedure,
  • The risks and benefits of a proposed treatment or procedure,
  • Alternatives (regardless of cost or health insurance coverage),
  • The risks and benefits of the alternative treatments and,
  • The risks and benefits of not the procedure.

The requirements for informed consent are spelled out in statutes and case law in all 50 states. It is a necessary protocol for all hospitals, medical clinics, podiatry practices and ASCs.

Inadequacy of Traditional Consent Forms-to-Date

The typical informed consent process, particularly one that relies solely on traditional generic consent forms, is often inadequate, incomplete or offers the potential for not fully explaining and documenting a particular procedure to a given patient. 

Traditional consent forms are subject to errors and omissions, such as missing signatures (patient, provider or witness), missing procedure(s), and missing dates that place the validity of consent at risk. Lost or misplaced forms may result in delayed or postponed procedures often at the expensive of costly operating room time. Moreover, far too many forms are generic in nature and wholly unsuited for a specific patient or increasingly sophisticated medical procedure.

Patient Safety Background

According to the Institute of Medicine’s [IOM] repot, To Err is Human, more than 1 million injuries and nearly 100,000 deaths occur annually in the United States due to mistakes in medical care. Wrong patient, wrong-side, wrong-procedure and wrong-toe surgery are particularly egregious. In fact, these are among several other “never-events” that Medicare, and an increasing number of private insurance companies are refusing to reimburse.

Based on the need to make healthcare safer, the Agency for Healthcare Research and Quality (AHRQ) undertook a study to identify patient safety issues and develop recommendations for “best practices”.

AHRQ Evidence Report

The AHRQ report identified the challenge of addressing shortcomings such as missed, incomplete or not fully comprehended informed consent, as a significant patient safety opportunity for improvement.

The authors of the AHRQ report hypothesized that better informed patients “are less likely to experience errors by acting as another layer of protection.” And, the AHRQ study ranked a more interactive informed consent process among the top 11 practices supporting more widespread implementation.

General Accounting Office report found that malpractice insurance premiums were relatively flat for most of the 1990’s, but projections began to increase dramatically to 2010.

Results of Improper Informed Consent

Failure to obtain adequate informed consent, depending on state law, may place surgeons, resident, fellows, ambulatory and office surgery centers, medical clinics and hospitals at risk for litigation ranging from medical negligence to assault and battery.

Proceedings Involving Informed Consent

Informed consent is often a factor in medical malpractice litigation. Some attorneys note that physicians are liable, and that plaintiffs may be able to recover damages, in cases involving improper informed consent, even if the procedure is successful. Inadequate informed consent is often cited as a secondary cause in malpractice complaints and anecdotal evidence suggests this strategy may be especially pursued in podiatric malpractices cases.

Avoiding Litigation

The AMA advises its membership of the following regarding informed consent:  

“To protect yourself in litigation, in addition to carrying adequate liability insurance, it is important that the communications process itself be documented. Good documentation can serve as evidence in a court of the law that the process indeed took place. A timely and thorough documentation in the patient’s chart by the physician providing the treatment and/or performing the procedure can be a strong piece of evidence that the physician engaged the patient in an appropriate discussion.”

Impact of Comprehensive Informed Consent Forms

Another study found that providing informed consent information to patients in written form increased comprehension of the procedure. It was also hypothesized that: 

  • Better informed patients are more compliant with medical advice and recover faster.
  • Informed consent discussions strengthen physician-patient relationships and increase patients’ confidence in their doctor.
  • Well informed patients are more engaged in their own care, and are thus less likely to experience surgical errors than more passive, or less informed patients. 

Medical Ethics

The ethical foundation of informed consent is based on the creation of an environment that supports respect for patients and protects their right to autonomous, informed participation in all collaborative Healthcare 2.0 decisions. 

Assessment 

Thus, the essence of the informed consent problems of modern medicine today!

More: http://www.ePodiatryConsentForms.com 

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Conclusion

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