Accelerating Improvement and Narrowing Gaps: Trends in Patients' Experiences with Hospital Care Reflected in HCAHPS Public Reporting

Abstract

Objective: Measure HCAHPS improvement in hospitals participating in the second and fifth years of HCAHPS public reporting; determine whether change is greater for some hospital types.

Data: Surveys from 4,822,960 adult inpatients discharged July 2007-June 2008 or July 2010-June 2011 from 3,541 U.S. hospitals.

Study design: Linear mixed-effect regression models with fixed effects for time, patient mix, and hospital characteristics (bedsize, ownership, Census division, teaching status, Critical Access status); random effects for hospitals and hospital-time interactions; fixed-effect interactions of hospital characteristics and patient characteristics (gender, health, education) with time predicted HCAHPS measures correcting for regression-to-the-mean biases.

Data collection methods: National probability sample of adult inpatients in any of four approved survey modes.

Principal findings: HCAHPS scores increased by 2.8 percentage points from 2008 to 2011 in the most positive response category. Among the middle 95 percent of hospitals, changes ranged from a 5.1 percent decrease to a 10.2 percent gain overall. The greatest improvement was in for-profit and larger (200 or more beds) hospitals.

Conclusions: Five years after HCAHPS public reporting began, meaningful improvement of patients' hospital care experiences continues, especially among initially low-scoring hospitals, reducing some gaps among hospitals.

Keywords: HCAHPS; bedsize; for-profit; improvement.

Figure 1

Mean Adjusted HCAHPS Score, by Bedsize by Year Note. Vertical lines indicate 95% confidence intervals for each of the four point estimates.

Figure 2

Mean Adjusted HCAHPS Score, by Profit Status by Year Note. Vertical lines indicate 95% confidence intervals for each of the four point estimates. Neither the two 2011 confidence intervals nor the two 2008 confidence intervals overlap.