Association of Patient-Reported Readiness for Discharge and Hospital Consumer Assessment of Health Care Providers and Systems Patient Satisfaction Scores: A Retrospective Analysis

Abstract

Background: Patient-reported outcomes (PRO) have been increasingly emphasized, however, determining clinically valuable PRO has been problematic and investigation limited. This study examines the association of readiness for discharge, which has been described previously, with patient satisfaction and readmission.

Study design: Data from adult patients admitted to our institution from 2009 to 2012 who completed both the Hospital Consumer Assessment of Healthcare Providers and Systems and the Press Ganey surveys post discharge were extracted from an existing database of patients (composed of 220 patients admitted for small bowel obstruction and 98 patients with hospital stays ≥ 21 days). Using the survey question, "Did you feel ready for discharge?" (RFD), 2 groups were constructed, those RFD and those with lesser degrees of readiness (ie, less ready for discharge [LRFD]) using topbox methodology. Outcomes, readmission rates, and satisfaction were compared between RFD and LRFD groups.

Results: Three hundred and eighteen patients met the inclusion criteria; 45% were female and 94% were Caucasian. Median age was 62.3 years (interquartile range 52.5 to 70.8 year). Median length of stay was 10 days (interquartile range 6.0 to 24.0 days) and 69.2% were admitted with small bowel obstruction. The 30-day readmission rate was 14.3% and 55% indicated they were RFD. Those RFD and LRFD had similar demographics, comorbidity scores, and rates of surgery. Those RFD had higher overall hospital satisfaction (87.3% RFD vs 62.4% LRFD; p < 0.001), higher physician communication scores (median 3.0 RFD vs 2.0 LRFD; p < 0.001), and higher nursing communication scores (median 3.0 RFD vs 2.0 LRFD, p < 0.001). Readmission rates were similar between the groups (11.4% RFD vs 18.2% LRFD; p = 0.09).

Conclusions: Readiness for discharge appears to be a clinically useful patient-reported metric, as those RFD have higher satisfaction with the hospital and physicians. Prospective investigation into variables affecting patient satisfaction in those LRFD is needed.

Figure 1

Distribution of responses to “Did you feel ready for discharge?” plot of the data from all patients studied; many of the points overlap.....”. Edit 2nd and 3rd sentences: Correct the grammar: it currently is inconsistent and missing words: Suggestion: “The values on the y-axis represent.... patient responses to...... The values on the x-axis represent ......”.

Figure 2

Correlation between readiness for discharge and satisfaction measures for total group. (A) Plot of the total patient population; since many of the points overlapped secondary to the same responses to both questions, a very small random number was added or subtracted to the response to improve the visual depiction of the data. The values y-axis represents the actual patient response to the readiness for discharge question. The value on the x-axis represents the number of topbox responses to the physician communication composite questions. (B) Plot of the total patient population; since many of the points overlapped secondary to the same responses to both questions, a very small random number was added or subtracted to the response to improve the visual depiction of the data. The values y-axis represents the actual patient response to the readiness for discharge question. The value on the x-axis represents the response to the overall hospital rating question.

Figure 2

Correlation between readiness for discharge and satisfaction measures for total group. (A) Plot of the total patient population; since many of the points overlapped secondary to the same responses to both questions, a very small random number was added or subtracted to the response to improve the visual depiction of the data. The values y-axis represents the actual patient response to the readiness for discharge question. The value on the x-axis represents the number of topbox responses to the physician communication composite questions. (B) Plot of the total patient population; since many of the points overlapped secondary to the same responses to both questions, a very small random number was added or subtracted to the response to improve the visual depiction of the data. The values y-axis represents the actual patient response to the readiness for discharge question. The value on the x-axis represents the response to the overall hospital rating question.

Figure 3

(A) Correlations of patient length of stay and physician communication scores. Plot of the total patient population; many of the points overlap secondary to the same responses to both questions. The value on the y-axis represents the number of topbox responses to the physician communication composite questions. The values x-axis represents length of stay in days. (B) Correlations of patient length of stay and overall hospital satisfaction scores. Plot of the total patient population; some of the points overlap secondary to the same responses to both questions. The value on the y-axis represents the response to the overall hospital rating question. The values x-axis represents length of stay in days.

Figure 3

(A) Correlations of patient length of stay and physician communication scores. Plot of the total patient population; many of the points overlap secondary to the same responses to both questions. The value on the y-axis represents the number of topbox responses to the physician communication composite questions. The values x-axis represents length of stay in days. (B) Correlations of patient length of stay and overall hospital satisfaction scores. Plot of the total patient population; some of the points overlap secondary to the same responses to both questions. The value on the y-axis represents the response to the overall hospital rating question. The values x-axis represents length of stay in days.