Gender Differences in Patients' Perceptions of Inpatient Care
RAND Corporation, Santa Monica, CA 90407, USA. Health Services Research
(Impact Factor: 2.78).
02/2012; 47(4):1482-501. DOI: 10.1111/j.1475-6773.2012.01389.x
To examine gender differences in inpatient experiences and how they vary by dimensions of care and other patient characteristics.
A total of 1,971,632 patients (medical and surgical service lines) discharged from 3,830 hospitals, July 2007-June 2008, and completing the HCAHPS survey.
We compare the experiences of male and female inpatients on 10 HCAHPS dimensions using multiple linear regression, adjusting for survey mode and patient mix. Additional models add additional patient characteristics and their interactions with patient gender.
We find generally less positive experiences for women than men, especially for Communication about Medicines, Discharge Information, and Cleanliness. Gender differences are similar in magnitude to previously reported HCAHPS differences by race/ethnicity. The gender gap is generally larger for older patients and for patients with worse self-reported health status. Gender disparities are largest in for-profit hospitals.
Targeting the experiences of women may be a promising means of improving overall patient experience scores (because women comprise a majority of all inpatients); the experiences of older and sicker women, and those in for-profit hospitals, may merit additional examination.
Available from: Michael Day
- "McNair et al., 2009). Previous studies have noted lower satisfaction scores in women across and within hospitals (Elliott et al., 2012), leading authors to conclude that targeting a gender experience may lead to improved satisfaction in women. Racial minorities also rate their care lower. "
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ABSTRACT: The purpose of this study was to determine whether development of a hospital-acquired condition (HAC) affected responses to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey questions. HCAHPS is a national, standardized satisfaction survey. Patient responses form, in part, the basis for Medicare reimbursement to hospitals via the value-based purchasing system established by the Patient Protection and Affordable Care Act of 2010. We hypothesized that patients who developed an HAC would be less satisfied with their care.
We randomly distributed the HCAHPS survey, a validated, standardized measure of patient satisfaction, to 6,056 patients discharged from our institution for any orthopedic admission over a 2-year period. All patients who develop HACs are logged by our hospital quality assurance monitoring system. We reviewed the HCAHPS database, identified completed surveys associated with patients who had developed an HAC, and compared satisfaction scores between patients with HACs and patients without HACs. Survey scores were normalized to a 100-point scale. Univariate analysis was performed for two global ratings, and six specific satisfaction categories. Subgroup analysis was performed for surgical site infections (SSIs) and venous thromboembolic disease (VTE).
A total of 2,876 controls and 159 HAC cases were identified from completed surveys. The cases and controls were similar in terms of race, however, the HAC group contained significantly more women (p < .001). Patients in the HAC group also were, on average, significantly older, with a mean age of 66.84 versus 58.65 (p < .001). There was no difference in satisfaction scores in patients' mean rating of communication by nurses (p = .81), communication by doctors (p = .31), communication about medications (p = .69), pain control (p = .66), the cleanliness of the hospital environment (p = .54), and the quietness of the hospital (p = .589). The mean normalized score for overall satisfaction was 93.99 (out of 100) for controls and 94.84 for HAC cases (p = .61). The mean normalized score for overall willingness to recommend the hospital to others was 90.22 for controls and 90.65 for HAC cases (p = .77). There was no statistically significant difference in satisfaction for patients with SSI versus VTE versus all other HACs (p > .05).
Performance on HCAHPS is an area that demands hospital attention both to provide patient-centered care and to maximize revenue. Development of an HAC was not associated with decreased satisfaction scores in a population of orthopedic surgery patients at a private, university-affiliated specialty center. The lack of any statistically significant difference in patient satisfaction may be attributable to patient satisfaction with care in response to complications, the decreased sensitivity inherent to using a general satisfaction survey, or a homogeneity among orthopedic surgery patients and their expectations of care.
Journal for Healthcare Quality 08/2013; 36(6). DOI:10.1111/jhq.12031 · 1.40 Impact Factor
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ABSTRACT: To understand reasons why California has lower Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores than the rest of the country, including differing patterns of CAHPS scores between Medicare Advantage (MA) and fee-for-service, effects of additional demographic characteristics of beneficiaries, and variation across MA plans within California.
Using 2008 CAHPS survey data for fee-for-service Medicare beneficiaries and MA members, we compared mean case mix adjusted Medicare CAHPS scores for California and the remainder of the nation.
California fee-for-service Medicare had lower scores than non-California fee-for-service on 11 of 14 CAHPS measures; California MA had lower scores only for physician services measures and higher scores for other measures. Adding race/ethnicity and urbanity to risk adjustment improved California standing for all measures in both MA and fee-for-service. Within the MA plans, one large plan accounted for the positive performance in California MA; other California plans performed below national averages.
This study shows that the mix of fee-for-service and MA enrollees, demographic characteristics of populations, and plan-specific factors can all play a role in observed regional variations. Anticipating value-based payments, further study of successful MA plans could generate lessons for enhancing patient experience for the Medicare population.
Health Services Research 06/2011; 46(5):1646-62. DOI:10.1111/j.1475-6773.2011.01279.x · 2.78 Impact Factor
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ABSTRACT: Abstract Background: The quality of end-of-life (EOL) care at Veterans Affairs Medical Centers (VAMC) has improved. To date, however, the quality and outcomes of end-of-life care delivered to women veterans have not been examined. Objective: The goal of this study was to evaluate gender differences in the quality of EOL care received by patients in VAMCs nationwide. Design: The study was conducted via retrospective medical chart review and telephone survey with next of kin of recently deceased inpatients. Setting/subjects: The chart review included records for all patients who died in acute and long-term care units in 145 VAMCs nationwide (n=36,618). For the survey, the documented next of kin were invited to respond on behalf of the deceased veteran; a total of 25,638 next of kin completed the survey. Measurements: Chart review measures included five indicators of optimal end-of-life care. Bereaved family survey items included one global and nine specific items (e.g., bereavement care, pain management) describing care in the last month of life. Results: Receipt of optimal end-of-life care did not differ significantly between women and men with respect to frequency of discussion of treatment goals with a family member, receipt of palliative consult, bereavement contact, and chaplain contact with a family member. Family members of women were more likely than those of men to report that the overall care provided to the veteran had been "excellent" (adjusted proportions: 63% versus 56%; odds ratio (OR)=1.33; 95% confidence interval (CI) 1.10-1.61; p=0.003). Conclusions: In this nationwide study of all inpatient deaths in VAMCs, women received comparable and on some metrics better quality EOL care than that received by male patients.
Journal of palliative medicine 05/2013; 16(7). DOI:10.1089/jpm.2012.0537 · 1.91 Impact Factor
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