1. System and Study of Patient
Satisfaction Scoring
Geraldine C. Fike DNP, MSN/Ed, RN, CCRN
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Introduction
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey of patient satisfaction used as a national benchmark for consumers designed for a person with a 6th grade reading level.1 The purpose of this study was to explore an alternative method of obtaining completed HCAHPS surveys from local residents with a reading level less than 6th grade or spoke English as a second language (ESL).
Results: This randomized & controlled pilot study suggests that higher rates of HCAHPS returns will occur when the survey is sent and an augmented telephone follow-up occurs in real time.
Recommendation: Providers who serve a population with literacy below the 6th grade or are ESL may want to consider incorporating telephone calls by a bilingual staff member.
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Background
Historically, the HCAHPS survey has only been mailed to patients post discharge. The result has been low return rates (<1%) in some departments. As a result it was imperative to implement methods to increase the return rates to the regulatory minimum.
A key issue identified in the low return rate was the literacy level of the survey. The HCAHPS was designed for patients with a literacy level of the 6th grade or above. Demographic data from the community showed that many residents have less than a high-school education and are non-English speaking.
As a result this study was conducted to apply alternative methods of survey completion to be effective in obtaining important patient perspectives on care.
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Objectives
Describe and compare the results of dissemination of the HCAHPS survey to adult patients with low literacy post inpatient hospital discharge.
Compare response rates for two modes of survey dissemination.
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Methods
Participants were 286 patients with less than high school education. Eligibility criteria included adults who were age >18 and who spoke English or Spanish.
The experimental design included:
An intervention: The survey was sent to patients by mailing of the survey or telephone with follow-up reading/clarification of the survey items, if needed.
Control group participants received the survey via mail.
Participants were randomly assigned to receive the HCAHPS survey from either the mail or phone mode of dissemination.
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Phase I
Self-reported data obtained on the education level of potential participants using a demographic instrument
Individuals who reported less than a high-school education served as a proxy
333 (86.3%) agreed to answer the preliminary demographic survey questions and participate
47 participants (14.1%) did not meet eligibility criteria
286 participants were eligible to proceed to Phase II
Literacy level, an important variable and inclusion criterion for Phase II
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Phase II
63.6% race/ethnicity Hispanic/Latino, African American (28.3%), White (5.6%), multi-racial (2.1%) or other, not specified (0.4%).
60.5% Spanish primary language (spoken or read)
Grade ranged from no schooling to 11 (Md, = grade 8). Ninety-seven (34.0%) did not attend high school in the United States all of whom self-reported their race/ethnicity as Hispanic/Latino.
With the exception of race/ethnicity, two groups were comparable by mode of dissemination.
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Key Findings:
7.4 times (95% confidence intervals [CI], 3.92, 14.01) more likelihood of survey returns among the phoned group compared to those who received the survey by mail
Phoned group more likely to complete all items compared to those who were mailed the survey (Odds Ratio, 33.5; 95% CI 3.3, 128.9).
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Conclusions
The first of its kind pilot study demonstrates that patients with low English literacy complete the HCAHPS survey at the highest rate when they receive a phone call. In addition 100% item completion were obtained when called.
The outcomes support the Vulnerable Populations Conceptual Model through its interrelationship of the concepts of availability of appropriate adequate resources (phone dissemination of HCAHPS survey), for low English literacy level to improve health status and quality of care through HCAHPS survey completion.
Obtaining feedback on the patient experience has the potential to improve future healthcare as patient’s needs are heard and quality of care processes are adjusted to meet the needs of the consumer.
Assessing the health literacy of patients is critical to ensure that the HCAHPS is understood and the survey returned and items completed.
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References
Centers for Medicare & Medicaid Services. (2013). HCAHPS fact sheet.
Contact Information
California State University San Bernardino
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Contact Information
California State University San Bernardino