The voice of the consumer

This month, the Centers for Medicare and Medicaid (CMS) begin reporting patient experience data from its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS®) program. The first of its kind, the program sets a national standard for collecting and publicly reporting information that will allow consumers to compare the patient experience across hospitals. The CMS worked with the Agency for Healthcare Research and Quality, which brought a rigorous scientific process to developing and testing the survey used to collect data. The program has three aims:
• to provide comparable data about care from the patient’s perspective
• to create an impetus for hospitals to improve the quality of care
• to enhance public accountability for the quality of hospital care.The survey is divided into sections called Your care from nurses, Your care from doctors, The hospital environment, Your experiences in this hospital, When you left the hospital, Overall rating of hospital, and About you. The questions address key elements of a patient’s experience, such as communication, courteous and respectful treatment, responsiveness of the staff, pain control, cleanliness, noise level, information about medicines, and discharge. Other questions help adjust for patient mix and assess the patient’s overall rating and willingness to recommend a specific hospital.If you work in a hospital, you should be aware of the questions patients will answer by selecting never, sometimes, usually, or always. Questions include: During this hospital stay,
• how often did nurses treat you with courtesy and respect?
• after you pressed the call button, how often did you get help as soon as you wanted it?
• how often did nurses explain things in a way you could understand?
• how often did nurses listen carefully to you?
• how often was your pain well controlled?
To read the entire survey and additional background information on it, visit www.cms.hhs.gov/HospitalQualityInits/30_HospitalHCAHPS.asp#TopOfPage and www.hcahpsonline.org.

All short-term, acute-care, non-specialty hospitals may participate by surveying a random sample of patients over 18 who have had an overnight stay. Patients with psychiatric diagnoses can’t take the survey. Participating hospitals submit at least 300 completed surveys a year, though smaller hospitals can submit as few as 100. Surveys can be done by mail, telephone, mail followed by telephone, or active-interactive voice response. Questions are available in English, Spanish, and Chinese. Most hospitals already use an outside vendor to survey patient satisfaction, and the HCAHPS questions can be incorporated into an existing tool. Hospital participation is voluntary, but hospitals that don’t report survey findings may be ineligible for full payment updates beginning this year.

The first publicly reported data will come from surveys of patients discharged between October 2006 and June 2007. Hospitals will receive a preview report and have the option of keeping their results from public display. Consumers will be able to find HCAHPS and comparative information on quality at the CMS Hospital Compare website, www.hospitalcompare.hhs.gov. Currently, this website shows information comparing a hospital’s performance to core measures of care for heart attacks, heart failure, pneumonia, surgical care, and infection prevention to help consumers make an informed choice when seeking care.

So what might the implications be for the future? Other patient surveys already address nursing homes, physician group practices, and people with impaired mobility. Surveys on emergency care and home care may be on the horizon. And Congress could incorporate the results into pay-for-performance plans.

As a nurse, you can use the information to help guide a friend or family member in making healthcare choices by explaining terminology and interpreting the data. Also, you can use it to reinforce the patient-centered nature of a nurse’s work in the hospital—and to remind others to do whatever is best for patients and their family at all times.

The survey questions address some of patients’ core experiences with nursing care. Our patients will be telling us how well we’re doing.


Pamela F. Cipriano, PhD, RN, FAAN
Editor-in-Chief

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