A survey of more than 17,000 parents of hospitalized children, conducted by the Center of Excellence for Pediatric Quality Measurement at Boston Children's Hospital, gives mixed responses about the quality of the inpatient experience at 69 U.S. children's hospitals. The analysis, the largest to date in pediatrics, found much variability from hospital to hospital. The findings are reported online today in the journal Pediatrics.
"Patient and family experience is one of the core aspects of quality healthcare, and has been associated with improved health outcomes," says lead author Sara Toomey, MD, MPhil, MPH, MSc, medical director of patient experience at Boston Children's and assistant professor of pediatrics at Harvard Medical School. "This large data set gives us a much-needed overview of how well hospitals are doing in providing positive pediatric patient and family care experiences."
Although adult patients have been surveyed through the Adult Hospital Consumer Assessment of Healthcare Providers and Systems (Adult HCAHPS) Survey for more than 10 years, this is the first large-scale survey in the U.S. capturing the hospital care experience of children and their families.
Parents of hospitalized children completed the Child HCAHPS survey from December 2012 to February 2014. The survey asked about 18 measures of patient experience in five categories: communication with the parent, communication with the child, attention to safety and comfort, hospital environment and overall experience during the hospital stay.
The average hospital rating was 73 percent overall, but scores varied from measure to measure. For example, the average hospital scores were lowest for "preventing mistakes and helping you report concerns" (55 percent) and highest for "keeping you informed about your child's care in the emergency room" (84 percent).
There was substantial variability among hospitals on each of the 18 measures. For example, scores on "involving teens in their care," ranged from 53 to 96 percent; "how well doctors communicate with your child," 55 to 91 percent; "communication about your child's medicines," 70 to 96 percent; and "paying attention to your child's pain," 59 to 94 percent.
"These ranges suggest that we can do better at involving families in patient safety and empowering them to speak up when safety concerns present themselves," says Toomey.
Dedicated children's hospitals tended to score somewhat better than children's wards within general hospitals. Teaching hospitals performed better than non-teaching hospitals in most categories, but got lower scores for quietness.
"The fact that we see variation across participating hospitals, with some doing very well and some lagging, suggests that there is an opportunity to try to help hospitals improve and learn from each other how they can do better," says senior author Mark Schuster, MD, PhD, chief of the Division of General Pediatrics at Boston Children's and professor of pediatrics at Harvard.
The study was supported by the Agency for Healthcare Research and Quality, the Centers for Medicare & Medicaid Services and Harvard Catalyst/Harvard Clinical and Translational Science Center.
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