Drivers of Inpatient Hospital Experience Using the HCAHPS Survey in a Canadian Setting.

OBJECTIVE: To identify factors associated with patients' overall rating of inpatient hospital care. DATA SOURCES: Two years of patient interview data (April 1, 2011 to March 31, 2013), linked to inpatient administrative records. STUDY DESIGN: Patients rated their overall health on a scale of 0 (worst care) to 10 (best care) using the HCAHPS instrument administered via telephone, up to 42 days postdischarge. Logistic regression was used to generate odds ratios for each independent predictor. DATA EXTRACTION: HCAHPS data were linked to inpatient records based on health care numbers and dates of service. The outcome (overall health experience) was collapsed into two groups (10 vs. 0-9). PRINCIPAL FINDINGS: Overall hospital experience of 0-9 was associated with younger age, male gender, higher level of education, being born in Canada, urgent admission, not having a family practitioner as the most responsible provider service, and not being discharged home. A length of stay of less than 3 days was protective. The c-statistic for the multivariate model was 0.635. CONCLUSIONS: Our results are novel in the Canadian population. Several questions for future research have been generated, in addition to opportunities for quality improvement within our own organization.

Parents' global rating of mental health correlates with SF-36 scores and health services satisfaction.

BACKGROUND: Patient satisfaction surveys are often used to measure quality of care. However, patient satisfaction may not be a reliable indicator of service quality because satisfaction can be influenced by clients' characteristics such as their health status. METHODS: Parents of children attending a pediatric neurology clinic completed the Short Form Health Survey (SF-36) and global ratings of their physical and mental health. They also completed the Client Satisfaction Questionnaire (CSQ), the Measure of Processes of Care (MPOC), and the Family-Centered Care Survey (FCCS). RESULTS: 104 parents completed the survey. The correlation between the global rating of physical or mental health and their corresponding SF-36 scores was high. The majority (88%) of parents were satisfied, with a median CSQ score of 28 (IQR, 24 to 31) and a FCCS score of 4.7 (IQR, 4.2 to 4.9). Logistic regression identified parents' mental health as a significant predictor of client satisfaction (OR, 1.07; 95% CI, 1.01 to 1.14). CONCLUSIONS: Given the positive association between parents' mental health and satisfaction with care, it is important to consider mental status as a covariate in interpreting satisfaction surveys. Parents' global rating of mental health appears to be a reasonable indicator of their SF-36 mental scores.

Adolescent quality of life and satisfaction with care.

PURPOSE: 1) To describe adolescents' responses to a client satisfaction and family-centered care survey; 2) to examine the relationship between satisfaction with health care and health-related quality of life (HRQL) among these adolescents; and 3) to determine if adolescents and their parents differ in their satisfaction with services. METHODS: We recruited 104 adolescents who attended the Alberta Children's Hospital pediatric neurology clinic. Each family completed the Client Satisfaction Questionnaire (CSQ), the Family Centered Care Survey (FCCS), the Measure of Processes of Care (MPOC) survey, the Give Youth a Voice (GYV) survey, and the Pediatric Quality of Life Inventory (PedsQL). RESULTS: Of 116 eligible families, 104 (90%) completed the study. The majority (83%) of adolescents were satisfied with services provided. Adolescents who were very satisfied on the CSQ and the FCCS had higher PedsQL psychosocial scores (p = .009 and .013, respectively). Multivariate analysis revealed that adolescents' psychosocial HRQL was the most significant predictor of their satisfaction with care (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01 to 1.06). There was a difference between parents' and adolescents' responses to the FCCS (p = .02), with adolescents being less satisfied overall. CONCLUSIONS: Given that adolescents and parents differ in their satisfaction with health care, it is helpful to have direct input from adolescents on health services surveys. The positive relationship between adolescents' psychosocial HRQL and satisfaction with care highlights the potential impact of emotional health on subjective rating of services. Further studies should determine if improvement in adolescents' mental health is associated with greater satisfaction with health care and/or increased adherence with medical treatments.

Creating frameworks for providing services closer to home in the context of a network.

Networks can be used to develop shared frameworks that extend limited specialized healthcare services beyond tertiary level settings to provide services closer to home. This article provides an overview of networks, describes the context and purpose of the Southern Alberta Child & Youth Health Network, reports on early experiences with implementation of an Outreach Services Framework, and discusses implications from a network perspective.