Prospective Cohort Study on the Impact of Early Versus Late Inpatient Palliative Care on Length of Stay and Cost of Care.

Aim: To evaluate the impact of early vs late palliative care on (1) length of stay (LOS) in the context of expected LOS measures and (2) total cost of care to the hospital for each patient. Methods: A prospective cohort study was performed at a single large academic medical center on patients who received an inpatient palliative care consultation. The two cohorts were early palliative care (within 3 days of admission) and late palliative care (after 3 days of admission). Comparisons were made between patients' actual LOS, expected LOS, and total hospital costs between both cohorts. Results: Compared to the late palliative care cohort (N = 126), patients who received early palliative care (N = 68) had a significantly shorter LOS (P < .001) and also performed better compared to CMS-Expected LOS standards (Observed/Expected 3.1 vs 1.5 respectively; P < .001). Early palliative care patients also saw an average decline of $1431 in total costs 1-day pre/post consult as opposed to a more modest $403 decline in the later palliative care cohort (P < .001). Similarly, patients who received early palliative care had a $5839 decline in aggregated total 3-day costs, as opposed to a $1478 decline in those who received late palliative care (P < .001). Conclusions: In the competitive and rapidly evolving healthcare system, the opportunity to suppress costs and lower patient LOS has increasing importance. Our study strongly supports the implementation of earlier palliative care intervention to assist hospitals in approaching LOS targets and reducing patient costs.

Prevalence and predictors of mother-infant skin-to-skin contact at birth: findings from a U.S. tertiary medical center.

BACKGROUND: Immediate skin-to-skin contact has well-established benefits for both mother and baby. However, its implementation varies widely, with limited data on predictors. OBJECTIVE: This study aimed to investigate prevalence, duration, and maternal and newborn predictors of immediate skin-to-skin contact following vaginal deliveries. STUDY DESIGN: We conducted a retrospective cohort study of vaginal deliveries from May to October 2019 at Albany Medical Center. We abstracted patient demographic and clinical predictor variables from medical records. The primary outcome was prevalence of skin-to-skin contact during the first hour of life, including any and that meeting the World Health Organization standard of care (defined as initiation within 5 minutes lasting for 60 minutes without separation). The secondary outcome was skin-to-skin contact duration in minutes during the first hour of life. Data were analyzed using multivariate logistic and linear regression models as appropriate. RESULTS: Among 635 mother-infant dyads, the prevalence of any skin-to-skin contact was 74% and the prevalence of skin-to-skin contact meeting the World Health Organization standard of care was 43%. Maternal higher education increased odds of any skin-to-skin contact [adjusted odds ratio, 2.34; 95% confidence interval, 1.07, 5.13], while maternal delivery complications were associated with decreased odds [adjusted odds ratio, 0.39; 95% confidence interval, 0.17, 0.91]. Infants with 1-minute Apgar scores of 0-3 were four times less likely to receive any skin-to-skin contact compared with infants with scores of 7-10 [adjusted odds ratio, 0.26; 95% confidence interval, 0.09, 0.75]. Other neonatal factors that decreased odds of skin-to-skin contact were multiple gestation [adjusted odds ratio, 0.06; 95% confidence interval, 0.02, 0.19], preterm delivery [adjusted odds ratio, 0.39; 95% confidence interval, 0.19, 0.78], and neonatal intensive care unit admission [adjusted odds ratio, 0.13; 95% confidence interval, 0.06, 0.29]. All significant neonatal predictors also significantly decreased skin-to-skin contact duration in minutes. CONCLUSION: The practice of immediate skin-to-skin contact after vaginal delivery did not meet the recommended standard. Neonatal complications and lower maternal educational level further reduced prevalence and duration, indicating the need for targeted educational interventions for patients and providers. CONDENSATION: The prevalence and duration of immediate skin-to-skin contact after vaginal delivery are lower than recommended. Staff and patient education could mitigate some barriers.HighlightsSkin-to-skin contact occurs less often and with shorter duration than recommendedNewborn health is a stronger predictor of skin-to-skin contact than maternal healthHigher maternal education increases prevalence of skin-to-skin contact.

Does Coaching Hospitalists in a Community Hospital Improve the Measured Experience of Care?

Hospitals initiate physician communication training programs expecting to improve patient experience measures. However, most efforts have relied on methods with limited attention to bedside physician-patient interactions. We conducted an intensive in-person hospitalist coaching program to improve patient experience in a community hospital. Full-time hospitalists were coached twice monthly by physician-coaches using a structured process featuring direct observation of care and immediate recommendations. Coach-observed care measures improved marginally. Difference-in-differences analysis of 1137 Hospital Consumer Assessment of Healthcare Providers and Systems surveys revealed no significant improvements by trained hospitalists in preintervention versus intervention comparisons, calling into question the strategy of using coaching programs to improve hospitals' doctor communication measures.

Direct-to-Consumer Hospital Advertising and Domestic Medical Travel in the United States.

EXECUTIVE SUMMARY: Expanding hospitals' geographic market area has been proposed as a means to increase competition and reduce healthcare costs. However, most patients in the United States receive care locally and are unlikely to seek out distant hospitals, effectively limiting competition to local markets. We hypothesize that mass media advertising can help overcome patients' reluctance to travel for elective medical care. We examined hospitals' advertising in distant markets to determine whether their expenditures predict the number of patients who travel to those hospitals.We obtained data on 2015 advertising expenditures by 273 U.S. academic medical centers from a market research firm. Regression models examined associations between hospitals' advertising expenditures and patient volume metrics: inpatients, encounters, and charges originating from distant markets where the medical centers advertised. Results showed that hospitals' advertising expenditures in distant markets were associated with higher numbers of inpatient admissions, patient visits, and charges from those markets. Compared to the distant markets where they advertised, the hometown markets of these hospitals are smaller with lower per capita income, suggesting hospitals are seeking incremental patient volume from more lucrative markets.Findings suggest that advertising may familiarize patients with distant facilities, encouraging domestic medical travel and enabling broader geographic competition among hospitals.

Predicting HCAHPS scores from hospitals' social media pages: A sentiment analysis.

BACKGROUND: Social media is an important communication channel that can help hospitals and consumers obtain feedback about quality of care. However, despite the potential value of insight from consumers who post comments about hospital care on social media, there has been little empirical research on the relationship between patients' anecdotal feedback and formal measures of patient experience. PURPOSE: The aim of the study was to test the association between informal feedback posted in the Reviews section of hospitals' Facebook pages and scores on two global items from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, Overall Hospital Rating and Willingness to Recommend the Hospital. METHODOLOGY/APPROACH: We retrieved star ratings and anecdotal comments posted in Reviews sections of 131 hospitals' Facebook pages. Using a machine learning algorithm, we analyzed 57,985 comments to measure consumers' sentiment about the hospitals. We used regression analysis to determine whether consumers' quantitative and qualitative postings would predict global measures from the HCAHPS survey. RESULTS: Both number of stars and the number of positive comments posted on hospitals' Facebook Reviews sections were associated with higher overall ratings and willingness to recommend the hospital. The findings suggest that patients' informal comments help predict a hospital's formal measures of patient experience. CONCLUSION: Consistent with crowd wisdom, ordinary consumers may have valid insights that can help others to assess patient experience at a hospital. Given that some people will judge hospital quality based on opinions voiced in social media, further research should continue to explore associations between anecdotal commentary and a variety of quality indicators. PRACTICE IMPLICATIONS: Administrators can tap into the wealth of commentary on social media as the forum continues to expand its influence in health care. Comments on social media may also serve as an early snapshot of patient-reported experiences, alerting administrators to problems that may appear in subsequent HCAHPS survey results.

Hospital Advertising, Competition, and HCAHPS: Does It Pay to Advertise?

OBJECTIVE: To test whether hospital advertising expenditures predict HCAHPS global ratings. DATA SOURCES/STUDY SETTING: We examined media advertising expenditures by 2,142 acute care hospitals in 209 markets in the United States. Data on hospital characteristics, location, and revenue came from CMS reports; system ownership was obtained from the American Hospital Association. Advertising data came from Kantar Media. HCAHPS data were obtained from HospitalCompare. STUDY DESIGN: Regression models examined whether hospitals' advertising spending predicts HCAHPS global measures and whether market concentration moderated this association. DATA COLLECTION/EXTRACTION METHODS: Hospital advertising spending was calculated by adding each individual hospital's expenditures to the amount spent by its parent health system, proportionally allocated by hospital revenue. Health system market share was used to estimate market concentration. These data were compared to hospitals' HCAHPS measures. PRINCIPAL FINDINGS: In competitive markets (HHI below 1,000), hospital advertising predicted HCAHPS global measures. A 1-percent increase in advertising was associated with a 1.173-percent increase in patients rating the hospital a "9" or "10" on the HCAHPS survey and a 1.540-percent increase in patients who "definitely" would recommend the hospital. In concentrated markets, this association was not significant. CONCLUSIONS: In competitive markets, hospitals that spend more on advertising earn higher HCAHPS ratings on global measures.

The value of patients' handwritten comments on HCAHPS surveys.

Some patients write comments on their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, but survey vendors do not record them, and the value of this anecdotal information is not well understood. However, many rating websites contain both numerical ratings and anecdotal comments from consumers who wish to share their experiences, and the option to write comments enhances the appeal of these survey forums. Recent research shows that numerical ratings do not sufficiently capture the range of consumer experiences and that comments contain additional information that complements survey responses. In this study, we investigate the contribution of anecdotal comments on HCAHPS surveys to the prediction of two global outcome measures: overall hospital rating and intention to recommend. HCAHPS surveys were collected retrospectively from 589 inpatients at two community hospitals, whose answers to the HCAHPS questions plus any handwritten comments were entered into a database. Nearly 20% of the surveys contained at least one written comment. A content analysis was performed, and comments were classified as positive, negative, neutral, or mixed. Regression analyses showed that negative comments significantly affected patients' overall hospital rating with and intention to recommend the hospital. After adjusting for their quantitative ratings on the HCAHPS questions, we found that patients who wrote negative comments gave the hospitals significantly lower satisfaction and intention scores. Consistent with prior research, our study showed that the information contained in numerical HCAHPS composite measures was enhanced by patients' commentary. In addition, quantitative HCAHPS ratings appear to underestimate the feelings of people who write negative comments, validating practices at hospitals that use surveys containing negative anecdotes in quality improvement initiatives.

Consumers' use of HCAHPS ratings and word-of-mouth in hospital choice.

OBJECTIVE: To investigate the impact of the HCAHPS report of patient experiences and word-of-mouth narratives on consumers' hospital choice. DATA SOURCES: Online consumer research panel of U.S. adults ages 18 and older. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS: In an experiment, 309 consumers were randomly assigned to see positive or negative information about a hospital in two modalities: HCAHPS graphs and a relative's narrative e-mail. Then they indicated their intentions to choose the hospital for elective surgery. PRINCIPAL FINDINGS: A simple, one-paragraph e-mail and 10 HCAHPS graphs had similar impacts on consumers' hospital choice. When information was inconsistent between the HCAHPS data and e-mail narrative, one modality attenuated the other's effect on hospital choice. CONCLUSIONS: The findings illustrate the power of anecdotal narratives, suggesting that policy makers should consider how HCAHPS data can be affected by word-of-mouth communication.

Price and consumer cost responsibility effects on quality perceptions and price negotiation likelihood for healthcare services.

This paper presents the results of an experimental study that assessed potential differences in consumer quality perceptions and price negotiation likelihood for three healthcare procedures: a routine physical, rhinoplasty, and a root canal, based on varying levels of price and consumer cost responsibility. Results of this study did not support a general positive price-perceived quality relationship for any of the three procedures. However, several significant effects were observed for price negotiation likelihood. First, price negotiation likelihood was found to be higher for more expensive services (i.e., rhinoplasty) than less expensive services (i.e., routine physical). In addition, consumers were more likely to negotiate price when they were both responsible for the entire cost of an expensive procedure and not accustomed to paying the full cost. Lastly, people who likely perceived a relationship between price and quality were less likely to negotiate pricing at high price levels vis-à-vis low price levels.

Predicting health plan member retention from satisfaction surveys: the moderating role of intention and complaint voicing.

Many health plans have tried to increase member retention by improving their scores on customer satisfaction surveys. However, prior research has demonstrated weak relationships between member satisfaction and retention, suggesting that other variables are needed to understand how satisfaction impacts member retention. In a longitudinal study 4,806 health plan members who completed satisfaction surveys were re-assessed three years later; we compared measures of satisfaction, intention, and complaining behavior from voluntary disenrollees and retained members. The relationship between satisfaction and retention was moderated by members' intentions to disenroll. The findings suggest that health plans can enhance the predictive validity of their satisfaction surveys by including measures of both satisfaction and intentions.