Positive patient experiences linked to quality measure improvements

By Jeffrey Bendix, Senior Editor, for Medical Economics

Leaving your patients with a good feeling about their office visit may not just help your reviews on websites like Yelp and Healthgrades.com. It could also result in better patient outcomes.
As Americans increasingly use online rankings and reviews when choosing a healthcare provider, a new study suggests a link between the way patients experience their care and other measures of healthcare quality, including adherence, clinical outcomes and patient safety while in a hospital.

The study, published online in Health Care Research and Review, analyzes literature on the association between patient experience measures and other healthcare quality measures. The authors focus on articles that use results of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) and the CAHPS hospital survey, which are considered the most widely used source of patient experience measures. They define “patient experiences” as “any process observable by patients, including subjective experiences, objective experiences and observations of physician, nurse or staff behavior.”

According to Rebecca Anhang Price, Ph.D., the study’s lead author, about two-thirds of the studies reported findings from surveys regarding experiences of outpatient care, with most of those evaluating the relationship between care experiences and patient behaviors, such as adherence to provider recommendations, and processes of care, including adherence to clinical guidelines. “Our findings regarding the relationship between care experiences and clinical outcomes are largely informed by studies in the inpatient setting,” Price adds.

The authors divide their findings into five categories: patient behavior, clinical processes, clinical outcomes, efficiency and safety. In patient behavior they found studies showing that better provider communication is positively associated with adherence to hypoglycemic medications among patients with diabetes, better diabetes self-management among veterans, improved adherence to hypertension medications among African-American patients and to tamoxifen among breast cancer patients.

In the clinical processes category, patients’ ratings of their hospitals are positively associated with the hospitals’ performance on the Centers for Medicare and Medicaid Services’ process measures for pneumonia, congestive heart failure, acute myocardial infarction (AMI) and surgical care.

Under clinical outcomes, the authors cite a pair of studies showing that, controlling for other factors, patient reports of better patient-centered care have a significant association with better survival one year after discharge for AMI treatment, and higher patient ratings of hospitals were associated with lower hospital inpatient mortality rates among AMI patients.

In the category of efficiency, the authors find that “some aspects of patient-centered care may help to reduce unnecessary healthcare use.” For example, they cite a study showing that patients’ ratings of their hospitals’ care and discharge planning were associated with lower 30-day readmission rates for AMI, heart failure and pneumonia. Another study showed that children whose parents report longer waits for primary care visits were more likely to have emergency department visits for non-urgent reasons than those reporting shorter wait times.

When it comes to safety, the authors say, positive patient experiences have been associated with lower prevalence of patient care complications such as pressure ulcers, post-operative respiratory failure and pulmonary embolism.

The authors conclude by noting that the studies they reviewed “reveal no inherent trade-off between strong performance on patient experience indicators and performance on clinical quality measures. Rather, the empirical evidence indicates that…positive patient experiences, best practice clinical processes, lower hospital readmissions and desirable clinical outcomes are often positively associated across provider organizations.”