A novel approach to the classification of performance on inpatient perception of hospitalization experience across the US 52 states

Abstract

Background: Medical groups identified as high-performing with different approaches have been proposed for classification of performance in the literature, but no consistently-applied approach exists for identifying high performers for the benefit of healthcare providers. Most organizations classify hospitals using domain scores and assign a letter grade (e.g., from A to F in Leapfrog Groups) to the performance level. Whether bibliometrics can be an alternative for classifying healthcare givers’ performances is worthy of study. This study was performed to visualize survey results about inpatients’ perceptions of hospitalization experience for the US states using bibliometrics. Methods: We downloaded the 2014 summaries of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Services) data. Four indices of h, PI, Ag, and x were applied to evaluate performance based on the core domains derived from the ten domain scores for each state in the US, and then displayed online dashboards to show hospitalization satisfaction across states on Google Maps. Choropleth maps were plotted for classifying the performnces into six grades using the quantiles method.Results: The top three states for hihg quality-of-care are Louisiana, Nebraska, and South Dakota using either x or Ag-index to assess. The Ag-index earns the mean correlation coefficient (=0.86) higher than the other three. The inpatient perception of hospitalization experience or the US states were classified and displayed on choropleth maps. Conclusions: The classification of healthcare performance is sensitive to the domain scores, the approach in classification, and the choice of metrics. The absence of a consistently-applied approach to identify healthcare performers impedes efforts to reliably compare, select, and reward high-performing providers. The x-index is recommended for quantifying the performance of healthcare givers in the foreseeable future.