Predictors of a Top-Box Patient Experience: A Retrospective Observational Study of HCAHPS Data at a Safety Net Institution

Abstract

Hospitals commonly seek to improve patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, yet there are limited data to guide improvement efforts. The HCAHPS survey was developed for interhospital comparisons, whereas its use in intrahospital comparisons has not been validated. We sought to better understand the validity of utilizing intrahospital score comparisons and to identify the factors that may predict top-box HCAHPS scores. We performed a retrospective observational cohort study at an academic urban safety-net hospital examining 4898 HCAHPS surveys completed by hospitalized patients. We found that while most Patient-Mix Adjustment factors for which HCAHPS scores are adjusted were associated with top-box scores on intrahospital comparisons, few additional variables were associated with top-box scores. Further, HCAHPS questions pertaining to nurse and doctor communication were highly correlated with overall hospital rating, suggesting that communication-related factors may influence a patient’s hospital experience more strongly than do administrative factors.

Findings From Implementing a Patient Experience Survey in a Quality Measurement System for Substance Abuse Disorder Treatment Facilities in 6 States

“…For the 5 linear ordinal scales and 2 yes/no quality measure questions in the survey (Table 1), responses were binarized by separating responses indicating the most positive possible answer from other possible responses. The results of this analysis, known as top box scoring, 32 allowed comparison across facilities, and is shown in Table 3. For example, to the question “How much have you been helped by the treatment here?” 10% of facilities saw 100% of their patients respond “a lot” while the bottom 10% of facilities saw 65% or fewer of their patients respond “a lot” (Table 3).…”

Primary Care Physician Preferences Regarding Communication from Orthopaedic Surgeons

“…Clinical Scenario Importance and Preferred Communication Survey respondents were asked questions regarding multiple clinical scenarios. To identify scenarios in which communication from orthopaedists was perceived as most important, we applied a "top-box" scoring methodology wherein responses of "4 -Important" or "5 -Very Important" were combined 22 and clinical scenarios were deemed highly important if significantly >50% of the respondents gave the scenario of interest a top-box rating (i.e., 4 or 5). This was accomplished with use of a 1-way test of proportions.…”