HLTH 4110 Week 10 HCAHPS Medicines Score Read Example

Fifty-Eight Percent Always: Reading the Hospital's HCAHPS Communication About Medicines Score as Data With a Method Behind It

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Walden University

HLTH 4110: Healthcare Quality and Safety

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Month Day, Year

Fifty-Eight Percent Always: Reading the Hospital's HCAHPS Communication About Medicines Score as Data With a Method Behind It

The Number and Its Two Readings

On the hospital's public patient experience results, 58% of surveyed patients said staff always explained new medicines, a figure several points below the national comparison shown beside it. (The values are illustrative for a composite hospital.) Leaders have read it two ways. One group reads it as a verdict on care: nurses are not teaching patients about their medicines. Another dismisses it as a perception that says nothing about what was actually taught. This paper treats it as neither. It reads the score as data produced by a survey with a sampling frame, a response rate, adjustments and a scoring rule, and asks what it can support about medicine teaching, including teaching about insulin, the medicine this term's papers have followed.

What the Survey Asks

The communication about medicines measure is a composite of two items in the national hospital patient experience survey. Patients who say they were given a medicine they had not taken before are asked how often staff told them what the medicine was for, and how often staff described possible side effects in a way they could understand. Answers are never, sometimes, usually or always. Patients who report no new medicine skip both items, so the composite describes only that subgroup. On a medical unit where many patients continue home medicines, that subgroup may be small, which makes the hospital-wide figure lean on the units that start many new drugs, such as surgery and maternity. Insulin may or may not count as new; a patient on insulin at home who received it in the hospital would likely answer that no new medicine was given.

How the Number Was Made

The survey is sent to a random sample of eligible adult patients after discharge, between two days and six weeks after they leave, and results are reported for rolling four-quarter periods (Giordano et al., 2010). Scores are adjusted for the survey mode, since mail and telephone responses differ, and for patient mix, such as age, education and self-rated health, because those characteristics affect how people answer regardless of the care received (Elliott et al., 2009). The publicly reported figure is the top-box score: the share answering always. Hospitals also receive the full distribution of answers, but the public page and most dashboards show only the top box. A patient who says usually counts the same as one who says never in that figure. The hospital's response rate for the period was 19% (illustrative), so the score reflects the minority of sampled patients who chose to answer.

What the Score Can Support

Within those limits, the score supports a modest claim. Among patients who reported receiving a new medicine and who answered the survey, fewer at this hospital than nationally said staff always explained its purpose and side effects, after adjustment for mode and patient mix. Because the gap is in the always category, it may reflect a shift from always to usually rather than a failure to teach at all. Because the result covers a full year and all units, it suggests a pattern across the hospital rather than a problem on one unit or with one nurse.

What It Cannot Support

Unit or medicine. The public figure is hospital-wide and does not separate medical units, surgical units or the maternity floor, and it does not name any medicine. It cannot show whether insulin teaching on 5 West is good or poor, and a strong unit can be hidden inside a weak hospital average.

Whether teaching happened. The items record what patients remember weeks later, not what was said. A patient who was taught on a confusing day may not recall it.

Whether harm followed. The score says nothing about whether patients took their medicines correctly after discharge or were harmed.

Nonresponse. With a response rate near one in five, the patients who answered could differ from the silent majority in ways that adjustment cannot fully correct (Elliott et al., 2009).

Perception and Care

Perception is not a lesser kind of data, and it should not be dismissed because it is subjective. Whether a patient understood what a medicine is for affects whether they take it correctly, and a patient's report is the only direct evidence of that understanding. An early national analysis of these survey results found that hospitals with higher patient experience scores also tended to perform somewhat better on clinical quality measures, though the relationship was modest (Jha et al., 2008). The score is therefore worth taking seriously as a signal, while recognizing that it is a weak instrument for locating the cause of a problem.

What the Hospital Should Do With It

The useful response is to ask a sharper question with better-matched data. The hospital could add one item to its existing post-discharge phone calls for patients discharged on insulin: before you went home, did someone show you how to take your insulin and what to do if your sugar runs low? Answers by unit would show where teaching is weak. Nurses on 5 West could also adopt teach-back for insulin, asking patients to explain the dose and the signs of low blood sugar in their own words before discharge. The public score would then serve as a slow, hospital-wide check on whether these changes are noticed by patients, which is the job it can actually do.

One more step would make the public score more useful. The hospital receives its own survey results quarterly in more detail than the public page shows, including results by the unit a patient was discharged from when samples allow. Asking the survey vendor for the medicine composite by unit, even with wide margins of error, would show whether the medical units sit below the hospital average or whether the gap is spread evenly. Those internal results carry the same limits described above, but they would narrow the question enough to decide where teach-back should start.

References

Elliott, M. N., Zaslavsky, A. M., Goldstein, E., Lehrman, W., Hambarsoomians, K., Beckett, M. K., & Giordano, L. (2009). Effects of survey mode, patient mix, and nonresponse on CAHPS hospital survey scores. Health Services Research, 44(2), 501-518. https://doi.org/10.1111/j.1475-6773.2008.00914.x

Giordano, L. A., Elliott, M. N., Goldstein, E., Lehrman, W. G., & Spencer, P. A. (2010). Development, implementation, and public reporting of the HCAHPS survey. Medical Care Research and Review, 67(1), 27-37. https://doi.org/10.1177/1077558709341065

Jha, A. K., Orav, E. J., Zheng, J., & Epstein, A. M. (2008). Patients' perception of hospital care in the United States. New England Journal of Medicine, 359(18), 1921-1931. https://doi.org/10.1056/NEJMsa0804116