Patient experience in safety-net hospitals: implications for improving care and value-based purchasing

Area of Science:

• Health Services Research
• Healthcare Quality Improvement
• Patient Experience Measurement

Background:

• Patient-centered care is crucial for safety-net hospitals (SNHs) and their performance in value-based purchasing (VBP).
• Assessing patient-reported experiences is key to understanding care quality in SNHs versus non-SNHs.

Purpose of the Study:

• To compare patient-reported hospital experience performance and improvement between SNHs and non-SNHs.
• To evaluate the implications for SNHs under value-based purchasing (VBP) initiatives.

Main Methods:

• Analysis of 3096 US hospitals, defining SNHs by the highest quartile of the Disproportionate Share Hospital (DSH) index.
• Utilized national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data from 2007 and 2010.
• Examined overall hospital performance and changes in patient experience metrics over time.

Main Results:

• SNHs demonstrated lower performance on most patient experience measures compared to non-SNHs.
• Significant disparities were observed in overall hospital ratings, discharge information, and physician communication.
• While both hospital types improved, the performance gap between SNHs and non-SNHs widened between 2007 and 2010.
• SNHs had significantly lower odds of meeting VBP performance benchmarks.

Conclusions:

• SNHs exhibit poorer patient-reported experience outcomes compared to non-SNHs.
• Improvement in patient experience metrics has been slower in SNHs under public reporting.
• SNHs are projected to perform unfavorably within value-based purchasing programs.