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Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric
Chenyang Pei1, Xueyan Han1,2, Qiannan Liu3
1School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Insights
This study identified key factors like child health status and respondent relationship to adjust patient experience scores in China. Case-mix adjustment improves the comparability of pediatric healthcare quality ratings.
Area of Science:
- Pediatric Healthcare Quality
- Patient Experience Measurement
- Health Services Research
Background:
- Assessing pediatric patient experience is crucial for healthcare quality improvement in China.
- The Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) requires validated case-mix adjusters.
- Understanding factors influencing patient experience ratings is essential for accurate comparisons.
Purpose of the Study:
- To identify case-mix adjusters for the Chinese Child-HCAHPS.
- To evaluate the impact of case-mix adjustment on pediatric patient experience measures in China.
- To establish a foundation for developing robust case-mix adjustment models in Chinese pediatric facilities.
Main Methods:
- Retrospective analysis of data from six National Regional Centers for Pediatrics in China.
- Utilized the Chinese Child-HCAHPS survey administered to children (≤17 years) and their guardians.
- Assessed candidate case-mix adjusters using explanatory power and quantified changes in hospital rankings post-adjustment.
Main Results:
- Identified child's global health status and mother as respondent as significant case-mix adjusters.
- Developed case-mix adjustment models for 18 pediatric patient experience items.
- Observed high correlation (Kendall's τ: 0.73–1.00) in hospital rankings before and after adjustment.
Conclusions:
- Case-mix adjustment is feasible and necessary for pediatric healthcare in China.
- The identified adjusters enhance the comparability of institutional patient experience ratings.
- This study provides evidence for developing standardized case-mix adjustment protocols in diverse healthcare settings.
Background:
The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China.
Methods:
This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment.
Results:
A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7-15%. The child's global health status and the respondent being the child's mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall's τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00.
Conclusions:
Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China.
Impact:
Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings. Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients' experience measures in a Chinese population. This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China.
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