Hospital Consult - April 2016
Hospital Access Management - Hospital Case Management - Hospital Employee Health
Hospital Infection Control - Hospital Peer Review - Healthcare Risk Management
Case Management Advisor - IRB Advisor - Medical Ethics Advisor - Same-Day Surgery
Yelp Reviews Bolster Information on How Patients View Hospitals
PHILADELPHIA – If government surveys don’t give you enough information on how your hospital is viewed by patients, try going online.
A study published recently in the journal Health Affairs points out that Yelp reviews of hospitals cover topics not found in the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey.
Researchers from the University of Pennsylvania’s Perelman School of Medicine say that additional information, such as positive or negative reviews from Yelp contributors, not only influences patient decisions on where to seek hospital care but also can provide valuable feedback to hospital quality professionals and administrators.
The 33rd most visited website in the United States, with 142 million unique monthly visitors, Yelp publishes online crowd-sourced reviews about local businesses and services. Hospitals can be ranked from one to five stars, and reviewers often discuss features of a hospital experience most important to them.
For the recent study, researchers compared about 17,000 Yelp reviews to HCAHPS reviews of the same 1,352 hospitals.
"Nearly 75% of U.S. Internet users reported looking online for health information in 2012," said the study's senior author Raina M. Merchant, MD, MSHP. "Forty-two percent reported looking at social media for health-related consumer reviews. Meanwhile, only 6% of Americans had heard of the government website where the HCAHPS survey is reported, as of 2008. This divergence presents an opportunity for online consumer reviews to augment and even improve formal rating systems such as HCAHPS and increase their use in consumer decision-making."
Using natural language-processing techniques, researchers analyzed the text of Yelp narrative reviews of hospitals posted as of July 15, 2014, to categorize them; for example, a post that contained the terms "pain, doctor, nurse, told, medication, meds, gave," was labeled under the category "pain medications."
When possible, the categories were matched up with HCAHPS domains. The Yelp reviews ended up including information about seven of the 11 HCAHPS domains, but also covered 12 additional areas not included in the federal survey: cost of hospital visit, insurance and billing, ancillary testing, facilities, amenities, scheduling, compassion of staff, family member care, quality of nursing, quality of staff, quality of technical aspects of care, and specific type of medical care.
Interestingly, among the categories not covered by HCAHPS domains were four of the top five topics most strongly associated with positive Yelp review ratings: caring doctors, nurses, and staff; comforting; surgery/procedure and peri-operative care; and labor and delivery.
HCAHPS domains also didn’t encompass two of the top five Yelp categories most strongly associated with negative review ratings: insurance and billing, and cost of hospital visit.
"Yelp reviews are in real time and often written by patients for patients," Merchant said. "In addition, patients' perceptions of what matters most to them can change over time. HCAHPS may not be able to respond as agilely to these kinds of changes as social media."
Skin Infection Patients Fail to Follow Drug Regimen After Hospital Discharge
LOS ANGELES – When a skin and soft tissue infection patient leaves the hospital with antibiotic prescription in hand, chances are fairly good you’ll see them again.
Why? A new study reports that low medication adherence by patients with S. aureus infections resulted in nearly half of them getting a new infection or needing additional treatment for the existing skin infection.
The research, published recently in Antimicrobial Agents and Chemotherapy, reports that those patients took only slightly more than half — 57% — of the antibiotic doses prescribed to them as they left the hospital.
For the study, led by researchers from the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed), antibiotic dosing was measured at enrollment, 14 days, and 30 days by using medication containers fitted with electronic caps that kept track when the patient opened the pill container.
That way, study authors were able to spot a large discrepancy between patient reports and the electronic measurement: While patients reported taking, on average, 96% of their medication, the electronic caps suggested the percentage was a little more than half as much.
"We have seen similar differences and similar failures to take all the prescribed medications in many other conditions, including hypertension, diabetes, and HIV," lead researcher Loren G. Miller, MD, MPH, explained. "But these failures have never been studied in skin infections or linked with clinical outcomes. These findings suggest that we need better methods to have patients receive antibiotics for skin infections, such as counseling them on the importance of adhering to the medication dosing or by using newer antibiotics that require only once-weekly dosing."
Overall, of the 87 patients who had complete records after hospitalization for S. aureus associated skin and soft tissue infections, 40 required additional treatment within 30 days of leaving the hospital because:
- a new skin infection developed,
- their infections needed incision and drainage, or
- the infection hadn’t cleared and new antibiotics were necessary.
Higher rates of non-adherence to antibiotic regimens were identified among patients who were prescribed more than one antibiotic after leaving the hospital, didn't see the same healthcare provider for follow-up visits, or reported they didn't have a regular healthcare provider, according to the results.
“In conclusion, we found patient adherence to oral antibiotic therapy for SSTI after hospital discharge was low (57%) and associated with poor clinical outcome,” the study authors wrote. “Patients commonly overstate their medication adherence, which may make identifying patients at risk for non-adherence and poor outcomes challenging. Further studies are needed to improve post-discharge antibiotic adherence after SSTIs.”
Three IT Capabilities Key to Improving Patient Care with Information Technology
COLUMBIA, MO – With more than 1,000 health information technology vendors to choose from — up from 60 since 2008 — hospitals can easily fall prey to dysfunctional systems that fail to meet the goal of improving patient care, according to a new study.
In light of that, the article published recently in Health Care Management Review offers information to make it easier to navigate the crowded marketplace.
Research from the University of Missouri School of Medicine has identified three IT capabilities hospitals must have to assure higher rates of employee productivity and flexibility which, in turn, improves patient care.
"Health information technologies have a great potential to improve patient safety and reduce cost of care," said lead researcher Naresh Khatri, PhD, associate professor in the Department of Health Management and Informatics. "However, the benefits of these services have remained far from realized due to a lack of proper implementation. This study found that specific IT capabilities boosted employee efforts and flexibility, leading to improved patient care."
For the report, Khatri and his colleagues surveyed representatives from more than 450 hospitals across the United States, questioning them about their hospitals' IT capabilities, quality of patient care, and the productivity and flexibility of their employees, with "flexibility" defined as employees' willingness to take on increasing workloads during challenging times.
Survey answers were then used to test whether the relationship of certain IT capabilities and the quality of patient care delivered could be controlled by employee productivity. Results indicate that specific IT capabilities had significant positive correlations with employee productivity, leading to improvement in the quality of patient care at U.S. hospitals.
The study found that the three IT capabilities U.S. hospitals needed for more productive employees include:
- having a competent and visionary chief information officer,
- an infrastructure designed to develop IT applications that improve patient care and business processes, and
- on-site professionals with expertise developing cost-effective IT programs that support clinical and business needs of the organization.
"To deliver exemplary care, healthcare workers need technologies that can support them in their interactions with patients," Khatri said. "This means moving from clinician-centric to patient-centric IT models."
According to the study, hospitals with greater IT capabilities tend to get more out of their IT investments because they can identify more appropriate, potent, and cost-effective health information technologies that can be deployed more effectively.
“The chief information officer’s IT vision and the professional expertise and professionalism of IT staff are important IT capabilities in U.S. hospitals,” the study authors concluded.
No Link Found Between Hospital’s Financial and Patient Care Success
DALLAS – Financial performance might be the bottom line for hospital administrators, but it doesn’t always say much about how successfully patients are treated.
That’s according to a new study in the Journal of Hospital Medicine, which also found that loss of revenue was not the inevitable result of patient outcome improvement on several commonly assessed criteria.
For the study, University of Texas Southwestern researchers compared financial performance from 279 hospitals to their 30-day mortality and readmission rates for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA). No consistent relationship between measures of financial performance in 2008 and publicly reported outcomes were found from 2008 to 2011 for AMI and PNA, although hospital financial performance was associated with a modest 0.26% increase in CHF mortality rates. In addition, no significant association was identified for outcomes from 2008 to 2011 and subsequent financial performance in 2012.
"This finding suggests hospitals that are financially well off do not necessarily do better on these publicly reported outcomes than hospitals with worse financial performance," explained study lead author Oanh Nguyen, MD, assistant professor of Internal Medicine and Clinical Sciences at UT Southwestern.
At the same time, "We also found that improved performance on these outcome metrics was not associated with a subsequent loss in revenue, which has been a major concern in policy circles," said senior author Anil Makam, MD, assistant professor of Internal Medicine and Clinical Sciences.
The authors suggest that public reporting of outcomes might have had less than the intended impact in pushing hospitals to invest in quality improvements, but note that financial incentives in addition to public reporting, such as penalties for excessive readmissions, could help motivate hospitals with good financial performance to further improve outcomes.
For the study, researchers collected audited hospital financial data from the Office of Statewide Health Planning and Development in California in 2008 and 2012, and linked this data to 30-day mortality and readmission data from the CMS Hospital Compare website. Financial performance was based on net revenue from operations, operating margin, and total margin.
“Robust financial performance is not associated with improved publicly reported outcomes for AMI, CHF, and PNA,” study authors concluded. “Financial incentives in addition to public reporting, such as readmissions penalties, may help motivate hospitals with robust financial performance to further improve publicly reported outcomes. Reassuringly, improved mortality and readmission rates do not necessarily lead to loss of revenue.”
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