Impact of Hospitalist Team Structure on Patient-Reported Satisfaction with Physician Performance
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Department of Internal Medicine, University of Utah School of Medicine & George E. Whalen VA Hospital, Salt Lake City, UT, USA; 2Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
BACKGROUND: Patient experience is valuable because it reflects how patients perceive the care they receive within the healthcare system and is associated with clinical outcomes. Also, as part of the Hospital Value-Based Purchasing (HVBP) program, the Center for Medicare and Medicaid Services (CMS) rewards hospitals with financial incentives for patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. It is unclear how the addition of residents and advanced practice clinicians (APCs) to hospitalist-led inpatient teams affects patient satisfaction as measured by the HCAHPS and Press Ganey survey. OBJECTIVE: To compare patient satisfaction with hospitalists on resident, APC, and solo hospitalist teams measured by HCAHPS and Press Ganey physician performance domain survey results. DESIGN: Retrospective observational cohort study. PARTICIPANTS: All patients discharged from the Internal Medicine inpatient service between July 1, 2015, and July 1, 2018, who met HCAHPS survey eligibility criteria and completed a patient experience survey. MAIN MEASURES: HCAHPS and Press Ganey physician performance domain survey results. KEY RESULTS: No differences were observed in the selection of “top box” scores on the HCAHPS physician performance domain between resident, APC, and solo hospitalist teams. Adjusted Press Ganey physician performance domain survey results demonstrated significant differences between solo hospitalist and resident teams, with solo hospitalists having higher scores in three areas: time physician spent with you (4.58 vs. 4.38, p = 0.050); physician kept you informed (4.63 vs. 4.43, p = 0.047); and physician skill (4.80 vs. 4.63, p = 0.027). Solo hospitalists were perceived to have higher physician skill in comparison with hospitalist-APC teams (4.80 vs. 4.69, p = 0.042). CONCLUSION: While Press Ganey survey results suggest that patients have greater satisfaction with physicians on solo hospitalist teams, these differences were not observed on the HCAHPS physician performance survey domain, suggesting physician team structure does not impact HVBP incentive payments by CMS. Prior Presentations None. Received December 6, 2019 Accepted March 6, 2020
KEY WORDS: patient satisfaction; HCAHPS; Press Ganey; hospitalist; team structure. J Gen Intern Med DOI: 10.1007/s11606-020-05775-5 © Society of General Internal Medicine 2020
INTRODUCTION
Patient experience is valuable because it reflects how patients perceive the care they receive (e.g., communication regarding diagnosis, new medications) within the healthcare system. It is also associated with clinical outcomes, including adherence to medical treatment, patient use of primary care and preventative services, and hospital readmission rates.1–3 With the initiation of the Hospital Valu
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