Stephen C Howell*, Andrea Jackson and Scott Simon
Purpose: Patient satisfaction is one of the most important components of assessing the quality of healthcare facilities. In 2006, the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to capture specific elements of patient satisfaction. The publicly reported survey data is meant to create incentives for quality improvement and enhance accountability. In 2010, the Affordable Care Act allowed CMS to include HCAHPS scores among the measures to be used to calculate value-based incentive payments which help determine reimbursement rates for hospitals. This study will assess the impact that pharmacists and pharmacy students can have on HCAHPS scores through the discharge medication delivery (DMD) service with counseling. Additionally, this study will evaluate changes in 30-day readmission rates before and after implementation.
Methods: Patients were eligible for the DMD program if they were being discharged from one of three units of the hospital, the pulmonary, the cardiac, and the orthopedic unit, and were not being admitted to a rehabilitation or long-term care facility. When enrolled, patient’s new medications were delivered to bedside prior to discharge. Patients were counseled on indication, duration, and common side effects of new medications from January 2019 through March 2019 throughout St. Elizabeth Edgewood. Top-box responses to HCAHPS survey questions from January 2017 through March 2017 prior to the DMD service were utilized to compare the impact of the service with counseling. In addition, readmission rates within 30 days of discharge have been obtained from retrospective chart review during the same timeframe and have been compared to rates following implementation of the DMD service with counseling.
Results: A total of 112 patients were counseled across three units. HCAHPS scores for question 25 (patient understood purpose of medication at discharge), question 16 (hospital staff told patient what the medicine was for), and question 17 (hospital staff told patient about medicine’s side effects) were evaluated. HCAHPS scores across all three units were either maintained or increased in the intervention period. In some instances, the percentage of top-box responses decreased, however, relative to other hospitals the score improved, resulting in higher percentile rankings. Only the pulmonary unit showed a statistically significant increase in response to question 16, increasing from 77% (below average) in Quarter 1 of 2017 to 92% (90th percentile) in Quarter 1 of 2019 (P=0.03). Readmission rates for Quarter 1 of 2017 were 19.8% (N=630) for the pulmonary unit, 14.9% (N=767) for the cardiac unit, and 6.1% (N=784) for the orthopedic unit. Readmission rates for Quarter 1 of 2019 of patients that were counseled were 8.3% (N=24) for the pulmonary unit, 22.2% (N=18) for cardiac unit, and 2.9% (N=70) for orthopedic unit. No data for readmission rates was statistically significant.
Conclusions: HCAHPS survey top-box responses were increased or maintained post-intervention. An increase in patient responses to question 16 of the HCAHPS survey (hospital staff told patient what the medicine was for) was statistically significant. No other values were statistically significant. Although pharmacy can have a positive impact on HCAHPS scores and readmission rates, a larger study will be needed to show outcomes from additional counseling.
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