“We can do better,” Dr. Mark Schuster told attendees of a pediatric roundtable session at the 2014 Press Ganey National Client Conference in Orlando, Florida last week.
The director of the Center of Excellence for Pediatric Quality Measurement (CEPQM) at Boston Children’s Hospital (BCH) was referring specifically to the findings of a national field test of the CAHPS Child Hospital Survey (Child HCAHPS). The study revealed substantial hospital-level variation and disparities in pediatric inpatient family experience of care in 69 hospitals across 34 states that participated in the trial.
The ability to identify these disparities and pinpoint the underlying drivers of suboptimal experiences in pediatric care is invaluable for targeting improvement efforts. But children are not little adults, and the intricacies of understanding the inpatient experience of this population require an instrument that goes above and beyond the existing HCAHPS tool. To this end, Dr. Schuster and theCEPQM team conducted an intensive, multi-phased development program with funding from the Agency for Health Care Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS).
Because children’s hospitals face “the unique challenge” of meeting the needs of patients and their families, Child HCAHPS is, by design, more encompassing than the adult instrument, according to Dr. Schuster, who is also chief of the Division of General Pediatrics and Vice Chair for Health Policy, Department of Medicine at BCH and William Berenberg Professor of Pediatrics at Harvard Medical School. Specifically, the survey asks parents or guardians to report on both their child’s experience as an inpatient and their own experience with their child’s inpatient hospital stay, he explained.
In addition to the core items that cut across all CAHPS surveys with some variations for different settings, the CEPQM team developed a number of new items for Child CAHPS pertaining specifically to hospital care for children, such as helping the child feel comfortable, involving teens in their care and assessing how well caregivers communicate with both the patient and the parents.
While most children’s hospitals rise to the special challenges of their patient and family populations, the results of the national field test, which yielded more than 17,000 surveys, indicate there is still “much room for improvement,” said Dr. Schuster. For example, the average mean top box percentages for the items within each category range from 56% (preventing mistakes and helping you report concerns) to 84% (keeping you informed about child’s care in the ER). Similarly, the average mean top box percentages for HCAHPS across publicly reported hospitals by state for the most recent reporting period ranged from 51% to 90%.
As CAHPS programs expand to new service lines, many children’s hospitals have declared Child HCAHPS strategies an operational imperative to improve the value of care they provide to patients and their families, Dr. Schuster said.
Sometimes, the knowledge that “we can do better” is the most powerful motivator for making it happen.