Abstract
Background: Patient perceptions of care and health-related quality of life (HRQOL) are important outcomes for hospitalized patients.Purpose: This study examined patient experiences with hospital care and HRQOL in individuals hospitalized at a west coast teaching hospital.Methods:We assessed patient experiences with care and HRQOL using interviews with 1,207 hospitalized, general medicine patients participating in a multidisciplinary provider team intervention at a large academic medical center. Patient outcome variables included the Picker dimensions of hospital care (Continuity and Transition, Coordination of Care, Emotional Support, Information and Education, Involvement of Family and Friends, Physical Comfort, Respect for Patient Preferences, Overall Impression), the Health Utilities Index Mark 3 (HUI-3), and the SF-12 physical (PCS-12) and mental health (MCS-12) summary scores.Results: Patients randomized to a multidisciplinary intervention reported higher emotional support (b = 3.32), t(903) = 2.01, p =.044, and physical comfort (b = 3.49), t(863) = 2.25, p = .025, from health care providers than did the control group, but these effects became nonsignificant after adjusting for multiple comparisons. The HUI-3, PCS-12, and MCS-12 summary scores improved significantly from baseline to the 30-day, ts(943, 919, 860) = 4.94, 2.20, and 5.31, ps < .0001, = .03, and < .0001, respectively, and the 4-month follow-ups, ts(871, 919, 943) = 7.25, 8.68, and 8.08, ps < .001, < .001, and < .0001, respectively, but change on these measures did not differ between intervention and control patients. Baseline health was significantly associated with patient evaluations of hospital care, but patient evaluations did not predict future health.Conclusions: There were no differences in reports and ratings of hospital care or HRQOL between the control and the intervention groups. Hence, the behavioral changes in hospital staff in the intervention group had no effect on patient-reported outcomes. Mental health at baseline was predictive of patient evaluations of the hospitalization, but evaluations of care were not associated with subsequent HRQOL. Thus, it may be important to adjust patient evaluations of hospital care for case-mix differences in health.
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This study was supported by a grant from the Agency for Healthcare Research and Quality (5R01 HS010734-03).
We are grateful to nurse practitioners Kristen Beck, R.N., M.S.N., F.N.P.; Barbara Stehr, M.S.N., A.C.N.P.; and Suetfei Won, R.N., M.S.N., A.C.N.P; data collectors Chia-Yi Chen, R.N., M.A., M.S.; Martha Harmon, R.N., M.N., M.B.A.; Gina Moody, R.N., B.S.N.; and Daria Zandi, R.N., B.S.N.; the nurses at the hospital, CathyWard, R.N., D.N.Sc (Clinical Director of Nursing); Rebecca Heffler, R.N., M.N. (Unit Manager 5 East); and Christina Iu, R.N., M.N. (Unit Manager 5W); the members of the Multidisciplinary Team 5 East; attending physicians, residents, and interns on 5 East and 5 West; and DSMB committee members Sam Bozzette, Ph.D.; Heidi Crooks, R.N., M.N.; Alan Fogelman, M.D.; Michael Karpf, M.D.; Harland Sathers, Ph.D.; and Neil Wenger, M.D.
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Hays, R.D., Eastwood, JA., Spritzer, K.L. et al. Health-related quality of life and patient reports about care outcomes in a multidisciplinary hospital intervention. ann. behav. med. 31, 173–178 (2006). https://doi.org/10.1207/s15324796abm3102_9
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DOI: https://doi.org/10.1207/s15324796abm3102_9