Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act.
Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act.
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DOI：
10.1001/jamanetworkopen.2023.11253
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发表时间：
2023-05-01
影响因子：
13.8
通讯作者：
Chatterjee, Paula
中科院分区：
文献类型：
--
作者：
Lee, Courtney R.;Taggert, Elizabeth;Coe, Norma B.;Chatterjee, Paula
《医护人员建议、记录、启用(护理)法案》是一项州级政策，旨在促进住院期间患者、护理人员和临床护理团队之间的沟通，这是否与患者体验的不同改善有关？在这项针对2013年至2019年2763家短期急性护理美国医院的队列研究中，与政策通过后的非护理法案州相比，CARE法案州在多种措施上发现患者体验的不同改善，包括与护士和医生的沟通以及出院信息的接收。这些发现表明，正式整合沟通的政策可能会改善患者的预后。这项队列研究调查了《护理者建议、记录、启用(护理)法案》的通过是否与患者体验的改善有关。在住院期间，与照顾者的沟通往往没有建立或标准化。《护理人员建议、记录、启用(护理)法案》是一项州级政策，旨在促进患者、护理人员和临床护理团队在住院期间的沟通，以改善患者体验；自2014年以来，已有42个州通过了这项政策，但它是否与实现这些目标有关尚不清楚。以确定护理法案的通过是否与患者体验的改善有关。这项队列研究使用了2013至2019年美国短期急性护理医院的差异分析，分析了位于通过了CARE法案的州的医院与未通过CARE法案的州的医院在实施CARE法案之前与实施后的患者体验的变化。分析是在2021年9月1日至2022年7月31日之间进行的。医院是否处于通过《护理法案》的状态的时变指标。患者通过医院消费者对医疗服务提供者的评估和系统调查报告的体验。共有2763家医院被纳入，其中2188家医院在CARE法案州，575家医院在非CARE法案州。在与护士沟通(未调整的平均[SD]分，78.40%[0.42%]；差异，0.18个百分点；95%CI，0.07~0.29个百分点；P = .002)、与医生沟通(平均[SD]分，80.00%[0.19%]；差异，0.17个百分点；95%CI，0.06~0.28个百分点；政策通过后，CARE法案州与非CARE法案州之间的出院信息(平均[SD]分数，86.40%[0.22%]；差异0.11个百分点；95%CI，0.02-0.21个百分点；P = .02)，以及出院信息的接收(平均[SD]分数，86.40%[0.22%]；差异，0.11个百分点；P = .02)。在分组分析中，在医疗保健提供者的基准医院消费者评估和系统性能指标较低的医院中，与护士沟通、与医生沟通和医院整体评级的指标改善较大。这些发现表明，CARE法案的实施与患者体验的几个指标的改善有关。在住院期间正式将照顾者纳入患者护理的政策可能会改善患者的结局。
Was passage of the Caregiver Advise, Record, Enable (CARE) Act, a state-level policy designed to facilitate communication among patients, caregivers, and clinical care teams during hospitalization, associated with differential improvements in patient experience? In this cohort study of 2763 short-term, acute-care US hospitals from 2013 to 2019, differential improvements in patient experience were found across multiple measures, including communication with nurses and physicians and receipt of discharge information, among CARE Act states compared with non–CARE Act states after policy passage. These findings suggest that policies that formally integrate communication may improve patient outcomes. This cohort study examines whether passage of the Caregiver Advise, Record, Enable (CARE) Act was associated with improvements in patient experience. Communication with caregivers is often not established or standardized during hospitalization. The Caregiver Advise, Record, Enable (CARE) Act is a state-level policy designed to facilitate communication among patients, caregivers, and clinical care teams during hospitalization to improve patient experience; 42 states have passed this policy since 2014, but whether it was associated with achieving these goals remains unknown. To determine whether passage of the CARE Act was associated with improvements in patient experience. This cohort study used a difference-in-differences analysis of short-term, acute-care US hospitals from 2013 to 2019 to analyze changes in patient experience before vs after CARE Act implementation in hospitals located in states that passed the CARE Act compared with those in states that did not. Analyses were performed between September 1, 2021, and July 31, 2022. Time-varying indicators for whether a hospital was in a state that passed the CARE Act. Patient-reported experience via the Hospital Consumer Assessment of Healthcare Providers and Systems survey. A total of 2763 hospitals were included, with 2188 hospitals in CARE Act states and 575 in non–CARE Act states. There were differential improvements in patient experience in the measures of communication with nurses (unadjusted mean [SD] score, 78.40% [0.42%]; difference, 0.18 percentage points; 95% CI, 0.07-0.29 percentage points; P = .002), communication with physicians (mean [SD] score, 80.00% [0.19%]; difference, 0.17 percentage points; 95% CI, 0.06-0.28 percentage points; P = .002), and receipt of discharge information (mean [SD] score, 86.40% [0.22%]; difference, 0.11 percentage points; 95% CI, 0.02-0.21 percentage points; P = .02) among CARE Act states compared with non–CARE Act states after policy passage. In subgroup analyses, improvements were larger among hospitals with lower baseline Hospital Consumer Assessment of Healthcare Providers and Systems performance on measures of communication with nurses, communication with physicians, and overall hospital rating. These findings suggest that implementation of the CARE Act was associated with improvements in several measures of patient experience. Policies that formally incorporate caregivers into patient care during hospitalization may improve patient outcomes.
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