Best Practices for Patient Experience in Military Treatment Facilities 2019 AMSUS Annual Meeting

December 4, 2019

Presenters: Kimberley Marshall Aiyelawo, PhD and Melissa Gliner, PhD

Defense Health Agency/Department of Defense

“Medically Ready Force…Ready Medical Force”

Disclaimer∎ The opinions expressed herein are those of the authors, and are not necessarily

representative of the opinions or policies of the Department of Defense (DoD); or the United States Army, Navy, Air Force, or Coast Guard.

Presenter Disclosures

∎ Presenter’s has no relevant financial or non-financial interests to disclose.∎This continuing education activity is managed and accredited by AffinityCE in collaboration with AMSUS. AffinityCE and AMSUS staff as well as Planners and Reviewers, have no relevant financial or non-financial interests to disclose.∎ Commercial Support was not received for this activity

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Learning Objectives

• Identify the tools for measuring patient experience in the MHS (TRISS and other surveys)

• Examine the relationship between nurse hourly rounding, post-discharge calls and patient experience scores

• Explore the benefits of recent patient experience improvement initiatives in military hospitals

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MHS & Surveys Overview

The Military Health System (MHS)

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The Quadruple Aim

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Defense Health Agency (DHA)

∎Manages the TRICARE health benefit

∎ Improves health care through: research, education, centers of excellence, forensic investigations, and input to policy changes

∎As of Oct 1, 2018 beginning to lead administration of all Military Treatment Facilities (MTFs)*

*Stand alone clinics or hospitals with substantial ambulatory care clinics

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MHS Survey Program

• Formally established in response to the National Defense Authorization Act in 1992, calling for an annual formal survey of persons receiving health care to determine:

• Availability of services

• Familiarity with availability and facilities

• Health status

• Satisfaction and quality

• DHA Decision Support Division (DSD) health care scientists collect survey data.

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Patient Experience Survey Trends

MHS Patient Experience Surveys

Event-Based (episode of care) Surveys • Joint Outpatient Experience Survey (JOES)

• JOES-C (CAHPS)• Consumer Assessment of Healthcare Providers & Systems

• TRICARE Inpatient Satisfaction Survey (TRISS)

Population Surveys• Healthcare Survey of Department of Defense Beneficiaries (HCSDB)

• Survey of Civilian Provider Acceptance of/Beneficiary Access to TRICARE Standard (TSS)

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Patient Experience Trends in MHS

*Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Benchmark: 50th

percentile based on national scores. FY19 Scores are based on data from FY19Q1 and Q2 only.11

60%

70%

80%

90%

100%

FY16 FY17 FY18 FY19 FY16 FY17 FY18 FY19 FY16 FY17 FY18 FY19

Medical Surgical Obstetric

TRISS Overall Hospital Rating TrendsFY 2016-2019

Patient Experience Trends in MHS

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Benchmark: 50th

percentile based on national scores. FY19 Scores are based on data from FY19Q1 and Q2 only.12

60%

70%

80%

90%

100%

FY16 FY17 FY18 FY19 FY16 FY17 FY18 FY19 FY16 FY17 FY18 FY19

Medical Surgical Obstetric

TRISS Recommend Hospital TrendsFYs 2016-2019

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Patient Care Practices and Patient Experience Scores

Patient Care Practices Measured by TRISS

• Studer Group, a private healthcare consulting company, developed four patient experience questions to assess patient engagement practices deemed critical to care. The questions were added to the TRISS survey to assess frequency of these practices across the MHS.

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Patient Care Practices Measured by TRISS

How often did nursing staff come into your room to check or round on you during the day? Would you say every hour, every two hours, every few hours, or a couple times a day?

At shift change, did the nurses include you in their conversation regarding your plan of care?

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Patient Care Practices Measured by TRISS

Did a nurse leader visit you during your stay?

After discharge, did you receive a phone call from a hospital staff member regarding your recovery at home?

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Engagement in Patient Care Practices by Product Line

∎ Medical and Surgical scores are similar – Obstetric engagement in these patient care practices was lower in all categories.

0%20%40%60%80%

100%

Nurse HourlyRounding

Nurse LeaderVisit

Post-DischargeTelephone Call

Nurse BedsideShift Reporting

Average Scores on Studer Practices by Product Line FY17

Medical Surgical Obstetric

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Hourly Rounding and Recommend Hospital (TRISS FY18 QTR4 – FY19 QTR1)

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74.0% 75.3%82.7% 84.8%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

FY18 QTR4 FY19 QTR1

Ave

rage

Sco

re

HCAHPS Recommend Hospital

Nurse Hourly Rounding - No Nurse Hourly Rounding - Yes

Hourly Rounding and Overall Hospital Rating (TRISS FY18 QTR4 – FY19 QTR1)

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70.6% 71.3%

81.6% 83.3%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

FY18 QTR4 FY19 QTR1

Ave

rage

Sco

re

HCAHPS Overall Hospital Rating

Nurse Hourly Rounding - No Nurse Hourly Rounding - Yes

Top Inpatient Experience Drivers

Top Ranking Drivers of Inpatient Experience Scores TRICARE Inpatient Satisfaction Survey (TRISS) FY 2018

Ranking Overall Hospital Rating Recommend Hospital

1 Communication with Nurses Communication withNurses

2 Communication with Doctors

Communication with Doctors

3 Cleanliness of Room/ Bathroom

Cleanliness of Room/ Bathroom

Studer Practices do not score as the top drivers of patient experience,

but may be contributing factors for communication and health outcomes

(i.e. fewer falls with more hourly rounding).

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Summary of Findings

∎ Engagement in patient care practices varies by product line, with lower levels of engagement in hourly rounding specifically

∎ Hourly rounding appears to impact patient experience scores, with more engagement leading to higher Overall Hospital and Recommend Hospital scores

∎ Top drivers of patient experience scores are still Communication with Doctors and Nurses, but the patient care practices highlighted in this study impact both scores and patient outcomes.

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Acknowledgments & Contact Information

∎ The authors would like to thank the participating MTF interviewees.

∎ The Defense Health Agency within the Department of Defense funded the study.

∎ For more information, contact kimberley.a.aiyelawo.civ@mail.mil.

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How to Earn CE

∎ If you would like to earn continuing education credit for this activity, please visit: http://amsus.cds.pesgce.com

∎ CE Certificates will only be available for 30 Days after this event

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