The data are then risk-adjusted and aggregated to the hospital level before being released quarterly to the public ( Giordano, Elliott, Goldstein, Lehrman, & Spencer, 2010). The 27-item HCAHPS survey asks a sample of patients in all Medicare participating hospitals to evaluate their short term, acute care hospital experience. These databases also provided patient demographic information and information on other diagnoses and procedures that allowed for risk adjustment.ĭata on patient assessments of their care experience from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey were obtained from the Centers for Medicare and Medicaid Services (CMS) publicly available Hospital Compare website. We used the administrative databases based on hospital discharge abstracts for all patients from the four study states to identify the patient level outcomes of 30-day inpatient mortality and failure to rescue among surgical patients. We used data from other sources to examine hospital quality from a variety of perspectives. The aggregated nurse-reported measures of the hospital practice environment and quality of care were then linked to data from the 2006 to 2007 American Hospital Association Annual Survey of hospitals, which includes information on hospital structure, services, personnel, facilities, and financial performance from nearly all U.S. Patient care hospital nurses were surveyed about features of their work environment they also provided the names of their employers, which allowed us to aggregate their responses by hospital.
The nursing licensure lists in the four states established the sampling frame to survey nurses directly via mail. The sampling approach has been detailed previously ( L. Aiken et al., 2011)-a survey of nurses’ work conditions and quality of care carried out in the four study states in 2006–2007. Our primary data source for nurse reported quality of care was the Multi-State Nursing Care and Patient Safety Study ( L. We focused our attention on adult, non-federal acute care hospitals from four states: California, Pennsylvania, Florida, and New Jersey. We conducted a retrospective secondary analysis of data to estimate the relationship between nurse reported quality of care and standard hospital quality measures. Establishing a correspondence between nurse reported quality of care and measures from other sources could demonstrate the validity of a single item quality of care measure. Our purpose was to examine the association between nurse reported quality of care and standard indicators of quality including patient outcomes measures (i.e., mortality, failure to rescue, and patient satisfaction) and process of care measures. Aiken et al., 2001, 2012 Leveck & Jones, 1996 Shortell, Rousseau, Gillies, Devers, & Simons, 1991). There is ample evidence that hospitals that are known to be good places for nurses to work (e.g., Magnet hospitals and other hospitals with good practice environments) have better outcomes including nurse reported quality of care ( L. One such opportunity is the use of nurses as informants about overall quality of care in the acute care hospital setting. Although there are well enumerated obstacles related to measuring healthcare quality ( Loeb, 2004), there are also underexplored opportunities. Quality of care has been at the forefront of researchers’ agenda for several decades because healthcare quality measures are integral to the decision-making of regulators, consumers, and purchasers ( Chassin & Loeb, 2011 Donabedian, 1969, 1988 Institute of Medicine, 2001).
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Thus, nurses’ perceptions of quality are built on more than an isolated encounter or single process-they are developed over time through a series of interactions and direct observations of care. Examples include direct care giving, surveillance and monitoring of health status, emotional support for patients and families, assistance with activities of daily living, interprofessional team collaboration, and patient education. The work nurses do as the primary bedside care provider and intermediary between patients and all other clinicians intimately involves them in all aspects of patient care. They are the de facto surveillance system overseeing the patient care experience. Nurses are in an ideal position to report on the quality of care in hospitals.
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