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BACKGROUND

The Institute of Medicine has defined “patient-centered care” as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”1 The Committee on Quality of Health Care in America in 2001 included patient-centered care as a quality indicator of national health services.2 In obstetrics, this is particularly important, as it may be the only time that some women of childbearing age ever encounter the healthcare system. A positive birth experience has been associated with a feeling of empowerment, accomplishment, and easier adaptation to motherhood. A negative experience has been associated with postpartum anxiety, depression, and reduced future reproduction.2

Nationwide, approximately 38% of hospitals use obstetric hospitalists or laborists.3 Hospitalists, by definition, provide care during Labor and Delivery (L&D) and do not participate in prenatal care. This is a model that has evolved over the years to replace the prior model of an obstetrician being available 24/7 to provide care for the patient, regardless of when labor begins. This division of labor creates unique challenges related to the delivery of patient-centered care. It also creates unique demands on obstetric hospitalists to assess patient values and choices, adapt their communication style, and provide continuity in philosophy of care. Hospitals have looked to evaluate how this new staffing model affects patient satisfaction because scores affect hospital reputation, payment, and competitive advantage. Studies to assess patient satisfaction in the hospitalist model do not demonstrate significant differences with the traditional model, but this area has not been rigorously researched.35

MEASURING AND IMPROVING PATIENT-CENTERED CARE FOR HOSPITALIZED PATIENTS

KEY QUESTIONS

  • How is patient-centered care measured and incentivized?

  • What are the key concepts related to improving patient-centered care?

Patient-satisfaction surveys have become an integral part of measuring and improving the delivery of patient-centered care.6 These surveys measure patients’ perception of communication, respectfulness, and responsiveness by providers and healthcare systems. Improved patient satisfaction is associated with increased patient adherence, increased patient follow-up, lower utilization of services, lower annual charges, and lower mortality rates.79 It is thought to provide important incremental information on quality of care beyond the clinical performance metrics.9 In 2005, the Centers for Medicare and Medicaid Services (CMS) developed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey.10 More than 4500 acute-care hospitals in the United States routinely send this survey to a random subset of their discharged patients. The results are publicly reported and empower patients to make informed choices about selecting providers. Payments to hospitals are now linked to performance on this metric.11 Hospital leaders devote substantial resources to improve their performance in this area. The HCAHPS survey results are publicly available through the CMS on their “Hospital Compare” website.12

A hospital's performance on the HCAHPS affects its ...

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