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This study explores the relationship between inpatient unit design and patient experience and how spatial features and visibility impact patients' perception of staff responsiveness. The first part of this study is a retrospective pre-post and cross-sectional study evaluating the impacts of unit design on patient experience at the unit level. This study compares patient experiences based on Press Ganey and HCAHPS surveys in two orthopedic units (existing unit in Atrium building and new unit in Tower) with differing design features at Rush University Medical Center. The chi-square test results show that when moving from the old orthopedic unit to the new unit, almost all patient survey items related to patient experience showed statistically significant improvements. The second part of this study is a room level on the new unit. The ANOVA and Pearson correlation tests revealed that the visibility measure of metric step depth had significant impacts on patients' perception of staff's "promptness in responding to call button" and "help with toileting". This study confirms that inpatient unit design plays a direct role in improvement for patient experience and should be considered as an important area of focus for future development.

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A developing body of evidence indicates that chaplain care is associated with higher levels of patient/family satisfaction with their hospital care. We examined the association between chaplain care and patient experience among patients at Rush University Medical Center in Chicago who responded to Hospital Consumer Assessment of Healthcare Providers and Systems and Press Ganey survey items between 2011 and 2017. Information about chaplain care was taken from the inpatients' electronic medical record. Our analyses included 11 741 patients, 26.5% of whom had received any chaplain care. Patients with lower self-rated health were more likely to have received chaplain care (P < .001). In bivariate analyses, chaplain care was associated with lower likelihood of reporting the highest score for 4 patient experience items (P < .001). In multi-variable models that adjusted for patient self-rated health and other factors, the association between chaplain care and the 4 patient experience items was nonsignificant. There was no effect modification for patient religious affiliation, self-rated health, or other demographic factors. The chaplain care-patient experience association may be more complex than has initially appeared, and further research is needed to help us better understand it.

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Facility planning for healthcare organizations has become increasingly important in recent years, due primarily to the complicated needs of patient rooms and the escalating pressure to provide high-quality care to satisfy patients. Concurrently, there has been a considerable development in the field of evidence-based design (EBD) on the impact the healthcare environment has on patients and the operations of clinical staff. Although tools are being developed to assist in measuring EBD principles, they have not been universally adopted by organizations regarding how they either develop or assess healthcare facilities. This case study focuses on our attempt to implement an internal facilities evaluation process and a Post-Occupancy Evaluation (POE) on a major Academic Medical Center's (AMC) new bed tower. An assembled auditing team comprised of diverse professional healthcare backgrounds performed an audit on three patient rooms using a Center for Health Design POE Questionnaire. The results of this evaluation were then compared to the guiding principles developed for the hospital during its design. Results indicated that the project narrowly missed the threshold score agreed upon by the AMC's facilities leadership. This project demonstrated the difficulty in implementing a POE without prior experience, while highlighting the value of a standardized evaluation tool to assess past and future facilities projects.

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Prior research has demonstrated poorer patient-provider communication ratings among African American compared to White patients. The quality of patient-provider communication has been shown to impact treatment outcomes among cancer patients. A secondary data analysis design was used to determine the relationship of six patient-provider communication variables on the physical health quality of life (PHQOL) and mental health quality of life (MHQOL) of African American and White cancer patients (N = 479). We also examined whether the relationship between communication patterns and QOL differed based on race/ethnicity. Mean physical and mental health QOL scores for the sample were 69.8 and 77.6, respectively. After controlling for significant sociodemographic, clinical, and hospital variables, results showed that patients who experienced fewer interpersonal communication barriers who were more satisfied with the information given by providers had higher PHQOL and MHQOL scores. Additionally, patients who felt more comfort in asking questions or had fewer unmet information needs had higher MHQOL. A stratified analysis showed that the relationship of overall satisfaction with information on MHQOL was stronger among African American patients than White patients. Future research should focus on the development of interventions to improve patient-provider communication as a means for enhancing QOL outcomes among cancer survivors.

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BACKGROUND: Physical inactivity in midlife women is associated with increased intra-abdominal adipose tissue development. We describe an innovative multimethod study 1) to better understand barriers to physical activity (PA) and 2) to engage midlife women to product test physical activities and identify local community-based providers and sustainable and fun PA experiences. METHODS: Formative research on PA barriers from the Chicago site Study of Women's Health Across the Nation (SWAN) ancillary study of midlife women was used to develop a pilot testing measure. Feasibility, acceptability and sustainability of the PA activities were determined using the measure. RESULTS: Desirable locations and/or instructors were identified. The first 2 groups identified, pilot tested, and then ranked activities for their ability to promote sustained PA. The 6 top-ranked were: circuit training, total body fitness, kickboxing, Zumba, Pilates, and pedometer. The final group pilot tested highly ranked PA in 2-week blocks, and ranked pedometer and Zumba in their top 3. CONCLUSION: Consensus was reached regarding activities that could be valuable in promoting sustained PA in midlife women. Choosing convenient sites and popular instructors further facilitates sustainability. Building relationships with key community partners is essential for sustainability. Community-based participant involvement in study design is a critical element in developing a healthy living intervention.

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BACKGROUND: Changes in reproductive hormones during menopause are associated with accumulation of intra-abdominal adipose tissue (IAAT), a subclinical indicator of cardiometabolic disease risk. Independent of reproductive hormones, unhealthy lifestyle contributes to IAAT gain. The Women in the Southside Health and Fitness (WISHFIT) Study aims to develop a lifestyle approach to slowing IAAT accumulation as women begin the menopausal transition. METHODS: The primary aim is to develop and conduct a proof-of-concept test of a multi-component, multi-level behavioral intervention targeting jointly physical activity, diet, and psychological well-being. Participants attend group sessions over 2 years to experiment with healthy living through both experiential and didactic learning, cultivate a health network, and draw on community resources to sustain change. The primary endpoint is 2-year IAAT progression, assessed using computerized tomography. Behavioral targets of treatment and secondary endpoints will be evaluated at 6, 12, 18 and 24 months. Change in social networks and community support will be assessed at 2 years. RESULTS: WISHFIT recruited 71 pre- and peri-menopausal Caucasian and African American women (mean ± SD age = 47.6 ± 3.4 yrs; BMI = 33.6 ± 7.3 kg/m2; 52% African American). Baseline IAAT was 2104.1 ± 1201.3 cm3. IAAT, physical activity, BMI, and self-reported family income and resilience differed by ethnicity at baseline. CONCLUSIONS: WISHFIT is a multi-component, multi-level intervention aimed at producing a sustained improvement in physical activity, diet, and psychological well-being early in the menopausal transition to slow menopause-related accumulation of IAAT. It provides a model for the process of developing a behavioral treatment to manage a chronic disease.

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PURPOSE: To assess the impact of using an advanced electronic health record (EHR) on hospital quality and patient satisfaction. METHOD: This retrospective, cross-sectional analysis was conducted in 2012 to evaluate the association between advanced EHR use (Healthcare Information Management Systems Society [HIMSS] Stage 6 or 7 as of December 2012) and estimated process and experience of care scores for hospitals under the Medicare Hospital Value-Based Purchasing Program, using data from the American Hospital Association for 2008 to 2010. Generalized linear regression models were fit to test the association between advanced EHR use with process of care and experience of care, controlling for hospital characteristics. In a second analysis, the models included variables to account for HIMSS stage of advanced EHR use. RESULTS: The study included 2,988 hospitals, with 248 (8.3%) classified as advanced EHR users (HIMSS Stage 6 or 7). After controlling for hospital characteristics, advanced EHR use was associated with a 4.2-point-higher process of care score (P < .001). Hospitals with Stage 7 EHRs had 11.7 points higher process of care scores, but Stage 6 users had scores that were not substantially different from those of nonadvanced users. There was no significant difference in estimated experience of care scores by level of advanced EHR use. CONCLUSIONS: This study evaluated the effectiveness of the U.S. federal government's investment in hospital information technology infrastructure. Results suggest that the most advanced EHRs have the greatest payoff in improving clinical process of care scores, without detrimentally impacting the patient experience.

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Concerns about both the cost and quality of health care have led to a growing interest in, and call for "pay for performance." Increasingly, as well, patient satisfaction is being viewed as an essential aspect of care that should be considered in judging performance. At the same time, there are concerns about the validity of patient satisfaction as a relevant quality measure. We argue that patient satisfaction is not only an outcome measure, but also an essential part of the process of care itself. This experiential aspect of care, however, is evaluated by patients, whereas formal processes and outcomes are recorded and evaluated by providers. As such, the 2 measures are evaluating different aspects of care that need not--but typically do--coincide. We also suggest that where patient satisfaction is utilized in pay for performance calculations, it constitutes a very small portion of the total money at stake and is unlikely to lead to "gaming" through acquiescence to patients' requests for unnecessary treatments.

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This study identified themes in patient-written comments about meals served in a hospital and determined the relationship of those themes to patient food-quality satisfaction ratings among medical and surgical patients. Data from 2 years of quantitative Press Ganey patient-satisfaction ratings and qualitative comments related to meals by 1,077 patients discharged from a Midwest urban medical center were reviewed retrospectively. Themes in comments were identified. Results indicated that patient satisfaction with food quality did not differ based on sex or age, but did differ based on length of stay, perceived health status, and whether a patient provided written comments or not. The most common comments focused on the temperature of hot food, receiving what was ordered, and satisfaction with foodservice staff. The tenor of comments differed by food-quality rating given. Overall food quality rating was best predicted by food-related comments rather than comments about staff, or other issues not addressed in the Press Ganey quantitative questionnaire.

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PURPOSE: Because costs associated with malpractice litigation draw substantial resources away from patient care, many health care organizations are seeking efficient methods to manage these risks. The purpose of this study was to identify methods by which commonly available patient satisfaction indicators could be used to identify potential malpractice litigation risks. SUBJECT AND METHODS: Using data from the risk management department of a large academic medical center, we combined yearly administrative records from 1998 to 2006 of malpractice-related litigation activity, with patient satisfaction scores related to attending physicians. We then applied 3 approaches to code patient satisfaction for each year: (1) calculating the overall mean, (2) assigning tertiles, and (3) identifying the minimum satisfaction response to any question. We then estimated 3 versions of random-effect logit models to examine which estimators predicted whether an attending physician was named in a lawsuit in a given year. RESULTS: Minimum satisfaction score was significantly associated with malpractice activity; the other analytic approaches did not yield significant associations. Although patient satisfaction explained little variation in an individual physician's contribution to malpractice risk, accounting for the minimum score explained more than a quarter of a department's contribution. CONCLUSIONS: Findings suggest that minimum satisfaction score may provide a useful metric for identifying and prioritizing malpractice risks.

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