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- Title
Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act.
- Authors
Lee, Courtney R.; Taggert, Elizabeth; Coe, Norma B.; Chatterjee, Paula
- Abstract
Key Points: Question: 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? Findings: 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. Meaning: 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. Importance: 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. Objective: To determine whether passage of the CARE Act was associated with improvements in patient experience. Design, Setting, and Participants: 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. Exposure: Time-varying indicators for whether a hospital was in a state that passed the CARE Act. Main Outcomes and Measures: Patient-reported experience via the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Results: 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. Conclusions and Relevance: 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.
- Subjects
UNITED States; HOSPITALS; SERVICES for caregivers; CONFIDENCE intervals; HEALTH outcome assessment; POPULATION geography; PATIENTS' attitudes; HUMAN services programs; NURSE-patient relationships; PSYCHOLOGY of caregivers; COMMUNICATION; HOSPITAL care; DESCRIPTIVE statistics; RESEARCH funding; DATA analysis software; LONGITUDINAL method
- Publication
JAMA Network Open, 2023, Vol 6, Issue 5, pe2311253
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.11253