More than 20 hospitals in New Hampshire are signing up volunteers in a statewide effort to follow patients a year beyond their initial stay and determine the impact of medical care and caregiving on their lives.
During that period, patients who undergo treatment for a heart attack or a total hip replacement will receive three questionnaires: at the end of the hospital stay, three months later and at the one-year mark.
The exercise will produce comprehensive information about patient experiences in the hospital as well as with home care and follow-up treatment in physician offices and ambulatory facilities.
The statewide initiative, called the Patient-centered Care Project, aims to measure patient satisfaction beyond the limited focus of current hospital surveys, which deal with overall satisfaction and usually are confined to the length of the inpatient stay.
By contrast, the questionnaires will provide diagnosis-specific information about critical aspects of patients' hospital care and recovery, said Mike Hill, president of the NHHA and its subsidiary, the Foundation for Healthy Communities, which is spearheading the effort.
"This survey isn't about whether our waiting rooms are cozy or the food was good," Hill said. "It's about patients: Are they being treated with dignity and respect, are they recovering as expected, and do they understand how illness and recovery affect their lives?"
By asking the same specific questions about functional status at varying points in the recovery process, the survey can relate results to original treatment, said Rachel Rowe, NHHA vice president and project director.
That will give physicians data to help them identify variations in practice and provide a foundation to relate practices to outcomes, Rowe said.
The questionnaires also will help tie together the efforts of all providers of care, uncovering areas where more coordination and attention to detail is needed, she said. The project has picked up support from the Home Care Association of New Hampshire and also is endorsed by the New Hampshire Medical Society.
All hospitals are examining their medical results as part of quality-improvement efforts, but those efforts have their limits, said Thomas Wilhelmsen, president and chief executive officer of Southern New Hampshire Regional Medical Center in Nashua.
"You could only maybe (compare) to your other patients, but the hospital down the road may be having better functional results," Wilhelmsen said.
The project probably won't allow hospital-to-hospital comparisons, but it will supply aggregate answers to dozens of questions that can help hospitals determine how they stack up, he said.
The project also will give hospital administrators a sense of the continuum of care provided to inpatients once they go home. "A full year later, you're in touch with that same patient," Wilhelmsen said.
And the patients are being given plenty of chances to comment frankly on caregiver performance. A number of questions ask for ratings on the courtesy of physicians and nurses, the amount of information communicated about the procedures, discussion of anxieties and fears, and whether caregivers said one thing and did another.
In addition to evaluations of physicians, nurses, hospital staff, surgery experiences and pain management responses common to both procedures studied, the questionnaires measured progress in rebounding from the conditions that put the patients in the hospital in the first place (See chart).
The questionnaire volume exceeds 70 questions just in the first installment, but that hasn't discouraged volunteering since the program began in January.
In fact, Rowe said, patients have been "thrilled" to be asked their opinion. The consensus, she said, is that patients see the project as evidence that the hospital cares about them-not only that the procedure goes well, but also that they get better.
More than 500 have been recruited, and only three turned down the request statewide so far, she said.
The project is expected to take two years, with patients continuously enrolling during the first year and going though a year of questioning. The first report, due in September, will provide the first look at results of initial and three-month questionnaires administered between January and May, Rowe said.
Boston-based Picker Institute developed the questionnaire in collaboration with the NHHA and will administer it under a two-year contract. The cost of that contract and other administrative expenses, about $180,000, will be shared by the 21 participating hospitals. New Hampshire has 26 acute-care facilities.
Rowe said it was important to standardize not just the measurement instrument but the administration, so the results aren't biased according to when and how the questionnaires are posed to the volunteers.