Strategies to improve patient-physician communication

An intervention that included standardized communication, standardized rounding and monthly feedback was associated with an improvement in patients’ perception of physician communication as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey, according to a recently published study in the American Journal of Medical Quality.

According to the researchers, CMS ties financial reimbursement to these survey scores as part of its Value-Based Purchasing program, and also uses the survey to assess patient’s thoughts on their health care experience.

“Good physician-patient communication has been associated with improved patient satisfaction, reduced litigation, and improved compliance and self-management of chronic diseases such as diabetes and hypertension,” Devin J. Horton, MD, division of general internal medicine, University of Utah, and colleagues wrote.

They also noted that previous research has indicated a higher score on the Hospital Consumer Assessment of Healthcare Providers and Systems survey usually leads to fewer 30-day readmissions and better quality of care for inpatient conditions,

Horton and colleagues wrote that they spent time discussing the Hospital Consumer Assessment of Healthcare Providers and Systems survey and current strategies with an academic medical center’s employees. Based on these discussions, the researchers came up with these interventions:

sitting at eye level with patients, introducing team members to patients and their families, and knocking before entering a patient’s room;
presenting findings and treatment plans in language that is easy for the patient to comprehend;
creating and distributing cards with rounding expectations, and reviewing these cards every week;
teaching the hospitalist group about expectations and strategies; and
reviewing Hospital Consumer Assessment of Healthcare Providers and Systems survey data at least monthly in group meetings, using these opportunities to drive home the previously mentioned expectations and strategies

To gauge the success of the interventions, the researchers surveyed all patients at an academic medical center from July 1, 2012, through June 30, 2014, asking them the following questions about their stay:

How often did doctors treat you with courtesy and respect?
How often did doctors listen carefully to you?
How often did doctors explain things in a way you could understand?

They found that of the 7,043 responses, the percentage of patients who answered ‘always’ remained relatively the same, 65% to 66%, among those who made up the control group from July 1, 2012 to June 30, 2013. However, those who answered ‘always’ to the questions increased from 56% to 63% among an intervention group.

Researchers stated that control group’s starting level may have been higher than the intervention group because average younger age and lower average Charlson Comorbidity Index among this group. The level may have also been higher because it included surgical services, which frequently involve planned admissions and only one team of providers with whom they communicate. This is different than hospitalist admissions, which are not planned, and there are several teams of specialties and providers to take into consideration.

Horton and colleagues also tracked responses over time, and noted that the intervention group had a downward trend before the intervention and that following the intervention, the trend changed course and surpassed the control group’s percentage of ‘always’.

“This significant change in trend indicates that the intervention had a continuous effect. The lack of an immediate level of change seems to indicate that changes in communication take time to realize,” Horton and colleagues wrote.

Although the research was conducted at an academic medical center, the authors said the findings could be applied in any medical setting.

"A major strength of this study is its generalizability to other institutions or hospitalist groups as establishing specific communication standards is neither costly nor time intensive," Horton and colleagues wrote. "While the importance of consistent processes in health care is widely accepted, this study is notable in highlighting the effectiveness of standardization in an area that has sometimes been considered more art than science." – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.