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Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric

Pediatric Research volume 94, pages 1562–1569 (2023)Cite this article

Abstract

Background

The aim of the study was to identify case-mix adjusters for the Chinese version of the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child-HCAHPS) and assess the impact of case-mix adjustment on patient experience measures in China.

Methods

This study analyzed data collected from six National Regional Center for Pediatric across China retrospectively. Participants were children aged ≤17 years and their guardians who completed the survey. The Chinese Child-HCAHPS was used to measure pediatric inpatient care experience. Candidate case-mix adjusters were assessed using a summary measure of explanatory power. Changes in scores and rankings of the six centers were quantified to assess the impact of adjustment.

Results

A total of 2708 respondents completed the survey from January to March 2021, with a response rate of 7–15%. The child’s global health status and the respondent being the child’s mother were identified as case-mix adjusters, and case-mix adjustment models for 18 patient experience items were constructed. Kendall’s τ correlation of hospital rankings before and after adjustment ranged from 0.73 to 1.00.

Conclusions

Although the impact of case-mix adjustment may appear modest in our sample, it demonstrated the feasibility, necessity, and methodology for further development of case-mix adjustment models in pediatric healthcare facilities in China.

Impact

  • Case-mix adjustment models adjust for factors that are unamendable by healthcare providers that may affect patient experience ratings, thereby improving the comparability of institutional-level ratings.

  • Standardized case-mix adjustment protocols for quality measures need to be modified in different settings. This is the first study to identify adjustment variables and the possible impact of case-mix adjustment on pediatric inpatients’ experience measures in a Chinese population.

  • This study provided evidence on the feasibility and necessity for further development of case-mix adjustment models for pediatric healthcare facilities in China.

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Fig. 1: Adjusted and unadjusted “top-box” scores of the included hospitals.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was supported by Special Research Fund of National Institute of Hospital Administration, National Health Commission (YLZLXZ22K028), Special Research Fund for Central Universities, Peking Union Medical College (3332019087), and Scientific research seed fund of Peking University First Hospital (2021SF62).

Author information

Authors and Affiliations

  1. School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Chenyang Pei & Xueyan Han

  2. Department of Medical Statistics, Peking University First Hospital, Beijing, China

    Xueyan Han

  3. National Institute of Hospital Administration, NHC, Beijing, China

    Qiannan Liu

  4. Institute of Medical Information/Center for Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Guangyu Hu

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  1. Chenyang Pei
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Contributions

G.H.: concept and design; acquisition, analysis, or interpretation of data; critical revision of the manuscript for important intellectual content; statistical analysis; obtained funding; administrative, technical, or material support; supervision and final approval of the version to be published. C.P.: acquisition, analysis, or interpretation of data; drafting of the manuscript; statistical analysis. X.H.: acquisition, analysis, or interpretation of data; critical revision of the manuscript for important intellectual content; obtained funding. Q.L.: critical revision of the manuscript for important intellectual content; obtained funding; administrative, technical, or material support; supervision.

Corresponding author

Correspondence to Guangyu Hu.

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The authors declare no competing interests.

Ethics approval and consent to participate

Ethical approval was obtained from the Ethics Committee of the Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College (IMICAMS/04/19/HREC). Participation was voluntary, and informal consent was obtained from the respondents before the survey.

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Pei, C., Han, X., Liu, Q. et al. Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric. Pediatr Res 94, 1562–1569 (2023). https://doi.org/10.1038/s41390-023-02488-3

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