Quality of communication about medicines in United States hospitals: A national retrospective study

Abstract

Background: Despite the benefits of improving transitions across care, literature is very limited on inpatient "Communication about Medicines" (ComMed) by staff across United States (U.S.) hospitals.

Objectives: To evaluate ComMed quality variations by hospital characteristics.

Methods: In a cross-sectional, retrospective study of publicly available U.S. Medicare's Hospital Consumer Assessment of Health Care Plans Survey (HCAHPS) data (January 2013-September 2014), ComMed quality (high = above average/excellent vs. low = average/below average/poor star ratings) of 3125 hospitals were compared across region, rural-urban location, and health information technology (HIT) infrastructure giving providers access to patients' electronic medical records. Multivariate logistic regression analysis was conducted with adjusting for confounders (hospital - bed size, ownership, type, ED services, the number of completed HCAHPS surveys).

Results: After adjusting for other characteristics, Midwest versus Western region hospitals (OR = 1.55, 95% CI: 1.21-1.98, p=<0.0001), hospitals with HIT infrastructure (OR = 1.29, 95% CI: 1.05-1.59, p = 0.02) were more likely while Northeast vs. Western region hospitals (OR = 0.67, 95% CI: 0.50-0.89, p=<0.0001) and hospitals in metropolitan areas with 1 million or more population vs. Nonmetro area with less than 2500 population were less likely (OR = 0.68, 95% CI: 0.48-0.95, p=<0.0001), to be associated with high ComMed quality. Hospitals' small bed-size, physician/non-profit ownership, critical-access type, absent ED services, and 100-299 HCAHPS completed surveys were more likely to be associated with high ComMed quality.

Conclusions: One of the first national studies found significant variations in ComMed quality across U.S. hospitals by location (high in Midwest and low in Northeast regions and urban areas) and by access to HIT infrastructure (high) after controlling for other hospital characteristics. With this baseline data, hospital providers and policymakers can design, implement, and evaluate service programs with pharmacists and HIT to enhance ComMed quality in the future delivery of patient-centered care.

Keywords: Accountable care act; Center for Medicare and Medicaid Services; Communication about medicines; Star ratings.