Supplemental Digital Content
Table 2. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Hospital-Level Characteristics Associated with Hospital-Acquired Pressure Ulcers (HAPUs)
Hospital Metric Odds Ratio (95% CI) p-value
Patient Satisfaction HCAHPS Areasa,b
Communication with nurses .863 (.769, .968) .0116
Communication with physicians .961 (.860, 1.073) .4759 Responsiveness of hospital staff .912 (.813, 1.023) .1165
Pain management .899 (.806, 1.002) .0546
Communication about medications .895 (.799, 1.001) .0525
Discharge information .939 (.843, 1.045) .2498
Cleanliness of hospital environment .998 (.892, 1.117) .9741 Quietness of hospital environment .879 (.787, .980) .0205
Overall hospital rating .939 (.839, 1.052) .2769
Recommend the hospital .955 (.850, 1.073) .4359
Hospital-level Characteristicsc,d
Not-for-profit (vs. all other) hospital 1.349 (.921, 1.974) .1238 Government-owned (vs. all other) hospital 2.011 (1.262, 3.204) .0033 Teaching (vs. nonteaching) hospital 1.397 (1.099, 1.775) .0063 Hospital size (number of beds) 1.105 (1.036, 1.180) .0026
Urban (vs. rural) hospital 1.172 (.784, 1.752) .4381
Nursing staff FTE per 1000 discharges 1.020 (.918, 1.133) .7120
a For each of the 10 measures, the percentage of patients scoring the hospital according to each measure’s scale is reported. The 6 composite measures included: (1) communication with nurses: percentage of patients reporting their nurses communicated well; (2)
communication with physicians: percentage of patients reporting their physicians
communicated well; (3) responsiveness of hospital staff: percentage of patients reporting they received help as soon as they wanted; (4) pain management: percentage of patients
reporting their pain was well controlled; (5) communication about medications: percentage of patients reporting the staff explained about medications before administration; and (6) discharge information: percentage of patients reporting they were given information about what to do during recovery at home. For these 6 composite measures, the scale used for composite measures 1 to 5 was 1 = always, 2 = usually, and 3 = sometimes or never. The scale for composite measure 6 was 1 = yes and 2 = no.2,5 HCAHPS’ 2 individual items included (the first individual item) cleanliness of hospital environment: percentage of patients reporting their room and bathroom were clean, and (the second individual item) quietness of hospital environment: percentage of patients reporting the area around their room was quiet at night; both items were rated according to the following scale: 1 = always, 2 = usually, and 3 = sometimes or never. HCAHPS’ 2 global items included (the first global item) overall hospital rating on a scale of 0 (lowest) to 10 (highest): percentage of patients rating (1 = 9–10, 2 = 7–8, and 3 = 6 or lower), and (the second global item) recommend the hospital: percentage of patients reporting they would recommend the hospital (1 = definitely, 2 = probably and 3 = not recommend).2,5
b Reported in the table is the odds of the occurrence of a HAPU associated with each of the HCAHPS measure after adjusting for all of the hospital-level characteristics.
c Hospital-level characteristics examined were taken from the AHA Annual Survey.
Hospital type was specified as for-profit, not-for-profit, and government owned. Teaching hospital was defined as either a hospital with an AMA-approved residency program, a hospital that is a member of the Council of Teaching Hospitals, or a hospital that has a ratio of full-time equivalent interns and residents to beds of .25 or higher.18 Hospitals not meeting 1 of these 3 criteria were classified as a nonteaching hospital. Hospital bed size was categorized by the number of beds: 0–99, 100–199, 200–299, 300–399, 400–499, 500–
749, and 750 and larger. Location of the hospital, rural or urban, was also included.
Nursing staff full-time equivalent (FTE) per 1000 discharges, including registered nurses and licensed practical nurses, was considered as a hospital-level control variable. Hospital- level covariates were modeled as hospital type (2 dummy variables, 1 = government- owned, 0 = for-profit; 1 = not-for-profit, 0 = for-profit); teaching status (1 = teaching, 0 = nonteaching); location (1 = urban, 0 = rural); bed size (1 = 0–99, 2 = 100–199, 3 = 200–
299, 4 = 300–399, 5 = 400–499, 6 = 500–749, and 7 = 750 and larger); and nursing staff FTE per 1000 discharges (quartiles: 1 = 0 to < 25, 2 = 25 to < 50, 3 = 50 to < 75 and 4 = 75–100).
d Reported in the table are the odds of the occurrence of a HAPU associated with each hospital-level characteristic. Odds ratio associated with an increase in size 100 beds (e.g., from 100–199 to 200–299 beds) and a quartile change in nursing staff full time equivalent (FTE).
