Experts say it is important to assess how the COVID-19 pandemic was adversely associated with patients’ care experiences. Elliott, et al. (2023) sought to describe differences in 2020 to 2021 patient experiences from what would have been expected from pre-pandemic (2018-2019) trends and assess correlates of changes across hospitals.

This cohort study compared 2020 to 2021 data with 2018 to 2019 data from 3 900 887 HCAHPS respondents discharged from 3381 HCAHPS-participating U.S. hospitals. The data were analyzed from 2022 to 2023.

Of the 3,900,887 HCAHPS 2020 to 2021 respondents, 59% were age 65 years or older, and 35% (11%) were in the surgical (maternity) service lines. Compared with trends expected based on pre-pandemic (2018-2019) data, HCAHPS-SS was 1.2 percentage points (pp) lower for quarter (Q) 2/2020 discharges and −1.9 to −2.0 pp for Q3/2020 to Q1/2021, which then declined to −3.6 pp by Q4/2021. The most affected measures (Q4/2021) were staff responsiveness (−5.6 pp) and cleanliness (−4.9 pp); the least affected were discharge information (−1.6 pp) and quietness (−1.8 pp). Overall rating and hospital recommendation measures initially exhibited smaller-than-average decreases, but then fell as much as the more specific experience measures by Q2/2021. Quietness did not decline until Q2/2021. The HCAHPS-SS fell most for hospitals with the lowest pre-pandemic staffing levels; hospitals with bottom-quartile staffing showed the largest decrements, whereas top-quartile hospitals showed smaller decrements in most quarters. Hospitals with better overall pre-pandemic quality showed consistently smaller HCAHPS-SS drops, with effects for 5-star hospitals about 25% smaller than for 1-star and 2-star hospitals.

The results of this cohort study of HCAHPS-participating hospitals found that patient experience scores declined during 2020 to 2021. By Q4/2021, the HCAHPS-SS was 3.6 pp lower than would have been expected, a medium effect size. The most affected measures (staff responsiveness and cleanliness) showed large effect sizes, possibly reflecting high illness-associated hospital workforce absenteeism. Hospitals that were lower performing and less staffed pre-pandemic may have been less resilient to reduced staff availability and other pandemic-associated challenges. However, by Q4/2021, even pre-pandemic high-performing hospitals had similar declines.

Reference: Elliott MN, et al. Changes in Patient Experiences of Hospital Care During the COVID-19 Pandemic JAMA Health Forum. 2023;4(8):e232766. doi:10.1001/jamahealthforum.2023.2766