Data-Driven Identification of Risk Factors of Patient Satisfaction at a Large Urban Academic Medical Center.

BACKGROUND:The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first publicly reported nationwide survey to evaluate and compare hospitals. Increasing patient satisfaction is an important goal as it aims to achieve a more effective and efficient healthcare delivery system. In this study, we develop and apply an integrative, data-driven approach to identify clinical risk factors that associate with patient satisfaction outcomes. METHODS:We included 1,771 unique adult patients who completed the HCAHPS survey and were discharged from the inpatient Medicine service from 2010 to 2012. We collected 266 clinical features including patient demographics, lab measurements, medications, disease categories, and procedures. We developed and applied a data-driven approach to identify risk factors that associate with patient satisfaction outcomes. FINDINGS:We identify 102 significant risk factors associating with 18 surveyed questions. The most significantly recurrent clinical risk factors were: self-evaluation of health, education level, Asian, White, treatment in BMT oncology division, being prescribed a new medication. Patients who were prescribed pregabalin were less satisfied particularly in relation to communication with nurses and pain management. Explanation of medication usage was associated with communication with nurses (q = 0.001); however, explanation of medication side effects was associated with communication with doctors (q = 0.003). Overall hospital rating was associated with hospital environment, communication with doctors, and communication about medicines. However, patient likelihood to recommend hospital was associated with hospital environment, communication about medicines, pain management, and communication with nurse. CONCLUSIONS:Our study identified a number of putatively novel clinical risk factors for patient satisfaction that suggest new opportunities to better understand and manage patient satisfaction. Hospitals can use a data-driven approach to identify clinical risk factors for poor patient satisfaction to support development of specific interventions to improve patients' experience of care

Hieratical clustering on binary responses for 18 questions.

<p>The cluster consists of similarity of 18 questions (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156076#sec006" target="_blank">Methods</a>).</p

Top Ranked Risk Factors for Each Category and Directions.

<p>Top Ranked Risk Factors for Each Category and Directions.</p

Network of risk factors (selected more than once in risk model profile) to each question.

<p>The network consists of the 38 risk factors, which have been selected more than once in risk model profile (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156076#pone.0156076.t001" target="_blank">Table 1</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156076#pone.0156076.s004" target="_blank">S3 Table</a>) and 18 questions (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0156076#pone.0156076.s002" target="_blank">S1 Table</a>) with the LASSO algorithm. Risk factors (blue rectangle) and questions (orange circles) are connected by green lines (negative association) or red lines (positive association). The node size reflects the amount of associated risk factors. The edge width and the color grade reflect strength of the odds ratio from the risk model. This network was visualized using Cytoscape 3.2.0.</p

Q-Q similarity network based on common risk factors.

<p>The network consists of the 18 questions connected to each other with a criterion of q ≤ 0.01. Questions (circles) are connected by gray lines. The width of the edge reflects the significance of the q value. This network was visualized by Cytoscape 3.2.0.</p

Effect of Cholecalciferol Supplementation on Inflammation and Cellular Alloimmunity in Hemodialysis Patients: Data from a Randomized Controlled Pilot Trial

<div><p>Background</p><p>Memory T-cells are mediators of transplant injury, and no therapy is known to prevent the development of cross-reactive memory alloimmunity. Activated vitamin D is immunomodulatory, and vitamin D deficiency, common in hemodialysis patients awaiting transplantation, is associated with a heightened alloimmune response. Thus, we tested the hypothesis that vitamin D₃ supplementation would prevent alloreactive T-cell memory formation in vitamin D-deficient hemodialysis patients.</p><p>Methods and Findings</p><p>We performed a 12-month single-center pilot randomized, controlled trial of 50,000 IU/week of cholecalciferol (D₃) versus no supplementation in 96 hemodialysis patients with serum 25(OH)D<25 ng/mL, measuring effects on serum 25(OH)D and phenotypic and functional properties of T-cells. Participants were randomized 2∶1 to active treatment versus control. D₃ supplementation increased serum 25(OH)D at 6 weeks (13.5 [11.2] ng/mL to 42.5 [18.5] ng/mL, p<0.001) and for the duration of the study. No episodes of sustained hypercalcemia occurred in either group. Results of IFNγ ELISPOT-based panel of reactive T-cell assays (PRT), quantifying alloreactive memory, demonstrated greater increases in the controls over 1 year compared to the treatment group (delta PRT in treatment 104.8+/−330.8 vs 252.9+/−431.3 in control), but these changes in PRT between groups did not reach statistical significance (p = 0.25).</p><p>Conclusions</p><p>D₃ supplements are safe, effective at treating vitamin D deficiency, and may prevent time-dependent increases in T-cell alloimmunity in hemodialysis patients, but their effects on alloimmunity need to be confirmed in larger studies. These findings support the routine supplementation of vitamin D-deficient transplant candidates on hemodialysis and highlight the need for large-scale prospective studies of vitamin D supplementation in transplant candidates and recipients.</p><p>Trial Registration</p><p><a href="http://clinicaltrials.gov/show/NCT01175798" target="_blank">Clinicaltrials.gov NCT01175798</a></p></div

Laboratory parameters of bone and mineral metabolism and activated Vitamin D requirements.

<p>Mean (SD) unless otherwise specified.</p><p>*p-values for comparison of change from baseline to 12 months between groups (treatment vs control).</p><p><b>**</b>n = 41 in treatment group and 27 in control group.</p><p>Laboratory parameters of bone and mineral metabolism and activated Vitamin D requirements.</p

Vitamin D supplementation may prevent the time-dependent increase in PRT.

<p>(A) Representative ELISPOT PRT wells in duplicate at baseline and one year with no stimulation (media control) or response to allogeneic B cells. (B) Quantified results reveal a significant increase in the number of IFNγ ELISPOTs over time in the control group (517.4+/−280.8 to 797.8+/−542.3 spots, p = 0.03), but the comparison of “delta” PRT (1 year – baseline) in the treatment vs control group did not reach statistical significance (104.8+/−330.8 in treatment vs 252.9+/−431.3 in control, p = 0.25).</p

Gating strategy for enumeration of T cell and monocyte subsets.

<p>CD4 and CD8 memory (CD45RO+/CD45RA^neg) and naïve (CD45RO^neg/CD45RA+) T cells, and the Foxp3+/CD25+/CD4+ population containing regulatory cells were evaluated. Monocytes were identified by a CD19^neg/HLA-DR+ phenotype, and further characterized into the CD14++/CD16^neg classical subset, and the CD14^lo/CD16+ non-classical M-DC8+ and M-DC8^neg subsets.</p