Narrative comments about pediatric inpatient experiences yield substantial information beyond answers to closed-ended CAHPS survey questions.
Denise D Quigley, Marc N Elliott, Mary E Slaughter and 2 others
PMID 38431461WHAT IT FOUND
Parent comments on pediatric inpatient surveys added information beyond closed-ended scores.
Negative or actionable comments were linked with eight to nine points lower global ratings. Reviewing negative comments can help spot fixable care problems.
Key findings
01Comments deemed negative or actionable at the organization level were associated with a drop of eight to nine points in global ratings.
02Adding comment valence and actionability indicators explained an additional 10% of variance in Overall Rating and 7% in Willingness to Recommend.
03Respondents who provided comments had significantly lower Overall Rating scores than those who did not, by 8.6 points.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done at a 131-bed children's hospital with two facilities, so it may not apply to other hospitals. The survey response rate was 10 to 11% each year, and the authors could not compare respondents with the general patient population. Comments were more common from White respondents and those with higher educational attainment, so parent feedback may underrepresent some families. The analysis is observational; it reports associations between comment characteristics and ratings, not effects of acting on comments. The study did not collect child's specific age, only whether the child was 13 years of age or older. Missing data were imputed using hospital-specific means, and missingness ranged from 2.0% to 4.3% for case-mix variables and 1.2% to 5.9% for screener questions. Mixed comments were coded as both positive and negative.
The easy way to misread this
Do not read these survey associations as proof that comments cause worse ratings or that reviewing comments improves care. The study was a single hospital survey analysis with a 10 to 11% response rate, and it did not test an intervention.