Decoding Hospital Dynamics: The Role of Hospital Structure and Processes in Shaping Healthcare Outcome Success.

Abstract

Significant efforts have been dedicated to reducing post-discharge adverse events (AEs) and improving patient satisfaction, but there are still many calls for improvements. Thus, this study aims to identify the underlying mechanism to aid US hospitals in reducing post-discharge AEs and improving patient satisfaction, thereby improving the quality of care. Based on Donabedian's structure-process-outcome (SPO) model of healthcare quality, we conducted a cross-sectional analysis of hospital performance and examined hospital structure, process, and outcomes in the USA using five data sources. Separate multiple linear regression analyses and ordinal regression analyses were conducted to analyze the quality of care. We found that hospital structure had associations with hospital process: lower provider-patient communication scores were associated with having a higher bed count, operating under a for-profit structure, having higher percentages of Medicare, and being in Metropolitan areas. Additionally, we found hospital process had associations with healthcare outcomes. In particular, provider-patient communication ratings, especially nurse-patient communication and care transition guidance, was positively related to patient satisfaction. Furthermore, having post-discharge medical primary care physician (PCP) follow-up visits within 14 d showed a lower incidence of AEs such as emergency room (ER) visits and readmissions within 30 d.