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Background: Federal law mandates that Medicare-certified home healthcare agencies measure patient satisfaction using the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey. Results are publicly reported to allow prospective patients to make meaningful comparisons between home healthcare agencies and to provide incentives for home healthcare agencies to improve their services. Medicare payments are also tied to HHCAHPS survey results. VNA Health Care, Inc.(VNAHC) currently falls below their own preferred standards for two key measures of patient satisfaction from the HHCAHPS survey: 1.)"Overall Rating of Care"; 2.)"Likelihood of Recommending "the agency to family or friends.

Objectives: The objective of this project was to identify variables which may influence these two key measures of patient satisfaction, and in doing so, to identify areas of opportunity for VNAHC to improve patient satisfaction and their HHCAHPS survey scores.

Methods: Three analyses were under taken during this project including an initial data review, logistic regression analysis and qualitative analysis. For the initial data review, 19 HHCAHPS survey questions across five categories were analyzed. VNAHC's average scores in each category were compared to Connecticut and national averages in both 2011 and 2012. For the logistic regression analysis, HHCAHPS survey data from 200 randomly selected VNAHC patients were analyzed using a bivariate logistic regression model. A chi-square test was used to assess associations between specific HHCAHPS variables and VNAHC’s "Overall Rating of Care". For the qualitative analysis, areas for improvement identified through the initial data review were used to construct a VNAHC employee questionnaire. Telephone interviews were conducted with 20 VNAHC employees to identify barriers to delivering quality patient care.

Results: The initial data review revealed that VNAHC's average scores in five categories increased between 2011 and 2012. In 2012, each of the five categories exceeded either the Connecticut or national average. The initial data review also identified several questions on which VNAHC has consistently scored lower over the last two years as well as several questions on which VNAHC has consistently scored higher. The regression analysis revealed that a variety of characteristics regarding the patient-provider relationship significantly affect the odds of patients rating VNAHC’s “Overall Rating of Care” at least 9 (out of 10). Finally, the qualitative analysis revealed opportunities for improving patient care in the following areas:1.) transfer of patient information from hospitals to VNAHC staff; 2.) transfer of patient information among VNAHC staff; 3.) communication with patients about medications and side effects.

Publication Date



Community Health and Preventive Medicine

Improving Patient Satisfaction: Assessment and evaluation of VNA Healthcare’s HHCAHPS performance (Visiting Nurse Association Healthcare Inc.)