title: Qualitative complaints and their relation to overall hospital rating using an H-CAHPS-derived instrument.
abstract: Due to the multitude of questions in the Hospital-Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) survey, it may be difficult to decide where quality improvement efforts should be focused. Our organisation has supplemented the survey with a 'patient complaints' section. The study objectives were to determine (1) the frequency of qualitative complaints and the demographic/clinical profile of patients lodging them, (2) the most frequent complaint themes and their association with overall experience scores and (3) whether overall experience scores varied based upon the complaint action taken by the patient or the degree of patient satisfaction in the handling of complaints.
  
  
  
  From April 2013 to March 2014, 8929 telephone surveys were completed by patients discharged from 93 acute care hospitals in Alberta, Canada. These were successfully linked with the corresponding inpatient record. Open-ended complaints were themed into categories. Mean differences in overall inpatient experience were assessed for each complaint theme, including overall and multiple complaints.
  
  
  
  1870 patients (20.9%) reported at least one open-ended complaint. Most frequent complaint themes were nursing (n=491; 5.5% of cohort), medications (n=219; 2.5%) and food (n=193; 2.2%). Increased odds of having a complaint were associated with younger age, being born in Canada and having no documented medical comorbidities. Protective factors were male gender, lower education level, urgent hospital admission, lower resource intensity and length of stay (LOS) <3 days.
  
  
  
  This is the first investigation of its type using H-CAHPS-based data in a Canadian context. Through replication of this study, other healthcare organisations may determine the association between open-ended complaints and their own overall experience scores.
authors.affiliation: Analytics (DIMR), Alberta Health Services, Calgary, Canada Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Kyle
authors.initials: K
authors.lastname: Kemp
authors.affiliation: Analytics (DIMR), Alberta Health Services, Calgary, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Warren
authors.affiliation: Analytics (DIMR), Alberta Health Services, Calgary, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Chan
authors.affiliation: Analytics (DIMR), Alberta Health Services, Calgary, Canada.
authors.forename: Brandi
authors.initials: B
authors.lastname: McCormack
authors.affiliation: Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Santana
authors.affiliation: Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000416:Alberta; D005260:Female; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Health services research; Patient satisfaction; Quality improvement; Quality improvement methodologies; Surveys