title: Patient Perceptions of the Environment of Care in Which Their Healthcare is Delivered.
abstract: OBJECTIVE
  To measure patients' perceptions of the environment of care (EOC), with a focus on the physical environment, in which healthcare is delivered.
  
  
  BACKGROUND
  The EOC may impact patient experiences, care perceptions, and health outcomes. EOC may be improved through redesign of existing physical structures or spaces or by adding nurturing amenities.
  
  
  METHODS
  Demographics, health status, hospital use, and data on the environment (physical, comfort, orientation, and privacy) were collected via a mailed cross-sectional survey sent to patients seen at four hospital Centers of Innovation (COIs; that implemented many modifications to the healthcare environment to address physical, comfort, orientation, and privacy factors) and four matched controls, supplemented with checklist and VA administrative data. A modified Perceived Hospital Environment Quality Indicators instrument was used to measure patients' EOC perceptions.
  
  
  RESULTS
  Respondents (3,321/5,117; 65% response) rated, [mean (SD)], exterior space highest, 3.09 (0.73), followed by interior space, 2.96 (0.74), and privacy, 2.44 (1.01). COIs had significantly higher ratings than controls on interior space (2.99 vs. 2.96, p = .02) and privacy (2.48 vs. 2.38, p = .005) but no differences for exterior space. Subscales with significantly higher ratings in COIs (vs. controls) in interior space were "spatial-physical comfort" and "orientation," for example, clean, good signage, spacious rooms, and for privacy included "not too crowded" and "able to talk without being overheard." Checklist findings confirmed the presence of EOC innovations rated highly by patients.
  
  
  CONCLUSIONS
  Patients identified cleanliness, good signs/information points, adequate seating, nonovercrowding, and privacy for conversations as important. Hospital design modifications, with particular attention to the physical environment, can improve patient EOC perceptions.
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University Chicago, Chicago, IL, USA sherri.lavela@va.gov.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: LaVela
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA.
authors.forename: Bella
authors.initials: B
authors.lastname: Etingen
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Hill
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Miskevics
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D006272:Health Facility Environment / Q000592:standards*; D006749:Hospital Design and Construction / Q000592:standards*; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D017060:Patient Satisfaction; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States
keywords: health facility environment; hospital design; patient preference; patient-centered care; veterans