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Running head: HCAHPS DATABASE PROJECT 1

Hospital Consumer Assessment of Healthcare Providers and Systems Database Project

Submitted to:

Juhi Israni, MS

Prepared by:

Karen Huacasi, BSN, RN

Master of Science in Nursing in Healthcare Informatics

May 11, 2018


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Executive Summary

Sharp Healthcare has decided to start collecting data about patient experience at five of

its hospitals. It has decided to the use the Hospital Consumer Assessment of Healthcare

Providers and Systems (HCAHPS) survey to find out what discharged patients think about their

hospital experience. It then created a database to store the data collected. Sharp Healthcare found

that overall, patients have had positive experiences at their hospitals. However, the data is being

used to pinpoint areas of care that need improvement. Use of the HCAHPS survey has helped

Sharp administrators make important decisions on where to invest time and money to improve

consumer satisfaction.
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Hospital Consumer Assessment of Healthcare Providers and Systems Database Project

Sharp Healthcare has decided to use the HCAHPS survey to collect data about patients

and their experience at five different Sharp hospitals. The five hospitals include, Sharp Coronado

Hospital, Sharp Chula Vista Medical Center, Sharp Grossmont Hospital, Sharp Memorial

Hospital, and Sharp Mesa Vista Hospital. A database will be created to store and manipulate the

collected data.

The HCAHPS survey, is a standardized survey instrument that measures and publicly

reports patients’ perspectives on hospital care. This survey asks discharged patients their

opinions of various elements of their recent hospital stay. These results are publicly reported,

which enables consumers to compare hospitals that participate. The results are used by Medicare

to calculate value-based incentive payments. (Rowell & Cutrell, 2013).

Data elements of the survey include survey topics, survey questions, responder answers,

and responder personal information. The various survey topics include “Your care from nurses”,

“Your care from doctors”, “Your experiences in this hospital”, “The hospital environment”,

“When you left the hospital”, “Overall rating of hospital”, and “About You”. There are 29 survey

questions that fall under the above survey topics. Most of the answer choices to these questions

are “Never”, “Sometimes”, “Usually”, and “Always”. There are also some “yes” or “no” answer

choices, and more variation from question 18 onward.

Methodology

The database created to store the data collected from the HCAHPS surveys consists of

three tables so far. Two forms have been created to make data entry and data searching user

friendly. Two queries were made to explore the data collected from the survey.

Tables
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Three tables were created to collect data. The first table is titled “SurveyTable”. The

attributes include “SurveyQuestionID”, “SurveyQuestion”, “SurveyTopic”, and

“SurveyTopicID”. The data source used for this table is the HCAHPS survey (Centers for

Medicare and Medicaid, 2018).

Entity Attribute Data Type Field Primary Definition


Size Key

SurveyTable SurveyQuestionID AutoNumber Long Yes a unique number


Integer assigned to an
individual survey
question
SurveyQuestion Long Text No the question presented
on the HCAHPS
survey
SurveyTopic Short Text 225 No the title of the topic
under which the
survey question is
categorized
SurveyTopicID Number Long Foreign a unique number
Integer Key assigned to each
individual topic

The second table is called “AnswersQuestion1”. The attributes include “ResponderSSI”,

“Answer”, “SurveyQuestionID”, and “ResponderID”. The main data source for this table is

responder personal identification information.

Entity Attribute Data Field Primary Definition


Type Size Key
Answers ResponderSSN Number Long Yes A unique number issued to U.S
Question Integer citizens, residents, and
1 temporary residents.
Answer Short 225 No The responder’s answer to the
Text survey question
SurveyQuestio Short 225 No A unique number assigned to
nID Text an individual survey question
ResponderID Number Long Foreign A unique number assigned to
Integer key each individual that completed
the survey. Used as an
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alternate primary key in this


table.

The third table is titled “ResponderTable”. The attributes of this table are

“ResponderID”, “FirstName”, “LastName”, “Street”, “City”, “State”, “Zipcode”, and “Hospital”.

The data source for this table is responder personal identification information.

Entity Attribute Data Type


Field Primary Definition
Size Key
Responder ResponderID AutoNumber Long Yes A unique number assigned to
Table Integer each individual that
completed the survey uased
as an alternate primary key
in this table
FirstName Short Text 225 No First name of each responder
LastName Short Text 225 No Last name of each responder
Street Short Text 225 No The street address of each
responder
City Short Text 225 No The city of each responder
State Short Text 225 No The state of each responder
Zipcode Number Long No The zipcode of each
Integer responder
Hospital Short Text 225 No The hospital at which each
responder received care

This is a list of all the tables in Database Design Language Format.

SurveyTable (SurveyQuestionID, SurveyQuestion, SurveyTopic, SurveyTopicID).

 Primary Key is “SurveyQuestionID”.

AnswersQuestion1 (ResponderSSI, Answer, SurveyQuestionID, ResponderID).

 Primary Key is “ResponderSSI”.

 Foreign Key is “SurveyQuestionID”

 Alternate Key is “ResponderID”

 The relationship between “SurveyTable” and “AnswersQuestion1” is one to many.

ResponderTable (ResponderID, FirstName, LastName, Street, City, State, Zipcode, Hospital).


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 Primary Key is “ResponderID”.

 The relationship between “AnswersQuestion1” and “ResponderTable” is one to many.

Forms

The first form is titled Responder. The purpose of this form is to allow for easy responder

data entry, new record creation, and responder data search. It allows the user to input the

responders first name, last name, address, and hospital. It automatically creates a unique

ResponderID for each new record. A drop-down menu is used to display the hospitals available

to choose from. This helps reduce spelling errors that can occur with the use of free text. The

“Add Record” and “Find Record” buttons are used to make it easy to find and add a record.

The second form is titled “Answers to question 1”. This form is designed to allow easy

data entry of the responders and their answers to the corresponding survey question. A drop-

down menu is used to display the answer choices for the first survey question. This again helps

reduce errors that can occur with the use of free text. The buttons labeled “Add Record” and

“Find Record” stand out in a way that makes it easy for the user to add or find a record.
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Queries

The first query seeks to find out which responders answered that nurses never treated

them courteously during their hospital stay. It also seeks to find out from which hospital these

responders received care. The results were requested to be ordered by hospital. Finding out

which patients had a negative experience and at which hospital this occurs helps to direct

improvement efforts in the right direction. The first query is stated as:

 List the hospital and responder ID for every patient that responded “never” when asked

how often nurses treated them courteously during their hospital stay

(SurveyQuestionID=1). Order the records by hospital.

 SELECT Hospital, ResponderTable.ResponderID

FROM ResponderTable, AnswersQuestion1

WHERE ResponderTable.ResponderID=AnswersQuestion1.ResponderID

AND SurveyQuestionID='1' AND Answer='never' ORDER BY Hospital;

 Query1
Hospital ResponderID
Sharp Chula Vista Medical Center 21
Sharp Chula Vista Medical Center 3
Sharp Grossmont Hospital 12
Sharp Mesa Vista Hospital 8
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The second query seeks to find out which survey questions do not have anything to do

with care received from doctors, nurses, or the about you section. This will help identify factors

within the hospital environment that need improvement, that excludes hospital staff. The query is

stated as:

 List the survey question and survey topic for survey question that is NOT about the care

received from doctors or nurses, or about you.

 SELECT SurveyQuestion, SurveyTopic FROM SurveyTable

WHERE NOT SurveyTopic='Your care from nurses'

AND NOT SurveyTopic='Your care from doctors' AND NOT SurveyTopic='About you';

Query2
SurveyQuestion SurveyTopic
During this hospital stay, how often were your room and bathroom The hospital
kept clean? environment
During this hospital stay, how often was the area around your room The hospital
quiet at night? environment
During this hospital stay, did you need help from nurses or other Your experience in
hospital staff in getting to the bathroom or in using a bedpan? this hospital
How often did you get help in getting to the bathroom or in using a Your experience in
bedpan as soon as you wanted? this hospital
During this hospital stay, did you have any pain? Your experience in
this hospital
During this hospital stay, how often did hospital staff talk with you Your experience in
about how much pain you had? this hospital
During this hospital stay, how often did hospital staff talk with you Your experience in
about how to treat your pain? this hospital
During this hospital stay, were you given any medicine that you had Your experience in
not taken before? this hospital
Before giving you any new medicine, how often did hospital staff Your experience in
tell you what the medicine was for? this hospital
Before giving you any new medicine, how often did hospital staff Your experience in
describe possible side effects in a way you could understand? this hospital
After you left the hospital, did you go directly to your own home, to When you left the
someone else’s home, or to another health facility? hospital
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Query2
SurveyQuestion SurveyTopic
During this hospital stay, did doctors, nurses or other hospital staff When you left the
talk with you about whether you would have the help you needed hospital
when you left the hospital?
During this hospital stay, did you get information in writing about When you left the
what symptoms or health problems to look out for after you left the hospital
hospital?
Using any number from 0 to 10, where 0 is the worst hospital possible Overall rating of
and 10 is the best hospital possible, what number would you use to hospital
rate this hospital during your stay?
Would you recommend this hospital to your friends and family? Overall rating of
hospital
Results

The results of this exercise can be visualized using reports.

Reports

The first report is based off the first query, “List the hospital and responder ID for every

patient that responded ‘never’ when asked how often nurses treated them courteously during

their hospital stay (SurveyQuestionID=1). Order the records by hospital”. The report showed that

four people responded that nurses never treated them courteously during their hospital stay. Two

responders stayed at Sharp Chula Vista Medical Center, One stayed at Sharp Grossmont

Hospital, and one stayed at Sharp Mesa Vista Hospital.


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The second report is based off the second query, “List the survey question and survey

topic for survey question that is NOT about the care received from doctors or nurses, or about

you”.
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Conclusions and Recommendations

In this make-believe scenario, Sharp Healthcare created a database to store data collected

using the HCAHPS survey. The queries were made to use the data to answer questions. These

queries sought to identify specific hospitals or parts of the hospital that needed improvement.

Sharp Healthcare found most patients that responded that “nurses never treated them courteously

during their hospital stay” were patients that received care at Sharp Chula Vista Medical Center.

They also found that there are fifteen different questions in the survey that ask about the hospital

stay in general. A useful addition to this database would be an additional 27 tables containing the

responses to the next 27 questions. It would also help to have specific information about the unit

or floor from which the patient received care. Finally, it would be useful to know the acuity of

the patient’s condition during the hospital stay. Overall, this database allows for safer storage,

easier input, and better manipulation of data than the excel spreadsheet that had been previously

used. Sharp Healthcare has benefited from the use of this database.
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References

Rowell, K. S., & Cutrell, A. (2013). The best boring book ever of select healthcare classification

systems and databases. Newton, MA: HealthDataViz.

Centers for Medicare and Medicaid. (2018, March). HCAHPS Survey. Retrieved April 6, 2018,

from http://www.hcahpsonline.org/globalassets/hcahps/survey-instruments/mail/july-1-

2018-and-forward-discharges/2018_survey-instruments_english_mail.pdf.