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Many hospitals wish to improve their patients' experience of care. To learn whether social media could be used as a tool to engage patients and to identify opportunities for hospital quality improvement (QI), we solicited patients' narrative feedback on the Baystate Medical Center Facebook page during a 3-week period in 2014. Two investigators used directed qualitative content analysis to code comments and descriptive statistics to assess the frequency of selected codes and themes. We identified common themes, including: (1) comments about staff (17/37 respondents, 45.9%); (2) comments about specific departments (22/37, 59.5%); (3) comments on technical aspects of care, including perceived errors and inattention to pain control (9/37, 24.3%); and (4) comments describing the hospital physical plant, parking, and amenities (9/37, 24.3%). A small number (n = 3) of patients repeatedly responded, accounting for 30% (45/148) of narratives. Although patient feedback on social media could help to drive hospital QI efforts, any potential benefits must be weighed against the reputational risks, the lack of representativeness among respondents, and the volume of responses needed to identify areas of improvement., (© 2015 Society of Hospital Medicine.)

Background: Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement., Methods: Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup., Results: The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls-patients treated before bundle implementation-45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p=.24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p=.43), and lower median posthospital payments ($704 versus $1,121, p=.002), and were more likely to receive guideline-consistent care (99% versus 95%, p=.05)., Discussion: The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams.

This study examined the uncertainty experienced by persons with asthma and the coping strategies they used. The sample of 99 adults was interviewed by the investigators. Subjects responded to demographic and illness-related questions and completed the Mishel Uncertainty in Illness Scale and the Jalowiec Coping Scale. Subjects who had asthma for a longer duration reported lower levels of uncertainty. Those who were hospitalized because of asthma and those for whom pollen was a trigger experienced greater uncertainty. Females, individuals who went to an emergency department because of asthma, and those who attended pulmonary support groups used more coping strategies. Understanding the sources of perceived uncertainty may assist individuals to cope with and manage the chronic and acute phases of asthma.