Childbirth-specific patient-reported outcomes as predictors of hospital satisfaction

Abstract Background Under value-based payment programs, patient-reported experiences and outcomes (PROs) can impact hospital and physician revenue. To enable obstetrical providers to improve the childbirth experience, a framework for understanding what women expect and desire during childbirth is needed. Objective To identify key predictors of childbirth hospital satisfaction using the Childbirth Experiences Survey (CBEX). Study Design This study builds on a larger effort that used Patient-Reported Outcomes Management Information System (PROMIS®) methodology to develop a childbirth-specific preliminary PRO item bank. These efforts led to the development of an antepartum and postpartum survey (CBEX Parts 1 and 2). All phases of the study were conducted with the participation of a community-based research team. We conducted a prospective observational study using national survey response panels organized through Nielsen to identify women’s antepartum values and preferences (VP and 2) 23 childbirth-specific PROs were identified. Examples of these PROs, such as being told about progress in labor and being involved in decisions regarding labor pain management, appeared especially relevant to women experiencing childbirth. A final model predicting women’s satisfaction with hospital childbirth services included a total of eight items that could be optimized by doctors, midwives, and hospitals. These included the patient’s report of how well she coped with labor pain, whether the hospital provided adequate space and food for their support person, and whether she received practical support for feeding the newborn. Conclusions This study identified 23 childbirth-specific PROs that were predictors of childbirth hospital satisfaction. The implementation of CBEX Parts 1 and 2 in a multi-hospital setting may lead to the development of childbirth hospital performance measures and strategies for improvement of the childbirth experience.