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Center for Health Services and Outcomes Research

Innovative Methods: New Applications

Longitudinal Profiling of Hospital Performance on Patient Experience of Care: Applications to Value-Based Purchasing (VBP)

The Centers for Medicare & Medicaid Services (CMS) incorporates improvement information into the scheme of scoring hospitals’ performance by comparing a hospital’s scores at two different time periods. This type of direct comparison, however, may not reliably reflect a hospital’s performance change over time. This study is building a multilevel model to examine longitudinal performance on patient care experiences measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey over time. It is also developing a new approach for profiling hospitals based on Empirical Bayes (EB) residuals of performance levels and trends, and  comparing the types of hospitals that may be financially rewarded or penalized for HCAHPS performance under the VBP program.


Zhu J, Dy SM, Wenzel J, Wu AW. Association of Magnet status and nurse staffing with improvements in patient experience with hospital care, 2008-2015. Med Care. 2018;56(2):111-120

Zhu J. Trends in patient experience of hospital care in the United States, 2007-2013. Podium Presentation, AcademyHealth’s Annual Research Meeting, Minneapolis, MN, 2015

Zhu J, Weingart SN, Ritter GA, Tompkins CP, Garnick DW. Racial/ethnic disparities in patient experience with communication in hospitals: real differences or measurement errors? Med Care. 2015; 53(5):446-454.