196


Table 1. Patient Demographics Patient Characteristics


Age, mean (SD)


Gender Male


Female Race White Non-White


Payer type Medicaid Medicare Private Self-Pay Other


Length of stay, mean (SD) APR SOI index


74 26


7


37 32 1


24 5.0 (6.0)


127 239 328


Note. SD, standard deviation; APR SOI, all-patient refined severity score. aPatient not in isolation at any point during their hospital stay. bPercentage unless otherwise indicated. cPatient in isolation for at least 50% of their hospital stay.


However, our adjusted analysis showed that patient isolation


was associated with inferior experience on a narrower set of items. Patients reported worse experience with responsiveness to toi- leting needs (aOR, 0.77; P=.0009), responsiveness to call button (aOR, 0.78; P<.0001), staff doing everything to help with pain (aOR, 0.77, P=.0001), and overall rating (aOR, 0.78; P<.0001). There was no association with nursing communication. Patients in isolation reported worse experience with only 1 of the 3 phy- sician items, doctors listened carefully (74% vs 80%; OR, 0.82; P=.0007). Dose-response analysis was nonsignificant for all items (Table 2). The Press Ganey item on nursing responsiveness was also negatively associated with patient isolation status (52% vs 61%; aOR, 0.81; P=.0003), but there was no association with time the physician spent with the patient (52.5% vs 56.5%; aOR, 0.92; P=.14). A subgroup analysis of the contact-only isolation group had similar results as the combined isolation group. A subgroup analysis of the droplet and airborne isolation groups did not show any significant association with patient experience.


Discussion


In this retrospective analysis of HCAHPS data from a single, academic, tertiary-care hospital, we found that patient isolation


sizes.11–13 Vinski et al14 conducted one of the larger studies. Our findings are consistent with theirs in showing worse patient experience with staff responsiveness. To contextualize this find- ing, hospitals reporting composite patient experience scores of 61% on staff responsiveness (similar to our control group) are at 46th percentile and those reporting 51% (similar to our exposure group) are at 5th percentile nationally. We additionally note that patients reported worse experience with overall care. Their study did not adjust for any potential confounders and noted a trend toward worse experience in multiple other domains. Our study had a larger sample size, and we found those trends to be sta- tistically significant in the unadjusted models. However, the association with isolation was markedly attenuated in the adjusted models, suggesting that the associations with inferior experience


was associated with worse patient experience on items susceptible to timely staff responsiveness and with overall care. Patients did not report adverse experience with nursing communication and, for the most part, with physician communication. The absence of a dose response to an increase in percentage of days spent in isolation could suggest that differences in experiences may be the result of unmeasured cofounders related to illness rather than isolation itself, or that any exposure to isolation status, however brief, still taints patient experience. Prior negative studies have had relatively small sample


61 39


15 48 21 1


16 7.5 (10.6) 6


27 49


46 17 <.0001 <.0001 <.0001


Zishan K. Siddiqui et al


Patients Not in Isolation (n=18,816), %a,b


58.1 (16.0)


49 51


Patients in Isolation (n=1,784), %b,c


59.7 (15.1)


47 53


P Value <.0001


.0640


<.0001


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