{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:31:39Z","timestamp":1793302299299,"version":"4.5.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"JSPS KAKENHI","award":["JP23K16269"],"award-info":[{"award-number":["JP23K16269"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the increasing adoption of patient experience measurement in Asia, including Japan, limited progress has been made in identifying suitable patient-level adjusters and developing statistical methods for case-mix adjustment. This study aimed to develop and evaluate a case-mix adjustment model for the Japanese version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) using nationwide benchmark survey data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter cross-sectional study using data from 83 hospitals across Japan that participated in the 2023 national patient experience survey. Self-administered questionnaires were distributed to adult inpatients (aged \u226520\u2009years) discharged between September and November 2023. The Japanese version of HCAHPS, comprising six composite measures and two global ratings, was used to calculate top-box scores (percentage of most positive responses). Candidate case-mix adjusters included age, gender, self-rated general health, self-rated mental health, and admission through the emergency department. The explanatory power (EP) of each adjuster was calculated as the product of predictive power and the between- versus within-hospital variance ratio. The impact of adjustment was evaluated by comparing unadjusted and adjusted scores and by assessing hospital rank changes using Kendall\u2019s \u03c4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data from 13\u2009602 patients were analyzed. Self-rated mental and general health showed the highest EP, whereas gender and emergency admission contributed minimally. The mean absolute adjustment of top-box scores ranged from 0.77 to 1.96 points. Case-mix adjustment changed hospital rankings in 3.4%\u201310.2% of all possible pairwise comparisons (Kendall\u2019s \u03c4\u2009=\u20090.80\u20130.93).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides the first evidence-based case-mix adjustment model for HCAHPS scores in Japan. Applying such an adjustment is crucial to ensure fair benchmarking of PX across hospitals and to support data-driven quality improvement and accountability initiatives within Japan\u2019s evolving healthcare quality framework.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag160","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T12:23:22Z","timestamp":1790425402000},"source":"Crossref","is-referenced-by-count":0,"title":["Case-mix adjustment of HCAHPS scores based on national benchmarks in Japan: a multicenter cross-sectional study"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8232-2155","authenticated-orcid":false,"given":"Takuya","family":"Aoki","sequence":"first","affiliation":[{"name":"Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine , Tokyo,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1031-9096","authenticated-orcid":false,"given":"Masato","family":"Matsushima","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine , Tokyo,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"2026102914494820200_mzag160-B1","volume-title":"Crossing the Quality Chasm: A New Health System for the 21st Century","author":"Institute of Medicine (US) Committee on Quality of Health Care in America","year":"2001"},{"key":"2026102914494820200_mzag160-B2","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1215\/03616878-3620881","article-title":"Evolving concepts of patient-centered care and the assessment of patient care experiences: optimism and opposition","volume":"41","author":"Cleary","year":"2016","journal-title":"J Health Polit Policy Law"},{"key":"2026102914494820200_mzag160-B3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001570","article-title":"A systematic review of evidence on the links between patient experience and clinical safety and effectiveness","volume":"3","author":"Doyle","year":"2013","journal-title":"BMJ Open"},{"key":"2026102914494820200_mzag160-B4","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1177\/1077558714541480","article-title":"Examining the role of patient experience surveys in measuring health care quality","volume":"71","author":"Anhang Price","year":"2014","journal-title":"Med Care Res Rev"},{"key":"2026102914494820200_mzag160-B5","doi-asserted-by":"publisher","first-page":"1977","DOI":"10.1111\/j.1475-6773.2005.00477.x","article-title":"Measuring hospital care from the patients\u2019 perspective: an overview of the CAHPS hospital survey development process","volume":"40","author":"Goldstein","year":"2005","journal-title":"Health Serv Res"},{"key":"2026102914494820200_mzag160-B6","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1177\/1077558709341065","article-title":"Development, implementation, and public reporting of the HCAHPS survey","volume":"67","author":"Giordano","year":"2010","journal-title":"Med Care Res Rev"},{"key":"2026102914494820200_mzag160-B7","doi-asserted-by":"publisher","first-page":"e040240","DOI":"10.1136\/bmjopen-2020-040240","article-title":"Translation, adaptation and validation of the hospital consumer assessment of healthcare providers and systems (HCAHPS) for use in Japan: a multicentre cross-sectional study","volume":"10","author":"Aoki","year":"2020","journal-title":"BMJ Open"},{"key":"2026102914494820200_mzag160-B8","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/s12913-022-07467-8","article-title":"The contribution of benchmarking to quality improvement in healthcare. 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