Hospital-based professional spiritual care: evaluating the utilization, availability, and impact of chaplains.

BACKGROUND: The Affordable Care Act, enacted in 2010, transformed healthcare policy and forced hospitals to reevaluate traditional methods for care delivery. Researcher advocated for patient-centered models of care to reduce costs, address inequitable access to services, and improve service quality. These models prioritize patient values, preferences, and beliefs inclusive of patients’ religious and spiritual needs. Professional chaplains provide religious and spiritual care within many hospital settings. This dissertation explored the characteristics of hospitalized persons using chaplains, the factors associated with a hospital reporting a chaplaincy department, and how those services impacted patient satisfaction. METHODS: The first analysis used a two-part hurdle model to examine characteristics of those hospitalized at one midwestern hospital from 2012 to 2017. The second analysis employed Resource Dependency Theory and Institutional Theory to analyze the American Hospital Association (AHA) and Area Health Resource File (AHRF) through a pooled logistic regression model. The final paper used AHA and AHRF data combined with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data to identify if a difference in patient satisfaction scores existed between hospitals with and without chaplaincy departments. Contingency Theory guided the final analysis. FINDINGS: Persons with longer hospitalizations and with poor or fair self-rated health used a chaplain more often and at a higher rate than those with less acute health needs. Larger hospitals, those with increasing percent Medicare days, accredited by the Joint Commission, non-profit, and health system members were more likely to report a chaplaincy department as well as those in more munificent environments. Medium size hospitals had better patient satisfaction and more respondents likely to recommend it when they had a chaplaincy department. CONCLUSIONS: Hospitalized persons with more acute health needs utilize chaplaincy at a greater rate; hospitals with the institutional framework and more munificent environments provide these services. Medium sized hospitals have higher patient satisfaction rates, a metric influential in reimbursement. Although the presence of these services has increased over the past ten years, no standardization of service provision exists. The ability for some hospitals to provide chaplaincy, a service that could impact reimbursement, warrants further standardization by administrators and healthcare policymakers