In first national survey, patients give low scores to hospitals

The study appears in the October 30, 2008 issue of The New England Journal of Medicine.

"These data really represent a sea change for the health care system. Patient-centered care is at the heart of a high-performing system and until now, we have lacked information on how patients feel about their care. With this information now freely available, providers and policymakers can begin to focus on improving patients' experiences in the hospital," said lead author Ashish K. Jha, MD, MPH, and assistant professor of health policy at HSPH.

The researchers analyzed data collected in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which asked patients questions about their hospital experiences and their demographic characteristics. Responses were grouped into six areas: communication with doctors, communication with nurses, communication about medications, quality of nursing services, how well hospitals prepared patients for discharge and pain management. More than 2,400 hospitals (about 60% of U.S. hospitals) reported data.

To view data on individual hospitals, go to the U.S. Department of Health & Human Services Hospital Compare website (www.hospitalcompar … pare.hhs.gov) and click on the "Find and Compare Hospitals" button. The site provides data on patient experiences as well as other quality-of-care measures.

The results showed that, on average, about 67% of patients would definitely recommend the hospital at which they were treated. Patients were more satisfied with hospitals that had a greater ratio of nurses to patients, which wasn't surprising to the researchers. However, the HCAHPS survey provides the first national data to show the important role that nurses can play in providing patient-centered care.

Another important finding of the study was that hospitals with more satisfied patients generally provided higher quality of care as measured by standard quality metrics. Hospitals in which patients rated their care highly were more likely to provide the appropriate care for heart attack, congestive heart failure, pneumonia and prevention of surgical complications.

"Our study confirms that there need be no tradeoff between ensuring that care is technically superb and addressing the needs of the patients," said senior author Arnold Epstein, MD, MA, and chair of the Department of Health Policy and Management at HSPH.

There were large variations in patient-satisfaction performance across the country. For example, 71.9% of hospital patients in Birmingham, AL, gave their care a high rating (9 or 10 on a 10-point scale); hospitals in Knoxville, TN (69.9%) and Charlotte, NC (69.4%) received the next-highest scores. Patients gave hospitals in East Long Island, NY (49.9%), Fort Lauderdale, FL (51.9%) and New York City (52.3%) the lowest marks. (Interested reporters can view a list of the 40 largest local regions in the U.S. and their performance by contacting Todd Datz in the HSPH Office of Communications, whose contact information appears on this release.)

The researchers were surprised by some results. Pain management has been the target of both accreditation and quality-improvement initiatives for many years, but nearly a third of patients did not give high ratings in that area. Discharge instructions have similarly been targeted for quality initiatives, but about a fifth of patients did not rate communications in that area highly. "Given that we spend more than $2 trillion annually for health care in our country, we should expect that the basics are addressed, like always treating pain adequately," Jha added.

Jha and his colleagues are hopeful that the public reporting of patient experience data will lead to improvements in patient-centered care. "As medicine becomes increasingly high-tech, sometimes the basic needs of patients have gotten lost. Our hope is that by systematically measuring and publicly reporting on how patients experience their care, hospitals will be inspired to better meet the needs of their patients," he said.

Citation: "Patients' Perception of Hospital Care in the United States," Ashish K. Jha, E. John Orav, Jie Zheng, Arnold M. Epstein, The New England Journal of Medicine, October 30, 2008, 359;18.

Source: Harvard School of Public Health