In first national survey, patients give low scores to hospitals

October 29, 2008

Boston, MA -- The quality of hospitals across the U.S. is inconsistent. To address this issue, the federal government and private organizations have begun to publicly report data, such as how well hospitals treat certain conditions. But until now, there has been no data on how patients themselves feel about the care they received. A new study by Harvard School of Public Health (HSPH) researchers analyzed the first national data on patients' experiences in hospital settings and found that though patients are generally satisfied with their care, there is substantial room for improvement in a number of key areas, including pain management and discharge instructions.

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.hospitalcompare.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.
-end-
Support for the research was provided by the Commonwealth Fund, New York, and The Robert Wood Johnson Foundation Faculty Scholar Program.

"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.

Harvard School of Public Health ( http://www.hsph.harvard.edu ) is dedicated to advancing the public's health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

Harvard T.H. Chan School of Public Health

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200852.

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.