October 30, 2008
People don't much like what they find when they go the hospital.
In 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 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 reported data.
The results showed that, on average, about 67 percent 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 percent of hospital patients in Birmingham, AL, gave their care a high rating (9 or 10 on a 10-point scale); hospitals in Knoxville, TN and Charlotte, NC received the next-highest scores.
On the other hand, patients gave hospitals in East Long Island, NY, Fort Lauderdale, FL and New York City the lowest marks.
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 said.
