How do hospital patients rate their experiences with hospital care?
Between 6 and 26 percent of community-dwelling adults receiving treatment at 254 U.S. hospitals during 2005 gave survey ratings suggesting deficiencies in some aspects of the quality of their hospital care. Patients gave the highest ratings to interactions with physicians and nurses, whereas they gave the lowest ratings to the adequacy of communication about medications.
Why is this important?
Many hospitals are interested in learning about patients' experiences in an effort to promote patient-centered caregiving. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey was developed by the federal Agency for Healthcare Research and Quality on behalf of the Centers for Medicare and Medicaid Services to allow comparisons of patient experiences across hospitals and to support hospital quality improvement efforts. The survey was piloted among 254 hospitals during 2005.
Findings
In a survey of adult patients treated at 254 U.S. hospitals during 2005, the majority of respondents (58% to 81%) gave the best rating possible in seven critical aspects of hospital care or service. Patient interactions with physicians and nurses were the aspects of care that received the highest scores.
Conversely, up to one-quarter of respondents (6% to 26%) gave ratings suggesting deficiencies in these seven aspects of care. Respondents gave the lowest ratings to communications about medications and discharge instructions (AHRQ 2006).
Overall, one-half of respondents (55%) rated the hospital very highly (nine or 10 on a scale from 0–10), and most respondents (94%) said that they would definitely (71%) or probably (23%) recommend the hospital to friends and family.
Implications
These results provide a preliminary look at how patients view critical aspects of their experience in hospitals and confirm findings of prior surveys in which patients have reported problems in their care (Coulter and Cleary 2001).
The fact that many patients identified potentially serious problems in communication about medications and discharge information, while also giving high ratings to their overall interactions with clinicians, demonstrates the importance of asking specific questions to identify care processes that warrant improvement.
Improvement Ideas and Resources
Beginning in 2007, the Centers for Medicare and Medicaid Services will publicly report hospital-specific results from the CAPHS Hospital Survey for hospitals that volunteer to participate in data collection under the Hospital Quality Alliance initiative, a publicprivate partnership. Given that many patients say they would consider changing hospitals in response to scores on the survey (Sofaer et al. 2005), public reporting is expected to provide external incentives for improvement.
Measure:
The CAHPS Hospital Survey was developed through "a rigorous process of consumer testing, field testing, statistical analysis, and public feedback." Among 18 substantive questions, 16 are combined into seven composite measures that assess a particular aspect of care or service:
- communication with doctors (three questions);
- communication with nurses (three questions);
- responsiveness of hospital staff among those who pressed a call button or needed help with toileting (two questions);
- cleanliness and quietness of the hospital (two questions);
- pain control among those who needed medication to control pain (two questions);
- communication about medicines among those who were given new medications in the hospital (two questions); and
- discharge information among those discharged home (two questions).
The other two substantive questions ask participants whether they would recommend the hospital to friends and family and to rate the facility on a scale of 0 (worst possible) to 10 (best possible) (AHRQ 2006).
The reference population is adults ages 18 and older who received treatment at one of 254 test-site hospitals that voluntarily administered the CAHPS Hospital Survey during 2005. As used in the narrative, respondents mean survey participants who responded to a survey question when applicable (some questions are limited to subpopulations based on responses to a screening question). Some response categories were combined in the charts.
Limitations:
Results are not nationally representative and were not audited for accuracy. In comparison to all U.S. hospitals, participating hospitals were more likely to be larger and teaching institutions and less likely to be government owned or controlled and to be located in the West Central, Mid Atlantic, or New England regions. Hospitals fielded their surveys at different times during the year and were not required to follow standard protocols. Response rates averaged 44 percent across 184 hospitals that reported response rates (range 11% to 100%).
Source:
Results were compiled by the National CAHPS Benchmarking Database (AHRQ 2006), sponsored by the Agency for Healthcare Research and Quality, using data submitted by 254 test-site hospitals that voluntarily administered the CAHPS Hospital Survey by mail, telephone, or interactive voice response during 2005.
References:
* Indicates source of data used in the chart(s).
Coulter, A., and P. D. Cleary. 2001. Patients' Experiences with Hospital Care in Five Countries. Health Affairs 20 (3): 24452.
* AHRQ (Database, N. C. B.). 2006. CAHPS Hospital Survey Chartbook: What Patients Say About Their Experiences with Hospital Care. Report of Summary Data from Hospital Test Sites. AHRQ Pub. No. 06-0049. Rockville, Md.: Agency for Healthcare Research and Quality.
Sofaer, S., C. Crofton, E. Goldstein et al. 2005. What Do Consumers Want to Know About the Quality of Care in Hospitals? Health Services Research 40 (6 Pt 2): 201836.