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Journal Article


Patients' Perception of Hospital Care in the United States

An abstract is available at:

In the Literature


Using data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), researchers examined patients' experiences in U.S. hospitals—in the first study of its kind—and found that patients have moderately high levels of satisfaction with their care. The quality of clinical care and certain hospital characteristics, such as a higher ratio of nurses to patient-days, were associated with greater patient satisfaction.

The Issue

IMPORTED: www_commonwealthfund_org__usr_img_Jha_pull_quote_10_30_08.gif The quality of U.S. health care generally, and in hospitals specifically, varies widely. Although efforts are being made to collect and publicly report hospital quality data, patients' perceptions of care are not well known—even though the Institute of Medicine has identified patient-centered care as a key element of a high-quality health care system.

Key Findings

  • On average, 63 percent of patients responding to the HCAHPS survey gave their care a high overall rating (9 or 10, on a scale of 0 to 10); another 26 percent rated care as 7 or 8. Only 11 percent rated care as 6 or lower.
  • Sixty-seven percent of patients said they would definitely recommend the hospital in which they received care, and another 27 percent said they would probably recommend the hospital.
  • The ratio of nurses to patient-days was associated with patients' satisfaction: a larger percentage of patients in hospitals placing in the top quartile of nurses-to-patient-days ratio gave their hospital a 9 or 10 rating, compared with patients in bottom-quartile hospitals (66% vs. 61%).
  • Fewer patients in for-profit hospitals gave a 9 or 10 rating than patients in either private or public nonprofit hospitals (59% vs. 65% and 65%, respectively).
  • HCAHPS data indicated specific areas for improvement in nursing care, communication about medications, pain control, and provision of clear discharge instructions.
  • Patients' satisfaction with care was associated with quality of clinical care for four conditions: acute myocardial infarction, congestive heart failure, pneumonia, and prevention of surgical complications.
  • Patients' satisfaction ranged widely across regions: 72 percent of patients in Birmingham, Ala., gave 9 or 10 ratings, compared with 50 percent of patients in East Long Island, N.Y.

Addressing the Problem

While most patients are generally satisfied with their care, there is substantial room for improvement. Surprisingly, even in clinical areas that have been the target of quality improvement initiatives—like pain control, an area of focus for the Joint Commission—performance is suboptimal. But just as the public release of data on clinical performance has prompted improvements in clinical care, the regular reporting of patient satisfaction measures could similarly stimulate hospitals to deliver patient-centered care.

About the Study

The researchers assessed the performance of hospitals across multiple domains of patients' experiences—including communication, quality of nursing services, and pain management—using HCAHPS survey data from July 2006 to July 2007. Researchers compared HCAHPS scores with Hospital Quality Alliance data, which measures hospital compliance on evidence-based processes with respect to care for medical conditions, and with American Hospital Association data on hospital characteristics—such as nurse-staffing levels, profit status and bed size. The sample included 2,429 hospitals.

The Bottom Line

Across U.S. hospitals, there is a consistent positive relationship between patient-reported experiences and the quality of care, suggesting that the aims of providing patient-centered care and ensuring high clinical standards can be met simultaneously.

Publication Details



A. K. Jha, E. J. Orav, J. Zheng, and A. M. Epstein, "Patients' Perception of Hospital Care in the United States," New England Journal of Medicine, Oct. 30, 2008 359(18):1921–31.