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Study Assesses Patients' Views on Quality of Hospital Care

By Neda Semnani, CQ Staff

November 7, 2008 -- A new study on hospitals' quality of medical care shows 63 percent of patients reported being satisfied, but they also point to areas for improvement.

Researchers at the Harvard School of Public Health (HSPH), Boston's Brigham and Women's Hospital, and Boston's Veterans Affairs Health Care System found that although patients reported being generally satisfied with the quality of care they received, they were less satisfied when asked about specific aspects of care, such as the quality of pain management and patient discharge instructions provided.

The study, published in the New England Journal of Medicine, found that hospitals with higher levels of overall patient satisfaction were also more likely to be those with a greater nurse-to-patient ratio, a public hospital, or private nonprofit institutions. Such hospitals were also more likely to have scored higher in areas of "nursing services, discharge instructions, communication with nurses, and communication about medication."

Researchers also uncovered significant regional disparities in patient satisfaction levels, with Birmingham, Ala., representing the highest patient satisfaction ratings in the country and East Long Island, N.Y., as the lowest.

The study reported that patients also considered clinical expertise in treating conditions like heart attack, heart failure, and pneumonia when rating the quality of care, but that clinical excellence was no longer the sole barometer for measuring quality. "Until now, we have lacked information on how patients feel about their care," said Ashish Jha, the lead author and assistant professor of health policy at HSPH. This study demonstrates that as medical care has become increasingly hi-tech, Jha said, "the basic needs of patients have gotten lost."

"Our study confirms there need be no trade-off between ensuring that care is technically superb and addressing the needs of patients," agreed Arnold Epstein, senior author and chairman of health policy at HSPH.

Nancy Foster, vice president for quality and patient safety policy with the American Hospital Association (AHA), argued that the report does not mention enough of how hospitals are attempting to address gaps in how patient needs are being met. She pointed to Web sites like HospitalCompare, which were created in partnership with hospitals, as clear examples of hospitals' efforts. She also pointed out that studies like this one are drawing from information disseminated by the hospital group.

"Hospitals are working diligently to collect information on the patient experience, because we know there are opportunities for us to better serve them," Foster said.

The study was funded by the Commonwealth Fund and the Robert Wood Johnson Foundation and used information collected by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys, the first national patient assessment survey. The HCAHPS survey asked patients to rate communication with doctors, communication with nurses, communication about medication, quality of nursing services, discharge preparations, and pain management. Their responses were matched against AHA-provided information about hospital characteristics.

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