Patients generally pleased with hospital care

Three in five inpatients are extremely satisfied with their hospital care. And two of three patients would definitely recommend their hospital to friends and family, according to new survey data released last month by the U.S. Dept. of Health and Human Services.

The patient satisfaction data also show that eight in 10 patients said their physicians always explained things clearly, listened carefully and treated them with courtesy and respect.

Randomly selected patients from more than 2,500 hospitals were surveyed between October 2006 and June 2007 about a hospital stay of at least one night. Approximately 3,000 patients per hospital were asked about 22 issues, including doctor and nurse communication, quality of pain management and hospital noise level at night.

Organizations representing seniors, businesses, labor unions, hospitals, nurses and academic medical centers greeted the findings as a step forward in the movement to give patients useful health care quality information to help them decide where to seek care.

"We are deeply committed to improving the quality of health care, and transparency is an important ingredient in the mix to achieve that," said Blair Childs, a spokesman for Premier Inc., a health care purchasing alliance of 1,700 nonprofit hospitals. "As we all are trying to improve satisfaction with the health care system broadly, the more patient-oriented we get, the better."

While the numbers look good, experts said patients' firsthand reports about their hospital experiences reveal opportunities for improvement.

For example, even though 79% of patients said doctors always communicated well with them, 21% said their physicians sometimes failed in this area. A third of patients said their pain was inadequately controlled, and four in 10 said staff failed to explain the purpose of medications they were given.

"The results indicate areas where we all -- not just doctors -- need to work on improving communication," said Carolyn M. Clancy, MD, director of HHS' Agency for Healthcare Research and Quality. "One of the findings that jumped out for me was that 20% of patients reported that they did not get written materials about what to do in discharge and follow-up. On the receiving end in practice, I've often been in the role of trying to play medical detective trying to figure out what happened in the hospital."

Dr. Clancy said poor discharge planning increases patients' chances of being readmitted to the hospital.

Experts stress that the patient survey, known as the Hospital Consumer Assessment of Health Care Providers and Systems, differs from some previous efforts that seemed to focus on the superficial aspects of the hospital experience.

"This is not about what doctors will often call the amenities or hotel features," said Shoshanna Sofaer, PhD, a professor in the Baruch College School of Public Affairs in New York who helped test the hospital survey with focus groups of recently hospitalized patients. "There's no question on the food. We know what the answer will be: The food stinks. That's really not important to people. ... What people want is to be taken care of well when they go to hospital, not pampered."

User-friendly comparisons?

There was no money at stake for hospitals in deciding whether to participate in this first round of surveys. But starting this July, they will face a 2% cut in Medicare inpatient care reimbursements if they opt out. The Centers for Medicare & Medicaid Services said it expects about 3,900 hospitals to cooperate with the patient survey process later this year.

For the first time, HHS last month released volume and average Medicare payment information on a limited range of surgical procedures. Meanwhile, AHRQ is developing standardized patient questionnaires to compare office-based physicians.

Even as the push for more public reporting moves ahead, there are doubts about the impact such reporting has on quality improvement and patients' medical decision-making. A systematic review in the Jan. 15 Annals of Internal Medicine found that public reports stimulate quality activity in hospitals, but there is little evidence they improve the effectiveness, safety or patient-centeredness of care.

Experts say one reason for public reports' modest impact is that patients often find them difficult to use to make meaningful comparisons. With the release of the new data, the Hospital Compare Web site was redesigned in an attempt to make it easier to use (link). So how does it measure up?

The site "is just not very user-friendly," said Judith H. Hibbard, PhD, who studies how patients understand and use health care information. She said the search function is subpar and that it is hard for users to compare hospitals on more than one metric at a time.

HHS has done "80% of the work, and someone else can do the other 20%," said Dr. Hibbard, professor in the University of Oregon's Dept. of Planning, Public Policy & Management. "This might be excellent data for information intermediaries to repackage for consumers. Other Web sites can use the information more effectively."