PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Most hospitals in the United States rely on patient satisfaction ratings to see how well they are providing high-quality, patient-centered care. However, there has been little research about what affects patients’ ratings.

Project Purpose

The researchers wanted to know if hospitals’ measures of patient-centered care related to things like the outcomes of patient care or the kinds of services patients received when they arrived and when they left the hospital. They also wanted to know if the patient-centered care measurements were related to a patient’s race/ethnicity, age, gender, medical conditions, or seriousness of those conditions. The research team also looked at whether there was any connection between patient-centered care measurements and use of electronic health records in the hospital.

Methods

The researchers used information from acute care hospital records in 14 states over three years (2009–2011) to understand how different factors affected a patient’s rating of their satisfaction with their hospital stay.

The researchers used information about

• Patients’ experience during their hospital stay
• Age, gender, illness, race/ethnicity, and other patient characteristics
• Whether patients got better or worse while they were at the hospital
• How much the hospitals used electronic health records in caring for patients

Findings

Patients reported lower satisfaction scores at hospitals that had larger numbers of Medicaid patients, Medicare patients, or minority patients. Patients at hospitals owned by for-profit organizations reported lower satisfaction than patients at nonprofit hospitals. Hospitals that offered critical care also had lower patient satisfaction scores than other hospitals. Researchers found that hospitals with high patient satisfaction scores didn’t always have the best patient outcomes. They also found that patient satisfaction scores improved overall for different types of hospitals and all kinds of patients from 2009 to 2011.

Limitations

The researchers only looked at one period of time. The results might be different during other years. They did not use information from all hospitals in the United States. The results might be different at other hospitals.

Importance of Findings

The findings encourage all hospitals, but especially for-profit hospitals and those that serve large numbers of Medicaid, Medicare, or minority patients, to look for ways to increase patient-centered care and improve the patient experience.

Sharing the Results

The researchers have published articles based on this work and have presented their results at meetings. (see below)

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Patient satisfaction in the hospital has become an important part of high-quality patient-centered care. However, few studies have examined what hospital features, patient characteristics, and hospital processes influence higher levels of patient satisfaction. This study sought to address this research gap.

Project Purpose

This PCORI project built a national hospital database centered on the patient’s care experience for all acute care hospitals in 14 states and evaluated the relationships among hospital measures of patient-centered care (PCC), hospital processes, and various clinical and resource outcomes. Specific aims of the project included:

• Analyzing the extent to which hospital PCC measures correlate with hospital evidence-based processes, costs, and clinical outcomes
• Evaluating how hospital PCC measures are influenced by the patient’s race/ethnicity, age, gender, chronic conditions, and severity of illness
• Analyzing the relationship between hospital PCC measures and the implementation of the electronic health record (EHR)
• Assessing the potential implications for hospitals and PCC of value-based incentive reimbursement

Study Design

The research team developed and used a causal model that analyzes the influence of major variables from the hospital’s environment, market structure, patient characteristics, and processes on the patient’s satisfaction with their hospital stay.

Data Sources

Researchers created a 14-state database linked, by hospital, to three years (2009–2011) of patient data from multiple national data sets representing a comprehensive mix of market, structure, process, patient satisfaction, and outcomes data. These data sets were:

• Hospital Consumer Assessment of Healthcare Providers and Systems
• Corresponding Agency for Healthcare Research and Quality State Inpatient Databases hospital discharge data for all acute care hospitals in 14 states, with detailed information on patients’ outcomes and their race/ethnicity, age, gender, chronic conditions, and severity of illness
• American Hospital Association (AHA) Annual Survey for 2010, with details on the structural and process characteristics of study hospitals
• AHA Survey of EHR Implementation for 2010, reflecting the extent of hospital implementation of EHRs
• Data from the Health Resources and Services Administration’s Area Resource File, with market data on hospitals’ environment

Data Analysis

Descriptive and multivariate data techniques were used to evaluate relationships among measures of the hospitals’ environment, market structure, and processes and patients’ satisfaction with their hospital stay.

Findings

Findings from this study included:

• Poorer patient satisfaction levels in hospitals serving higher levels of Medicaid patients were observed;
• Hospitals with higher shares of Medicare patients or a higher proportion of minority patients, as well as hospitals owned by for-profit organizations and critical care hospitals, showed decreased patient satisfaction;
• Many significant differences persisted in PCC measures associated with nearly all major dimensions of the hospitals studied, and for many of the PCC measures, differences in patient satisfaction scores were significant;
• Hospitals with the highest patient satisfaction scores did not always have the best patient outcomes;
• During the 2009–2011 period, almost all aspects of patients’ experience of care showed improvement;
• For nearly every patient and hospital characteristic measured, patients’ satisfaction with their hospital care improved.

Limitations

Results are focused on the 2009–2011 time period and represent only one-third of the nation’s acute care hospitals.

Conclusions

Hospitals may need different strategies to cope with the pressing demand for both quality and efficiency, and patients may continue to experience lower degrees of satisfaction in for-profit hospitals or those serving higher levels of Medicaid, Medicare, or minority patients.

Dissemination

Several articles have been published from this research (see below), and several presentations were made at national meetings.