Perception of Hospital Care in the U.S.

Summary and Comment |
October 29, 2008

Perception of Hospital Care in the U.S.

  1. Neil H. Winawer, MD

Some patients weigh in . . .

  1. Neil H. Winawer, MD

Patient-centered care is a key element of high-quality healthcare systems, yet we know little about the quality of hospital care from the patient’s perspective. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was administered at hospitals nationwide. Researchers used data (patient surveys completed in 2006–2007) from approximately 2500 hospitals to assess four questions.

  • How do hospitals perform on measurements of patients’ experiences? Among patients who responded to the survey (approximately one third of recipients), 63% scored their care as 9 or 10 (out of a possible 10) on a global rating scale. An additional 26% rated their care as 7 or 8, and 11% assigned ratings of 6 or lower.

  • What characteristics of hospitals lead to better experiences? Hospitals with higher nurse–to–patient-day ratios scored higher on the surveys; for-profit hospitals scored lower than not-for-profits, and teaching hospitals scored similarly to nonteaching hospitals.

  • How do hospitals’ survey scores relate to their performance on measures of clinical quality? Hospitals in the top quartile of HCAHPS ratings performed slightly better than those in the bottom quartile with respect to treatment of acute myocardial infarction, congestive heart failure, and pneumonia.

  • How variable is the performance of hospitals across regions? A substantial range of performance was noted across the 40 largest hospital-referral regions. Birmingham, Alabama, received the highest global rating (72% of patients assigned scores of 9 or 10), whereas East Long Island, New York, received the least positive ratings (50% of patients assigned 9 or 10).


Most patients who completed the survey were satisfied with their hospital experiences. Although we might guess that hospitals with a high ratio of nurses to patients would score better, what explains the regional variations in patients’ experiences? This difference might be related to quality of care, but differences in patients’ expectations in various parts of the U.S. also could play a role, too. (Perhaps native New Yorkers, like myself, are hard to please?) The main limitation of the study is that 40% of hospitals failed to provide HCAHPS data for this reporting cycle. Nevertheless, these results put patient-centered care on the map and will lead to further analyses aimed at improving U.S. hospital care.


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