Patients Say Hospitals Can Fall Short on Care

By Rita Rubin

Though most patients generally are satisfied with their care, many hospitals fall short in relatively low-tech areas such as pain control and communication, researchers report today.

The authors analyzed data collected by the federal government in an ongoing survey of patients at all hospitals that get Medicare payments. Responses covered six areas: communication with doctors, with nurses and about medications; and quality of nursing services, discharge information and pain management.

"These data really represent a sea change," says lead author Ashish Jha, assistant professor of health policy at the Harvard School of Public Health. "We’ve been talking about (health care) quality for 20 years, but patients’ experiences have not been part of the discussion."

Overall, 63% of respondents rated care a 9 or 10 on a scale of zero to 10, the authors write in the New England Journal of Medicine, and 26% rated it a 7 or 8.

But nearly a third of patients didn’t rate pain control highly, and a fifth didn’t rate discharge instructions highly. "When you look at this data, you can recognize that no one is doing that great," says Anne-Marie Audet, vice president for quality improvement and efficiency at the Commonwealth Fund, which funded the study.

Says Jha: "We spend $2.1 trillion on health care. That stuff should be happening 95% to 100% of the time."

The better hospitals did on standard measures of quality of care, the higher their patient ratings. "Our study says there need not be any tradeoffs," Jha says.

A high ratio of nurses to patients was linked to higher patient satisfaction. The authors say they were surprised to find that teaching hospitals were rated higher than non-teaching, not-for-profits higher than for-profits.

There were wide regional variations: 72% of patients in Birmingham, Ala., hospitals gave their care a 9 or 10, compared with only 50% of patients in East Long Island, N.Y., hospitals. Differences in patient expectations and caregiving styles might partly explain that, the researchers write.

For the survey’s first year, ending Sept. 30, hospitals weren’t required to submit their results, and of the more than 4,000 U.S. hospitals, about 40% didn’t. To compare hospitals’ data, visit hospitalcompare.hhs.gov. (c) Copyright 2008 USA TODAY, a division of Gannett Co. Inc.