Noteworthy News

New Study Draws Distinction Between Patient Satisfaction and Quality of Care

A happy patient may not necessarily be a well cared-for patient and an unhappy patient could be receiving excellent care, according to a new study.

The Journal JAMA Surgery reports that there is little relationship between the satisfaction hospital patients express about their surgical experiences and the quality of care they received.

In the April 2013 article “Patient Satisfaction as a Possible Indicator of Quality Surgical Care,” the study’s authors wrote that

Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated.  Patient satisfaction may provide information about a hospital’s ability to provide good service as part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.

The study’s findings echo the National Association of Urban Hospitals’ frequently expressed concern about the use of patient satisfaction surveys in influencing Medicare quality payments as part of the Medicare value-based purchasing program.  In a letter to the Department of Health and Human Services in response to the proposed FY 2013 Medicare inpatient prospective payment system regulation, NAUH wrote that

We believe the survey is biased against large urban hospitals in several respects.  In some instances, we believe the survey’s questions are biased against large urban hospitals; in others, we believe the manner in which the survey’s findings are weighted is biased against large urban hospitals.

NAUH also wrote that

We think it is inappropriate, for example, to compare the degree of quietness of a seventy-five-year-old hospital with semi-private rooms located in a congested urban area with that of a new facility with private rooms located on a sylvan, multi-acre campus set well off any major thoroughfares.  

And NAUH noted that

We think it is unfair, for example, to downgrade the survey results from the kinds of patients urban safety-net hospitals serve in especially high numbers and proportions, such as maternity patients and those for whom English is not their native language.  Similarly, the American Hospital Association has found that more seriously ill patients are more likely to respond with negative observations when completing the HCAHPS survey.  Urban safety-net hospitals care for such patients in disproportionate numbers and believe this situation calls for appropriate adjustment.  In addition, CMS’s own data shows significantly lower scores in more urbanized states – the very places in which most urban safety-net hospitals can be found.  Consequently, NAUH believes more should be done to adjust HCAHPS scores appropriately before they are used to influence Medicare payments to hospitals.

NAUH’s complete comments can be found here.

Read a Kaiser Health News report on the JAMA Surgery article here and find the complete study hereSurgical Instruments.

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