Chris Privett
Duke University
The Fuqua School of Business
100 Fuqua Drive
P.O. Box 90120
Durham, NC 27708-0125
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Satisfied Patients are the Best Measure of Hospital Quality, Duke Study Finds
February 14, 2011
DURHAM, N.C. — Asking your friends and neighbors to recommend a good hospital is the best way to find high-quality care, according to a study from Duke University's Fuqua School of Business.
The researchers compared patient satisfaction surveys and clinical performance measures, such as administering standardized tests, from two large federal databases. Focusing on three common ailments, heart attack, heart failure and pneumonia, the team measured 30-day readmission rates at roughly 2,500 hospitals. The readmission rate reflects the number of patients who are hospitalized again within 30 days of discharge.
The patient satisfaction scores were more closely linked with high-quality hospital care than clinical performance measures, the authors found.
"Patients can sense if a hospital is doing things right," said co-author Richard Staelin, professor of business administration at Fuqua. "If you want to figure out if a hospital is providing high-quality care, asking patients if they were satisfied with their care is a better indicator than whether the staff competently performs a battery of tests."
The researchers analyzed the June 2009 release of the Hospital Compare data from the U.S. Department of Health and Human Services and the June 2009 release of Medicare's Hospital Care Quality Information from the Consumer Perspective. The Hospital Compare database provides readmission rates for heart attack, heart failure and pneumonia, as well as each condition's clinical performance measures. The database offers information on patients' perceptions of their hospital experiences, including interactions with staff.
In addition to assessing overall patient satisfaction, the survey determined whether hospital staff asked patients if they would have help after leaving the hospital, and if they received information in writing about symptoms or health problems to look for after leaving the hospital.
Hospitals that scored highly on patient satisfaction with discharge planning also tended to have the lowest number of patients return within a month for all three specified ailments, the study found. Overall, high patient satisfaction scores were more closely linked to a hospital's low readmission rates than a solid showing on clinical performance measures.
"Our findings support the use of patient-reported information to complement objective clinical measures when assessing the quality of patient care for a given hospital," said Staelin. "These patient-level measures not only are more predictive, but they also seem to be clinically important in terms of providing a way to increase the quality of care."
The study's authors are Staelin; William Boulding, Fuqua professor of business administration and deputy dean; Seth Glickman, associate professor of emergency medicine at the University of North Carolina at Chapel Hill, Fuqua doctoral student Matthew Manary; and Kevin Schulman, director of Duke's Health Sector Management Program.
The researchers say hospitals have significant financial incentives to reduce the number of patients who return to the hospital within 30 days of discharge. Under the Affordable Care Act, hospitals with high readmission rates will face cuts in Medicare reimbursements. About 20 percent of Medicare patients return to the hospital within 30 days, which cost taxpayers more than $17 billion in 2004.
"Hospitals have devoted substantial resources to improving clinical performance measures for heart failure, but there has been virtually no reduction in readmission rates or costs over the last four years," said Boulding. "Patient perceptions about hospital care in general, and discharge planning specifically, may provide an important new tool for measuring and increasing the quality of care."
A report on the study appears in the January 2011 issue of The American Journal of Managed Care.
The authors recommend hospitals that wish to improve their clinical performance focus on improving the interactions between patients and hospital staff.
In the Medicare survey of hospital quality, good communication with nurses was the strongest driver of patient satisfaction, Staelin noted. Providing tasty food and attractive rooms was low on the list.
"Patient satisfaction is less about trying to make patients happy and more about increasing the quality of their interactions with hospital personnel, especially nurses and physicians," said Schulman.
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