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U.S. Hospitals Lag in Patient Satisfaction

Pain management, discharge instructions not rated high in survey

WEDNESDAY, Oct. 29 (HealthDay News) -- Patients in many U.S. hospitals are not satisfied with their care, Harvard researchers report.

In the first national survey of patients' experiences, many hospitals were found wanting in key areas such as pain management and discharge instructions. In fact, almost one-third of patients gave low ratings to pain management, and one-fifth gave low ratings to communication at discharge.

"These data represent a sea change for the health-care system," said study author Dr. Ashish K. Jha, an assistant professor for health policy at the Harvard School of Public Health. "Until now, we have had no high-quality information about how patients perceive the care they receive."

"Even though we spend $2 trillion on health care, you would think that things like always managing patients' pain in the hospital is something we would have gotten right by now," Jha said.

Yet patients report that their pain isn't always treated adequately, that medications are not explained to them adequately, and that they are not really given good information about what to expect after they are discharged, Jha said. "This is really the basic stuff. Patients shouldn't assume that hospitals always get these basic things right," Jha added.

Jha also puts part of the onus on patients to improve care. "Patients need to be proactive -- ask questions," he said. "The more engaged patients are, the better the care they will receive and the better the care all of us will receive, because they will drive the change for better systems of health care."

The report was published in the Oct. 30 issue of the New England Journal of Medicine.

For the study, Jha's team reviewed data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Of the 4,032 hospitals that report quality of care data, 2,429 reported patients' experience. That's 60.2 percent of all U.S. hospitals.

The researchers found that 67.4 percent of the patients said they would recommend the hospital where they were treated. Hospitals that had a higher ratio of nurses to patients were rated higher.

In addition, patients rated hospitals that had higher quality of care as offering a more satisfying experience. These hospitals were those that had better care for heart attack, congestive heart failure, pneumonia and prevention of surgical complications.

Patient satisfaction varied by location, Jha's group found. In Birmingham, Ala., 71.9 percent of patients rated their care as highly satisfying. The next highest scores were given by patients in Knoxville, Tenn. (69.9 percent) and Charlotte, N.C. (69.4 percent).

The lowest satisfaction scores were given to hospitals in East Long Island, N.Y. (49.9 percent), Fort Lauderdale, Fla. (51.9 percent), and New York City (52.3 percent).

"By making this information publicly available, I hope hospitals will begin to pay more attention, and I hope patients will pay more attention. Hopefully, this will motivate them to choose higher quality providers," Jha said. "Through that, I hope hospitals will begin to improve."

Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program, noted that for-profit hospitals rated lower in patient satisfaction.

"The study suggests a simple way to simultaneously improve quality and save money -- get rid of for-profit hospitals," Woolhandler said. "The study shows that for-profit hospitals have significantly lower ratings and once more affirms that profit-seeking has no role in care of the sick."

Jim Conway, senior vice president at the Institute for Healthcare Improvement, agreed that there is a huge gap in hospital quality.

"A lot of our processes are very flawed," Conway said. "Anecdotally, we are hearing lots of cases from patients and their families, where they didn't believe that staff was available to give them the care they need when they need it."

Hospitals need to put patients first, Conway said. "Governing boards and leaders have to say that, 'In this hospital, nothing is more important than the patient,' " he said. "If there is not that clarity of purpose, great results will not be achieved."

In addition, Conway believes patients need to play an active role in their care. "If a patient is satisfied with their care, there is a very strong likelihood that the patient is going to be actively managing their care," he said.

More information

For more on hospital quality, visit the U.S. Department of Health & Human Services.

SOURCES: Ashish K. Jha, M.D., M.P.H., assistant professor, health policy, Harvard School of Public Health, Boston; Jim Conway, senior vice president, Institute for Healthcare Improvement, Boston; Steffie Woolhandler, M.D., M.P.H., associate professor, medicine, Harvard Medical School, Boston, and co-founder, Physicians for a National Health Program; Oct. 30, 2008, New England Journal of Medicine

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