Quality of Care and Patient Satisfaction

We would all likely assume that when patients get better quality care they would be more satisfied with that care.  That would assume that health quality experts define quality the same way patients do, which is a very bad assumption.  A CareChex study by the Delta Group shows how there can be a disconnect.   (CareChex Study) The group first looked at both patient satisfaction and hospital quality of care by state and metro area.  It then examined whether there was any correlation between the two ratings.

To examine patient satisfaction, the researchers used CMS’ Hospital Consumer Assessment of Healthcare Providers and Systems database, which includes communication, responsiveness, environment and information provision and explanation elements.  They grouped hospitals by state and metropolitan area and found that the worst states were the District of Columbia, Nevada, Florida, and California.  The highest scores were in Vermont, Maine and New Hampshire.  The lowest ranked cities were all in Florida and the highest were Greensbor0/Winston Salem and Charlotte in North Carolina and New Orleans.

For quality, the Hospital Quality Alliance process of care measures were used, along with CMS’ patient satisfaction database described above, and the CMS MedPAR file, which has outcome measures.  These were adjusted for patient mix and again aggregated at the state and metro area level.  DC brought up the rear again, along with Nevada, Hawaii, New Mexico and New York.  High quality was found in Ohio, Michigan, Indiana and Wisconsin.  Good cities were Cincinnati and West Palm Beach and the lowest quality ranking was in the New York/Northern New Jersey Metro area.

When the two rankings were compared, there was no overall correlation between patient satisfaction score and quality ranking.  DC was obviously bad on both and few other states had similar rankings on each scale, but a statistically significant pattern did not exist.  Probably not surprising since, again, most patients don’t have any understanding of process of care or quality outcome measures and may equate quality more with how nice their individual caregivers were and how responsive to their needs.  Better quality by the experts’ standards won’t necessarily make patients’  happier.