Thomas Jefferson University is releasing a study that re-examines the role of patient satisfaction in measuring hospital quality. Patient satisfaction scores are both intrinsically important and also help to determine hospital reimbursement rates. However, they may not be the best gauge of a good hospital. The study will appear next week in Risk Management and Insurance Review.
Factors such as the noise in a hospital room or the responsiveness of a nurse are critically important to patients. But these same factors are more likely to characterize a large, busy urban hospital -- busy because of high caseloads. Numerous studies have linked high caseloads to better medical outcomes.
"Patients who have chronic conditions like heart failure should go to large hospitals that treat a lot of other patients with heart failure," said the study's lead author, Robert D. Lieberthal, Ph.D., Assistant Professor in the Jefferson School of Population Health.
"There is a lot of information patients can use to select a hospital," said Dr. Lieberthal. "However, this is usually a laundry list of indicators that may not mean much for the lay person or that they may be unaware even exists. Our method compares hospitals directly, so that a patient choosing between two or three hospitals can easily compare them and choose the highest quality facility."
Dr. Lieberthal has refined an existing statistical methodology known as the PRIDIT to gauge hospital quality. Dr. Lieberthal's model was developed to establish a steady, predictable scale for hospital quality so that actuaries could map out reimbursement rates over years for programs like Medicare and the Patient Protection Affordable Care Act. Drastic, year-to-year changes in scores would make it difficult to predict reimbursement rates -- and large, complex hospitals rarely improve or worsen in a meaningful way in a short time. The method for scoring hospital quality includes indicators such as patient satisfaction and medical outcomes and is weighted heavily by factors including patient mortality rates and the number of beds at the hospital. (More beds indicates more cases and better outcomes.)
Under the Lieberthal model, a patient in a highly-rated hospital might dislike the noise and bad food, but survive his life-threatening heart attack.
"Based on this study, the hospitals that have the best survival outcomes are not doing the best job of satisfying patients," said Dr. Lieberthal.
- Robert D. Lieberthal and Dominique M. Comer. What Are the Characteristics That Explain Hospital Quality? A Longitudinal Pridit Approach. Risk Management and Insurance Review, September 2013
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