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GE Rosenthal, MD Iowa City VA Medical Center, VA Quality Scholars Program, and the University of Iowa College of Medicine; SM Fuehrer, MBA, Cleveland VA Medical Center; DL Harper, DO, Cleveland Health Quality Choice

Objectives: Compare patient satisfaction in VA hospital and in private sector hospitals serving a common health care market.

Methods: 1516 randomly selected medical and surgical patients in a university-affiliated VA hospital in 1996-97 were surveyed by mail 2-3 months after discharge. Satisfaction was measured using the Patient Judgment System (PJS), a validated instrument that measures 7 dimensions of hospital care (admission [n=3 items], coordination [n=4], nursing [n=5], physician care [n=6], information sharing [n=3], discharge preparation [n=3], ancillary staff [n=6], and accommodations [n=9]). The PJS also includes 2 single-item indicators (‘overall quality’ and how much patients were ‘helped by hospitalization’). Individual items are rated using five qualitative responses (i.e., poor-excellent) that are transformed to linear scores (0-100). VA data were compared to PJS data collected from 16,443 patients in 27 private sector hospitals in the same region during the study period; 5 of the 27 hospitals were major teaching (Council of Teaching Hospitals members), while 6 other hospitals had one or more accredited residencies.

Results: Responses were obtained from 869 VA patients (57%). Compared to private sector patients, VA patients were similar in mean age (63 vs. 64 years; p=.05), but were more likely (p<.001) to be male (96% vs. 44%) and non-white (27% vs. 18%), and less likely to be high school graduates (69% vs. 76%). VA patients were also more likely to report their overall health as ‘poor’ or ‘fair’ (63% vs. 40%) or ‘fair’ (44% vs. 31%), and less likely to report their health as ‘very good’ or ‘excellent’ (8% vs. 24%). For each of the scales and 2 single-item indicators of satisfaction, mean scores were lower (p<.001) in VA than private sector patients: admission (60 vs. 70); nursing (65 vs. 71); physician (70 vs. 75); information (63 vs. 70); coordination (66 vs. 72); discharge (61 vs. 70); ancillary (68 vs. 72); accommodations (61 vs. 67); overall quality (68 vs. 73); and helped by hospitalization (67 vs. 73). When hospitals were ranked according to mean scores, the VA ranked last (i.e., 28) for all indicators except overall quality (rank = 26). Adjusting for age, gender, marital status, overall health, emergency admission, and DRG using linear regression, scores for all measures remained lower (p<.001) in VA patients, although the magnitude of the differences was somewhat less (e.g., for physician care, the adjusted difference was 2.7, compared to an unadjusted difference of 5.2). Findings were similar in comparative analyses limited to patients in the 5 major teaching or 6 other teaching hospitals.

Conclusions: Patient satisfaction was lower in VA hospital than in private sector hospitals serving the same health care market. If generalizable, the findings suggest that there are substantial opportunities to improve satisfaction with VA inpatient care.

Impact: While prior VA analyses suggest that patient satisfaction is lower in VA hospitals than private sector hospitals for certain aspects of care, no prior analyses have compared satisfaction in individual health care markets. However, in judging overall quality, measurement of patient satisfaction should be examined in the context of other available indicators of quality.