Study Suggests Measures of Patient Care Experiences Reflect Fair Hospital Assessments
Increasingly, consumers, providers, and purchasers are interested in using patient surveys to assess patient experiences with medical care. In 1995, the Agency for Healthcare Research and Quality initiated what is now referred to as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) project to develop standardized surveys to assess patient experiences. However, there are concerns about the fairness of using CAHPS survey measures to compare healthcare facilities if some have more "complex" patients that are harder to treat, and it has been argued that clinical variables should be included to adjust for such differences. Therefore, this study compared scores for different types of hospitals after making adjustments using only survey-reported patient characteristics – and then also using more complete clinical and hospital information. Investigators used clinical and survey data from a national sample of 1,858 Veterans who received care in one of 120 VA hospitals for an initial acute myocardial infarction (AMI) during FY03 and FY04. In addition to medical history and admission process characteristics (i.e., time of admission, transfer from ED), clinical data used in this study included 5 other measures predictive of 30-day survival after an AMI. Using VA's Survey of Healthcare Experiences of Patients (SHEP) data, investigators examined Veterans' perceptions of their inpatient experience using both an overall composite measure of patient-centered care (PCC) as well as evaluations of specific dimensions (e.g. access, physical comfort, family involvement). They compared these scores between patients seen at hospitals that differed with regard to size, location (urban vs. rural), teaching status, and facility complexity.
- Comparisons of composite PCC scores across types of hospitals that were adjusted only for patient-reported health status and sociodemographics were similar to those that also adjusted for patient clinical characteristics. Thus, study findings do not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics. The same was true when the various adjusted scores for specific dimensions of patient experience were compared across hospital types.
- Unadjusted composite PCC scores show that Veterans in smaller, non-urban, and non-teaching hospitals tended to report better experiences with care than Veterans at larger, urban, and teaching hospitals. However, these differences were not statistically significant.
- Lower complexity hospitals had significantly higher (more favorable) scores than high-complexity hospitals on the access, coordination, and respect for personal preferences dimensions.
- This study focused on only one condtion. Also, because patients treated in the VA healthcare system are more homogenous than in a broader sample of hospitals, one would expect the effect of adjusting for patient characteristics to be smaller in this study than in a larger study with a more heterogenous set of conditions and hosptials.
This study was partly supported by HSR&D (IIR 07-244). Dr. Meterko is part of HSR&D's Center for Healthcare Organization and Implementation Research in Boston, MA.
Cleary P, Meterko M, Wright S, Zaslavsky A. Are Comparisons of Patient Experiences across Hospitals Fair? A Study in Veterans Health Administration Hospitals. Medical Care. July 2014;52(7):619-625.