Quality experts continue to raise questions about the effectiveness of HHS' new patient-satisfaction data
The Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, survey is producing results that indicate patients favor rural hospitals and hospitals in Alabama—outcomes that are not impossible but invite closer analysis, they say.
The results from the HCAHPS survey seem to show patients are more satisfied by performance at smaller, rural hospitals. Such trends beg greater review of the data characteristics, according to Chip Kahn, president of the Federation of American Hospitals. The data are still preliminary, he said. "From an analytical standpoint, the numbers are not totally transparent," he said. The federation collaborates on the HCAHPS survey.
Based on the HCAHPS database, available through the Hospital Compare
Web site where the survey results and hospital quality indicators are posted, the facilities that performed best on the question asking whether patients would recommend their hospital are mostly smaller and rural. Forty-one-bed Garfield Memorial Hospital and Clinics, Panguitch, Utah, part of 18-hospital Intermountain Healthcare, Salt Lake City, is the highest-rated hospital in the country, with 100% of patients surveyed saying they would definitely recommend it to friends and family. Alabama had four hospitals in the top 11 list of responses for the question, and had a "definitely recommend" rate of 79%, No. 1 among all states. The national average was 67%.
Smaller hospitals also ranked lowest in that particular question, with 51-bed River Hospital in Alexandria Bay, N.Y., having only 23% of patients saying they'd definitely recommend it. Ben Moore, River Hospital's president and chief executive officer, said he was not surprised at that result. If patients are looking for a general hospital offering a wide variety of services, they probably would not choose River, which transfers severely ill patients immediately to a larger facility, he said. River Hospital scored high in quality indicators and in other areas of the HCAHPS survey, which could mean the survey questions or the data still require some tweaking to better reflect the hospital's overall performance, he said.
The ability to identify that "sweet spot" of high quality and high patient satisfaction which provides the perfect look at a hospital's performance has yet to be reached, according to Stacy Sochacki, executive director of the National Association for Healthcare Quality, a network for quality professionals. The HCAHPS results are patients' perceptions, only one variable in hospital performance. "You've got to take it in that context," she said.
HCAHPS surveyed patients on 10 different issues—mostly on communication and hospital environment questions—through mail, telephone and an interactive voice-recognition process. More than 2,500 hospitals participated in the initial release, which is based on data obtained from hospital stays that occurred between October 2006 and June 2007.
There are a number of factors that might have contributed to HCAHPS' seemingly skewed results, according to data experts. While some adjustments were made to the survey responses to account for differences in patient populations, no adjustments were made to hospital characteristics, said Deirdre Mylod, vice president of public policy at Press Ganey Associates, one of the companies involved in developing the HCAHPS survey tool.
Press Ganey has seen that smaller hospitals tend to do better. "We've noticed a relationship between the smaller the bed size, the higher the scores," Mylod said.
The results of a California HCAHPS pilot three years ago showed similar results for smaller hospitals, said Nancy Foster, vice president for quality and patient safety for the American Hospital Association, a partner in the Hospital Compare Web site. The CMS, which analyzed the HCAHPS data collected by hospitals and survey vendors, audits the information, said CMS spokesman Peter Ashkenaz.
Rosemary Blackmon, Alabama Hospital Association spokeswoman, said it's "exciting" to see patients recognize the effort hospitals are making toward increasing the patient experience, although the association will continue to monitor the data with its members. There are several factors going into the survey results that could have led to the results, she said. "You have all these questions."
Some of the hospitals in the South that ranked higher on the list said the reason for the trend could simply be Southern hospitality. "The South is known for hospitality, and we try to build on that," said Joe Neely, senior vice president at the two-hospital St. Francis Health System, Tulsa, Okla, and administrator of its 64-bed St. Francis Hospital South, Broken Arrow, Okla.
As a faith-based organization, 176-bed Shelby Baptist Medical Center, Alabaster, Ala., encourages its employees to practice their faith with patients, something that is "well-received" and mentioned in survey responses, said David Wilson, president of Shelby, which is part of four-hospital Baptist Health System, Birmingham, Ala.
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