Patients give California hospitals high marks for attention to physical comfort but believe they could do better in providing adequate emotional support, according to a statewide patient-experience survey released last week.
The results of the latest Patients' Evaluation of Performance in California survey, or PEP-C, closely mirror performance on a national level, where hospitals also excelled in providing physical comfort but lagged on emotional support. The voluntary survey is co-sponsored by the California HealthCare Foundation and the California Institute for Health Systems Performance, and is administered by National Research Corp., also known as NRC/Picker.
"Physical comfort includes pain control and other quasi-clinical things that hospitals have traditionally focused on," said Lisa Payne Simon, acting director of the quality initiative for the California HealthCare Foundation, an Oakland, Calif.-based philanthropy. "But providing emotional support for patients' fears and anxieties ... takes an entirely different set of skills, as well as more time and resources, which is a challenge for hospitals."
PEP-C-which its sponsors call the largest publicly reported and most scientifically valid survey of its kind-is part of a growing movement to publicly report performance of healthcare organizations. It grades hospitals on seven quality indicators: coordination of care; emotional support; information and education; involvement of family and friends; physical comfort; respect for patients' preferences; and transition to home.
The latest survey tabulated responses from nearly 35,000 patients who spent at least one night in a participating hospital from July to October 2002. Hospitals received one, two or three stars-for below average, average and above average, respectively-on each of the seven measures as well as an overall rating.
A total of 181 hospitals volunteered for the latest survey, a 60% increase from 2001, when 113 hospitals took part. Still, a full 53% of the state's 383 hospitals declined to participate in 2002, citing a variety of reasons, including cost, time and a preference for their own patient-satisfaction surveys (June 23, p. 6). Ninety-three percent of the participating hospitals were not-for-profit, while 7% were for-profit, and 5% were public hospitals.
Overall, 25% of PEP-C participants scored above average in 2002, up from 22% the previous year. Meanwhile, a smaller portion scored below average-about 18% last year compared with 20% in 2001. California hospitals also did slightly better than the national average, scoring higher on four of the seven measures as well as on all measures combined. National statistics were derived from NRC/Picker's U.S. database.
In addition to ensuring physical comfort, California hospitals tended to fare well in coordinating patients' care and in showing respect for their personal preferences. But they also fell short in helping patients transition to home, including informing them of what to expect in terms of possible side effects and danger signs.
Hospitals with fewer than 100 beds scored better on average than their larger counterparts, presumably because of greater community support and their ability to provide more personalized care. Several small hospitals-such as 15-bed Mammoth Hospital, Mammoth Lakes, Calif., and 49-bed Santa Paula (Calif.) Memorial Hospital-scored above average, while a number of nationally renowned facilities including Cedars-Sinai Medical Center, Los Angeles, and Stanford Hospital and Clinics, Palo Alto, Calif., scored average.
"Some of that may be because (smaller hospitals) are better able to provide a family-type orientation for the patient," said Marsha Nelson, vice president of the Sacramento-based CIHSP. "Many larger medical centers also have a teaching and research mission, which sometimes is in opposition to the compassionate, caring, family-type atmosphere that smaller hospitals can focus on primarily."
PEP-C's sponsors stressed that the survey is not a gauge of hospitals' clinical competency. Indeed, although Cedars-Sinai and Stanford both scored average or below average across all measures, when it came to whether patients would recommend the hospitals, each received a three-star rating. "This is not a report on good and bad hospitals," Payne Simon said.
Although clinical outcomes are generally considered the most accurate way to evaluate hospital performance, such data are not yet widely available and are often limited to specialized procedures. For example, the American Hospital Association's report card scores hospitals in only three areas: heart attack, heart failure and pneumonia.
What PEP-C does is help hospitals identify specific areas where they can improve their service and bedside manner, said Mark Smith, president and chief executive officer of the California HealthCare Foundation.
For example, Oakland-based Kaiser Permanente-15 of whose 27 California hospitals scored below average in 2001-has been working to correct its patient-perception problem through a variety of measures, including additional staff training, spokesman Mike Byrne said. In the latest survey, 11 of the system's hospitals scored below average. The rest received an average rating.
Regardless of their current scores, hospitals that volunteered for PEP-C should be commended for their commitment to public accountability, Payne Simon said. "Even if they get one star in any particular area, consumers can be assured that the hospitals know where they need to improve," she said. "That cannot necessarily be said about hospitals with no stars, which may not be gathering this information, let alone reporting it publicly."
Smith emphasized that participating hospitals also will be better prepared when the federal government requires a similar survey within the next few years. The Centers for Medicare and Medicaid Services is testing a standardized hospital report card in Arizona, Maryland and New York. It plans to expand the survey nationwide and to make participation mandatory.