NEJM: Patients give low scores to hospitals in U.S. survey

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The quality of hospitals across the U.S. is inconsistent, according to a new study that analyzed the first national data on patients' experiences in hospital settings and found that though patients are generally satisfied with their care, there is substantial room for improvement in a number of key areas, including pain management and discharge instructions. The study is in Oct. 30 issue of The New England Journal of Medicine.

"These data really represent a sea change for the healthcare system...With this information now freely available, providers and policymakers can begin to focus on improving patients' experiences in the hospital," said lead author Ashish K. Jha, MD, and assistant professor of health policy at Harvard School of Public Health in Boston.

The researchers analyzed data collected in the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which asked patients about their hospital experiences and their demographic characteristics. More than 2,400 hospitals (about 60 percent of U.S. hospitals) reported data.

The results showed that, on average, about 67 percent of patients would definitely recommend the hospital at which they were treated. The survey provided the first national data to show the important role that nurses can play in providing patient-centered care, according to the researchers.

Hospitals with more satisfied patients generally provided higher quality of care as measured by standard quality metrics. Hospitals in which patients rated their care highly were more likely to provide the appropriate care for heart attack, congestive heart failure, pneumonia and prevention of surgical complications.

There were large variations in patient-satisfaction performance across the country. For example, 71.9 percent of hospital patients in Birmingham, Ala., gave their care a high rating (9 or 10 on a 10-point scale); hospitals in Knoxville, Tenn., (69.9 percent); and Charlotte, N.C.; (69.4 percent) received the next-highest scores. Patients gave hospitals in East Long Island, N.Y.; (49.9 percent), Fort Lauderdale, Fla.; (51.9 percent) and New York City (52.3 percent) the lowest marks. 

The researchers were surprised that: pain management has been the target of both accreditation and quality-improvement initiatives for many years, but nearly a third of patients did not give high ratings in that area; discharge instructions have similarly been targeted for quality initiatives, but about a fifth of patients did not rate communications in that area highly.

“Given that we spend more than $2 trillion annually for healthcare in our country, we should expect that the basics are addressed, like always treating pain adequately," Jha said.

To view data on individual hospitals, on the Department of Health & Human Services Hospital Compare website (, click on the "Find and Compare Hospitals" button.