Home The Washington Diplomat January 2009 Health of U.S. HospitalsGauged in Major Survey

Health of U.S. HospitalsGauged in Major Survey


Your son breaks his leg climbing a tree. Your mother experiences severe chest pains. What you thought was just a bad chest cold turns out to be pneumonia. For all of these situations, you’ll probably find yourself at the local hospital for care — but just how good is your local hospital?

According to a report in the New England Journal of Medicine, most people who’ve recently received hospital care in the United States think that it was pretty good. As part of the national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, run by the public-private Hospital Quality Alliance, patients were asked 27 questions about their experiences and the quality of care they received in the hospital.

On a scale of 1 to 10, 63 percent of patients ranked their hospital’s care as a 9 or a 10, while only 10 percent gave it a ranking of 6 or less. Moreover, 67 percent of patients said they would definitely recommend their hospital, and another 27 percent of patients said they would probably recommend it.

This sounds good, at first glance. But as the New England Journal of Medicine authors note, very few hospitals got the highest rating of 9 or 10 from 90 percent or more of their patients. And several areas that have been a major focus of quality-improvement efforts for hospitals, including pain control and communication about medications, got suboptimal ratings.

What’s more, there’s one key problem with the HCAHPS survey: A substantial minority of hospitals didn’t respond to it at all. The survey represents some 2,400 hospitals, but that still means that nearly 40 percent of U.S. hospitals failed to provide HCAHPS data. And it’s not a stretch to imagine that if a hospital doesn’t bother to provide data on patient satisfaction surveys, it may have a problem with patient satisfaction.

So where are the highest-ranked hospitals located? People seemed to be happiest with their care in Birmingham, Ala., Knoxville, Tenn., and Charlotte, N.C. They were least satisfied in New York City, Fort Lauderdale, Fla., and East Long Island, N.Y.

The patient survey is just one component of the way in which HCAHPS assesses hospital performance, however. All hospitals are asked to submit data to HCAHPS that reflects how well they’ve performed over the last year on a variety of measures that have been determined to give a good snapshot of overall care. Hospitals aren’t required to submit this data, but most hospitals now recognize that if they don’t participate in the program, ultimately they’re likely to lose out when it comes to payments and reimbursements.

So what can you learn about your local hospital from this data? The Washington Diplomat took a quick tour of the survey on the Web site www.hospitalcompare.hhs.gov and compared three major hospitals in the D.C. area to see how they stacked up: Washington Hospital Center in the District, Virginia Hospital Center in Arlington, Va., and Washington Adventist Hospital in Takoma Park, Md.

In addition to the patient survey responses, the hospitals provided data on several other important areas of care and overall outcomes related to surgical improvement and surgical infection prevention, heart attack, heart failure and pneumonia.

For example, in surgical care, it turns out that all three of these Washington-area hospitals beat the national average rate for such measures as providing the appropriate antibiotics one hour before surgical incision and receiving treatment to prevent blood clots immediately before or after certain procedures. They also did better than the national average on most measures related to heart attack care — but not all. Overall, Virginia Hospital Center seemed to score highest in the most categories, with Adventist coming in second.

But the patient survey responses seemed to tell a different story. On issues such as how well nurses and doctors communicated with patients, how quickly they received help from hospital staff, how well pain was controlled, and how often staff explained medications before giving them out, the three area hospitals got lower rankings than the national average. Nonetheless, for all three, patients said they would recommend the hospitals to friends and family at higher rates than the national average.

In other words, the picture of hospital care in the United States — and in the Washington area — is a complex and oftentimes confusing one. The information available from the Hospital Compare site helps to answer some questions, but probably can’t address everything a patient might want to know. And sometimes you, the patient, can’t actually use this information. If you think you have pneumonia, for instance, you might have enough time to compare hospitals online, but not if you’re having a heart attack. (Although it’s possible that local governments could use the data on quality of heart attack care to mandate or recommend where their ambulances should take heart attack patients.)

Still, the information from Hospital Compare is a treasure trove of knowledge compared to what patients previously had to go through to assess their local hospitals. Even if the condition you’re seeking treatment for isn’t measured on Hospital Compare (and most aren’t), visiting the site can give you a good overall picture of how well the hospitals in your area perform. It’s not a bad idea to check them out now — before you check them out in person.

About the Author

Gina Shaw is the medical writer for The Washington Diplomat.