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commentary

(The RAND Blog)

July 28, 2014

Putting Patients First Can Result in Better Care Overall

Photo by Tyler Olson/Fotolia

by Rebecca Anhang Price, Marc N. Elliott, Ron D. Hays

Hospitals, doctors, and other health care providers are increasingly being held accountable for results from patient surveys about their health care experiences. In the United States, the most widely used surveys of this type are from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) project. These surveys ask patients to report about specific experiences, such as “Before giving you any new medicine, how often did the hospital staff tell you what the medicine was for?” CAHPS surveys also ask patients to rate care on a scale from zero to 10. Results from these surveys are used to help determine how much providers are paid in various settings—for example, hospitals in Medicare's incentive program for inpatient care. Survey results are also publicly reported on Medicare websites intended to provide consumers with information to compare performance of hospitals, nursing homes, and home health agencies.

Increased emphasis on patient surveys has led critics to ask whether focusing on giving patients a good experience comes at the expense of providing clinical care that is of high technical quality. To investigate this issue, our team reviewed nearly three dozen studies that assess the relationship between patient-reported experiences of care and other dimensions of health care quality.

Our review, published online in Medical Care Research and Review, found that health care providers and plans can simultaneously offer good patient experiences and high technical quality of care. Positive patient experiences with care tend to be either positively associated with, or unrelated to, lower hospital readmissions, recommended care for conditions such as heart failure and pneumonia, and better clinical outcomes, such as survival after a heart attack. Just one study reported a negative correlation between patient experiences and the technical quality of care.

In other words, we found that there is not a tradeoff between achieving good scores on patient surveys and providing high-quality clinical care.

Surveys of patient experience have intrinsic value: they give patients a voice, allowing them to directly report on whether they think their care is respectful of and responsive to their needs and preferences. Our review finds that better patient-reported care experiences also can be associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, particularly in hospitals, and less health care utilization. These results suggest that patient surveys complement measures of clinical processes and outcomes, and that it is therefore appropriate and essential to assess how providers are doing using both types of measures in incentive programs that link payment to provider performance.


Rebecca Anhang Price is a policy researcher, Marc N. Elliott is a senior statistician and Ron D. Hays is a member of the adjunct staff at the nonprofit, nonpartisan RAND Corporation.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.