Using Patient Surveys to Rate Hospitals


Mar 22, 2012

A woman calling a nurse from her hospital bed

This commentary originally appeared in New York Times on March 22, 2012.

This letter to the editor is a response to the op-ed "Hospitals Aren't Hotels."

To the Editor:

Theresa Brown's critique of patient experience surveys notes the value of multiple measures of patient care. We agree. Unfortunately, she also repeats two common misconceptions about the Hospital Consumer Assessments of Healthcare Providers and Systems survey, which we helped develop.

One is that there are necessarily tradeoffs between good patient experiences and good clinical care. The preponderance of the evidence (at least four recent studies) suggests the opposite: hospitals that perform better on the survey tend to do better on clinical measures, have fewer readmissions within 30 days and have lower risk-adjusted mortality.

A second misconception is that the survey is primarily a measure of satisfaction, and that high scores are achieved by catering to patients' desires for unwarranted treatment. In fact, the survey focuses on important aspects of care such as whether new medications and post-discharge care instructions were explained clearly, which can be measured only by asking the patient. Evidence suggests that patients want clear communication, not unnecessary care.

We believe neither that conscientious clinicians will withhold unpleasant but essential treatments to obtain better patient assessments, nor that patient assessments are responsible for overuse of medical care.

Santa Monica, Calif., March 16, 2012

Dr. Elliott is a senior statistician at the RAND Corporation. Dr. Zaslavsky is a professor of health care policy at Harvard Medical School. The letter was also signed by Paul D. Cleary, Susan Edgman-Levitan and Ron D. Hays. All five helped prepare the survey.

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