CONTACT: BECKY SOGLIN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-6660; fax (319) 335-9917
Release: July 9, 1999
Patients' assessments of hospital maternity care may
be useful consumer tool
IOWA CITY, Iowa -- As the '90s come to a close, people
are taking more of a consumer approach to health care. But few standardized
resources are available to help people choose physicians, hospitals or health
care plans. This situation is beginning to change as researchers test questionnaires
and other tools designed to gather reliable consumer feedback on health care.
Patients' assessments of hospital maternity care may
help prospective mothers make informed health care choices, according to a
study led by a physician now at the University of Iowa. The study, one of
the largest of its kind, used patient satisfaction data from the Cleveland
Health Quality Choice program, which involved 18 northeast Ohio hospitals.
The findings were published in the June issue of Health Services Research.
"Very few studies have looked at whether patients'
assessments vary across hospitals or whether such measures are stable over
time," said lead investigator Gary E. Rosenthal, M.D., UI associate professor
of internal medicine and director of general internal medicine. "We found
that the survey measures used in our study distinguished between patient satisfaction
levels at the different hospitals. However, perhaps the most surprising result
was that the measurements varied little over three consecutive years, which
may make them very reliable for consumers."
At the time of the study, Rosenthal was an associate
professor of medicine at Case Western Reserve University and the Cleveland
Veterans Affairs Medical Center. Other investigators were Beth S. Finkelstein,
Ph.D., research associate at Case Western Reserve University, and Dwain L.
Harper, D.O., president of Quality Information Management Corporation in Cleveland.
The study was based on surveys mailed to 27,674 randomly
selected women who had delivered live infants at the Cleveland-area hospitals
between 1992 and 1994. The researchers analyzed 16,051 completed surveys,
a 58 percent response rate. The survey included questions designed to evaluate
physician care, nursing care and global assessment of care (whether the patient
would recommend the hospital to others seeking health care of any type).
The stability of the individual hospital scores was
important, Rosenthal said. "As a consumer, you have to rely on data that are
anywhere from six months to several years old as an indicator of what it might
be like if you used the hospital next week or next month. If the measures
aren't stable, then prior hospital performance might not be an accurate indicator
of what to expect in the future."
The researchers also examined the degree to which
patients' personal characteristics such as age, education and overall health
affected their assessments. The investigators found that adjusting for these
characteristics had little impact on the results.
"When you compare health care outcomes in different
hospitals," Rosenthal said, "you need to adjust for factors that may relate
to outcome in order not to penalize hospitals or doctors who care for patients
who are medically more challenging."
Rosenthal said patient assessment measures can be
used as ways to foster consumer choice in health care. Institutional purchasers
of health care, such as state governments and large employers, also seek data
when choosing providers and health plans for their employees. The Cleveland
Health Quality Choice project, which ended this year, disseminated hospital
performance reports to employers every six to 12 months and also sold reports
to the public through pharmacies.
Rosenthal noted several cautions in using the results
of such surveys because patient satisfaction is one of many potential quality-of-care
"Ideally, you want as wide a spectrum of measures
as possible," he said. "Unfortunately there's a dearth of data out there about
quality of care."
He added that it is unclear exactly how patient assessments
of care relate to other quality measures, but most people recognize that satisfying
the patient is important to health care.
"Some aspects of care, such as pain control or doctors'
and nurses' communication skills, can be assessed only by asking patients,"
Rosenthal said another study limitation was that the
researchers did not know details about the patients' individual health care
plans and could only categorize them generally as Medicaid, uninsured or commercial
"We don't know if some patients had aggressively managed
care health plans that may have limited their hospital care," he said. "Presumably
such factors could have affected their assessments of hospitals."
Rosenthal's work on the study was supported by a Career
Development Award from the Health Services Research and Development Services
of the U.S. Department of Veterans Affairs.
Finkelstein was supported by a National Research Service
Award from the Agency for Health Care Policy and Research, a part of the U.S.
Department of Health and Human Services.
Since joining UI Health Care and the Iowa City Veterans
Affairs Medical Center, Rosenthal has continued investigating the validity
and reliability of different measures of health care quality measures. He
said that although such research is complicated by limitations, it is important
that clinicians take as active a role as possible.
"The pressures for collecting and disseminating comparative
health care quality data are only going to intensify," Rosenthal said. "As
physicians in academic centers, we need to lead the pack to ensure that measures
used are as accurate as possible."