For the first time, Consumer Reports (CR) will provide patient satisfaction ratings for more than 3,400 hospitals across the United States. Subscribers to www.ConsumerReportsHealth.org will be able to look up their local hospitals to see how they stack up and the types of challenges patients have experienced. CR notes several areas of concern at hospitals nationwide; the vast majority of hospitals received the worst ratings for communication about new medications and discharge planning. To successfully navigate hospitalization, the magazine advises patients to “think like a nurse” (see sidebar below).
Consumer Reports’ new ratings demonstrate substantial differences in quality of care across the United States, including a link between patient satisfaction and intensity of care. It may come as a surprise to consumers that patients can be more satisfied in hospitals that tend to provide conservative care.
“Intensity of care is a critical part of the equation for consumers because it has many implications—if you land in a hospital that is aggressive, that will mean frequent diagnostic tests and doctor visits, more reliance on specialists instead of primary-care doctors, prolonged hospital stays, more days in the ICU and higher out-of-pocket expenditures, without necessarily improving outcomes,” said John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center. Those actions may potentially lead to an increased risk of complications and hospital-acquired infections.
Intensity of care and patient satisfaction
The online ratings are based on patient surveys collected by the federal government’s Hospital Consumer Assessments of Healthcare Providers and Systems Survey, known as HCAHPS. For the first time, the HCAHPS data will be available to consumers in a user-friendly interface using CR’s familiar ratings.
A team of statisticians and health experts analyzed the government data to develop the ratings. The Health Ratings Center also integrated intensity of care rankings, revealing a link between patient satisfaction and intensity of care. The hospitals that have above-average patient satisfaction ratings provide, on average, a more conservative—and less expensive—type of medical care. The intensity of care rankings is based on data from the Dartmouth Atlas of Health Care and the Dartmouth Institute for Health Policy and Clinical Practice.
“Our colleagues at Dartmouth have found that patients who live in regions with more intense care—longer hospitalizations and more doctor visits—rate the quality of care lower, and vice versa,” said Santa. When Consumer Reports culled a list of U.S. teaching hospitals—specifically, those that are rated significantly above the national average and those that are significantly below average—a similar pattern emerged. “Some of the teaching hospitals that got high marks were also among the ones with more conservative care,” said Santa.
Consumer Reports rates 3,415 U.S. hospitals online at www.Consumer
ReportsHealth.org. Consumers can log on to look up their local hospital in addition to a featured list of 48 teaching hospitals. Some examples of teaching hospitals that rose to the top of CR’s patient ratings, which also provide more conservative care: Gunderson Lutheran Medical Center (LaCrosse, Wisconsin), Mary Hitchcock Memorial Hospital (Lebanon, New Hampshire), University of Wisconsin Hospitals and Clinics (Madison, Wisconsin), and the University of North Carolina Hospital (Chapel Hill, North Carolina).
Some examples of teaching hospitals that fell to the bottom of
CR’s patient ratings, which also provide more aggressive care, include: Mount Sinai Medical Center (Miami Beach, Florida), Long Island College Hospital (Brooklyn, New York), Caritas Health Care (Elmhurst, New York), Brooklyn Hospital Center at Downtown Campus (Brooklyn, New York), and Bronx-Lebanon Hospital Center (Bronx, New York).
As noted above, several hospitals in the list containing the lowest patient ratings are in New York City, suggesting that teaching hospitals that practice an aggressive approach to chronic care are not leaving a positive impression on New Yorkers. “It’s especially important that hospitals responsible for teaching the next generation of physicians encourage an approach emphasizing care strategies that make optimal use of resources while satisfying patients,” Santa said.
Santa said CR’s ratings point to several areas of concern with U.S. hospitals. “Too many hospitals are falling down on the job in key areas such as communication about new medications, discharge planning and staff attentiveness,” he said. A total of 3,141 hospitals, or 92 percent of all hospitals rated, were given the lowest ratings for staff communication about new medications; 2,794 hospitals, or 82 percent, received the lowest marks for discharge instructions; and 910, or 27 percent, received low marks for attentiveness of staff. RNL
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Think like a nurse, CR advises hospital patients
To help consumers navigate hospitals, the Consumer Reports National Research Center conducted an April 2009 survey of a national sample of 731 nurses who worked throughout the hospital—in the emergency room, critical-care units, operating rooms and other parts of the hospital. The collective wisdom of these nurses is synthesized with findings from interviews with doctors, patients, social workers, hospital officials, hospital pharmacists and dietitians in an extensive report available in the September issue of Consumer Reports (CR) and online at www.ConsumerReportsHealth.org. The advice was gathered as part of CR’s launching of its first-time-ever rating of U.S. hospitals.
Do your homework: Looking up your local hospital will tell you what types of challenges other patients experienced there. Americans with health insurance should get an up-to-date list of providers in their network and get a good handle on their plan’s coverage rules, especially preauthorization requirements. Patients with a chronic medical condition that can lead to frequent hospitalization, such as heart disease or respiratory problems, may benefit even more than others from researching local hospitals.
Take steps to avoid chaotic care: When care is not properly coordinated, a patient can be subjected to unnecessary or duplicate tests and treatments. If your admitting doctor or hospitalist isn’t doing a good job of coordinating care, you have options, such as working with a patient advocate, social worker or case manager to coordinate your care. But remember, you may have to ask for their help.
Stay vigilant about problems: Just because a hospital looks clean doesn’t mean it is. Doctors and nurses pick up a lot of nasty germs, which they can transmit to other patients. Ask doctors and nurses to clean their hands where you can see them before treating you, and be sure to ask visitors to your room to wash up as well.
Plan your admission and discharge carefully: Errors in medications tend to happen during “care transitions,” when patients are admitted, transferred from one ward to another or discharged from the hospital. An ill-planned discharge can put you right back in the hospital, so be sure to identify someone, such as a patient advocate or case manager, to review your discharge plans. Another key step involves “medication reconciliation” to ensure that you leave the hospital with the medication regimen you need—no more, no less. |
