title: Patient satisfaction with hospital care: effects of demographic and institutional characteristics.
abstract: BACKGROUND
  There are a growing number of efforts to compare the service quality of health care organizations on the basis of patient satisfaction data. Such efforts inevitably raise questions about the fairness of the comparisons. Fair comparisons presumably should not penalize (or reward) health care organizations for factors that influence satisfaction scores but are not within the control of managers or clinicians. On the basis of previous research, these factors might include the demographic characteristics of patients (eg, age) and the institutional characteristics (eg, size) of the health care organizations where care was received.
  
  
  OBJECTIVE
  The goal of this study was to examine the extent to which a patient's satisfaction scores are related to both his/her demographic characteristics and the institutional characteristics of the health care organization where care was received.
  
  
  METHODS
  We conducted an analysis of secondary data from the Veterans Health Administration (VHA), US Department of Veterans Affairs. The database contained patient responses to self-administered satisfaction questionnaires and information about demographic characteristics. Additional data from VHA were obtained regarding the institutional characteristics of the hospitals where patients received their care.
  
  
  RESULTS
  Among demographic characteristics, age, health status, and race consistently had a statistically significant effect on satisfaction scores. Among the institutional characteristics, hospital size consistently had a significant effect on patient satisfaction scores.
  
  
  CONCLUSIONS
  Study results can be interpreted as justifying the need to adjust patient satisfaction scores for differences in patient population among health care organizations. However, from a policy perspective, such adjustments may ultimately create a disincentive for health care organizations to customize their care.
authors.affiliation: Management Decision and Research Center, Veterans Affairs Health Services Research and Development Service, Boston University School of Public Health, Massachusetts, USA. health@bu.edu
authors.forename: G J
authors.initials: GJ
authors.lastname: Young
authors.forename: M
authors.initials: M
authors.lastname: Meterko
authors.forename: K R
authors.initials: KR
authors.lastname: Desai
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data; D006302:Health Services Research; D006304:Health Status; D006787:Hospitals, Veterans / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D044469:Racial Groups; D011795:Surveys and Questionnaires; D017749:Total Quality Management; D014481:United States; D014493:United States Department of Veterans Affairs