Components of care vary in importance for overall patient-reported experience by type of hospitalization.
BACKGROUND
Patients are hospitalized for disparate conditions and procedures. Patient experiences with care may depend on hospitalization type (HT).


OBJECTIVE
Determine whether the contributions of patient experience composite measures to overall hospital ratings on the Hospital Consumer Assessment of Healthcare Providers and Systems Survey vary by HT.


METHODS
In cross-sectional observational data, we defined 24 HTs using major diagnostic category and service line (medical, surgical, or obstetrical). To assess the importance of each composite for each HT, we calculated the simultaneous partial correlations of 7 composite scores with an overall hospital rating, controlling for patient demographics.


METHODS
Nineteen thousand seven hundred twenty English- or Spanish-speaking adults with nonpsychiatric primary diagnoses discharged home 12/02-1/03 after an overnight inpatient stay in any of 132 general acute care hospitals in 3 states.


METHODS
Patient-reported doctor communication, nurse communication, staff responsiveness, physical environment, new medicines explained, pain control, and postdischarge information; overall 0 to 10 rating of care.


RESULTS
Nurse communication was most important overall, with a 0.34 average partial correlation (range: 0.17-0.49; P < 0.05 and among the 3 most important composites for all HTs). Discharge information was least important (0.05 average partial correlation; P < 0.05 for 10 of 24 HTs). Interactions demonstrated significant (P < 0.05) variation in partial correlations by HT for 5 of 7 composites (all but responsiveness and environment), with nurse communication, doctor communication, and pain control showing the most variation (F > 2, P < 0.05).


CONCLUSIONS
The importance of patient experience dimensions differs substantially and varies by HT. Quality improvement efforts should target those aspects of patient experience that matter most for each HT.
Elliott
Marc N
MN
RAND Corporation, Santa Monica, California, USA. elliott@rand.org
Kanouse
David E
DE
Edwards
Carol A
CA
Hilborne
Lee H
LH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010146:Pain / Q000188:drug therapy / Q000517:prevention & control; D010351:Patient Discharge; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010564:Personnel, Hospital; D010817:Physician-Patient Relations; D011787:Quality of Health Care / Q000145:classification* / Q000458:organization & administration*; D012959:Socioeconomic Factors; D055815:Young Adult