The association of hospital quality ratings with adverse events.
OBJECTIVE
To understand how patient-reported quality is related to adverse events (AEs).


METHODS
Random sample telephone survey.


METHODS
Sixteen acute care Massachusetts hospitals.


METHODS
Two thousand and five hundred and eight-two of 4163 (62% response rate) eligible adult patients.


METHODS
Patients hospitalized from 1 April 2003 to 1 October 2003 provided global quality ratings and whether they experienced AEs. Service recovery, defined as efforts by a service provider to return customers to a state of satisfaction after a lapse in service, was operationalized as high participation in one's care, timely discharge and disclosure of the circumstances of an AE.


RESULTS
Of respondents, 82% rated the quality as high and 23% reported one or more AEs. Patients with no AEs gave higher quality ratings (85 vs. 77 or 62% for patients with 1 or 2+ AEs, respectively, P < 0.001). Patients were more likely to rate the quality high if they reported high participation (86 vs. 53%), or felt discharge timing was just right (85 vs. 64%); for those with AEs, ratings were higher among those reporting disclosure (82 vs. 66%) (all P < 0.01). In adjusted analyses, patients with AEs experiencing all three service recovery components rated their quality higher (86 vs. 68%, P < 0.01).


CONCLUSIONS
Patients with AEs rate the quality of care lower than others. However, patients with AEs who experienced 'service recovery' as we defined it rated their quality of care at levels similar to those who did not experience AEs. Hospitals seeking to improve quality ratings might consider efforts to ensure patient safety and to address AEs in a transparent and responsive way.
Center for Surgery and Public Health, Boston, MA, USA. jweissman@partners.org.
Joel S
JS
Weissman
Lenny
L
López
Eric C
EC
Schneider
Arnold M
AM
Epstein
Stu
S
Lipsitz
Saul N
SN
Weingart
D000328:Adult; D030881:Disclosure; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups
adverse events; measurement of quality; patient safety; quality indicators