Study: Satisfied hospital patients less likely to go back

As the government continues to gather data on how satisfied patients are with their hospital stays, skeptics in the health-care community grumble that what really matters is the quality of treatment and how well people fare after going home.

It turns out that satisfaction and quality are related, according to a new study from Cooper University Health Care.

Using data from more than 3,000 U.S. hospitals, the authors found that higher patient-satisfaction ratings on a five-star scale were associated with lower rates of readmission within 30 days of discharge.

Higher satisfaction ratings also were linked to lower rates of some surgical complications, including a type of bloodstream infection, the authors reported in the Journal of Patient Experience.

Previous research has found some evidence of an association between the quality of medical care and patients' opinions of it, and there are a variety of reasons that might explain why it is true. But the new study is apparently the first to find such a connection with the five-star ratings, introduced last year by the U.S. Centers for Medicare & Medicaid Services.

The findings reinforce a basic tenet of medicine, said lead author Stephen Trzeciak, a professor at Cooper Medical School of Rowan University.

"Everybody has the same intrinsic duty to treat people the way they want to be treated," he said.

Among possible explanations that he and his coauthors listed for their findings:

The star ratings are based in part on patients' impressions of how well doctors and nurses communicated with them. That would explain why, on average, higher ratings mean lower readmission rates: Patients with a good understanding of discharge instructions are known to be less likely to need a return visit to the hospital.

The hospitals that provide a higher-quality patient experience may simply be more likely to do everything well.

Despite a lack of specialized training, patients can indeed get a good sense of when a hospital is well-run.

Patients whose care renders them healthier are simply more likely to be happy with their experience.

Ashish Jha, a professor of health policy at the Harvard T.H. Chan School of Public Health, welcomed the findings but said he was not surprised.

"When people complain about patient experience somehow not being important or 'soft,' I think this is good evidence that there is no trade-off here," Jha said. "The idea that you can't somehow both avoid infections and treat people with respect strikes me as silly."

Incidentally, Cooper itself did not fare too well in the most recently posted ratings, earning two stars out of five (it scored three stars last year). Also, its patients were more likely than average to need return visits to the Camden hospital.

Some researchers say that is to be expected from hospitals in poor urban areas, in part because patients may not have the resources to follow discharge instructions.

Temple University Hospital and Einstein Medical Center Philadelphia also both received two-star patient-satisfaction ratings for the most recent reporting period, April 2014 through March 2015. Like Cooper, both also had worse-than-average overall readmission rates.

Jha, who was not involved in the new study, has written that patients' socio-economic status should be taken into account when grading hospitals on their readmission rates.

As for the five-star satisfaction ratings, they are a composite based on patient responses to questions on 11 topics.

In addition to rating the communication skills of hospital staff, patients also evaluate how well their pain is managed, facility cleanliness, and noise level, among other topics.

The surveys are administered to a random sample of adult patients between 48 hours and six weeks after discharge.

Unlike other measures reported in Medicare's "Hospital Compare" database, the satisfaction ratings are gathered from patients with any kind of insurance, not just Medicare.

Though statistically significant, the connection between higher patient ratings and lower readmission rates was modest.

For example, at hospitals with a five-star rating (the highest), 12.1 percent of stroke patients needed to be readmitted within 30 days of discharge, compared with 14.3 percent of stroke patients at one-star hospitals.

Still, that difference is meaningful, said Cooper's Trzeciak - especially "if you're that one or two or three or however many out of 100 patients it affects." And it's big for insurers.

"From the payer's perspective,'' he said, "these are huge."

tavril@phillynews.com

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@TomAvril1