Patient Satisfaction Slightly Higher With Hospitalists

SAN DIEGO – Hospitals that employed more hospitalists had modestly higher patient satisfaction scores in an analysis of 2009 Medicare data for 135,722 patients at 2,843 hospitals.

Patient satisfaction scores came from the Hospital Consumer Assessment of Healthcare Providers and System, a 27-item survey that, starting in 2006, was administered to random adult patients within 48 hours to 6 weeks after discharge from the hospitals.

Approximately 63.5% patients at nonhospitalist hospitals would recommend the hospital to others, as would approximately 64.5% of patients at mixed hospitals and 66% of patients at hospitalist hospitals,

Use of hospitalists varied widely, with no hospitalists caring for general medicine patients at 17% of hospitals and all general medicine patients being cared for by hospitalists at less than 4% of hospitals. The analysis grouped hospitals as one of three types. "Nonhospitalist" facilities had 0%-20% of patients cared for by hospitalists. "Mixed" hospitals used hospitalists for 21%-50% of general medicine patients, and "hospitalist" hospitals placed 61%-100% of general medicine patients under hospitalist care.

Overall patient satisfaction rates were approximately 64% for nonhospitalist or mixed hospitals and nearly 66% for hospitalist facilities, Dr. Lena M. Chen and her associates reported at the annual meeting of the Society of Hospital Medicine.

Approximately 63.5% of the 33,265 patients at nonhospitalist hospitals would recommend the hospital to others, as would approximately 64.5% of the 52,844 patients at mixed hospitals and 66% of the 46,705 patients at hospitalist hospitals, said Dr. Chen of the University of Michigan, Ann Arbor.

On individual items, the largest difference between facilities was in patient satisfaction with discharge – an 80% rating at hospitalist facilities, which was significantly higher than the 78% rating for nonhospitalist hospitals. Smaller, but still statistically significant, differences were seen in higher satisfaction scores for hospitalist vs. nonhospitalist facilities in ratings on nursing services, quiet, communication with nurses, pain control, and communication about medications.

Starting in October 2012, Medicare will base part of its hospital payments on patient satisfaction scores, Dr. Chen noted. Inpatients increasingly are likely to be cared for by hospitalists.

"Given efforts to increase patient satisfaction, it would be important to understand why hospitals with more hospitalist care have higher patient satisfaction," she said.

The analysis adjusted for potentially confounding effects of various differences between types of hospitals. Nonhospitalist hospitals were significantly less likely to be teaching hospitals and significantly more likely to be in urban locations. Hospitalist facilities were significantly more likely to have a medical ICU and to have a higher nurse-to-bed ratio compared with nonhospitalist hospitals.

Hospitalists were defined as general internists with at least five Medicare billings in a year and with 90% or more of these billings from the care of hospitalized patients.

The 5% sample of elderly fee-for-service Medicare beneficiaries excluded patients with surgical admissions or readmissions, patients who did not have an acute care hospital stay, patients who were not cared for by a general internist, and patients who were cared for by both a hospitalist and nonhospitalists.

Dr. Chen reported having no financial disclosures.

SAN DIEGO – Hospitals that employed more hospitalists had modestly higher patient satisfaction scores in an analysis of 2009 Medicare data for 135,722 patients at 2,843 hospitals.

Patient satisfaction scores came from the Hospital Consumer Assessment of Healthcare Providers and System, a 27-item survey that, starting in 2006, was administered to random adult patients within 48 hours to 6 weeks after discharge from the hospitals.

Approximately 63.5% patients at nonhospitalist hospitals would recommend the hospital to others, as would approximately 64.5% of patients at mixed hospitals and 66% of patients at hospitalist hospitals,

Use of hospitalists varied widely, with no hospitalists caring for general medicine patients at 17% of hospitals and all general medicine patients being cared for by hospitalists at less than 4% of hospitals. The analysis grouped hospitals as one of three types. "Nonhospitalist" facilities had 0%-20% of patients cared for by hospitalists. "Mixed" hospitals used hospitalists for 21%-50% of general medicine patients, and "hospitalist" hospitals placed 61%-100% of general medicine patients under hospitalist care.

Overall patient satisfaction rates were approximately 64% for nonhospitalist or mixed hospitals and nearly 66% for hospitalist facilities, Dr. Lena M. Chen and her associates reported at the annual meeting of the Society of Hospital Medicine.

Approximately 63.5% of the 33,265 patients at nonhospitalist hospitals would recommend the hospital to others, as would approximately 64.5% of the 52,844 patients at mixed hospitals and 66% of the 46,705 patients at hospitalist hospitals, said Dr. Chen of the University of Michigan, Ann Arbor.

On individual items, the largest difference between facilities was in patient satisfaction with discharge – an 80% rating at hospitalist facilities, which was significantly higher than the 78% rating for nonhospitalist hospitals. Smaller, but still statistically significant, differences were seen in higher satisfaction scores for hospitalist vs. nonhospitalist facilities in ratings on nursing services, quiet, communication with nurses, pain control, and communication about medications.

Starting in October 2012, Medicare will base part of its hospital payments on patient satisfaction scores, Dr. Chen noted. Inpatients increasingly are likely to be cared for by hospitalists.

"Given efforts to increase patient satisfaction, it would be important to understand why hospitals with more hospitalist care have higher patient satisfaction," she said.

The analysis adjusted for potentially confounding effects of various differences between types of hospitals. Nonhospitalist hospitals were significantly less likely to be teaching hospitals and significantly more likely to be in urban locations. Hospitalist facilities were significantly more likely to have a medical ICU and to have a higher nurse-to-bed ratio compared with nonhospitalist hospitals.

Hospitalists were defined as general internists with at least five Medicare billings in a year and with 90% or more of these billings from the care of hospitalized patients.

The 5% sample of elderly fee-for-service Medicare beneficiaries excluded patients with surgical admissions or readmissions, patients who did not have an acute care hospital stay, patients who were not cared for by a general internist, and patients who were cared for by both a hospitalist and nonhospitalists.

Dr. Chen reported having no financial disclosures.

SAN DIEGO – Hospitals that employed more hospitalists had modestly higher patient satisfaction scores in an analysis of 2009 Medicare data for 135,722 patients at 2,843 hospitals.

Patient satisfaction scores came from the Hospital Consumer Assessment of Healthcare Providers and System, a 27-item survey that, starting in 2006, was administered to random adult patients within 48 hours to 6 weeks after discharge from the hospitals.

Approximately 63.5% patients at nonhospitalist hospitals would recommend the hospital to others, as would approximately 64.5% of patients at mixed hospitals and 66% of patients at hospitalist hospitals,

Use of hospitalists varied widely, with no hospitalists caring for general medicine patients at 17% of hospitals and all general medicine patients being cared for by hospitalists at less than 4% of hospitals. The analysis grouped hospitals as one of three types. "Nonhospitalist" facilities had 0%-20% of patients cared for by hospitalists. "Mixed" hospitals used hospitalists for 21%-50% of general medicine patients, and "hospitalist" hospitals placed 61%-100% of general medicine patients under hospitalist care.

Overall patient satisfaction rates were approximately 64% for nonhospitalist or mixed hospitals and nearly 66% for hospitalist facilities, Dr. Lena M. Chen and her associates reported at the annual meeting of the Society of Hospital Medicine.

Approximately 63.5% of the 33,265 patients at nonhospitalist hospitals would recommend the hospital to others, as would approximately 64.5% of the 52,844 patients at mixed hospitals and 66% of the 46,705 patients at hospitalist hospitals, said Dr. Chen of the University of Michigan, Ann Arbor.

On individual items, the largest difference between facilities was in patient satisfaction with discharge – an 80% rating at hospitalist facilities, which was significantly higher than the 78% rating for nonhospitalist hospitals. Smaller, but still statistically significant, differences were seen in higher satisfaction scores for hospitalist vs. nonhospitalist facilities in ratings on nursing services, quiet, communication with nurses, pain control, and communication about medications.

Starting in October 2012, Medicare will base part of its hospital payments on patient satisfaction scores, Dr. Chen noted. Inpatients increasingly are likely to be cared for by hospitalists.

"Given efforts to increase patient satisfaction, it would be important to understand why hospitals with more hospitalist care have higher patient satisfaction," she said.

The analysis adjusted for potentially confounding effects of various differences between types of hospitals. Nonhospitalist hospitals were significantly less likely to be teaching hospitals and significantly more likely to be in urban locations. Hospitalist facilities were significantly more likely to have a medical ICU and to have a higher nurse-to-bed ratio compared with nonhospitalist hospitals.

Hospitalists were defined as general internists with at least five Medicare billings in a year and with 90% or more of these billings from the care of hospitalized patients.

The 5% sample of elderly fee-for-service Medicare beneficiaries excluded patients with surgical admissions or readmissions, patients who did not have an acute care hospital stay, patients who were not cared for by a general internist, and patients who were cared for by both a hospitalist and nonhospitalists.

Dr. Chen reported having no financial disclosures.