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The Delta Group

Health Care

Three Studies Rank Quality of U.S. Hospital Care and Patient Satisfaction

Quality of care doesn’t guarantee patient satisfaction

Published: Wednesday, September 22, 2010 - 07:13

(The Delta Group: Greenville, SC) -- CareChex, a division of The Delta Group specializing in rating the quality of hospital and physician care, has released three new studies that reveal broad disparities between the quality of U.S. health care by state and metro area, and surprising regional differences in patient satisfaction with the care they are getting.

The first study, 2010 CareChex Quality of Care by U.S. Geographic Area, provides insight into the relative quality of care and the broad disparities in care delivered across different states and major metropolitan areas. The data also help explain the growing trend toward U.S. “medical tourism,” where patients travel outside their local market to receive higher quality care at a better price.

The second study,2010 CareChex Patient Satisfaction by U.S. Geographic Area, identifies the relative patient satisfaction with hospital care among states and major metropolitan areas, and gives an overview of which locations offer the best customer-centric care. With the rise of consumerism in health care, the hospital industry has realized that cost and quality alone are insufficient competitive differentiators in the minds of customers; service excellence also plays a vital role in determining value. The absence of customer-oriented care can often lead to patient dissatisfaction despite excellence in clinical quality.

The studies are paired with a third analysis that highlights a startling trend: Technical quality of care in the U.S. is a poor proxy for patient satisfaction with their hospital stay. In fact, some of the states with the most dissatisfied patients are the most highly ranked for quality of care.

“These findings underscore the need for hospitals to engage in regular patient satisfaction surveys rather than assume patients are satisfied with their medical care simply because a hospital meets a particular standard of clinical quality,” says Andrew Webber, president and CEO, National Business Coalition on Health (NBCH), a national membership organization of purchaser-led health care coalitions representing more than 7,000 employers and approximately 25 million employees and their dependents. “From the perspective of employers and purchaser-based coalitions, employee satisfaction with the care they receive is an important part of a hospital’s overall value equation. There’s simply no reason why we shouldn’t expect quality care to be provided along with a positive patient experience.”

Overall quality of care

In the study, states are rated for quality of care against a possible perfect score of 100. The top 10 states providing the best overall care are:

1. Ohio (98.0)
2. Michigan (96.1)
3. Delaware (94.1)
4. Massachusetts (92.2)
5. Connecticut (90.2)
6. Indiana (88.2)
7. Wisconsin (86.3)
8. Florida (84.3)
9. North Dakota (82.4)
10. Iowa (80.4)

The bottom 10 states in this category, scored in the same manner, are:

1. District of Columbia (0.1)
2. Nevada (2.0)
3. Hawaii (3.9)
4. New Mexico (5.9)
5. New York (7.8)
6. Alaska (9.8)
7. Wyoming (11.8)
8. Mississippi (13.7)
9. California (15.7)
10. West Virginia (17.7)

Patient satisfaction

Again, states are rated against a possible perfect score of 100. The top 10 states in delivering patient satisfaction are:

1. Vermont (98.0)
2. Maine (96.1)
3. New Hampshire (94.1)
4. Alabama (92.2)
5. Louisiana (90.2)
6. Wisconsin (88.2)
7. South Dakota (86.3)
8. North Carolina (84.3)
9. Nebraska (82.4)
10. Iowa (80.4)

At the bottom of this category are:

1. District of Columbia (0.1)
2. Nevada (2.0)
3. Florida (3.9)
4. California (5.9)
5. Hawaii (7.8)
6. New Jersey (9.8)
7. New York (11.8)
8. Maryland (13.7)
9. Arizona (15.7)
10. New Mexico (17.7)

Correlation—Disparity between quality of care and patient satisfaction

In this category, the study examines the gap between quality of care and patient satisfaction, and lists the 10 states with the broadest disparity. They are:

1. Ohio—care score 98.0, satisfaction score 33.3
2. Delaware—care score 94.1, satisfaction score 19.6
3. Connecticut—care score 90.2, satisfaction score 27.5
4. Florida—care score 84.3, satisfaction score 3.9
5. Illinois—care score 78.4, satisfaction score 23.5
6. Arizona—care score 70.6, satisfaction score 15.7
7. Vermont—care score 41.2, satisfaction score 98.0
8. Louisiana—care score 29.4, satisfaction score 90.2
9. Mississippi—care score 13.7, satisfaction score 72.6
10. Wyoming—care score 11.8, satisfaction score 70.6

Other key survey findings

• The District of Columbia has the lowest quality of overall hospital care and the lowest patient satisfaction score when compared to the rest of the country.
• With one of the highest levels of HMO-managed care penetration in the country, California has one of the lowest quality of care scores. Although more research is needed to determine why this may be, a link to aggressive ancillary cost reduction and shorter hospital stays may be adversely affecting quality of care.
• The three states with the highest patient-satisfaction scores—Vermont, Maine, and New Hampshire—are all from the Northeast.
• Five of 10 states with the highest quality of overall hospital care—Ohio, Michigan, Indiana, Wisconsin, and North Dakota—are in the Midwest.
• Six of 10 states with the lowest quality of overall hospital care—California, Wyoming, New Mexico, Nevada, Hawaii, and Alaska—are Western states.
• Puzzling disparities exist in some locations between quality of care and patient satisfaction. For example, the Raleigh/Durham, North Carolina, area has relatively low quality of care rankings and high patient satisfaction. Ohio, Delaware, and Connecticut have very high quality rankings but unusually low patient satisfaction. Mississippi, although ranked No. 44 among states for care quality, has a relatively high patient-satisfaction score.

Full quality rankings and percentile scores by state and metropolitan areas for overall hospital care and for patient satisfaction are available here. Also available are quality rankings and percentile scores for the 50 largest metro areas by select clinical categories (e.g., cardiac care, cancer care, and orthopedic care).

Maps available for reprinting showing state by state comparisons on quality of care, patient satisfaction with hospital care, and disparities between quality and satisfaction are available for reprinting here.

Study design, data sources, and methods

These research projects conducted by CareChex were designed as longitudinal studies spanning the most recent three years of federal fiscal year data, using all Medicare inpatient discharges from the Center for Medicare and Medicaid Studies (CMS) Medicare Provider Assessment and Review (MedPAR) file as well as the Department of Health and Human Services (DHHS) Hospital Compare database. All CareChex studies utilized public and proprietary methods validated by third‐party organizations for evaluating hospital quality performance.

These methods include process-of-care measures developed by The Joint Commission (TJC) for national accreditation of health care organizations; inpatient quality and patient safety measures developed by Stanford University under subcontract with the federal government’s Agency for Health Research and Quality (AHRQ); patient-satisfaction measures developed by CMS using a standardized national hospital survey; and proprietary outcome measures developed by The Delta Group for evaluating rates of hospital inpatient mortality, post‐surgical complications, and global patient safety events. In addition, specific statistical methods used in each of the three independent studies include statistical significance testing, distribution standardization, and correlation analysis.

For more information regarding the construction and validation of the aforementioned methods, please access the following web links:

Process of care measures
Inpatient quality measures
Patient safety measures
Patient Satisfaction measures
Proprietary outcome measures


About The Author

The Delta Group’s picture

The Delta Group

As the nation’s largest privately‐held healthcare information services company, The Delta Group provides an extensive array of products and services designed to measure, manage, and monitor the clinical, financial, and market performance of healthcare organizations.

CareChex, a division of The Delta Group, specializes in rating and ranking the quality of hospital and physician care using both public and proprietary measures of performance including process of care, outcomes of care, and patient satisfaction.