PATIENTS PERCEPTION OF QUALITY HOSPITAL-CARE AND HOSPITAL OCCUPANCY -ARE THERE BIASES ASSOCIATED WITH ASSESSING QUALITY CARE BASED ON PATIENTS PERCEPTIONS

There currently is interest in evaluating medical outcomes based on pa tient perceptions. However, in the US there may be biases associated w ith these perceptions because of past marketing activities and other f actors, such as facility location. The research question examined is w hether perceived overall quality could predict hospital occupancy. To assess this, the quality ratings of 155 local hospitals by over 20000 household beads surveyed in 20 US states were analyzed using an ecolog ical research design. Facility image and hospital occupancy were asses sed after controlling for community, facility and quality care differe nces between facilities. Results indicated that hospitals in more urba nized areas (p = 0.003), with lower costs (p = 0.0001), that were non- teaching (p = 0.033) and those with more employees per bed (p<0.0001) had higher occupancies, but that perceived quality did not predict adm issions after facility differences were controlled (p = 0.302). Howeve r, further analysis suggested both positive and negative biases may ex ist: controlling for community, facility, and quality care differences , facilities with ''high'' ratings appeared to have consistently highe r occupancies, those with ''low'' ratings consistently lower occupanci es, and facilities with ''average'' ratings appeared to be unaffected. Based on this finding, an interaction effect was tested and confirmed for community rating x facility size (p = 0.015), suggesting that sma ller hospitals with low ratings had lower than expected occupancies. A lthough this study has limitations, it was suggested that researchers should use quality indicators based on patients' perceptions with caut ion and be open to additional scientific research, until these measure s are better understood. Copyright (C) 1996 Elsevier Science Ltd.