Patient satisfaction with hospital care - Effects of demographic and institutional characteristics

BACKGROUND. There are a growing number of efforts to compare the service qu ality of health care organizations on the basis of patient satisfaction dat a. Such efforts inevitably raise questions about the fairness of the compar isons. Fair comparisons presumably should not penalize (or reward) health c are organizations for factors that influence satisfaction scores but are no t within the control of managers or clinicians. On the basis of previous re search, these factors might include the demographic characteristics of pati ents (eg, age) and the institutional characteristics (eg, size) of the heal th care organizations where care was received. OBJECTIVES. The goal of this study was to examine the extent to which a pat ient's satisfaction scores are related to both his/her demographic characte ristics and the institutional characteristics of the health care organizati on where care was received. METHODS. We conducted an analysis of secondary data from the Veterans Healt h Administration (VHA), US Department of Veterans Affairs. The database con tained patient responses to self-administered satisfaction questionnaires a nd information about demographic characteristics. Additional data from VHA were obtained regarding the institutional characteristics of the hospitals where patients received their care. RESULTS. Among demographic characteristics, age, health status, and race co nsistently had a statistically significant effect on satisfaction scores. A mong the institutional characteristics, hospital size consistently had a si gnificant effect on patient satisfaction scores. CONCLUSIONS. Study results can be interpreted as justifying the need to adj ust patient satisfaction scores for differences in patient population among health care organizations. However, from a policy perspective, such adjust ments may ultimately create a disincentive for health care organizations to customize their care.