The University of Iowa
The University of Iowa News Services Home News Releases UI in the News Subscribe to UI News Contact Us


2130 Medical Laboratories
Iowa City IA 52242
(319) 335-6660; fax (319) 335-9917

Release: July 9, 1999

Patients' assessments of hospital maternity care may be useful consumer tool

IOWA CITY, Iowa -- As the '90s come to a close, people are taking more of a consumer approach to health care. But few standardized resources are available to help people choose physicians, hospitals or health care plans. This situation is beginning to change as researchers test questionnaires and other tools designed to gather reliable consumer feedback on health care.

Patients' assessments of hospital maternity care may help prospective mothers make informed health care choices, according to a study led by a physician now at the University of Iowa. The study, one of the largest of its kind, used patient satisfaction data from the Cleveland Health Quality Choice program, which involved 18 northeast Ohio hospitals. The findings were published in the June issue of Health Services Research.

"Very few studies have looked at whether patients' assessments vary across hospitals or whether such measures are stable over time," said lead investigator Gary E. Rosenthal, M.D., UI associate professor of internal medicine and director of general internal medicine. "We found that the survey measures used in our study distinguished between patient satisfaction levels at the different hospitals. However, perhaps the most surprising result was that the measurements varied little over three consecutive years, which may make them very reliable for consumers."

At the time of the study, Rosenthal was an associate professor of medicine at Case Western Reserve University and the Cleveland Veterans Affairs Medical Center. Other investigators were Beth S. Finkelstein, Ph.D., research associate at Case Western Reserve University, and Dwain L. Harper, D.O., president of Quality Information Management Corporation in Cleveland.

The study was based on surveys mailed to 27,674 randomly selected women who had delivered live infants at the Cleveland-area hospitals between 1992 and 1994. The researchers analyzed 16,051 completed surveys, a 58 percent response rate. The survey included questions designed to evaluate physician care, nursing care and global assessment of care (whether the patient would recommend the hospital to others seeking health care of any type).

The stability of the individual hospital scores was important, Rosenthal said. "As a consumer, you have to rely on data that are anywhere from six months to several years old as an indicator of what it might be like if you used the hospital next week or next month. If the measures aren't stable, then prior hospital performance might not be an accurate indicator of what to expect in the future."

The researchers also examined the degree to which patients' personal characteristics such as age, education and overall health affected their assessments. The investigators found that adjusting for these characteristics had little impact on the results.

"When you compare health care outcomes in different hospitals," Rosenthal said, "you need to adjust for factors that may relate to outcome in order not to penalize hospitals or doctors who care for patients who are medically more challenging."

Rosenthal said patient assessment measures can be used as ways to foster consumer choice in health care. Institutional purchasers of health care, such as state governments and large employers, also seek data when choosing providers and health plans for their employees. The Cleveland Health Quality Choice project, which ended this year, disseminated hospital performance reports to employers every six to 12 months and also sold reports to the public through pharmacies.

Rosenthal noted several cautions in using the results of such surveys because patient satisfaction is one of many potential quality-of-care indicators.

"Ideally, you want as wide a spectrum of measures as possible," he said. "Unfortunately there's a dearth of data out there about quality of care."

He added that it is unclear exactly how patient assessments of care relate to other quality measures, but most people recognize that satisfying the patient is important to health care.

"Some aspects of care, such as pain control or doctors' and nurses' communication skills, can be assessed only by asking patients," he said.

Rosenthal said another study limitation was that the researchers did not know details about the patients' individual health care plans and could only categorize them generally as Medicaid, uninsured or commercial insurance.

"We don't know if some patients had aggressively managed care health plans that may have limited their hospital care," he said. "Presumably such factors could have affected their assessments of hospitals."

Rosenthal's work on the study was supported by a Career Development Award from the Health Services Research and Development Services of the U.S. Department of Veterans Affairs.

Finkelstein was supported by a National Research Service Award from the Agency for Health Care Policy and Research, a part of the U.S. Department of Health and Human Services.

Since joining UI Health Care and the Iowa City Veterans Affairs Medical Center, Rosenthal has continued investigating the validity and reliability of different measures of health care quality measures. He said that although such research is complicated by limitations, it is important that clinicians take as active a role as possible.

"The pressures for collecting and disseminating comparative health care quality data are only going to intensify," Rosenthal said. "As physicians in academic centers, we need to lead the pack to ensure that measures used are as accurate as possible."