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Circ Cardiovasc Qual Outcomes. 2012 May;5(3):365-72. doi: 10.1161/CIRCOUTCOMES.111.964361. Epub 2012 Apr 10.

Patient satisfaction at America's lowest performing hospitals.

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  • 1Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.



Previous studies have identified hospitals with poor performance on cardiac process measures. How these hospitals fare in other domains, such as patient satisfaction, remains unknown.


We used Hospital Compare data to identify hospitals reporting acute myocardial infarction (AMI) and heart failure (HF) process measures during 2006 to 2008, and calculated respective composite performance scores. Using these scores, we classified hospitals as low-performing (bottom decile for all 3 years), top-performing (top decile for all 3 years), and intermediate (all others). We used Hospital Consumer Assessment of Healthcare Providers and Systems 2008 data to compare overall satisfaction between low, intermediate, and top-performing hospitals. Low-performing hospitals had fewer beds, fewer nurses per patient, and were more likely rural, safety-net hospitals located in the South, compared with intermediate and top-performing hospitals (P<0.01 for all). After adjusting for hospital characteristics, patients were less likely to recommend low-performing hospitals to family or friends, relative to intermediate and top-performing hospitals (AMI: 58.8% versus 63.9% versus 68.8%, HF: 61.3% versus 64.0% versus 66.8%; P<0.001 for all), or provide an overall rating of ≥ 9 out of 10 (AMI: 56.7% versus 60.7% versus 64.9%, HF: 57.8% versus 61.1% versus 63.6%; P<0.01 for all). Despite the association between the hospital's performance on process measures and patient satisfaction, we noted discordance between these measures (kappa statistic <0.20).


Hospitals with consistently poor performance on cardiac process measures also have lower patient satisfaction on average, suggesting that these hospitals have overall poor quality of care. However, there is discordance between the 2 measures in profiling hospital quality.

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