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Med Care. 2014 Jul;52(7):619-25. doi: 10.1097/MLR.0000000000000144.

Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals.

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*Yale School of Public Health, Yale School of Medicine, New Haven, CT †HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (152-M) ‡Department of Health Policy & Management, Boston University School of Public Health, Boston, MA §VA Office of Analytics and Business Intelligence, Washington, DC ∥Department of Health Care Policy, Harvard Medical School, Boston, MA.



Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients.


To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information.


We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI.


Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were >0.97 across 9 dimensions of inpatient experience.


This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics.

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