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Source: Zhihu
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Original question: why is there no popular review site for hospitals?
Answer: This is a valuable question, and in a well-developed health system, patients certainly have the power to enter into the process of evaluating health services. But to make this clear, a few questions need to be answered first: Is patient evaluation valuable? Who will organize the evaluation? How can evaluation be useful? Apart from evaluation indicators, what else should patients know? What are the difficulties?
1. Value: does patient satisfaction reflect quality of care?
Totally. The main criticisms of patient satisfaction are centered on the fact that it is difficult for patients' subjective feelings to reflect objective clinical operations. For example, in an operation, the patient doesn't know how the surgeon operates on him or her; all he or she feels is whether the pain is being managed effectively, the attitude of the doctors and nurses, and whether the environment in the hospital room is quiet and clean. But a study of more than 3,000 hospitals across the U.S. confirms that the higher a hospital's patient score, the lower the risk-adjusted mortality and readmission rates and the higher the guideline compliance, net of factors such as hospital size and grade. At the same time, patient satisfaction at a hospital was associated with pneumonia, heart attack and heart failure mortality and readmission rates at that hospital. Thus, patient satisfaction is statistically indicative of quality of care, even after discounting the impact of the hospital's own strengths. In the U.S., there is a Value-based Purchasing program for Medicare for people over 65 years old, and patient ratings are one of the reference indicators, and hospitals with high ratings will receive additional compensation.
2. Who organizes the evaluation?
Patient satisfaction is something that needs to be measured in a structured way. Going to the doctor is not a treat, after all, and it needs to be more precise and representative than a rough measurement like a popular review. Not all patient families have access to the Internet, and not all patients are willing to use the same website for reviews. MassHealth is under no obligation to ensure the scientific nature of the evaluations, but hospitals need to. For example, the sampling method for patient surveys needs to be designed, the structure of the questionnaire needs to be designed, and the results collected need to be risk-adjusted, the patient structure adjusted and the survey method adjusted. For example, one hospital admits patients with generally poor health, or one hospital has a lot of respiratory patients and another hospital has a lot of surgical patients, or, one hospital scores all of its patients online and the other hospital has nurses who take them to the bedside for you to score, all of which creates unfairness and all of which require statistical adjustments. Therefore, to get accurate data on hospital ratings, I don't think the popular review model is applicable to hospital evaluations, or we need a standardized measurement tool and a standardized research group to do the data processing and publication.
3. How does evaluation work?
As some of the answers said, there is not yet a direct link between how well many public hospitals themselves are run and whether patients are satisfied. The medical malpractice at the entrance to the Third Hospital of North Medicine singing love songs and sending off who knows how many graduates doesn't affect the hotness of the small hotels with patients' families living around them. Patient satisfaction is not very meaningful if it is just a statistic. It requires appropriate health policies to adjust the distribution of benefits to hospitals. In the United States, CMS is adjusted by way of compensation for highly rated hospitals, prompting hospitals to go to improve their service attitude.
4. In addition to evaluation, what else should be measured?
Most directly, hospital quality of care indicators. These include post-discharge follow-up mortality rates for many diseases, readmission rates, and rates of adherence to clinical guidelines. The subjective assessment of patients cannot fully replace the role of these indicators. In the United States, there is a Hospital Compare Web site (Datasets | Data.Medicare.gov), which patients can consult to obtain basic information about the hospital, and the various scores and be able to compare.
5. What are the difficulties?
The first is data disclosure. It's not as if there aren't organizations out there doing this for the government. In theory, the government is obliged to make this data public. But for reasons that are well known, much of the data is not publicly accessible for the time being. Of course, there are those who say that the reason why they are not made public is because the quality of which data is so poor that making it public is tantamount to losing face, and I think that's quite possible.
Secondly, there is a lack of domestic research data. But again, research depends heavily on that data above being made public.
Another point is the issue of medical spending, hospitals have a cost to get high ratings, neat environment, reassuring smiles, patient communication, all need medical staff to pay more time and labor, hospitals have to spend more money. And these funds will not fall from the sky, someone has to pay, either the patient, or all taxpayers.
References for original answer:
[1]Tsai, T. C., Orav, E. J., & Jha, A. K. (2014). Patient Satisfaction and Quality of Surgical Care in US Hospitals. Annals of Surgery, 00(00), 1-7.
[2]Boulding, W., Glickman, S. W ., Manary, M. P., Schulman, K. A., & Staelin, R. (2011). Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. The American Journal of Managed Care, 17(1), 41 -48.