In an attempt to provide a portrait of patients’ experiences in US hospitals, a team of researchers at the Harvard School of Public Health surveyed hospitals in 40 metropolitan areas and found that many institutions fell short in a number of basic areas such as pain control and communication, or giving clear discharge instructions.

Dr. Ashish Jha, a Harvard health policy researcher, and colleagues analyzed data collected by the federal government as part of the Hospital Consumer Assessment of Healthcare Providers and Systems survey, as well as clinical care measures from the Hospital Quality Alliance (HQA) program, the Centers for Medicare and Medicaid Services, and the Joint Commission. The survey included questions about communication with doctors, with nurses and about medications; quality of nursing services, discharge information and pain management.

“Patients in general were satisfied with the care they received, but boy there is a lot of room for improvement,” Jha said. “We’ve been talking about (health care) quality for 20 years, but patients’ experiences have not been part of the discussion.”

He said that pain was the most common complaint and the area that definitely needed improvement. Nearly a third of patients gave hospitals low marks in pain management, and about a fifth of patients said discharge instructions were not clearly communicated.

63% of respondents rated care a 9 or 10 on a scale of zero to 10 and 27 rated it a 7 or 8, according to the report in the Oct. 30 issue of the New England Journal of Medicine. Only 11% of respondents gave a rating of six or less.

The percentage of those who were satisfied by their pain care was higher in Birmingham than in East Long Island: 72% of patients in Birmingham, Ala., hospitals gave their care a 9 or 10, compared with only 50% of patients in East Long Island, New York, Fort Lauderdale, Florida and New York City hospitals. Almost 70 percent of patients at hospitals in Knoxville, Tennessee, and Charlotte, North Carolina, gave high marks to the hospitals in their region. The researchers said the differences in patient expectations might partly explain these results. In 2008, we should be at 95 percent, Jha said.

The percentage of those who said that doctors communicated well was higher (79%) than the percentage of those who said their room was always quiet.

Other areas that need improvement, besides pain management, were nursing care, communication about medications, and provision of clear discharge instructions.

The survey also noted some differences between teaching hospitals and non-teaching, as well as between not-for-profits and for-profits. Specifically, teaching hospitals got higher marks than non-teaching and not-for-profits hospitals were rated higher than for-profits.

Researchers hope that the public release of data on clinical performance will lead to improvements in the quality of patient care in hospitals. Jha said the results show that there are many areas in which hospital performance is still “pretty suboptimal.” It is clear that the performance of hospitals is variable and that there are many opportunities for improvement, Dr.Jha concluded.