Patient Ratings

Our Patient Ratings are based on the federal government's survey of over 1 million patients regarding their recent experiences during a hospital stay. The survey, called the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, focuses on:

• Communication with doctors and nurses
• Pain control
• How often help was received when needed
• Cleanliness and quietness of rooms
• Information about new medications
• Information about discharge
• Whether the patient would recommend the hospital to family and friends
• The patient's overall rating of their experience

From these survey results, Consumer Reports Health Ratings Center statisticians have created easy-to-understand Ratings, including an "overall score" for each hospital, to help you compare and choose hospitals. Our Ratings are on a "better to worse" scale.

For most of the components of Patient Ratings (except for the overall score and information about discharge), we calculated the percentage of respondents who said "always" or "usually" in response to the survey questions (e.g. 92% of respondents reported that their doctors always or usually communicated well). For discharge instructions, we used the percentage of patients who said they received discharge instructions. We then assigned Ratings scores using the scale shown below:

The overall score is based on the average of:

• The percentage of respondents who would "definitely" recommend the hospital
• The percentage of respondents who gave the hospital an overall rating of 9 or 10 on a scale of 0-10.

To find out more about the survey and how the Ratings were created, read our Technical Report, and learn more about what it all means for you from our Frequently Asked Questions.

Patient Ratings FAQs

How can Consumer Reports' Patient Ratings help me get better hospital care?
Our Ratings provide an idea of how satisfied you might be with key aspects of care at a particular hospital. The Ratings are based on the findings of a government survey of more than a million patients who have recently been discharged from over 3,000 hospitals nationwide.

If you have a choice of hospitals, these Ratings, along with our data on the hospital's approach to chronic care, provide you with information that can help you find hospitals in your geographic area that meet your needs. If you don't have a choice of hospitals, use the Ratings to understand what kind of problems other patients have run into at the hospital you are going to, so you can be better prepared to deal with them. For example, if previous patients have given your hospital low marks for discharge preparation, you can make a point of asking about discharge planning early in your stay.

What do high or low Ratings mean?
For most of the measures, the Ratings give you an idea of how frequently patients received the care they needed. For example, a high score on Communication with Nurses means that most patients reported that they often had respectful, helpful interactions with their nurses. If patients rated a hospital low for communication with doctors or for dispensing discharge instructions, then patients or family members may have had to make an effort to get the information they needed”or not gotten it at all. Choosing a hospital with a high overall score increases your chance of being generally satisfied with your hospital stay. Choosing one that scored lower increases the probability that you may encounter some challenges during your hospital stay.

Do higher Ratings mean better patient health outcomes?
Possibly. Researchers at the Harvard School of Public Health and elsewhere have found an association between higher patient scores and higher quality of clinical care for heart attack, congestive heart failure, pneumonia, and prevention of complications from surgery. Nurse staffing levels may be a factor that influences patient satisfaction. Hospitals that patients scored highest tended to have the highest ratio of full-time nurses to patients per day, according to the study, published in the Oct. 30, 2008 issue of The New England Journal of Medicine. Other research has also linked higher nurse-staffing levels with greater patient satisfaction scores and with lower complication and mortality rates. Other evidence also suggests that patients who have attentive nurses, physicians who communicate effectively, adequate pain management and well-planned hospital discharges may also have improved health outcomes.

In contrast, lower patient scores are associated with more aggressive care-longer hospitalizations under the care of multiple specialists and, possibly, worse patient outcomes, according to research by investigators at the Dartmouth Institute for Health Policy and Clinical Practice and the Dartmouth Atlas of Health Care in Lebanon, N.H.. Low scores were also associated with poorer technical quality measures for the management of heart attack, congestive heart failure and pneumonia, the team reported in the January-February 2009 issue of Health Affairs. Poorly coordinated care, they conclude, may be the culprit that links low patient experience scores with lower quality and more aggressive care.

What are the Patient Ratings based on?
The Ratings are based on results from the federal government's Hospital Consumer Assessment of Healthcare Providers and Systems survey, known as HCAHPS. The survey was developed by the federal Agency for Healthcare Research and Quality for the federal Centers for Medicare and Medicaid Services. Learn more about HCAHPS.

What kinds of questions were asked in the survey?
The HCAHPS survey asks patients questions about their hospital experience, focusing on these major areas:

• Communication with Nurses
• Communication with Doctors
• Responsiveness of Hospital Staff
• Pain Management
• Communication About Medicines
• Discharge Information
• Cleanliness of Room and Bathroom
• Quietness at Night

In addition, two overall questions regarding the patient experience include:

• Would you recommend this hospital to your friends and family?
• Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?

None of these patient experience scores are reported for specific diseases “ rather they are designed to measure general patient experience across a wide range of conditions.

Are there any differences between Consumer Reports' Patient Ratings and the government's HCAHPS survey results?
Yes. We've converted the government's survey data into easy-to-understand Ratings to provide you with:

• an easy-to-compare visual means to assess the data
• a scoring scheme to help you interpret what the numbers mean and
• an "overall" score for each hospital.

Why can't I find my hospital?
Childrens' hospitals are excluded because the HCAHPS survey asks about adult care only. Department of Defense and Veterans Affairs hospitals do not report HCAHPS data to the Centers for Medicare and Medicaid Services.

Our Ratings also exclude 331 hospitals that participated in the June 2009 HCAHPS data release. Of those, 121 hospitals reported fewer than 100 completed surveys--samples too small to yield reliable Ratings. We also excluded 219 hospitals that the Centers for Medicare and Medicaid Services noted had discrepancies in the data collection process (9 hospitals are excluded for both reasons). In addition, some hospitals were omitted due to a mapping issue. Read more in our Hospital Ratings Technical Report.

Are there other things to consider when choosing a hospital?
Yes, such as:

• Whether the hospital offers the specialized care—for example, pediatrics or oncology—you might require.
• Where your doctor has privileges at the hospital, meaning that she or he can visit you while you're there.
• Which hospitals are in your health plan's network.
• Other information is available from the government on the volume of certain procedures performed, outcome, and data on process of care, which shows how often hospitals give recommended treatments known to get the best results for patients with certain medical conditions or surgical procedures.
• The experience of the hospital and surgeon if you need an uncommon procedure, such as surgery for esophageal cancer; complicated surgery, such as prostate removal; or an inherently risky operation, such as for brain aneurysm. Some hospital report cards now give consumers information on the volume of particular surgeries performed at individual hospitals.

How can you compare hospitals if patients in some are sicker than patients in others?
The data have been statistically adjusted to minimize differences among hospitals due to the types of patients they serve, in order to allow consumers to compare one hospital with another directly. Read more in our Hospital Ratings Technical Report.

How is the survey administered?
Hospitals may administer the survey themselves, or use one of a number of government-approved vendors.

How often are Consumer Reports' Patient Experience Ratings updated?
We will update our Ratings four times a year, based on the government's quarterly updates of patient survey results. There's about a nine-month lag time between survey administration and the government's release of the results. For example, the government's June 2009 release, covers patients' experiences in the 12-month period between October 2007 and September 2008.

What are the limitations of the Ratings?
Our Ratings are based on a government survey of U.S. hospitals, but there are factors that are beyond our control. While the federal Centers for Medicare and Medicaid Services supervised the implementation of the survey, including training of survey vendors and data audits, it has not made public certain aspects of the data. Read more about the limitations of the data in our Hospital Ratings Technical Report.

What about patient privacy?
The survey results used to create our Ratings do not contain anything that could be used to personally identify an individual.