Patient perception of pain care in hospitals in the United States

Anita Gupta¹, Sarah Daigle², Jeffrey Mojica³, Robert W Hurley⁴

¹Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; ²Department of Anesthesiology and Critical Care, ³Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; ⁴Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

Study objective: Assessment of patients’ perception of pain control in hospitals in the United States.

Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.

Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable information on how hospital size, geographic location and practice setting may play a role in pain care in US hospitals.

Results: The data indicates that 63% of patients gave a high rating of global satisfaction for their care, and that an additional 26% of patients felt that they had a moderate level of global satisfaction with the global quality of their care. When correlated to satisfaction with pain control, the relationship with global satisfaction and “always” receiving good pain control was highly correlated (r > 0.84). In respect to the other HCAHPS components, we found that the patient and health care staff relationship with the patient is also highly correlated with pain relief (r > 0.85). The patients’ reported level of pain relief was significantly different based upon hospital ownership, with government owned hospitals receiving the highest pain relief, followed by nonprofit hospitals, and lastly proprietary hospitals. Hospital care acuity also had an impact on the patient’s perception of their pain care; patients cared for in acute care hospitals had lower levels of satisfaction than critical access hospitals.

Conclusions: The results of this study are a representation of the experiences of patients in US hospitals with regard to pain care specifically and the need for improved methods of treating and evaluating pain care. This study provides the evidence needed for hospitals to make pain care a priority in to achieve patient satisfaction throughout the duration of their hospitalization. Furthermore, future research should be developed to make strategies for institutions and policy-makers to improve and optimize patient satisfaction with pain care.

Keywords: pain care, HCAHPS, hospitals