Do patient, hospital, and community characteristics predict variations in overall inpatient experience scores? A multilevel analysis of hospitals in California

Abstract

The purpose of this cross-sectional study was to examine how patient, hospital, and community characteristics explain variations in overall inpatient experience with care. We used data from the Patients’ Evaluations of Performance in California survey, the American Hospital Association annual hospital survey, and the Area Resource File. The sample consisted of 24,887 adult patients who received either medical or surgical inpatient care in 173 hospitals located in 46 California counties. A null hierarchical linear model for overall inpatient experience showed that 96.17%, 3.24%, and 0.59% of the variations were within hospitals, between hospitals, and between communities, respectively. Conditional models showed that patient characteristics (sex, age, education, health status, and service line) explained 10.95% of the within-hospital variations; hospital characteristics (teaching status, registered-nurse staffing intensity, and resources directed to patient care) explained 34.12% of the between-hospital variations; and community characteristics (hospital competition, teaching hospitals, per-capita income, and percentage of minority population) explained 99.33% of the between-community variations. These findings suggest that multilevel variations need to be considered when patient experiences are compared across hospitals. Larger future studies are needed to understand how patient experience with care may vary based on patient health-care provider communication across patient subgroups.