Hospital characteristics and breast cancer patients’ evaluation of care.

Abstract

e17550 Background: There is a large body of research on patient evaluations of care and its associations with patient characteristics, such as the sociodemographics or the severity of diseases. A number of studies have recently been published that consider the characteristics of various hospitals in order to explain the differences in patient evaluations between hospitals in non-oncological patient populations. This study investigates the relationship between13 dimensions of satisfaction and breast center hospital characteristics which account for the patient case mix. Methods: The cross-sectional survey data of 3,601 newly-diagnosed breast cancer patients (response rate: 88% of consenting patients) who were treated in 85 out of 91 breast center hospitals in the German state of North Rhine-Westphalia in 2010 were combined with structural data from a key informant survey from the same hospitals. Multilevel linear regression models were calculated in order to investigate patients’ evaluations of the care differences between hospitals and their associations with hospital characteristics (i.e. teaching status, volume, network size, clinical studies, case manager employed) accounting for patient characteristics (self-rated health, mother language, insurance status, age, education, cancer stage, type of surgery). Results: Patients evaluated non-teaching hospitals as being statistically significantly better in 8 out of 13 satisfaction dimensions. None of the other hospital characteristics were significantly associated with any of the satisfaction dimensions. Overall, the differences between hospitals were small to moderate, with null model ICCs ranging from 0.02 to 0.09 for the different dimensions. Conclusions: Teaching breast cancer hospitals face substantial difficulties in achieving patient evaluations that are as good as those from non-teaching hospitals in Germany. The question of extra staffing for the additional teaching tasks needs to be discussed.