The effect of hospital size and teaching status on patient experiences with hospital care: a multilevel analysis

Med Care. 2007 Mar;45(3):252-8. doi: 10.1097/01.mlr.0000252162.78915.62.


Background: Hospitals rapidly change structure and organization. Little research has been conducted that documents whether hospital size and teaching status is associated with patient experiences.

Objectives: We sought to assess the effect of hospital size and teaching status on patient experiences with hospital care.

Methods: We undertook a cross-sectional survey of patients discharged from somatic hospitals in Norway. Multilevel regression analysis was used to assess the effect of interest. A total of 21,445 patients from 50 hospitals, categorized as small (36-85 beds, n=17), medium-sized (88-218 beds, n=17), large, nonteaching hospitals (226-725 beds, n=10), and large, teaching hospitals (380-997 beds, n=6) were studied. We used the Patients' Experiences Questionnaire (PEQ), which contains 10 scales measuring different aspects of hospital care.

Results: In general, the 10,626 respondents (50% response) rated their experiences as positive. Intraclass correlation ranged from 0.23% (Scale Information About Examinations) to 6.5% (Scale Hospital and Equipment), indicating that a small to modest proportion of the variance was at the hospital level. On 5 of the 10 PEQ scales, a statistically significant part of the variance between hospitals was attributed to hospital category. Small hospitals received the highest ratings and large, teaching hospitals the lowest. Patient characteristics and hospital category contributed together to a proportional reduction in variance ranging from 7.6% (Hospital and Equipment scale) to 53.1% (Hospital Organization scale).

Conclusion: The effect of hospital category on patient experiences with hospital care was small. Hospital category was not a major determinant of patient experiences during hospitalization.

MeSH terms

  • Communication
  • Cross-Sectional Studies
  • Female
  • Hospital Administration*
  • Hospital Bed Capacity*
  • Hospitals, Teaching / organization & administration*
  • Humans
  • Male
  • Middle Aged
  • Norway
  • Patient Satisfaction*
  • Quality of Health Care / organization & administration*