Sustained Hospital Performance on Hospital Consumer Assessment of Healthcare Providers and Systems Survey Measures: What Are the Determinants?

J Healthc Manag. 2018 Jan/Feb;63(1):15-28. doi: 10.1097/JHM-D-16-00006.


This study examines hospital characteristics associated with sustained superior performance on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures. We classified hospitals as sustainers if they remained in the top 25th percentile of overall patient ratings of inpatient experience from 2009 through 2013. We classified hospital characteristics as modifiable or unmodifiable. Modifiable characteristics are operational measures that hospitals can change to improve performance; these characteristics include registered nurse (RN) staffing levels, presence of hospitalists, and level of physician integration. Unmodifiable characteristics are core structural dimensions, such as hospital size and teaching status, that require substantial investment to change, as well as market-level factors such as competition and unemployment rates. Using logistic regression analysis, we found that RN staffing levels, Medicare share of inpatient days, teaching status, and market competition were significant predictors of the likelihood that a given hospital sustained high levels of patient ratings over time (i.e., the likelihood of a hospital being classified as a sustainer). Hospitals with a higher ratio of inpatient days to RN staffing and higher Medicare share of inpatient days had lower odds of being classified as sustainers.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Health Personnel / standards*
  • Health Personnel / statistics & numerical data*
  • Humans
  • Male
  • Medicaid / standards*
  • Medicaid / statistics & numerical data
  • Medicare / standards*
  • Medicare / statistics & numerical data
  • Middle Aged
  • Patient Protection and Affordable Care Act / standards*
  • Patient Protection and Affordable Care Act / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Quality of Health Care / standards*
  • Quality of Health Care / statistics & numerical data*
  • Surveys and Questionnaires
  • United States