While most patients definitely prefer a quiet room to a noisy one, or an attentive nurse to a flighty one, these smaller aspects of patient experience pale in comparison to the overall quality of treatment, a new study finds. It’s an aspect of patient care found largely at bigger hospitals, and one that smaller hospitals seldom offer.

Published in Risk Management and Insurance Review, the study built upon prior research into what makes one hospital “better” than another, utilizing a methodology called PRIDIT, a tool commonly used in detecting health care fraud. The researchers compiled multiyear data sets on U.S. hospitals and analyzed the different quality variables and outcomes to find out which type of facilities yielded the best overall rating. Even though large hospitals were worse at satisfying patients, their ability to deliver top-notch surgery and treatment options eclipsed the comforts of smaller hospitals.

"Patients who have chronic conditions like heart failure should go to large hospitals that treat a lot of other patients with heart failure," Robert D. Lieberthal, Ph.D., the study's lead author and assistant professor in the Jefferson School of Population Health, told Science Daily.

Lieberthal has worked with PRIDIT extensively in the past, and in his current study examines not only the intrinsic benefits of hospitals offering better care, but also the ways in which the hospitals’ reimbursement rates are determined based on that care.

The method has a number of benefits in the current medical landscape. Hospitals care because as programs like Medicare and the Patient Protection Affordable Care Act, otherwise known as Obamacare, slide into the foreground, insurance companies must evaluate appropriate terms of compensation. Over a number of years, erratic measures of hospital quality could cause the rates to become volatile, despite large, complex hospitals remaining relatively unchanged year to year.

Consumers also have skin in the game, especially as more Americans gain access to health insurance and must decide among the best hospitals available to them.

"There is a lot of information patients can use to select a hospital," Lieberthal said. "However, this is usually a laundry list of indicators that may not mean much for the lay person or that they may be unaware even exists. Our method compares hospitals directly, so that a patient choosing between two or three hospitals can easily compare them and choose the highest quality facility."

Lieberthal’s method employs a raft of variables, each receiving a specific weight, in order to evaluate what constitutes the “best” type of hospital. If a place has more beds, for instance, then that typically means it offers more care, which weighs favorably on the hospital's overall score. More overt signs of success are also measured, such as patient mortality and staff size.

The team’s findings highlight what may come as an obvious point — how the hospital’s food tastes is meaningless if you don’t survive the surgery — but the depth of the research signals areas for improvement, particularly among the larger hospitals that have more working parts. Greater attention to the smaller details still improves a hospital’s overall score, even if the primary roles — getting sick people well — are satisfied first.

In the meantime, the information obtained through the PRIDIT method should be useful for consumers, Lieberthal noted.

"Based on this study,” he said, “the hospitals that have the best survival outcomes are not doing the best job of satisfying patients.”

Source: Lieberthal R, Comer D. What Are the Characteristics That Explain Hospital Quality? A Longitudinal Pridit Approach. Risk Management and Insurance Review. 2013.