Rurality and patients' hospital experience: A multisite analysis from a US healthcare system

Area of Science:

• Healthcare Management
• Rural Health Disparities
• Patient Experience

Background:

• The association between patient residence rurality and hospital experience is not well understood.
• Existing research offers limited insight into how rurality impacts patient perceptions of hospital care.

Purpose of the Study:

• To compare hospital experiences between patients residing in rural and non-rural areas.
• To identify factors influencing hospital experience across different rurality classifications.

Main Methods:

• Utilized post-hospital Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data from 56,685 patients across 17 US Midwest hospitals.
• Classified patient residence rurality using rural-urban commuting area codes (metropolitan, micropolitan, small town, rural).
• Employed logistic regression and key driver analysis to assess associations between patient characteristics, HCAHPS items, and overall hospital ratings.

Main Results:

• Patients from metropolitan, micropolitan, and small towns reported lower odds of favorable overall hospital ratings compared to rural patients.
• Specific HCAHPS items showed varied associations with rurality; for instance, micropolitan patients had lower odds for recommending the hospital.
• Care transitions, communication about medicines, and environment were identified as key drivers of global hospital ratings, irrespective of patient residence rurality.

Conclusions:

• Rural patients generally reported similar or more favorable hospital experiences than non-rural patients.
• Understanding the determinants of favorable hospital experiences across different rurality levels can guide system-wide and targeted quality improvement initiatives.