Contract Labor Reliance and Subsequent Patient Experience Performance: Evidence from U.S. Short-Term Acute Care...

Background/Objectives: U.S. hospitals increasingly rely on contract labor to address persistent workforce shortages; however, the downstream implications for patient experience performance remain underexplored. This study examines whether contract labor reliance is associated with subsequent patient experience outcomes. Methods: Using a national sample of non-federal U.S. short-term acute care hospitals (N = 2099), this observational study evaluates whether contract labor reliance in 2024 was associated with patient experience outcomes in 2025. Contract labor reliance was measured as contract labor expense divided by total salary expense. Primary outcomes included HCAHPS Summary Star Rating and Hospital Compare Overall Rating. Multivariable ordinary least squares regression models with regional and ownership fixed effects were estimated, and quadratic specifications were used to assess nonlinear associations. Ordered logit models were also estimated as robustness checks and yielded substantively similar directional results. Results: Higher contract labor reliance was significantly associated with lower subsequent patient experience ratings across both outcomes (HCAHPS: β = -5.288, p < 0.001; Hospital Compare: β = -6.463, p < 0.001). Positive quadratic terms indicated a convex relationship, suggesting that marginal negative associations diminish at higher levels of reliance. Quartile-based analyses demonstrated a monotonic decline in patient experience performance across increasing levels of contract labor reliance. Conclusions: Contract labor reliance is significantly associated with subsequent patient experience performance. These findings should be interpreted as associations rather than causal effects and suggest that workforce composition may represent an important structural factor associated with hospital quality performance.