Inpatient Satisfaction at Indian Health Service Hospitals

American Indian and Alaska Native (AI/AN) populations receive care through multiple healthcare systems, including the Indian Health Service (IHS), which provides care to nearly two million users. To better understand inpatient quality of care, we examined patient satisfaction at IHS hospitals and assessed whether operation of IHS hospitals under self-determination contracts or compacts was associated with higher satisfaction than federally operated IHS hospitals.

We conducted a cross-sectional analysis of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data from October 1, 2020 to September 30, 2023. We evaluated top-box responses for nurse communication, physician communication, and overall hospital rating from 9642 surveys across 22 IHS hospitals. 19 of the 22 hospitals (86%) were located in non-metropolitan counties defined by US census tracts classified as rural or isolated rural by Rural-Urban Commuting Area (RUCA) codes. Multilevel logistic regression clustered by hospital examined associations with tribal operation of IHS hospitals, region, county poverty rate, and Area Deprivation Index.

Hospital-level averages for all HCAHPS measures were lower for IHS hospitals than the national HCAHPS average. Tribal operation of IHS hospitals was associated with higher odds of top-box overall hospital rating (OR 1.41, 95% CI 1.04-1.94) but not with nurse or physician communication. Physician communication scores were inversely associated with area deprivation. Substantial variation existed across IHS regions.

IHS hospitals demonstrated lower satisfaction scores than the national average, with wide variability across facilities. Tribal operation of IHS hospitals was associated with higher overall hospital ratings, suggesting potential benefits of local governance. Findings highlight opportunities to strengthen patient experience across the IHS and the value of examining high-performing hospitals to inform improvement efforts.