The importance of place of residence in patient satisfaction

OBJECTIVE: To determine the effect of patients' place of residence on their evaluations of care, and to explore related policy implications. STUDY DESIGN: We used a conditional regression analysis of stratum matched case controls to examine whether place of residence of patients living in the Greater Toronto Area (GTA) or in Ontario outside of the GTA affects patient satisfaction with their experiences during hospitalization. SETTING: One hundred and six acute care hospitals located in the province of Ontario, Canada. PARTICIPANTS: A total of 101 683 Ontario residents hospitalized as inpatients between 1 October 2002 and 30 June 2004. MAIN OUTCOME MEASURES: Patient satisfaction indicators publicly reported in Ontario comprising patient perceptions of consideration, responsiveness, communication, and overall impressions, scored on a continuous scale from 1 to 100. RESULTS: Patients who lived outside Toronto were consistently more satisfied than patients who lived inside Toronto when both types of patients were hospitalized in Toronto (P < 0.0001). In contrast, patients who lived inside Toronto were usually and substantially more satisfied than patients who lived outside Toronto when they were hospitalized in facilities outside Toronto (P < 0.02). These findings were consistent after adjustment for several patient-level predictor variables: age, sex, self-assessed health status and number of hospital stays in the last 6 months. CONCLUSION: Findings suggest that where patients live has a small but potentially important impact on how they rate their care. Residence may therefore be considered when designing public reporting systems and pay-for-performance programs. Further attention to patient-level factors may be important to accurate and useful public reporting of patient satisfaction.