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Women's assessments of maternity care can guide other women seeking such care

Regardless of their different demographic and clinical characteristics, women generally agree on which hospitals provide quality maternity care, concludes a study supported by the Agency for Health Care Policy and Research (National Research Service Award training grant T32 HS00059). Thus, their assessments may be a useful guide for pregnant women selecting physicians and hospitals for such care, suggests Beth S. Finkelstein, Ph.D., of Case Western Reserve University. Dr. Finkelstein and her colleagues examined mailed survey responses assessing maternity care by 16,051 women who were hospitalized for labor and delivery over a 3-year period (1992 to 1994) in 18 hospitals in Northeast Ohio.

The women's overall assessments of maternity care, as well as physician and nursing care, were significantly different for individual hospitals. Mean hospital scores were higher or lower than the sample mean for seven or more hospitals during each year of data collection. However, within individual hospitals, mean scores were reproducible over the 3 years. In addition, relative hospital rankings were stable over the 3-year period. Patient characteristics (age, race, education, insurance status, health status, type of delivery) explained only 2 to 3 percent of the variance in patient assessments, and adjusting for these factors had little effect on hospital scores.

These findings suggest that patient assessments may be a robust method for profiling hospital quality of care. If these patient assessment findings are generalizable to other patient populations and delivery settings, these measures may be a useful tool for consumers in selecting hospitals or other health care providers. Patient assessments of care also may be one way to ensure that hospitals remain sensitive to the needs of patients, and they may serve as a balance to market forces that challenge the patient-physician relationship. Further research is needed to determine the optimal method for disseminating and presenting patient assessments to consumers in order to foster choice in the health care marketplace, notes Dr. Finkelstein.

More details are in "Patient assessments of hospital maternity care: A useful tool for consumers?" by Dr. Finkelstein, Ph.D., Dwain L. Harper, D.O., and Gary E. Rosenthal, M.D., in the June 1999 Health Services Research 34(2), pp. 623-640.

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