Location, location, location

Location, location, location

Location of hospitals linked to patients’ ratings of pain

By Marilee Griffin

Hospital patients’ responses to a question about whether their pain is well-controlled may depend in part on where they live.

These findings could lead to system-level changes in patient care based on regional differences, said Patrick Tighe, M.D., M.S., an assistant professor of anesthesiology and the study’s first author.

“Acute pain management is a critically important factor in patient care,” he said. “Our data suggest that we may need to take regional differences in patient experience with pain management into account.”

As part of a national assessment, hospital patients were asked the question: “During this hospital stay, how often was your pain well-controlled?” It turns out that more patients in Louisiana answer this question with “always” than any other state in the country, whereas more patients in the District of Columbia answer it with “never.” Hospitals in the Midwest seem to receive the largest proportion of “always” responses from patients, whereas hospitals in the Mid-Atlantic states, Florida and coastal California seem to have the smallest proportion of “always” responses.

For the study, Tighe and co-authors Roger B. Fillingim, Ph.D., director of the UF Pain Research and Intervention Center of Excellence, and Robert W. Hurley, M.D., Ph.D., an associate professor of anesthesiology in the UF College of Medicine and chief of pain medicine at UF Health, used data from the 2011 Hospital Consumer Assessment of Healthcare Providers and Systems survey.

Tighe and colleagues looked at all U.S. hospitals with applicable survey data — about 3,645 — and created a composite score for each based on how many patients chose the following answers: “always,” “usually,” “sometimes” or “never.”

Louisiana hospitals had the largest proportion of patients, 75 percent, with “always” responses, while the District of Columbia had the lowest proportion. Likewise, the District of Columbia had the highest proportion of “never” responses at 12 percent, while Nebraska had the lowest.

“The results were somewhat unexpected,” Tighe said. “When we look at the reasons why patients may rate their experience a certain way, we generally don’t take into account the effect of hospital location.”

They found that high-scoring “always” hospitals tended be surrounded by other high-scoring hospitals. This phenomenon seems to occur in metropolitan areas where there are tight clusters of hospitals, as well as in areas where hospitals are farther apart but still loosely clustered.

“The value of this type of analysis is that it looks at how hospitals are connected to each other, not just whether they’re in some pre-defined region that we think is important,” said Fillingim, a professor in the UF College of Dentistry.