Rural disparities in hospital inpatient satisfaction: Multilevel analyses of the 2007 Massachusetts AHA data

Objective: Hospital inpatient satisfaction has been a salient policy concern. We examined rurality's impact on inpatient satisfaction measures. Methodology: We compared patients from 65 rural (n=15,491) and metropolitan hospitals (n=446,906) in Massachusetts, using the merged data from 2007 American Hospital Association Annual Survey (AHA), State Inpatient Database (SID) and Survey of Patients' Hospital Experiences (HCAHPS). Hierarchical binary logistic regression analyses were used to examine the rural disparities in inpatient satisfaction measures. Findings: After adjusting for other individual- and facility-level factors, rurality reduced the likelihood of cleanliness of hospital environment (OR=0.65, 95%CI[0.61, 0.68]); but increased the likelihood of responsiveness of hospital staff (OR=3.43, 95%CI[3.27, 3.59]) and quietness of hospital environment (OR=1.21, 95%CI[1.16, 1.27]). Hispanic patients were more likely to reside in a quiet hospital (OR=0.74, 95%CI[0.71, 0.78]). Medicare or Medicaid coverage each reduced the likelihood of staff responsiveness and cleanliness. Patients diagnosed with depression or psychosis disorders were less likely to experience higher responsiveness or cleanliness. Anxiety diagnosis reduced the likelihood of all measures. At the facility level, higher RNFTE increased the likelihood of all measures. Being a teaching hospital increased the odds of responsiveness and quietness; while hospitals adopting drug allergy alerts system reported lower rates of all measures. Implications: Rural patients experienced lower likelihood of staff responsiveness after adjusting for other factors. Hispanic patients were less likely to reside in quiet hospital environment. Research is needed to further explore the basis of these disparities. Diagnoses in depression and psychosis disorders also calles upon further studies in special care needs.