The effect of hospital size and teaching status on patient experiences with hospital care - A multilevel analysis

Background: Hospitals rapidly change structure and organization. Little research has been conducted that documents whether hospital size and teaching status is associated with patient experiences. Objectives: We sought to assess the effect of hospital size and teaching status on patient experiences with hospital care. Methods: We undertook a cross-sectional survey of patients discharged from somatic hospitals in Norway. Multilevel regression analysis was used to assess the effect of interest. A total of 21,445 patients from 50 hospitals, categorized as small (36-85 beds, n = 17), medium-sized (88-218 beds, n = 17), large, nonteaching hospitals (226-725 beds, n = 10), and large, teaching hospitals (380-997 beds, n = 6) were studied. We used the Patients' Experiences Questionnaire (PEQ), which contains 10 scales measuring different aspects of hospital care. Results: In general, the 10,626 respondents (50% response) rated their experiences as positive. Intraclass correlation ranged from 0.23% (Scale Information About Examinations) to 6.5% (Scale Hospital and Equipment), indicating that a small to modest proportion of the variance was at the hospital level. On 5 of the 10 PEQ scales, a statistically significant part of the variance between hospitals was attributed to hospital category. Small hospitals received the highest ratings and large, teaching hospitals the: lowest. Patient characteristics and hospital category contributed together to a proportional reduction in variance ranging from 7.6% (Hospital and Equipment scale) to 53.1% (Hospital Organization scale). Conclusion: The effect of hospital category on patient experiences with hospital care was small. Hospital category was not a major determinant of patient experiences during hospitalization.