Geospatial analysis of hospital consumer assessment of healthcare providers and systems pain management experience scores in U.S. hospitals.

Although prior work has investigated the interplay between demographic and intrasurvey correlations of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, these prior studies have not included geospatial analyses, or analyses that take into account location effects. Here, we report the results of a geospatial analysis (not equivalent to simple geographical analysis) of patient experience scores pertaining to pain. HCAHPS data collected in 2011 were examined to test the hypothesis that HCAHPS patient experience with pain management (PEPM) scores were geospatially distributed throughout the United States using Moran's Index, which measures the association between PEPM scores and hospital location. After limiting the dataset to hospitals in the continental United States with nonzero HCAHPS response rates, 3645 hospitals were included in the analyses. "Always" responses were geospatially clustered amongst the analyzed hospitals. Clustering was significant in all distances tested from 10 to 5000km (P<0.0001). We identified 6 demarcated groups of hospitals. Taken together, these results strongly suggest a regional geographic effect on PEPM scores. These results may carry policy implications for U.S. hospitals with regard to acute pain outcomes. Further analyses will be necessary to evaluate policy explanations and implications of the regional geographic differences in PEPM results.