Inpatients’ Willingness to Recommend: A Multi-level Analysis

Document Type


Publication Date


Publication Source

Health Services Management Research





Inclusive pages



Background: Satisfaction with health care is one of the most widely assessed measures of hospital care quality, yet studies that account for clustering effects are uncommon. We constructed a multilevel model to identify predictors of willingness to recommend while controlling for clustering effects due to hospital and care unit. We also examined differences in predictors by care unit. Purpose:The aim of this study was to identify factors that both influence patient perceptions of care and are potentially modifiable by the hospital delivering care. Methodology: Our sample includes Hospital Consumer Assessment of Healthcare Providers and Systems survey data collected between July 1, 2007, and June 30, 2008, for 131 hospitals and 33,445 patients. The primary outcome was willingness to recommend the hospital to family and friends. Variables were collected at three levels: patient (Hospital Consumer Assessment of Healthcare Providers and Systems survey item responses and demographics), care unit, and hospital. Data were analyzed using multilevel modeling. We also ran a series of two-level models to explore differences in predictors by care type. Findings: The strongest predictors of willingness to recommend, controlling for clustering effects, were items that generally reflected interpersonal aspects of care such as nursing and physician behaviors. In the two-level models, predictors of willingness to recommend overlapped across care units, but important differences were noted.


HCAHPS, inpatient satisfaction, multilevel modeling, willingness to recommend


Public Affairs, Public Policy and Public Administration

This document is currently not available here.