Patient Perception of Pain Care in the United
States: A 5-Year Comparative Analysis of Hospital
Consumer Assessment of Health Care Providers and
Systems
Authors: Gupta Anita 
Published: February 2021

Background: The necessity of aggressive pain management in the hospital setting is becoming
increasingly evident. It has been shown to improve patient outcomes, and is now an avenue for Medicare
to assess reimbursement. In this cohort analysis, we compared the March 2008 to the December 2012
Hospital Consumer Assessment of Health Plans Survey (HCAHPS) reports in order to determine if pain
management has improved in the United States after this national standardized survey was created.
Objective: To evaluate whether pain perception would improve in the 2012 report relative to the 2008
report.
Study Design: Statistical analyses were conducted with the HCAHPS report to compare pain control
in regards to hospital type, hospital ownership, and individual hospitals. Using the question, “How often
is your pain controlled?,” T-tests were used to compare each hospital type. Hospital ownerships were
assessed via analysis of variance (ANOVA) testing. T-tests were conducted to track the difference of
hospital performance between the 2008 and the 2012 report. Paired management data were obtained
from hospitals that participated in both reports and were assessed using paired T-tests.
Setting: This survey was administered to a random sample of adult inpatients between 48 hours and
6 weeks after discharge from any hospital reporting to Centers for Medicare and Medicaid (CMS) across
the US.
Limitations: Limitations of this study include response bias, recall bias, and there may be bias related
to types of people likely to respond to a survey, but this is inherent to data that is collected on a voluntary
response. Additionally, a 3% increase in the number of patients rating their pain as always well-controlled,
while statistically significant, admittedly may not be clinically significant. In addition, the raw data collected
is adjusted for the effects of patient-mix. The statistical analyses performed to derive the final quarterly
HCAHPS reports are unavailable to us and therefore we cannot comment on how individual factors such
as age, sex, race, and education or the interaction of the aforementioned affect responses about the
patient’s perception on how well their pain was controlled between 2008 and 2012.
Results: Two thousand three hundred and ninety five hospitals reported pain management data in
both 2008 and 2012. In 2012, hospitals improved their ability to “always control a patients pain” by
3.07% (P < 0.0001) in comparison to the baseline March 2008 report, which was statistically significant.
According to the 2012 data, the discrepancy in pain management between acute care hospitals and
critical access hospitals was 3.33% which was statistically significant (P < 0.05). Government hospitals
were shown to manage pain better at baseline, but all 3 types of ownership improved their pain scores
between the 2 reports which was shown to be statistically significant (P < 0.01).
Discussion: The HCAHPS survey is a national public standardized report used as a way to compare
care in the United States. Patient pain perception has improved between the 2008 and 2012 reports.
Further studies are needed to evaluate critical care hospitals.
Key words: HCAHPS, pain scores, patient perception, national comparison of hospitals, Agency for
Healthcare Research and Quality (AHRQ), acute care hospitals, critical access hospitals, pain management: