Hospitalized patients' participation and its impact on quality of care and patient safety

Saul N. Weingart, Junya Zhu, Laurel Chiappetta, Sherri O. Stuver, Eric C. Schneider, Arnold M. Epstein, Jo Ann David-Kasdan, Catherine L. Annas, Floyd J. Fowler, Joel S. Weissman

Research output: Contribution to journalArticlepeer-review


Objective: To understand the extent to which hospitalized patients participate in their care, and the association of patient participation with quality of care and patient safety. Design. Random sample telephone survey and medical record review. Setting: US acute care hospitals in 2003. Participants: A total of 2025 recently hospitalized adults. Main Outcome Measures: Hospitalized patients reported participation in their own care, assessments of overall quality of care and the presence of adverse events (AEs) in telephone interviews. Physician reviewers rated the severity and preventability of AEs identified by interview and chart review among 788 surveyed patients who also consented to medical record review. Results: Of the 2025 patients surveyed, 99.9% of patients reported positive responses to at least one of seven measures of participation. High participation (use of .4 activities) was strongly associated with patients' favorable ratings of the hospital quality of care (adjusted OR: 5.46, 95% CI: 4.15-7.19). Among the 788 patients with both patient survey and chart review data, there was an inverse relationship between participation and adverse events. In multivariable logistic regression analyses, patients with high participation were half as likely to have at least one adverse event during the admission (adjusted OR = 0.49, 0.31-0.78). Conclusions: Most hospitalized patients participated in some aspects of their care. Participation was strongly associated with favorable judgments about hospital quality and reduced the risk of experiencing an adverse event.

Original languageEnglish (US)
Article numbermzr002
Pages (from-to)269-277
Number of pages9
JournalInternational Journal for Quality in Health Care
Issue number3
StatePublished - Jun 2011
Externally publishedYes


  • Adverse events
  • Medical error
  • Patient participation

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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