Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey distributed by The Center for Medicare and Medicaid (CMS) services measures patient perceptions of hospital experience and impacts annual CMS reimbursement. This study focuses on the “Quiet at Night” variable, to identify the top box institutions and identify the key characteristics that enable their success.

Methods: Using the Linear Mean Scores and the Star Ratings’ inherent clustering algorithm and RStudio™, the top box scorers amongst the 5 Star Rated hospitals were isolated and grouped together as CMS Top Rated “Quiet at Night” Hospitals. These Star Ratings and the key characteristics of these institutions were compiled and compared to the US News Honor Roll Hospitals (2019-2020) to ascertain trends and determine the predictive value of the HCAHPS “Quiet at Night”’ hospitals’ characteristics.

Results: The mean Star Rating for CMS Top Rated “Quiet at Night” Hospitals was 5.00 compared to that of the US News Honor Roll Hospitals which was 2.67. An unpaired t-test of this data found a two-tailed P value of less than 0.0001, which is considered statistically significant under all conventional significance levels (Table 1). In comparing the key characteristics for these two lists documented by the American Hospital Directory a stark difference emerged between these groups with those that scored well on the “Quiet at Night” question identifying as predominantly privately controlled, specialized, surgical facilities with very few total hospital beds.

Conclusions: This study was the first of its kind to critically analyze hospitals that score well on the CMS “Quiet at Night” and compare them to the US News Honor Roll Best Hospitals. With the knowledge that these scores impact CMS reimbursement, it is important to determine the cultural and organizational shifts that enable hospitals to be top performers on the “Quiet at Night” metric. A greater understanding of how top CMS hospitals so efficiently provide care in a sleep protective way may help inform larger institutions about Best Practices.

IMAGE 1: Table 1. Comparison of HCAHPS Star Ratings between CMS Top Rated “Quiet at Night” Hospitals and the US News Honor Roll Hospitals derived from the CMS National Database