Patient Satisfaction and Quality and Cost of Care

Quality of healthcare is determined by various metrics, including processes of care and health outcomes. An additional component of quality healthcare is patient experience and satisfaction. The Centers for Medicare & Medicaid Services and the National Committee on Quality Assurance require participating health plans to report data on patient satisfaction along with other measures of quality. In addition, health plans utilize patient satisfaction measures to evaluate physicians and set incentive compensation rates.

Previous studies have demonstrated that patients who are satisfied with their care are most likely to be adherent to medication regimens and more loyal to their physicians. However, according to researchers, patient satisfaction has not been strongly linked with quality of healthcare and clinical outcomes. Evidence has suggested that satisfaction has “little or no correlation with Health Plan Employer Data and Information Set (HEDIS) quality metrics,” the researchers said.

Noting that associations among patient satisfaction, intensity of healthcare, and outcomes have not been studied in a large, national sample of adults of all ages, the researchers conducted an analysis utilizing Medical Expenditure Panel Survey (MEPS) data to evaluate the relationship between patient satisfaction and healthcare utilization, expenditures, and mortality. They reported results in Archives of Internal Medicine [2012;172(50:405-411].

MEPS data from 51,946 adult (≥18 years of age) respondents from 2000 through 2007, including 2 years of data for each patient and mortality follow-up data through December 31, 2006, for a 2000 through 2005 subsample (n=36,428), were included in the study.

Patient satisfaction was measured at year 1 using 5 items from the Consumer Assessment of Health Plans Survey (CAHPS). The researchers then estimated the adjusted associations between year 1 patient satisfaction and healthcare utilization in year 2 (any emergency department [ED] visits and any inpatient admissions), year 2 healthcare expenditures (including total expenditures and the cost for prescription medications), and mortality during a mean follow-up duration of 3.9 years.

The items from the CAHPS used to measure satisfaction included 4 relating to physician communication, asking how often in the previous 12 months physicians and other healthcare providers: (1) listened carefully; (2) explained things in a way that was easily understandable; (3) showed respect for what the patient had to say; and (4) spent enough time with the patient. The fifth item included in the analysis was a patient rating of care from all physicians and other healthcare providers in a scale of 0 (worst) to 10 (best care possible).

Highest year 1 satisfaction was significantly associated with older age, female sex, black race/ethnicity, and health insurance coverage. Adjustments were made for sociodemographics, insurance status, availability of a usual source of care, burden of chronic disease, health status, and healthcare utilization and expenditures in year 1. In adjusted analyses, patients with the highest levels of satisfaction also had higher 12-Item Short Form Health Survey scores (better physical and mental health status) and were more likely to rate their health as excellent or poor.

Relative to patients in the lowest quartile of satisfaction, those in the highest quartile had lower odds of any ED visit (adjusted odds ration [aOR], 0.92; 95% confidence interval [CI], 0.84-1.00; P=.06). Compared with those in the lowest satisfaction quartile, adjusted odds of any inpatient admission during year 2 were higher in the group of most satisfied patients (aOR, 1.12; 95% CI, 1.02-1.23; P=.02). Compared with those in the lowest group, patients in the highest satisfaction group had adjusted 8.8% greater year 2 total health expenditures and 9.1% greater prescription drug expenditures.