Blog | Monday, February 20, 2012

QD: News Every Day--Satisfied patients use more care, but also have more mortality

Higher patient satisfaction was associated with more use of inpatient care and more health care consumption, but also with significantly greater mortality risk compared with the least satisfied patients.

Is patient satisfaction and marker for better care, or just more of it?

Researchers conducted a prospective cohort study of nearly 52,000 respondents to the national Medical Expenditure Panel Survey from 2000 through 2007. Patient satisfaction was assessed using five items from the Consumer Assessment of Health Plans Survey. They then compared patient satisfaction in one year (year 1) and use in the following year (year 2) for emergency department visits, inpatient admissions, health care spending and prescription drugs, and mortality during a mean follow-up of nearly four years.

Results appeared online Feb. 13 at Archives of Internal Medicine.

More satisfied patients had fewer emergency department visits relative to the least satisfied patients (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.84 to 1.00; P=.06). Relative to the least satisfied patients, the adjusted odds of any inpatient admission during year 2 were higher among the most satisfied patients (aOR, 1.12; 95% CI, 1.02 to 1.23; P=.02).

Patients in the highest year 1 patient satisfaction quartile compared to those in the lowest had adjusted 8.8% (95% CI, 1.6% to 16.6%; P=.02) greater year 2 total health care expenditures and 9.1% (95% CI, 2.3% to 16.4%; P=.01) greater prescription drug expenditures.

During follow-up, nearly 1,400 patients died (3.8%). The most satisfied patients had a 26% greater mortality risk (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.05 to 1.53; P=.02). The association between higher patient satisfaction and mortality remained significant when researchers excluded patients with poor self-rated health and three or more chronic diseases (aHR, 1.44; 95% CI, 1.10 to 1.88; P=.008).

The authors wrote, "Patients typically bring expectations to medical encounters, often making specific requests of physicians, and satisfaction correlates with the extent to which physicians fulfill patient expectations. Patient requests have also been shown to have a powerful influence on physician prescribing behavior, and our findings suggest that patient satisfaction may be particularly strongly linked with prescription drug expenditures."

It's up to doctors to manage patient expectations even when they don't fulfill a physician's requests. (Learn more about this from ACP Internist's cover article on the subject.)

An editorialist commented overcoming the "more is always better" attitude remains an enormous challenge because of procedure-based reimbursement, and because of patients' expectations to receive care.

"It is time that we, as a profession and as a society, take responsibility for controlling this unrestrained system, by working to overcome the widespread misconception that more care is necessarily better care and to realign the incentives that help nurture this belief," the editorialist commented.