Is There a Relationship Between Patient Satisfaction and Health Care Utilization, Expenditures, and Mortality?
BACKGROUND AND PURPOSE:
Patient satisfaction is a metric used to assess health care quality
CMS requires participating health plans to publicize patient satisfaction scores and some plans use these surveys to assess physician quality and compensation
Data is limited as to whether patient satisfaction is associated with improved outcomes
Fenton et al. (JAMA Internal Medicine, 2018) assessed whether there is a relationship between patient satisfaction and health care utilization, expenditures, and outcomes
Prospective cohort study
Adult respondents to the 2000 through 2007 National Medical Expenditure Panel Survey (MEPS)
Annual national representative survey
Individuals were interviewed successively during 2 years
Year 1 patient satisfaction was assessed using 5 items from the Consumer Assessment of Health Plans Survey
Adjusted associations between Year 1 patient satisfaction and the following outcomes were estimated
Year 2 health care utilization (any emergency department visits and any inpatient admissions)
Year 2 health care expenditures (total and for prescription drugs)
Mortality during a mean follow-up duration of 3.9 years
Results adjusted for confounders
Sociodemographics | Insurance status | Availability of a usual source of care | Chronic disease burden | Health status | Year 1 utilization and expenditures
51,946 patients were included in the study
Respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had
Lower odds of any emergency department visit
adjusted odds ratio [aOR] 0.92; 95% CI, 0.84-1.00
Higher odds of any inpatient admission
aOR 1.12; 95% CI, 1.02-1.23
Greater total expenditures
aOR 8.8%; 95% CI, 1.6%-16.6%
Greater prescription drug expenditures
aOR 9.1%; 95% CI, 2.3%-16.4%
adjusted hazard ratio 1.26; 95% CI, 1.05-1.53
Association between high patient satisfaction and increased mortality was even greater after excluding patients with poor self-rated health and substantial chronic disease burden
Higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care, prescription drug expenditures, and increased mortality
The authors state
Without additional measures to ensure that care is evidence based and patient centered, an overemphasis on patient satisfaction could have unintended adverse effects on health care utilization, expenditures, and outcomes.
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