The Cost of Satisfaction A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality
The Cost of Satisfaction A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality
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DOI：
10.1001/archinternmed.2011.1662
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发表时间：
2012-03-12
影响因子：
--
通讯作者：
Franks, Peter
中科院分区：
文献类型：
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作者：
Fenton, Joshua J.;Jerant, Anthony F.;Franks, Peter
背景：患者满意度是一个广泛使用的医疗质量指标。然而，患者满意度与医疗保健利用、支出和结果之间的关系仍然不明确。我们对成年受访者进行了前瞻性队列研究（N= 51946）至2000年至2007年的全国医疗支出小组调查，包括截至2006年12月31日的每例患者2年的小组数据和死亡率随访数据，2000年至2005年的子样本（n= 36428）。第1年的患者满意度进行了评估，使用5个项目的消费者评估健康计划调查。我们估计了第一年患者满意度和第二年医疗保健利用率之间的调整后的关联（任何急诊科就诊和任何住院），第2年医疗保健支出平均随访时间为3.9年，包括总死亡率和处方药死亡率。根据社会人口统计学、保险状况、常规护理来源的可用性、慢性病负担、健康状况以及第1年的利用和支出进行调整，患者满意度最高四分位数的受访者（相对于最低的病人满意度四分位数）有较低的几率，任何急诊科就诊（调整后的比值比[aOR]，0.92; 95% CI，0.84-1.00），任何住院的比值更高（aOR，1.12; 95% CI，1.02-1.23），8.8%（95% CI，1.6%-16.6%）总支出增加9.1%（95% CI，2.3%-16.4%）处方药支出增加，死亡率升高结论：在全国代表性样本中，较高的患者满意度与较少的急诊使用相关，但与更多的住院使用相关，总体医疗保健和处方药支出较高，死亡率增加。
Background: Patient satisfaction is a widely used health care quality metric. However, the relationship between patient satisfaction and health care utilization, expenditures, and outcomes remains ill defined.Methods: We conducted a prospective cohort study of adult respondents (N=51 946) to the 2000 through 2007 national Medical Expenditure Panel Survey, including 2 years of panel data for each patient and mortality follow-up data through December 31, 2006, for the 2000 through 2005 subsample (n=36 428). Year 1 patient satisfaction was assessed using 5 items from the Consumer Assessment of Health Plans Survey. We estimated the adjusted associations between year 1 patient satisfaction and year 2 health care utilization (any emergency department visits and any inpatient admissions), year 2 health care expenditures (total and for prescription drugs), and mortality during a mean follow-up duration of 3.9 years.Results: Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, 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), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53).Conclusion: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.