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Patient satisfaction affects health care utilization, spending, mortality

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Despite the decrease observed in visits to the ED among patients satisfied with their health care use, spending and overall outcomes, patient satisfaction was associated with increased inpatient use, mortality and drug expenditures. The findings were published in Archives of Internal Medicine.

“Our findings raise concerns that efforts to satisfy patients may have downsides if they lead to unnecessary care that comes with health risks without benefits,” Joshua J. Fenton, MD, MPH, of the University of California, Davis, told Orthopedics Today's sister publication, Endocrine Today.

For the prospective cohort study, Fenton and colleagues pooled data on 51,946 adults included in the national Medical Expenditure Panel Survey between 2000 and 2007. Patient satisfaction was assessed during the first year; health care utilization and expenditures during the second year; and mortality during an average follow-up of 3.9 years.

Joshua J. Fenton

Compared with patients in the lowest satisfaction quartile, patients in the highest satisfaction quartile were less likely to visit the ED (OR=0.92; 95% CI, 0.84-1.0); more likely to be admitted to the hospital (OR=1.12; 95% CI, 1.02-1.23); had 8.8% greater total expenditures (95% CI, 1.6-16.6); 9.1% greater prescription drug expenditures (95% CI, 2.3-16.4); and higher mortality (HR=1.26; 95% CI, 1.05-1.53).

“[Patients] should be satisfied with doctors who provide timely, personalized care and advice in an empathic way,” Fenton said. “Patients who are satisfied with doctors who provide requested tests or treatments may be in danger of getting over-tested, over-treated or inappropriately treated with potential risks and no benefits.

“Evaluating patient satisfaction is a very important practice for health care institutions, and patients should be satisfied with the care they receive,” he said. “Striving for patient satisfaction, however, should not overpower the doctor–patient relationship. A weakness of most health systems in the United States is that doctors do not have enough time to do this, even though it could have huge health benefits while also reducing costs. We also need to establish wise policies — including physician incentive policies — so that patient satisfaction is not the sole driver of quality improvement.”

For more information:

• Fenton JJ. Arch Intern Med.2012;doi:10.1001/archinternmed.2011.1662.
• Disclosure: The researchers report no relevant financial disclosures.

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