Emergency department visita are lower among most satisfied patients

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Higher patient satisfaction appears to be associated with lower odds of emergency department use, higher odds for inpatient hospitalization, greater health care and prescription expenditures, and higher mortality risk.

Joshua J. Fenton, M.D., M.P.H., of the University of California-Davis, Sacramento, and colleagues used data from a nationally representative sample to study the widely used health care quality metric of patient satisfaction. They conducted a prospective cohort study of 51,946 respondents to the 2000 through 2007 national Medical Expenditure Panel Survey.

The authors found that the odds of any emergency department visit were lower among patients who were classified as most satisfied, and the odds of any inpatient admission were higher among this group of patients. Patients in the highest satisfaction group also had greater health care expenditures, greater prescription drug expenditures and higher mortality.

“In combination with reduced emergency department use, increased inpatient care among the most satisfied patients raises the question of whether more-satisfied patients may be differentially hospitalized for elective or less urgent indications, because nonelective urgent hospital admissions often begin with emergency department visits,” researchers comment. “It is also possible that patients who are least satisfied with their physicians may be more likely to seek health care at emergency departments rather than at outpatient clinics.”

Researchers also suggest that patient satisfaction may be a marker for illness and identify patients who rely more on their physicians, although in this study more satisfied patients were more likely to rate their health as excellent and had better physical and mental health status compared to less satisfied patients.

The authors note physicians also frequently consent to discretionary services, which may have little or no medical benefit, and that can be associated with higher patient satisfaction. Also, physicians whose income is more strongly linked with patient satisfaction are more likely to deliver on these discretionary services, such as advanced imaging for acute low back pain.

“While we do not believe that patient satisfaction should be disregarded, our data suggest that we do not fully understand what drives patient satisfaction as now measured or how these factors affect health care use and outcomes,” the authors note. “These associations warrant cautious interpretation and further evaluation, but they suggest that we may not fully understand the factors associated with patient satisfaction.”

They conclude: “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.”

Source: Archives of Internal Medicine, USA

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