According to results from a study conducted by Joshua J. Fenton, M.D., M.P.H., of the University of California-Davis Sacramento, and his team, higher patient satisfaction seems to be linked to higher mortality risk, greater health care and prescription costs, higher odds of inpatient hospitalization, and lower odds of emergency department use.
The study is published Online First by Archives of Internal Medicine, one of the JAMA/Archives journals.
In order to examine the extensively used health care quality metric of patient satisfaction, the team used data from a nationally representative sample and conducted a prospective cohort study of 51,946 individuals who responded to the 2000 through 2007 national Medical Expenditure Panel Survey.
The team discovered that individuals who reported higher satisfaction had greater prescription drug costs, higher mortality, and greater health care costs. In addition, they found that this group of patients had lower odds of any emergency department visit, and higher odds of any inpatient admission.
The researchers explain:
“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.
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.”
Even though this study found that patients with higher satisfaction had better physical and mental health status, and were more likely to rate their health as excellent, than patients who were less satisfied, the researchers suggest that patient satisfaction could be an indicator for illness and identify individuals who rely more on their physicians.
In addition, the researchers highlight that often physicians consent to discretionary service, which may provide little or no medical benefit, and that can be linked to higher patient satisfaction. The researchers also found that physicians are more likely to consent to discretionary services, such as advanced imaging for acute low back pain, if their income is more strongly associated with patient satisfaction.
The researchers explain:
“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.
These associations warrant cautious interpretation and further evaluation, but they suggest that we may not fully understand the factors associated with patient satisfaction.
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.”
Dr. Brenda E. Sirovich from the Department of Veterans Affairs Medical Center, VA Outcomes Group, White River Junction, Vt., and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N.H., explain in an invited commentary:
“The authors infer that efforts to cater to patients satisfaction may be ill guided; by implicitly encouraging health care providers to honor requests for (or to explicitly offer) discretionary health care services, such efforts may lead to over-utilization, higher costs and worse outcomes.
Practicing physicians have learned – from reimbursement systems, the medical liability environment and clinical performance scorekeepers – that they will be rewarded for excess and penalized if they risk not doing enough.”
Sirovich concludes:
“We, as a profession and as a society, can take responsibility for controlling the unrestrained system only if we commit to overcoming the widespread misconception that more care is necessarily better care, and to realigning the incentives that help nurture this belief.”
Written by Grace Rattue