Stroupe Kevin T, Hynes Denise M, Giobbie-Hurder Anita, Oddone Eugene Z, Weinberger Morris, Reda Domenic J, Henderson William G
Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Hines VA Hospital, Hines, Illinois 60141, USA.
Med Care. 2005 May;43(5):453-60. doi: 10.1097/01.mlr.0000160377.82164.d3.
Chronically ill patients who are not satisfied with their care may change healthcare providers or systems, which could disrupt continuity of care and impede management of their conditions. We examined whether patient satisfaction affected subsequent use of non-Veterans Affairs (VA) services among chronically ill veterans discharged from VA hospitals.
The data used in this study came from a multicenter trial of increased access to primary care. We enrolled patients with diabetes, heart failure, and/or chronic obstructive pulmonary disease who were discharged from 1 of 9 VA medical centers. At baseline, we assessed satisfaction using the Patient Satisfaction Questionnaire. VA and non-VA utilization over the subsequent 6 months were assessed using VA and Medicare administrative data, non-VA billing data, and patient interviews. Using multivariable logistic regression analyses, we examined whether baseline patient satisfaction was associated with non-VA inpatient or outpatient utilization during the next 6 months. We conducted the same analysis for Medicare-eligible veterans, a group with better access to non-VA care.
Of 1375 study patients, 174 (13%) used non-VA healthcare. Patients with non-VA utilization were older and lived farther from a VA. The odds of non-VA use decreased by 11% as satisfaction increased (odds ratio 0.89; 95% confidence interval 0.83-0.97; P = 0.005). This relationship was strongest among Medicare-eligible veterans (odds ratio 0.85; 95% confidence interval 0.77-0.93; P = 0.001).
Dissatisfied veterans discharged from the hospital were more likely to go outside VA for care. Thus, improvements in patient satisfaction may lead to improvements in continuity of care.
对医疗服务不满意的慢性病患者可能会更换医疗服务提供者或系统，这可能会扰乱医疗服务的连续性并妨碍对其病情的管理。我们研究了患者满意度是否会影响从退伍军人事务部（VA）医院出院的慢性病退伍军人随后对非VA服务的使用情况。
本研究使用的数据来自一项增加初级医疗服务可及性的多中心试验。我们纳入了从9家VA医疗中心之一出院的糖尿病、心力衰竭和/或慢性阻塞性肺疾病患者。在基线时，我们使用患者满意度问卷评估满意度。使用VA和医疗保险管理数据、非VA计费数据以及患者访谈来评估随后6个月内VA和非VA的医疗服务使用情况。通过多变量逻辑回归分析，我们研究了基线患者满意度是否与接下来6个月内非VA住院或门诊服务的使用相关。我们对符合医疗保险资格的退伍军人进行了相同的分析，这是一组更容易获得非VA医疗服务的人群。
在1375名研究患者中，174名（13%）使用了非VA医疗服务。使用非VA医疗服务的患者年龄较大，居住距离VA较远。随着满意度的提高，使用非VA医疗服务的几率降低了11%（优势比0.89；95%置信区间0.83 - 0.97；P = 0.005）。这种关系在符合医疗保险资格的退伍军人中最为明显（优势比0.85；95%置信区间0.77 - 0.93；P = 0.001）。
从医院出院的不满意退伍军人更有可能到VA以外的地方寻求治疗。因此，提高患者满意度可能会改善医疗服务的连续性。
