Fenton Joshua J, Jerant Anthony F, Bertakis Klea D, Franks Peter
Department of Family and Community Medicine and Center for Healthcare Policy and Research, University of California-Davis, 4860 Y St, Ambulatory Care Center, Ste 2300, Sacramento, CA 95817, USA.
Arch Intern Med. 2012 Mar 12;172(5):405-11. doi: 10.1001/archinternmed.2011.1662. Epub 2012 Feb 13.
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.
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.
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).
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.
患者满意度是一种广泛使用的医疗保健质量指标。然而，患者满意度与医疗保健利用、支出及结果之间的关系仍不明确。
我们对2000年至2007年全国医疗支出小组调查中的成年受访者（N = 51,946）进行了一项前瞻性队列研究，包括每位患者的两年面板数据以及2000年至2005年子样本（n = 36,428）截至2006年12月31日的死亡率随访数据。使用来自健康计划消费者评估调查的5个项目评估第1年的患者满意度。我们估计了第1年患者满意度与第2年医疗保健利用（任何急诊科就诊和任何住院入院）、第2年医疗保健支出（总计及处方药支出）以及平均随访时长3.9年期间死亡率之间的校正关联。
在对社会人口统计学、保险状况、常规医疗服务来源的可及性、慢性病负担、健康状况以及第1年的利用和支出进行校正后，患者满意度最高四分位数组的受访者（相对于患者满意度最低四分位数组）任何急诊科就诊的几率较低（校正比值比[aOR]，0.92；95%置信区间[CI]，0.84 - 1.00），任何住院入院的几率较高（aOR，1.12；95% CI，1.02 - 1.23），总支出高8.8%（95% CI，1.6% - 16.6%），处方药支出高9.1%（95% CI，2.3% - 16.4%），死亡率较高（校正风险比，1.26；95% CI，1.05 - 1.53）。
在一个具有全国代表性的样本中，较高的患者满意度与较少的急诊科使用相关，但与较多的住院使用、较高的总体医疗保健和处方药支出以及死亡率增加相关。
