Department of Family and Community Medicine, UC Davis School of Medicine, Sacramento, CA, USA.
Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
J Gen Intern Med. 2019 Aug;34(8):1459-1466. doi: 10.1007/s11606-019-05058-8. Epub 2019 May 29.
In a prior study, we found patient satisfaction was associated with mortality. However, that study included few deaths, yielding wide confidence intervals, was criticized for possible morbidity under-adjustment, and lacked power to explore sociodemographic moderation.
To revisit the satisfaction-mortality association in a larger national sample, allowing more precise risk estimates, sequential morbidity adjustment, and exploration of sociodemographic moderation.
Prospective cohort study.
2000-2015 Adult Medical Expenditures Panel Surveys (MEPS) respondents (N = 92,952), each enrolled for 2 consecutive years.
We used five Consumer Assessment of Health Plans Survey (CAHPS) items to assess patients' year 1 satisfaction with their clinicians. Death during the 2 years of MEPS participation was determined by proxy report. We modeled the satisfaction-mortality association in sequential regressions: model 1 included sociodemographics, model 2 added health status (approximating recommended CAHPS adjustment), and model 3 added smoking status, disease burden, and healthcare utilization.
Satisfaction was not associated with mortality in model 1. In model 2, higher satisfaction was associated with higher mortality (hazard ratios [95% CIs] for 2nd, 3rd, and 4th (top) quartiles vs. 1st quartile: 1.28 (1.01, 1.62), P = 0.04; 1.43 (1.12, 1.82), P = 0.004; and 1.57 (1.25, 1.98), P < 0.001, respectively). The associations were not attenuated in model 3. There was a significant interaction between gender and satisfaction (F[3, 443] = 3.62, P = 0.01). The association between satisfaction and mortality was significant in women only, such that their mortality advantage over men was eliminated in the highest satisfaction quartile.
The association of higher patient satisfaction with clinicians with higher short-term mortality was evident only after CAHPS-recommended adjustment, was not attenuated by further morbidity adjustment, and was evident in women but not men. The findings suggest that characteristics among women who are more satisfied with their clinicians may be associated with increased mortality risk.
在之前的一项研究中，我们发现患者满意度与死亡率相关。然而，该研究纳入的死亡人数较少，置信区间较宽，受到可能对发病率调整不足的批评，并且缺乏探索社会人口统计学调节作用的能力。
在更大的全国样本中重新研究满意度与死亡率的关联，以提供更精确的风险估计、连续发病率调整和探索社会人口统计学调节作用。
前瞻性队列研究。
2000-2015 年成人医疗支出面板调查（MEPS）应答者（N=92952），每人连续参加 2 年。
我们使用五项消费者评估医疗保健计划调查（CAHPS）项目来评估患者第 1 年对其临床医生的满意度。通过代理报告确定 MEPS 参与期间的死亡。我们在连续回归模型中对满意度与死亡率的关联进行建模：模型 1 包括社会人口统计学因素，模型 2 加入健康状况（近似推荐的 CAHPS 调整），模型 3 加入吸烟状况、疾病负担和医疗保健利用情况。
在模型 1 中，满意度与死亡率无关。在模型 2 中，较高的满意度与较高的死亡率相关（第 2、3 和 4（最高）四分位数与第 1 四分位数的风险比[95%置信区间]：1.28（1.01，1.62），P=0.04；1.43（1.12，1.82），P=0.004；1.57（1.25，1.98），P<0.001，分别）。在模型 3 中，关联并未减弱。性别与满意度之间存在显著交互作用（F[3，443]=3.62，P=0.01）。仅在女性中，满意度与死亡率之间存在显著关联，因此在满意度最高的四分位数中，女性的死亡率优势消失。
在经过 CAHPS 推荐的调整后，更高的患者对临床医生的满意度与短期更高的死亡率之间的关联才变得明显，并且在进一步的发病率调整后并未减弱，并且仅在女性中而不是男性中明显。这些发现表明，对其临床医生更为满意的女性的特征可能与更高的死亡风险相关。
