Chen Chi-Chen, Cheng Shou-Hsia
Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
Institute of Health Policy & Management, College of Public Health, and Population Health Research Center, National Taiwan University, Taipei, Taiwan.
Health Policy. 2023 Apr;130:104754. doi: 10.1016/j.healthpol.2023.104754. Epub 2023 Feb 24.
Numerous studies have investigated the relationship between continuity of care (COC) and patient satisfaction. However, COC and patient satisfaction were measured simultaneously; therefore, the direction of causality remains understudied. This study examined the effect of COC on the patient satisfaction of elderly individuals using an instrumental variable (IV) approach. Nationwide survey data acquired using a face-to-face interview were used to measure the patient-reported COC experiences of 1,715 participants. We applied an ordered logit model controlled for observed patient characteristics and a two-stage residual inclusion (2SRI) ordered logit model that accounted for unobserved confounding factors. Patient-perceived COC importance was used as an IV for patient-reported COC. The ordered logit models indicated that patients with high or intermediate patient-reported COC scores were more likely to perceive more patient satisfaction than those with low COC scores. Using the patient-perceived COC importance as an IV, we examined a strong significant association between the level of patient-reported COC and patient satisfaction. It is necessary to adjust for unobserved confounders to obtain more accurate estimates of the relationship between patient-reported COC and patient satisfaction. However, the results and policy implications of this study should be cautiously interpreted because the possibility of other bias could not be ruled out. These findings support policies aimed at improving patient-reported COC among older adults.
众多研究调查了医疗连续性（COC）与患者满意度之间的关系。然而，COC和患者满意度是同时测量的；因此，因果关系的方向仍未得到充分研究。本研究使用工具变量（IV）方法检验了COC对老年人患者满意度的影响。通过面对面访谈获得的全国性调查数据用于衡量1715名参与者的患者报告的COC经历。我们应用了一个控制了观察到的患者特征的有序logit模型和一个考虑了未观察到的混杂因素的两阶段残差纳入（2SRI）有序logit模型。患者感知的COC重要性被用作患者报告的COC的工具变量。有序logit模型表明，患者报告的COC得分高或中等的患者比COC得分低的患者更有可能感知到更高的患者满意度。使用患者感知的COC重要性作为工具变量，我们检验了患者报告的COC水平与患者满意度之间的强显著关联。有必要对未观察到的混杂因素进行调整，以更准确地估计患者报告的COC与患者满意度之间的关系。然而，本研究的结果和政策含义应谨慎解读，因为无法排除其他偏差的可能性。这些发现支持旨在提高老年人患者报告的COC的政策。
