The Relation Between Health Status Changes and Patient Satisfaction in Older Hospitalized Medical Patients

Authors

  • Kenneth E. Covinsky MD, MPH,

    1. Division of General Internal Medicine and Health Care Research, Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland Veterans Affairs Medical Center, Ohio,
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  • Gary E. Rosenthal MD,

    1. Division of General Internal Medicine and Health Care Research, Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland Veterans Affairs Medical Center, Ohio,
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  • Mary-Margaret Chren MD,

    1. Division of General Internal Medicine and Health Care Research, Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland Veterans Affairs Medical Center, Ohio,
    2. Department of Dermatology, Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland Veterans Affairs Medical Center, Ohio,
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  • Amy C. Justice MD, PhD,

    1. Division of General Internal Medicine and Health Care Research, Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland Veterans Affairs Medical Center, Ohio,
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  • Richard H. Fortinsky PhD,

    1. Division of General Internal Medicine and Health Care Research, Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland Veterans Affairs Medical Center, Ohio,
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  • Robert M. Palmer MD, MPH,

    1. Department of Geriatric Medicine, Cleveland Clinic Foundation, Ohio
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  • C. Seth Landefeld MD

    1. Division of General Internal Medicine and Health Care Research, Department of Medicine, Case Western Reserve University, University Hospitals of Cleveland, and the Cleveland Veterans Affairs Medical Center, Ohio,
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Dr. Covinsky: Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4961.

Abstract

OBJECTIVE:

To examine the relation between two patient outcome measures that can be used to assess the quality of hospital care: changes in health status between admission and discharge, and patient satisfaction.

DESIGN:

Prospective cohort study.

SETTING AND PATIENTS:

Subjects were 445 older medical patients (aged ≥70 years) hospitalized on the medical service of a teaching hospital.

MEASUREMENTS AND MAIN RESULTS:

We interviewed patients at admission and discharge to obtain two measures of health status: global health and independence in five activities of daily living (ADLs). At discharge, we also administered a 5-item patient satisfaction questionnaire. We assessed the relation between changes in health status and patient satisfaction in two sets of analyses, that controlled for either admission or discharge health status. When controlling for admission health status, changes in health status between admission and discharge were positively associated with patient satisfaction (p values ranging from .01 to .08). However, when controlling for discharge health status, changes in health status were no longer associated with patient satisfaction. For example, among patients independent in ADLs at discharge, mean satisfaction scores were similar regardless of whether patients were dependent at admission (i.e., had improved) or independent at admission (i.e., remained stable) (79.6 vs 81.2, p = .46). Among patients dependent in ADLs at discharge, mean satisfaction scores were similar regardless of whether they were dependent at admission (i.e., remained stable) or independent at admission (i.e., had worsened) (74.0 vs 75.7, p= .63). These findings were similar using the measure of global health and in multivariate analyses.

CONCLUSIONS:

Patients with similar discharge health status have similar satisfaction regardless of whether that discharge health status represents stable health, improvement, or a decline in health status. The previously described positive association between patient satisfaction and health status more likely represents a tendency of healthier patients to report greater satisfaction with health care, rather than a tendency of patients who improve following an interaction with the health system to report greater satisfaction. This suggests that changes in health status and patient satisfaction are measuring different domains of hospital outcomes and quality. Comprehensive efforts to measure the outcomes and quality of hospital care will need to consider both patient satisfaction and changes in health status during hospitalization.

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