El costo de la satisfacción: un estudio en satisfacción del paciente, uso de la salud y mortalidad – JAMA

Background 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.

Methods 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.

Results 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).

Conclusion 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.

While most health care quality metrics assess care processes and health outcomes, patient experience or satisfaction is considered a complementary measure of health care quality. Patient satisfaction data may empower consumers to compare health plans and physicians, and both the Centers for Medicare & Medicaid Services and the National Committee on Quality Assurance require participating health plans to publicly report patient satisfaction data. Health plans use patient satisfaction surveys to evaluate physicians and to determine incentive compensation, and consumer-oriented Web sites often report patient satisfaction ratings as the sole physician comparator.

Satisfied patients are more adherent to physician recommendations and more loyal to physicians, but research suggests a tenuous link between patient satisfaction and health care quality and outcomes. Among a vulnerable older population, patient satisfaction had no association with the technical quality of geriatric care, and evidence suggests that satisfaction has little or no correlation with Health Plan Employer Data and Information Set quality metrics.

In addition, patients often request discretionary services that are of little or no medical benefit, and physicians frequently accede to these requests, which is associated with higher patient satisfaction. Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services, such as advanced imaging for acute low back pain.

Although benefits of discretionary care are by definition limited or absent, discretionary services may lead to iatrogenic harm via overtreatment, labeling, or other causal pathways. In a national Medicare sample, health care intensity varied widely among patients across US regions, despite similar illness burdens. Within 3 chronic illness cohorts, greater health care intensity was associated with increased patient satisfaction with some aspects of care but also with higher mortality and without improvement in the quality of care. Discretionary care has been similarly associated with added risks and costs in other studies.

The associations among patient satisfaction, health care intensity, and outcomes have not been studied within a national sample that includes adults of all ages. Therefore, we used Medical Expenditure Panel Survey (MEPS) data to assess the relationship between patient satisfaction and health care utilization, expenditures, and mortality in a nationally representative sample.

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2010 © Foro Latinoamericano Colaborativo en Calidad y Seguridad en Salud

Desarrollado por IECS (Instituto de Efectividad Clínica y Sanitaria)

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