The Correlation Between Patient Satisfaction and Positive Clinical Outcomes

These are abstracts from research studies querying the relationship between patient satisfaction and positive clinical outcomes.  It is important to note that not all of these studies center on hospital patients.  However, the research constructs of patient satisfaction and outcomes were tested and are appropriate to cite as references.  Study outcomes are usually transferable, even though these patients might not have been hospitalized when the studies were done.  Important points or conclusions are highlighted.

J Bone Joint Surg Am. 2005 Jan;87(1):121-6.

 Determinants of patient satisfaction with outcome after rotator cuff surgery.
O'Holleran JD, Kocher MS, Horan MP, Briggs KK, Hawkins RJ.

BACKGROUND: The outcome after rotator cuff surgery has been reported frequently with use of condition-specific measures, but patient satisfaction has not been well studied. The purpose of this study was to identify the determinants of patient satisfaction with the outcome after rotator cuff surgery. METHODS: A cohort of 311 patients undergoing rotator cuff surgery was studied prospectively. Two hundred and fifty-four patients had subjective follow-up for a minimum of one year, and fifty-seven patients had subjective and objective follow-up for a minimum of one year. Diagnoses included tendinitis or impingement (eighty patients), a partial-thickness rotator cuff tear (fifty-five patients), and a full-thickness rotator cuff tear (176 patients). The dependent variable was patient satisfaction with the outcome, graded ordinally on a scale of 1 to 10. Independent variables included demographic, surgical, objective follow-up, and subjective follow-up parameters. Univariate and multivariate analyses were performed to identify the determinants of satisfaction. RESULTS: Univariate analysis of demographic variables demonstrated no significant differences (p > 0.05) with respect to patient satisfaction. Analysis of the surgical variables showed significantly decreased satisfaction (p < 0.05) for patients who had debridement for a massive, irreparable cuff tear; those who had subscapularis tears; and those with larger supraspinatus and infraspinatus tears. Analysis of the objective variables at follow-up demonstrated significantly decreased satisfaction (p < 0.05) for patients with diminished and weakened forward elevation, impingement signs, and acromioclavicular joint pain and tenderness. Univariate analysis of subjective variables at follow-up showed significantly decreased satisfaction (p < 0.001) for patients with pain, functional difficulty, and work disability. Multivariate analysis demonstrated significantly decreased satisfaction associated with pain (p < 0.001) and dysfunction (p < 0.05). A significant relationship (p < 0.05) was detected between satisfaction and a willingness to recommend the surgery to another. A significant relationship (p < 0.05) was also found between satisfaction and the American Shoulder and Elbow Surgeons score. CONCLUSIONS: Subjective variables of symptoms and function have the most robust associations with patient satisfaction following rotator cuff surgery. Thus, in assessing the outcome of rotator cuff surgery from the perspective of patient satisfaction with outcome, we emphasize the importance of patient-derived subjective assessment of symptoms and function.

 

Arch Phys Med Rehabil. 2005 Jul;86(7):1338-44.

Distinguishing patient satisfaction with treatment delivery from treatment effect: a preliminary investigation of patient satisfaction with symptoms after physical therapy treatment of low back pain.
George SZ, Hirsh AT.

OBJECTIVE: To investigate the discrepancy between ratings of pain intensity and patient satisfaction by evaluating a questionnaire item that assesses patient satisfaction with treatment effect. DESIGN: Inception cohort. SETTING: Ambulatory care. PARTICIPANTS: Sixty-six consecutive patients referred to outpatient physical therapy (PT) with acute low back pain (LBP). INTERVENTION: PT using treatment-based classification guidelines. MAIN OUTCOME MEASURE: Patient satisfaction 6 months after receiving PT for LBP. RESULTS: Patient satisfaction with symptoms was considerably lower than the other patient satisfaction items. Patient satisfaction with symptoms was responsive to measures of treatment effect (Spearman rho range, .36-.44, P < .01) and with whether expectations were met (Spearman rho = .45, P < .01). Patients who were satisfied with symptoms reported higher physical function, lower pain intensity, and less symptom bothersomeness (P < .01) at 6 months. The 2 strongest absolute and unique predictors of patient satisfaction with symptoms at 6 months were whether treatment expectations were met and change in symptom bothersomeness. CONCLUSIONS: This study suggested that a questionnaire item assessing patient satisfaction with symptoms allows patients to distinguish between satisfaction with treatment effect and treatment delivery.

Spine. 2005 Oct 1;30(19):2121-8.

Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA low back pain study.
Hurwitz EL, Morgenstern H, Yu F.

STUDY DESIGN: Observational study conducted within a randomized clinical trial. OBJECTIVES: The objective of this study is to estimate the effects of patient satisfaction on subsequent changes in pain and disability among low back pain patients randomized to chiropractic or medical care in a managed-care practice setting. SUMMARY OF BACKGROUND DATA: Recent studies of low back pain treatments have shown chiropractic patients to be more satisfied with their care than medical patients. However, little is known about the relation between patient satisfaction and clinical outcomes. METHODS: A total of 681 low back pain patients presenting to three southern California healthcare clinics and screened for serious spinal pathology and contraindications were randomized to medical care with and without physical therapy, and chiropractic care with and without physical modalities, and followed for 18 months. Satisfaction with back care was measured on a 40-point scale and observed at 4 weeks following randomization. The primary outcome variables, observed between 6 weeks and 18 months of follow-up, are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire, and remission from clinically meaningful pain and disability. Perceived change in low back symptoms was a secondary outcome. RESULTS: Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks (adjusted odds ratio [OR] for 10-point increase in satisfaction = 1.61, 95% confidence interval [CI] = 0.99, 2.68), but not at 6, 12, or 18 months (6 months: adjusted OR = 1.05, 95% CI = 0.73, 1.52; 12 months: adjusted OR = 0.94, 95% CI = 0.67, 1.32; 18 months: adjusted OR = 1.07; 95% CI = 0.76, 1.50). Perception of improvement was greater among highly satisfied than less satisfied patients throughout the 18-month follow-up period. The estimated effects of satisfaction on clinical outcomes were similar for medical and chiropractic patients. CONCLUSIONS: Patient satisfaction may confer small short-term clinical benefits for low back pain patients. Long-term perceived improvement may reflect, in part, perceived past improvement as measured by satisfaction.

J Am Osteopath Assoc. 2002 Jan;102(1):13-20.

Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment.
Licciardone J, Gamber R, Cardarelli K.

A patient survey was used to measure and explain patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment (OMT). Participating in the survey were 459 people who attended an ambulatory OMT specialty clinic from March 1998 through September 1998 and who had received OMT there at least twice previously. Standardized patient satisfaction scores were greatest for overall performance (0.61 +/- 0.29) and interpersonal manner (0.61 +/- 0.24). Satisfaction with finances (0.11 +/- 0.31) was significantly lower than for all other global dimensions of care (P < .001). Subjects perceived OMT to be highly efficacious (0.74 +/- 0.34) and reported significant relief from pain or discomfort (P < .001) and improvement in mobility (P < .001). Of all the respondents, 8.6% attributed an adverse reaction to OMT. Perception of OMT efficacy was significantly associated with all dimensions of patient satisfaction (P values ranged from less than .001 to .003). Relief from pain or discomfort was significantly associated with overall satisfaction (P < .001). Females had greater reduction in pain or discomfort than males (P = .001). Respondents perceived significant community shortages of OMT services through primary care (-0.45 +/- 0.50; P < .001) and specialty (-0.35 +/- 0.54; P < .001) physicians, and reported significant dissatisfaction with insurance coverage for OMT services (-0.09 +/- 0.57; P = .001). These findings suggest the need for greater access to OMT services.

 

Med Care. 2004 Aug;42(8):726-39.

Testing a new theory of patient satisfaction with treatment outcome.
Hudak PL, Hogg-Johnson S, Bombardier C, McKeever PD, Wright JG.

OBJECTIVES: Theories of patient satisfaction with treatment outcome have not been developed and tested in healthcare settings. The objectives of this study were to test a new theory linking patient satisfaction and embodiment (body--self unity) and examine it in relation to other competing theories. DESIGN: We conducted a prospective cohort study. SETTING: This study was conducted at a tertiary care hospital. PATIENTS: We studied 122 individuals undergoing elective hand surgery. METHODS: Satisfaction with treatment outcome approximately 4 months after surgery was examined against the following factors (representing 7 theories of satisfaction): 1) overall clinical outcome, 2) patients' a priori self-selected important clinical outcomes, 3) foresight expectations, 4) hindsight expectations, 5) psychologic state, 6) psychologic state in those with poor outcomes, and 7) embodiment. ANALYSIS: Seven hypotheses were tested first using univariate analyses and then multivariable regression analysis. RESULTS: Satisfaction with treatment outcome was significantly associated with embodiment. Three confounders--the extent to which surgery successfully addressed patients' most important reason for surgery, hindsight expectations, and workers' compensation--were also significant. The final model explained 84% of the variance in a multidimensional measure of satisfaction with treatment outcome. CONCLUSION: This research suggests that satisfaction with treatment outcome could be facilitated by developing strategies to improve body--self unity, and eliciting and addressing the patient's most important reason for undergoing treatment.

Diabet Med. 2003 Jun;20(6):486-90.

 The association between satisfaction with services provided in primary care and outcomes in Type 2 diabetes mellitus.
Alazri MH, Neal RD.

BACKGROUND: Patient satisfaction is of increasing importance, is taken into account when planning services, and is used by healthcare providers as a measure of healthcare quality. Satisfaction with medical care, including diabetic care, has been associated with various health-related behaviours and outcomes that have a direct bearing on health and illness. The association between satisfaction and health outcomes is poorly understood. AIM: The aim of the study was to determine whether there is an association between satisfaction in patients with Type 2 diabetes and the outcome of their diabetic care, and to determine the contribution of different aspects of satisfaction with the primary care. METHODS: Patients with Type 2 diabetes were identified from two general practices in Leeds. PATIENTS: scores on the General Practice Assessment Survey Questionnaire (GPAS) were correlated with the outcome of care, as measured by HbA1c level collected from patients' medical records. RESULTS: Data from 106 patients were analysed. There was a generally high satisfaction rate for all GPAS domains. The correlation between different GPAS domains and HbA1c level showed significant positive correlations (P < 0.001) for continuity of care, trust and overall satisfaction; and positive correlations (P < 0.01) for access, receptionists, interpersonal care, communication skills, knowledge of patient about the doctor, technical care, and practice nursing. CONCLUSION: The findings from this study demonstrate that there is an association between satisfaction and outcome in diabetes, which goes across all the GPAS domains. This suggests that processes that can act to increase patient satisfaction may be contributing to improved clinical outcomes. More development work is needed in this field to explore and elucidate the complex relationship between satisfaction and clinical outcomes.

 

Health Serv Res. 2004 Aug;39(4 Pt 1):727-48.

Patient satisfaction, treatment experience, and disability outcomes in a population-based cohort of injured workers in Washington State: implications for quality improvement.
Wickizer TM, Franklin G, Fulton-Kehoe D, Turner JA, Mootz R, Smith-Weller T.

OBJECTIVE: To determine what aspects of patient satisfaction are most important in explaining the variance in patients' overall treatment experience and to evaluate the relationship between treatment experience and subsequent outcomes. DATA SOURCES AND SETTING: Data from a population-based survey of 804 randomly selected injured workers in Washington State filing a workers' compensation claim between November 1999 and February 2000 were combined with insurance claims data indicating whether survey respondents were receiving disability compensation payments for being out of work at 6 or 12 months after claim filing. STUDY DESIGN: We conducted a two-step analysis. In the first step, we tested a multiple linear regression model to assess the relationship of satisfaction measures to patients' overall treatment experience. In the second step, we used logistic regression to assess the relationship of treatment experience to subsequent outcomes. PRINCIPAL FINDINGS: Among injured workers who had ongoing follow-up care after their initial treatment (n = 681), satisfaction with interpersonal and technical aspects of care and with care coordination was strongly and positively associated with overall treatment experience (p < 0.001). As a group, the satisfaction measures explained 38 percent of the variance in treatment experience after controlling for demographics, satisfaction with medical care prior to injury, job satisfaction, type of injury, and provider type. Injured workers who reported less-favorable treatment experience were 3.54 times as likely (95 percent confidence interval, 1.20-10.95, p = .021) to be receiving time-loss compensation for inability to work due to injury 6 or 12 months after filing a claim, compared to patients whose treatment experience was more positive.

Br J Plast Surg. 1999 Sep;52(6):448-52.

Psychosocial outcome and patient satisfaction following breast reduction surgery.
Faria FS, Guthrie E, Bradbury E, Brain AN.

There is an increasing awareness that psychosocial outcome and health status are important outcomes following breast reduction surgery. In this study, patients awaiting breast reduction surgery completed detailed and comprehensive psychosocial assessments before and after surgery. Of 33 patients who completed the preoperative assessment, 20 patients were operated on and 19 were reassessed 4 months post-surgery. Patients expressed high levels of satisfaction with specific and overall results of surgery. Scores for anxiety, depression, body image and body satisfaction improved significantly using specific questionnaires. Patients also reported significant improvements on five out of eight subscales on the Short Form 36 health status questionnaire. This study provides further evidence for overall improvement in health status and psychological functioning in patients undergoing breast reduction surgery and supports the provision of this service by the NHS.

 

Eur J Ophthalmol. 2005 Jan-Feb;15(1):102-8.

Patient satisfaction and vision improvement after multiple surgery for recurrent retinal detachment.
Lesnoni G, Rossi T, Gelso A, Nistril A.

PURPOSE: To assess patient satisfaction and functional status improvement after multiple surgery for recurrent retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C. Main outcome measures included visual acuity (VA), anatomic outcome, and patients' answers to a standardized multiple-choice questionnaire. METHODS: The authors retrospectively reviewed records of patients undergoing pars plana vitrectomy (PPV) for RRD with PVR grade C operated between 1997 and 1999. All included patients underwent a standardized telephone interview aimed at assessing the patients' visual performance and satisfaction. Statistical analysis used Wilcoxon signed-rank test, Mann-Whitney rank sum test, and Spearman rank correlation coefficient. p Values less than 0.05 were considered statistically significant. RESULTS: The population study included 62 patients with an average 19+/-4.1 months follow-up. The average number of operations was 2.9+/-0.7 with 1.45+/-0.50 recurrences. At the end of the study, 40/62 eyes had better than 5/400 vision and 14/62 better than 20/200; 2 patients had no light perception and 5 eyes still had RRD. Questionnaire answers yielded the following results: 61% believed their VA was better than before surgery, 13% the same, and 26% worse. Fifty-two percent noticed an improvement in binocular vision versus 35% stable and 13% worse: 84% thought their result had been worth the operation, 15% did not, and 2% did not know. Ninety percent believed the information they received before surgery was accurate. Results exceeded expectations in 35% of cases and matched them in 26%. Increase in binocular visual performance after intervention was significant for clothing, bathing, and home deambulation, climbing steps, watching TV, and reading, but not for car driving. The difference in VA improvement in satisfied and unsatisfied patients was significant. There was no significant correlation between patients' satisfaction and fellow-eye vision. CONCLUSIONS: The sample population showed a high rate of satisfaction and significant subjective improvement on four out of five tested activities, despite multiple surgeries and overall poor outcome, even in patients with a good VA in fellow eye. Many other factors such as visual field and contrast sensitivity improvement, not investigated by the authors, can play an important role in the visual functional status. Correct and extensive patient information remains critical in such settings.

 

J Clin Epidemiol. 2004 Feb;57(2):217; author reply 218.

Patient satisfaction: is it a measure for the outcome of care or the process of care?
Verbeek J.
THERE WAS NO ABSTRACT FOR THIS ARTICLE.

 

Med Clin (Barc). 2000;114 Suppl 3:26-33.

 Patient satisfaction as an outcome measure in health care
Mira JJ, Aranaz J.

In the last years an important change has taken place regarding doctor-patient relationships. One of its effects is that today healthcare results are measured in terms of effectiveness, efficiency, patient's perception of pain or autonomy, physical and mental well-being and, also, in terms of satisfaction with the achieved outcome. In literature it is easy to find studies on patient satisfaction with the conditions of hospitalization, emergencies, or visits. However, it is not usual, to find studies on patient satisfaction with medical outcomes, and this is the kind of information most relevant to clinical use. The concept of "patient-focused-care" obeys to this new position that is based on the recognition of patients' active role in the decision-making process and the notion that clinical decisions should take patients' views and perceptions into account. In this paper, the concept of patients' satisfaction is reviewed as a health outcome. The theories, instruments, methodological questions and implications of this measure are analysed in order to assess and improve the health care presently provided.

 

Clin J Pain. 2005 Jul-Aug;21(4):302-10.

Patient satisfaction with treatment for chronic pain: predictors and relationship to compliance.
Hirsh AT, Atchison JW, Berger JJ, Waxenberg LB, Lafayette-Lucey A, Bulcourf BB, Robinson ME.

OBJECTIVES: Patient satisfaction with treatment has been extensively researched in a variety of medical patients. However, satisfaction with treatment of chronic pain has received considerably less attention. The present study sought to identify the predictors of patient satisfaction with treatment of chronic pain. In addition, the relationship between patient satisfaction and compliance with treatment recommendations was explored. METHODS: One hundred eighty patients (84 men and 96 women) seeking treatment of chronic pain at University of Florida pain clinics were recruited for this telephone follow-up study. RESULTS: Satisfaction ratings were generally high, with ratings of satisfaction with care significantly higher (t179=9.58, P<0.001) than ratings of satisfaction with improvement. Aspects of the patient-provider interaction, pain relief, and anxiety at treatment onset predicted satisfaction with care. These same variables, with the exception of anxiety, also predicted satisfaction with improvement. Those patients who were more satisfied with their improvement were also more compliant with treatment recommendations, and this relationship was stronger for health care provider-rated compliance. DISCUSSION: Results suggest the importance of distinguishing between satisfaction with care and satisfaction with improvement in assessments. Satisfaction with treatment of chronic pain is not merely a matter of pain relief. To increase the probability of treatment success and satisfaction, attention to the interpersonal aspects of the health care provider-patient relationship appear critical. Explanations for satisfaction's stronger relationship to health care provider-rated compliance were discussed.

 

Dis Manag. 2005 Oct;8(5):288-300.

 Patient satisfaction measurement in the disease management industry.
Sen S, Fawson P, Cherrington G, Douglas K, Friedman N, Maljanian R, Fitzner K, Tang P, Soper S, Wood S.

In mid-2004, the Disease Management Association of America (DMAA) Patient Satisfaction Workgroup in association with J.D. Power and Associates (JDPA) conducted a literature review and a member survey to gain an understanding of the nature of patient satisfaction measurement as it pertains to disease management (DM) programs within the DM industry. A review of the relevant literature indicates that perhaps, with the exception of diabetes disease management, there are no prevalent, systematic, or statistically validated approaches for measuring patient satisfaction within the disease management industry. Most existing studies tend to focus on the effectiveness of a disease management program on clinical outcomes, with patient satisfaction measured only as a part of a battery of "outcome" measures. However, many of these studies do find positive associations between patient satisfaction and clinical outcomes. A majority of the 49 respondents who completed the member feedback survey hold relatively high positions in their organizations. The vast majority of respondents indicate their organizations conduct patient satisfaction surveys that assess overall satisfaction, satisfaction with materials and information provided, and with staff members. Patient satisfaction surveys are most common among the five common chronic diseases: diabetes, asthma, congestive heart failure (CHF), coronary artery disease (CAD), and chronic obstructive pulmonary disease (COPD). More than three in four respondents agree that patient satisfaction measurement is important to the long-term success of their programs. Respondents also indicate that along with intelligence on patients' overall satisfaction with the program, they would also like to gain an understanding of whether or not their programs actually help manage the patient's medical condition. Eight survey instruments currently in use and submitted by study participants were also reviewed. Most of these instruments are relatively short and basic, typically administered by mail, and vary in the types of questions and response categories presented to respondents. This research concludes that there exists an implied need for patient satisfaction measurement in the DM industry and an opportunity to develop and leverage a standardized measurement approach assessing patient satisfaction. Additionally, the authors suggest that there may be value to conceptualizing "patient satisfaction" not as an outcome in itself, but as a means to increase compliance, which, in turn, can improve medical outcomes.

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