Increased patient satisfaction tied to higher costs and mortality

  1. 10
    http://archinte.jamanetwork.com/arti...icleid=1108766

    This article was published in March of last year. It indicates that higher press-ganey and CAHPS scores are tied to higher healthcare costs and increased patient mortality.

    It supports what I have always suspected: healthcare cannot be held to the same standard that restaurants, hotels and plumbers are held to. Each of these can, to some degree, guarantee their products and services. We cannot. In most cases, we can't guarantee that you won't be worse off or possibly even dead by the time we're done with you.
    KelRN215, OCNRN63, NRSKarenRN, and 7 others like this.
  2. Get our hottest nursing topics delivered to your inbox.

  3. 8 Comments so far...

  4. 7
    This article addresses satisfaction with physician care as a determining factor for admission, ER use, adherence to medical plan of care as it may relate to mortality, and so forth. They also say that they aren't really making any conclusions about why these data are what they are-- your "tied to" doesn't mean "caused by." Association isn't causation.

    Nothing at all about nursing. Of course, it IS the JAMA. From the Comments section at the end of the paper (my emphasis in bold):

    "Limitations include, first, that the patient satisfaction measure addressed satisfaction with the physician and not other domains of health care satisfaction, although satisfaction with one's physician correlates with other satisfaction dimensions and with global satisfaction.24 Second, regardless of physician actions, patients may also have fundamental tendencies to be more or less satisfied that are associated with distinct care-seeking patterns; it is possible that patients who are likely to receive discretionary care may also be predisposed to express high satisfaction with their physicians. Third, we assessed the relationship between patient satisfaction in one year and health care utilization and expenditures in the following year, which may differ from the relationship between sustained patient satisfaction and longer-term utilization and expenditures.

    "Advocates of patient experience metrics argue that systematic routine measurement of patient satisfaction is a powerful quality improvement tool for physicians and health plans.1 While we do not believe that patient satisfaction should be disregarded, our data suggest that we do not fully understand what drives patient satisfaction as now measured or how these factors affect health care use and outcomes. Therapeutic responsibilities often require physicians to address topics that may challenge or disturb patients, including substance abuse, psychiatric comorbidity, nonadherence, and the risks of requested but discretionary tests or treatments. Relaxing patient satisfaction incentives may encourage physicians to prioritize the benefits of truthful therapeutic discourse, despite the risks of dissatisfying some patients.

    "In a nationally representative sample, higher patient satisfaction was associated with increased inpatient utilization and with increased health care expenditures overall and for prescription drugs. Patients with the highest degree of satisfaction also had significantly greater mortality risk. These associations warrant cautious interpretation and further evaluation, but they suggest that we may not fully understand the factors associated with patient satisfaction. Without additional measures to ensure that care is evidence based and patient centered, an overemphasis on patient satisfaction could have unintended adverse effects on health care utilization, expenditures, and outcomes."


    KelRN215, SummitRN, MBARNBSN, and 4 others like this.
  5. 3
    You're right about everything you wrote. I was being a bit cheap. But I do think the inference, according to the study, that the current drive toward increasing "patient satisfaction" from a medical perspective can (and in the case of this study) does result in poorer outcomes for patients as well as higher costs may have implications for nursing as well, but who knows? Nursing care is not really evaluated by patient outcome.

    But then, we're not paid per procedure or per test. So it may well be that with regard to this, we are entirely other and that this is just me venting my frustration with not being valued by the same criteria as other healthcare professionals, but by perception.

    And I say all this on the eve of my first meeting as representative of my unit as "service ambassador".

    Thank you for your input; as usual, you've been eloquent and incisive.
  6. 6
    It's because what it takes to please a pt to be satisfied, and what they really need to do to be compliant, are two different things sometimes.For example- copd-ers who rush out to smoke despite "teaching", CHF pt who eats fast food , despite teaching, ETOH -er who just got detoxed is back for a fall 2 weeks from d/c, with a BAC. ETC.
    Most patients don't want to hear what their plan is. They want what they want. Service means the customer is always right. Even when they aren't. This has no lace in health care. Hence, the increase in mortality?Coincedence?
    wooh, NRSKarenRN, weemsp, and 3 others like this.
  7. 0
    Most patients don't want to hear what their plan is. They want what they want. Service means the customer is always right. Even when they aren't. This has no lace in health care. Hence, the increase in mortality?Coincedence?
    I think not.
  8. 0
    why not?
  9. 0
    Quote from Anoetos
    You're right about everything you wrote. I was being a bit cheap. But I do think the inference, according to the study, that the current drive toward increasing "patient satisfaction" from a medical perspective can (and in the case of this study) does result in poorer outcomes for patients as well as higher costs may have implications for nursing as well, but who knows? Nursing care is not really evaluated by patient outcome.
    <snip>
    Thank you for your input; as usual, you've been eloquent and incisive.

    Thank you for the kind words. Alas, it appears by posts following yours that the message that people will take away from the paper is wrong.

    The authors very explicitly do NOT say that they conclude that "the current drive toward increasing 'patient satisfaction' from a medical perspective does result in poorer outcomes..." But it took careful reading of the original paper to learn that. Thank you for providing the link to it; now I hope more people will actually go read it.

    (but not holding breath)
  10. 0
    ok- re- reading article. But I still think I had a valid point.
    Many of the MD's I work with are sofrustrated that their hands are tied.
    Maybe they should have a study to prove that pt satisfaction doesn't always have the best outcomes.
  11. 1
    Now if we can just shout it from the rooftops...
    herring_RN likes this.


Top