The American Journal of Managed Care January 2011
Relationship Between Patient Satisfaction With Inpatient Care and Hospital Readmission Within 30 Days
Higher overall patient satisfaction with inpatient care and discharge planning is associated with lower 30-day readmission rates after adjusting for clinical quality.
Sixth, the period for the satisfaction data (2008) is not entirely contemporaneous with that for the clinical data and the outcome data (2005-2008). This was owing to pragmatic reasons associated with the availability of data. However, when we compared the 2009 satisfaction measures with the 2008 measures, we found no time trend and a correlation of 0.86 between the 2 yearly hospital-level measures, indicating that they were stable (reliable) and a good proxy for the 2 prior years.
In conclusion, higher hospital-level overall patient satisfaction and patient satisfaction with discharge planning are associated with lower 30-day risk-standardized readmission rates after adjustment for clinical quality. Although patients may have little insight into evidence-based medicine, they can assess other aspects of care that are associated with better health outcomes. Therefore, patient-reported information about hospital performance can have an important role in the evaluation and management of hospital quality.
Author Affiliations: From The Fuqua School of Business (WB, MPM, RS), the Duke Clinical Research Institute (SWG, KAS), and the School of Medicine (SWG, KAS), Duke University, Durham, NC; and the Department of Emergency Medicine (SWG), University of North Carolina, Chapel Hill, NC.
Funding Source: The authors report no external funding for this study.
Author Disclosures: Dr Glickman reports receiving support through a Physician Faculty Scholar Award from the Robert Wood Johnson Foundation. The other authors (WB, MPM, KAS, RS) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (WB, SWG, KAS, RS); acquisition of data (MPM); analysis and interpretation of data (WB, SWG, MPM, RS); drafting of the manuscript (SWG, MPM, RS); critical revision of the manuscript for important intellectual content (WB, SWG, KAS, RS); statistical analysis (WB, MPM, RS); administrative, technical, and logistic support (WB, KAS, RS); and supervision (WB).
Address correspondence to: Seth W. Glickman, MD, MBA, Department of Emergency Medicine, University of North Carolina at Chapel Hill, 170 Manning Dr, CB #7594, Chapel Hill, NC 27599. E-mail: firstname.lastname@example.org.
1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009; 360(14):1418-1428.
2. A path to bundled payment around a rehospitalization. In: Report to the Congress: Reforming the Delivery System. Washington, DC: Medicare Payment Advisory Commission; June 2005:83-103.
3. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178-187.
4. Greenwald JL, Denham CR, Jack BW. The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process. J Patient Saf. 2007;3(2):97-106.
5. Hospital Care Quality Information from the Consumer Perspective. HCAHPS fact sheet. Updated July 7, 2010. http://www.hcahpsonline. org/facts.aspx. Accessed December 7, 2010.
6. Darby C, Hays RD, Kletke P. Development and evaluation of the CAHPS hospital survey. Health Serv Res. 2005;40(6, pt 2):1973-1976.
7. US Department of Health and Human Services. Hospital Compare. http://www.hospitalcompare.hhs.gov/. Accessed October 24, 2009.
8. Premier Inc. Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration Project: findings from year two. http://www.premierinc.com/quality-safety/tools-services/p4p/ hqi/resources/hqi-whitepaper-year2.pdf. Accessed November 18, 2009.
9. Glickman SW, Ou FS, DeLong ER, et al. Pay for performance, quality of care, and outcomes in acute myocardial infarction. JAMA. 2007; 297(21):2373-2380.
10. Boulding W, Kalra A, Staelin R, Zeithaml VA. A dynamic process model of service quality: from expectations to behavioral interventions. J Mark Res. 1993;30(1):7-27.
11. Boulding W, Kalra A, Staelin R. The quality double whammy. Mark Sci. 1999;18(4):463-484.
12. White B. Measuring patient satisfaction: how to do it and why to bother. Fam Pract Manag. 1999;6(1):40-44.
13. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY: John Wiley & Sons; 1989.
14. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001. 15. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423-1433. 16. Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med. 2006;21(6):661-665. 17. Brody DS, Miller SM, Lerman CE, Smith DG, Caputo GC. Patient perception of involvement in medical care: relationship to illness attitudes and outcomes. J Gen Intern Med. 1989;4(6):506-511. 18. Glickman SW, Boulding W, Manary M, et al. Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010;3(2): 188-195. 19. Fonarow GC, Peterson ED. Heart failure performance measures and outcomes: real or illusory gains. JAMA. 2009;302(7):792-794. 20. Curtis LH, Greiner MA, Hammill BG, et al. Early and long-term outcomes of heart failure in elderly persons, 2001-2005. Arch Intern Med. 2008;168(22):2481-2488. 21. Krumholz HM, Normand SL, Spertus JA, Shahian DM, Bradley EH. Measuring performance for treating heart attacks and heart failure: the case for outcomes measurement. Health Aff (Millwood). 2007; 26(1):75-85. 22. Fonarow GC, Abraham WT, Albert NM, et al; OPTIMIZE-HF Investigators and Hospitals. Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA. 2007;297(1):61-70. 23. Shepperd S, Parkes J, McClaren J, Phillips C. Discharge planning from hospital to home [update in Cochrane Database Syst Rev. 2010;(1):CD000313]. Cochrane Database Syst Rev. 2004;(1):CD000313. 24. Covinsky KE, Rosenthal GE, Chren MM, et al. The relation between health status changes and patient satisfaction in older hospitalized medical patients. J Gen Intern Med. 1998;13(4):223-229.