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Patient Satisfaction with Clinicians and Short-Term Mortality in a US National Sample: the Roles of Morbidity and Gender.

Authors
  • Jerant, Anthony1
  • Fiscella, Kevin2
  • Fenton, Joshua J3
  • Magnan, Elizabeth M3
  • Agnoli, Alicia3
  • Franks, Peter3
  • 1 Department of Family and Community Medicine, UC Davis School of Medicine, Sacramento, CA, USA. [email protected]
  • 2 Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
  • 3 Department of Family and Community Medicine, UC Davis School of Medicine, Sacramento, CA, USA.
Type
Published Article
Journal
Journal of General Internal Medicine
Publisher
Springer-Verlag
Publication Date
Aug 01, 2019
Volume
34
Issue
8
Pages
1459–1466
Identifiers
DOI: 10.1007/s11606-019-05058-8
PMID: 31144280
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In a prior study, we found patient satisfaction was associated with mortality. However, that study included few deaths, yielding wide confidence intervals, was criticized for possible morbidity under-adjustment, and lacked power to explore sociodemographic moderation. To revisit the satisfaction-mortality association in a larger national sample, allowing more precise risk estimates, sequential morbidity adjustment, and exploration of sociodemographic moderation. Prospective cohort study. 2000-2015 Adult Medical Expenditures Panel Surveys (MEPS) respondents (N = 92,952), each enrolled for 2 consecutive years. We used five Consumer Assessment of Health Plans Survey (CAHPS) items to assess patients' year 1 satisfaction with their clinicians. Death during the 2 years of MEPS participation was determined by proxy report. We modeled the satisfaction-mortality association in sequential regressions: model 1 included sociodemographics, model 2 added health status (approximating recommended CAHPS adjustment), and model 3 added smoking status, disease burden, and healthcare utilization. Satisfaction was not associated with mortality in model 1. In model 2, higher satisfaction was associated with higher mortality (hazard ratios [95% CIs] for 2nd, 3rd, and 4th (top) quartiles vs. 1st quartile: 1.28 (1.01, 1.62), P = 0.04; 1.43 (1.12, 1.82), P = 0.004; and 1.57 (1.25, 1.98), P < 0.001, respectively). The associations were not attenuated in model 3. There was a significant interaction between gender and satisfaction (F[3, 443] = 3.62, P = 0.01). The association between satisfaction and mortality was significant in women only, such that their mortality advantage over men was eliminated in the highest satisfaction quartile. The association of higher patient satisfaction with clinicians with higher short-term mortality was evident only after CAHPS-recommended adjustment, was not attenuated by further morbidity adjustment, and was evident in women but not men. The findings suggest that characteristics among women who are more satisfied with their clinicians may be associated with increased mortality risk.

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