THE RELATION BETWEEN HEALTH-STATUS CHANGES AND PATIENT SATISFACTION IN OLDER HOSPITALIZED MEDICAL PATIENTS

OBJECTIVE: To examine the relation between two patient outcome measure s that can be used to assess the quality of hospital care: changes in health status between admission and discharge, and patient satisfactio n. DESIGN: Prospective cohort study. SETTING AND PATIENTS: Subjects we re 445 older medical patients (aged greater than or equal to 70 years) hospitalized on the medical service of a teaching hospital. MEASUREME NTS AND MAIN RESULTS: We interviewed patients at admission and dischar ge to obtain two measures of health status: global health and independ ence in five activities of daily living (ADLs). At discharge, we also administered a 5-item patient satisfaction questionnaire. We assessed the relation between changes in health status and patient satisfaction in two sets of analyses, that controlled for either admission or disc harge health status. When controlling for admission health status, cha nges in health status between admission and discharge were positively associated with patient satisfaction (p values ranging from .01 to .08 ). However, when controlling for discharge health status, changes in h ealth status were no longer associated with patient satisfaction. For example, among patients independent in ADLs at discharge, mean satisfa ction scores were similar regardless of whether patients were dependen t at admission (i.e., had improved) or independent at admission (i.e., remained stable) (79.6 vs 81.2, p = .46). Among patients dependent in ADLs at discharge, mean satisfaction scores were similar regardless o f whether they were dependent at admission (i.e., remained stable) or independent at admission (i.e., had worsened) (74.0 vs 75.7, p = .63). These findings were similar using the measure of global health and in multivariate analyses. CONCLUSIONS: Patients with similar discharge h ealth status have similar satisfaction regardless of whether that disc harge health status represents stable health, improvement, or a declin e in health status. The previously described positive association betw een patient satisfaction and health status more likely represents a te ndency of healthier patients to report greater satisfaction with healt h care, rather than a tendency of patients who improve following an in teraction with the health system to report greater satisfaction. This suggests that changes in health status and patient satisfaction are me asuring different domains of hospital outcomes and quality. Comprehens ive efforts to measure the outcomes and quality of hospital care will need to consider both patient satisfaction and changes in health statu s during hospitalization.