Measuring patient expectations - Does the instrument affect satisfaction or expectations?

BACKGROUND. Fulfillment of patients' expectations may influence health care utilization, affect patient satisfaction, and be used to indicate quality of care. Several different instruments have been used to measure expectatio ns, yet little is known about how different assessment methods affect outco mes. OBJECTIVE. The object of the study was to determine whether different measu rement instruments elicit different numbers and types of expectations and d ifferent levels of patient satisfaction. DESIGN. Patients waiting to see their physician were randomly assigned to r eceive I of 2 commonly used instruments assessing expectations or were assi gned to a third (control) group that was not asked about expectations. Afte r the visit, patients in all 3 groups were asked about their satisfaction a nd services they received. SUBJECTS. The study subjects were 290 male, primary care outpatients in a V A general medicine clinic MEASURES. A "short" instrument asked about 3 general expectations for tests , referrals, and new medications, while a "long" instrument nested similar questions within a more detailed list. Wording also differed between the 2 instruments. The short instrument asked patients what they wanted; the long instrument asked patients what they thought was necessary for the physicia n to do. Satisfaction was measured with a visit-specific questionnaire and a more general assessment of physician interpersonal skills. RESULTS. Patients receiving the long instrument were more likely to express expectations for tests (83% vs. 28%, P<0.001), referrals (40% vs. 18%, P<0 .001), and new medications (45% vs. 28%, P<0.001). The groups differed in t he number of unmet expectations: 40% of the long instrument group reported at least I unmet expectation compared with 19% of the short instrument grou p (P<0.001). Satisfaction was similar among the 3 groups. CONCLUSIONS. These different instruments elicit different numbers of expect ations but do not affect patient satisfaction.