More evidence that patient satisfaction may not be such a great indicator of care quality

March 18th, 2015

Evidence continues to mount that asking patients how satisfied they are with the care they received won’t tell you much about the actual quality of that care.

A few weeks ago, JAMA Internal Medicine printed a study in which researchers asked 177 patients on the day of their discharge to rate their level of satisfaction both with their hospital stay and with “their overall understanding of aspects of their hospitalization,” according to the study. “They were then asked to (1) list all their medical diagnoses, (2) identify the indicators for their medications from the discharge instruction sheet, and (3) identify the tests and/or procedures they underwent from a list of common tests and procedures provided.”

The answers the researchers got were disappointing, if not actually surprising. Basically, patients were happier if they thought they understood what happened to them and what they were supposed to do next – which is fine, and to be expected. The problem is, there was a pretty big gap between their perceived understanding and reality.

That’s disturbing for a couple of reasons. First, and most obviously, if patients think they understand their discharge instructions but actually don’t, they could be in for some serious complications once they’re out of the hospital.

It bothers me to think of patients leaving healthcare facilities really thinking they have a handle on what ails them and what they need to do about it when in fact they have no clue. And because they think they understand, they’re less likely to ask questions until possibly it’s too late to avoid another acute-care episode.

The negative implications of this for hospitals are clear – increases in 30-day readmission rates being just the tip of that particular iceberg.

But there are implications for the Centers for Medicare & Medicaid Services as well. How much more evidence needs to pile up before the government decides to remove patient satisfaction as a factor in reimbursement?