Is higher patient satisfaction associated with better stroke outcomes?

OBJECTIVES: To evaluate the association between patient satisfaction and cost, outcomes, and clinical performance of stroke care.

STUDY DESIGN: An ecological study was conducted on all participating hospitals of the Hospital Consumer Assessment of Healthcare Providers and Systems patient survey that reported stroke outcomes.

METHODS: Patient satisfaction measures were grouped into global, environmental, communication, pain control, staff responsiveness, care transition, and discharge information categories. Linear regression models compared risk-adjusted 30-day mortality, 30-day readmission, inpatient costs, and clinical performances by patient satisfaction.

RESULTS: Global patient satisfaction was negatively associated with risk-adjusted 30-day mortality (beta coefficient [β] = -0.39; standard error [SE], 0.16; P = .02) and readmission rates (β = -0.30; SE, 0.11; P = .006). Satisfaction with discharge information was positively associated with risk-adjusted 30-day mortality rate (β = 0.70; SE, 0.14; P <.001) and negatively associated with readmission rate (β = -0.37; SE, 0.09; P <.001). Satisfaction with discharge information were positively associated with inpatient management (β = 1.67; SE, 0.43; P <.001) and secondary care performance (β = 1.82; SE, 0.47; P <.001). The average cost among most satisfied hospitals was $6785, 7.3% higher than that among least satisfied hospitals ($6324). Hospitals with the highest environment satisfaction rating had 7% higher costs compared with the least satisfied hospitals.

CONCLUSIONS: Global patient satisfaction was positively associated with the quality of stroke care; however, improvements in patient satisfaction were linked to higher stroke care costs. In addition, patient satisfaction with discharge information was linked to worse outcomes. As a result, patient satisfaction should be used with caution as a quality indicator for stroke care.