Journal of General Internal Medicine

, Volume 23, Issue 11, pp 1729–1735

The Relationship Between Measured Performance and Satisfaction with Care Among Clinically Complex Patients

Original Article

DOI: 10.1007/s11606-008-0734-6

Cite this article as:
Werner, R.M. & Chang, V.W. J GEN INTERN MED (2008) 23: 1729. doi:10.1007/s11606-008-0734-6



Recent work has shown that clinically complex patients are more likely to receive recommended care, but it is unknown whether higher achievement on individual performance goals results in improved care for complex patients or detracts from other important but unmeasured aspects of care, resulting in unmet needs and lower satisfaction with care.


To examine the relationship between measured performance and satisfaction with care among clinically complex patients

Design and Participants

An observational analysis of a national sample of 35,927 veterans included in the External Peer Review Program in fiscal years 2003 and 2004.


First, compliance with individual performance measures (breast cancer screening with mammography, colorectal cancer screening, influenza vaccination, pneumococcal vaccination, lipid monitoring, use of ACE inhibitor in heart failure, and diabetic eye examination), as well as overall receipt of recommended care, was estimated as a function of each patient’s clinical complexity. Second, global satisfaction with care was estimated as a function of clinical complexity and compliance with performance measures.

Main Results

Higher clinical complexity was predictive of slightly higher overall performance (OR 1.13, 95% CI 1.09 to 1.18) and higher performance on most individual performance measures, an effect that was mediated by increased visit frequency. High measured performance was associated with higher satisfaction with care among patients with high clinical complexity. In fact, as complexity increased, the effect of achieving high performance on the odds of being satisfied with care also increased


Not only was measured performance higher in clinically complex patients, but satisfaction with care was also higher among clinically complex patients with high measured performance, suggesting that compliance with performance measures in clinically complex patients does not crowd out unmeasured care.


measured performancepatient satisfactionclinically complex patients

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  1. 1.Center for Health Equity Research and PromotionPhiladelphia Veterans Affairs Medical CenterPhiladelphiaUSA
  2. 2.Division of General Internal MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of SociologyUniversity of PennsylvaniaPhiladelphiaUSA