Abstract
OBJECTIVE: To examine whether patients’ experiences with nontechnical aspects of care such as patient education and discharge planning are associated with long-term outcomes.
DESIGN: Observational cohort study.
SETTING: Twenty-three New Hampshire hospitals during 1996 and 1997.
PARTICIPANTS: Acute myocardial infarction (AMI) patients (N=2,272) enrolled prior to discharge.
MEASUREMENTS: Surveys asking about problems with care and health were mailed to patients 1, 3, and 12 months after discharge. Patients were stratified into “worse” or “better” care groups on the basis of their hospital care problem score. Outcomes included self-reported overall health, physical health, mental health, chest pain, and shortness of breath. Other clinical measures were obtained from hospital discharge abstracts.
MAIN RESULTS: The 1-, 3-, and 12-month surveys were returned by 1,346 (59.2%), 1,046 (46%), and 964 (42.4%) enrolled patients, respectively. The primary analytic cohort consisted of the 762 patients who completed both the 1- and 12-month surveys. After adjustment for postdischarge health status and other clinical factors, patients experiencing worse hospital care had lower ratings of overall health (48.4 vs 52.5 on 100-point scale; P=.02) and physical health (59.7 vs 68.4; P<.001), and were more likely to have chest pain (odds ratio [OR], 1.6; confidence interval [CI], 1.0 to 2.4; P=.04) 12 months after their AMI than other patients. However, differences in reports of chest pain were reduced if patients reporting worse hospital care had better experiences with subsequent ambulatory care.
CONCLUSIONS: Patients’ experiences with nontechnical processes of AMI hospital care are associated with long-term outcomes; however the association between a negative hospital experience and subsequent chest pain may be offset by more positive outpatient experiences.
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References
Ayanian JZ, Guadagnoli E, McNeil BJ, Cleary PD. Treatment and outcomes of acute myocardial infarction among patients of cardiologists and generalist physicians. Arch Intern Med. 1997;157:2570–6.
Marciniak TA, Ellerbeck EF, Radford MJ, et al. Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project. JAMA. 1998;279:1351–7.
Guadagnoli E, Hauptman PJ, Ayanian JZ, Pashos CL, McNeil BJ, Cleary PD. Variation in the use of cardiac procedures after acute myocardial infarction. N Engl J Med. 1995;333:573–8.
O’Connor GT, Quinton HB, Traven ND, et al. Geographic variation in the treatment of acute myocardial infarction: the Cooperative Cardiovascular Project. JAMA. 1999;281:627–33.
Covinsky KE, Chren M, Harper DL, Way LE, Rosenthal GE. Differences in patient-reported processes and outcomes between men and women with myocardial infarction. J Gen Intern Med. 2000;15:169–74.
Cleary PD, Edgman-Levitan S, Roberts M, et al. Patients evaluate their hospital care: a national survey. Health Aff. 1991;10:254–67.
American Hospital Association and the Picker Institute. Eye on patients. Excerpts from a report on patients’ concerns and experiences about the health care system. Health Care Finance. 1997;23:2–11.
Cleary PD, Edgman-Levitan S, McMullen W, Delbanco TL. The relationship between reported problems and patient summary evaluations of hospital care. QRB Qual Rev Bull. 1992;18:53–9.
Bartlett EE, Grayson M, Barker R, Levine DM, Golden A, Libber S. The effects of physician communications skills on patient satisfaction, recall, and adherence. J Chronic Dis. 1984;37:755–64.
Zapka JG, Palmer RH, Hargraves JL, Nerenz D, Frazier HS, Warner CK. Relationships of patient satisfaction with experience of system performance and health status. J Ambulatory Care Manage. 1995;18:73–83.
Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102:520–8.
Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJ. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.
Brody DS, Miller SM, Lerman CE, Smith DG, Caputo GC. Patient perception of involvement in medical care: relationship to illness attitudes and outcomes. J Gen Intern Med. 1989;4:506–11.
DiMatteo MR. Enhancing patient adherence to medical recommendations. JAMA. 1994;271:79–83.
Lane DA, Kauls LS, Ickovics JR, Naftolin F, Feinstein AR. Early postpartum discharges. Impact on distress and outpatient problems. Arch Fam Med. 1999;8:237–42.
Lowes R. Patient-centered care for better patient adherence. Fam Pract Manag. 1998;5:46–7, 51–4, 57.
Gerteis M, Edgman-Levitan S, Daley J, Delbanco T, eds. Through the Patient’s Eyes: Understanding and Promoting Patient-Centered Care. San Francisco: Jossey-Bass Publishers; 1993.
Bienenfeld L, Frishman W, Glasser SP. The placebo effect in cardiovascular disease. Am Heart J. 1996;132:1207–21.
Glynn RJ, Buring JE, Manson JE, LaMotte F, Hennekens CH. Adherence to aspirin in the prevention of myocardial infarction. The Physicians’ Health Study. Arch Intern Med. 1994;154:2649–57.
Horwitz RI, Viscoli CM, Berkman L, et al. Treatment adherence and risk of death after a myocardial infarction. Lancet. 1990;336:542–5.
Horwitz RI, Horwitz SM. Adherence to treatment and health outcomes. Arch Intern Med. 1993;153:1863–8.
Allison TG, Williams DE, Miller TD, et al. Medical and economic costs of psychologic distress in patients with coronary artery disease. Mayo Clin Proc. 1995;70:734–42.
Yeung AC, Vekshtein VI, Krantz DS, et al. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med. 1991;325:1551–6.
Frasure-Smith N. In-hospital symptoms of psychological stress as predictors of long-term outcome after acute myocardial infarction in men. Am J Cardiol. 1991;67:121–7.
Brezinka V, Kittel F. Psychosocial factors of coronary heart disease in women: a review. Soc Sci Med. 1996;42:1351–65.
Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99:2192–217.
Trzcieniecka-Green A, Steptoe A. The effects of stress management on the quality of life of patients following acute myocardial infarction or coronary bypass surgery. Eur Heart J. 1996;17:1663–70.
Allen H. Anticipating market demand: tracking enrollee satisfaction and health over time. Int J Qual Health Care. 1998;10:521–30.
Kassirer JP. Hospitals, heal yourselves. N Engl J Med. 1999;340:309–10.
Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260:1743–8.
Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273:59–65.
Wilson IB. Quality of care and HIV infection: theory and practice. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;8(Suppl 1):31–44.
Cleary PD, Edgman-Levitan S, Walker JD, Gerteis M, Delbanco TL. Using patient reports to improve medical care: a preliminary report from 10 hospitals. Qual Manag Health Care. 1993;2:31–8.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.
Rose GA. Cardiovascular Survey Methods. Geneva: World Health Organization; 1982.
Rose G, McCartney P, Reid DD. Self-administration of a questionnaire on chest pain and intermittent claudication. British J Prev Social Med. 1977;31:42–8.
Normand SLT, Morris CN, Fung KS, McNeil BJ, Epstein AM. Development and validation of a claims based index for adjusting for risk of mortality: the case of acute myocardial infarction. J Clin Epidemiol. 1995;48:229–43.
Spertus JA, McDonell M, Woodman CL, Fihn SD. Association between depression and worse disease-specific functional status in outpatients with coronary artery disease. Am Heart J. 2000;140:105–10.
Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.
Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival. JAMA. 1993;270:1819–25.
Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation. 1995;91:999–1005.
Linden W, Stossel C, Maurice J. Psychosocial interventions for patients with coronary artery disease: a meta-analysis. Arch Intern Med. 1996;156:745–52.
Ruberman W. Psychosocial influences on mortality of patients with coronary heart disease. JAMA. 1992;267:559–60.
Williams RB, Chesney MA. Psychosocial factors and prognosis in established coronary artery disease. The need for research on interventions. JAMA. 1993;270:1860–1.
Aromaa A, Raitasalo R, Reunanen A, et al. Depression and cardiovascular diseases. Acta Psychiatr Scand. 1994;377:S77–82.
Docherty JP. Barriers to the diagnosis of depression in primary care. J Clin Psychiatry. 1997;58(Suppl 1):5–10.
Coyne JC, Schwenk TL, Fechner-Bates S. Nondetection of depression by primary care physicians reconsidered. Gen Hosp Psychiatry. 1995;17:3–12.
Hall JA, Roter DL, Milburn MA, Daltroy LH. Patients’ health as a predictor of physician and patient behavior in medical visits. A synthesis of four studies. Med Care. 1996;34:1205–18.
Berkman LF, Leo-Summers L, Horwitz RI. Emotional support and survival after myocardial infarction. A prospective, population-based study of the elderly. Ann Intern Med. 1992;117:1003–9.
Lynch J, Kaplan GA, Salonen R, Salonen JT. Socioeconomic status and progression of carotid atherosclerosis. Prospective evidence from the Kuopio Ischemic Heart Disease Risk Factor Study. Arterioscler Thromb Vasc Biol. 1997;17:513–9.
Epstein AM, Taylor WC, Seage GR III. Effects of patients’ socioeconomic status and physicians’ training and practice on patient-doctor communication. Am J Med. 1985;78:101–6.
Hall JA, Milburn MA, Roter DL, Daltroy LH. Why are sicker patients less satisfied with their medical care? Tests of two explanatory models. Health Psychol. 1998;17:70–5.
Covinsky KE, Rosenthal GE, Chren MM, et al. The relation between health status changes and patient satisfaction in older hospitalized medical patients. J Gen Intern Med. 1998;13:223–9.
Lasek RJ, Barkley W, Harper DL, Rosenthal GE. An evaluation of the impact of nonresponse bias on patient satisfaction surveys. Med Care. 1997;35:646–52.
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Portions of this paper were presented at the annual meeting of the Society of General Internal Medicine, Boston, Mass, May 5, 2000, and the annual meeting of the Association for Health Services Research, Chicago, Ill, June 28, 1999.
This study was supported by the Foundation for Healthy Communities, a voluntary partnership of hospitals, physicians, home care agencies, and health plans in northern New England.
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Fremont, A.M., Cleary, P.D., Hargraves, J.L. et al. Patient-centered processes of care and long-term outcomes of myocardial infarction. J GEN INTERN MED 16, 800–808 (2001). https://doi.org/10.1046/j.1525-1497.2001.10102.x
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DOI: https://doi.org/10.1046/j.1525-1497.2001.10102.x