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Journal of General Internal Medicine

, Volume 34, Issue 8, pp 1459–1466 | Cite as

Patient Satisfaction with Clinicians and Short-Term Mortality in a US National Sample: the Roles of Morbidity and Gender

  • Anthony JerantEmail author
  • Kevin Fiscella
  • Joshua J. Fenton
  • Elizabeth M. Magnan
  • Alicia Agnoli
  • Peter Franks
Original Research

Abstract

Background

In a prior study, we found patient satisfaction was associated with mortality. However, that study included few deaths, yielding wide confidence intervals, was criticized for possible morbidity under-adjustment, and lacked power to explore sociodemographic moderation.

Objective

To revisit the satisfaction-mortality association in a larger national sample, allowing more precise risk estimates, sequential morbidity adjustment, and exploration of sociodemographic moderation.

Design

Prospective cohort study.

Participants

2000–2015 Adult Medical Expenditures Panel Surveys (MEPS) respondents (N = 92,952), each enrolled for 2 consecutive years.

Main Measures

We used five Consumer Assessment of Health Plans Survey (CAHPS) items to assess patients’ year 1 satisfaction with their clinicians. Death during the 2 years of MEPS participation was determined by proxy report. We modeled the satisfaction-mortality association in sequential regressions: model 1 included sociodemographics, model 2 added health status (approximating recommended CAHPS adjustment), and model 3 added smoking status, disease burden, and healthcare utilization.

Key Results

Satisfaction was not associated with mortality in model 1. In model 2, higher satisfaction was associated with higher mortality (hazard ratios [95% CIs] for 2nd, 3rd, and 4th (top) quartiles vs. 1st quartile: 1.28 (1.01, 1.62), P = 0.04; 1.43 (1.12, 1.82), P = 0.004; and 1.57 (1.25, 1.98), P < 0.001, respectively). The associations were not attenuated in model 3. There was a significant interaction between gender and satisfaction (F[3, 443] = 3.62, P = 0.01). The association between satisfaction and mortality was significant in women only, such that their mortality advantage over men was eliminated in the highest satisfaction quartile.

Conclusions

The association of higher patient satisfaction with clinicians with higher short-term mortality was evident only after CAHPS-recommended adjustment, was not attenuated by further morbidity adjustment, and was evident in women but not men. The findings suggest that characteristics among women who are more satisfied with their clinicians may be associated with increased mortality risk.

KEY WORDS

gender morbidity mortality patient satisfaction population characteristics United States 

Notes

Contributors

None apart from the authors.

Funders

This work was supported by the Department of Family and Community Medicine, University of California, Davis. Several authors are faculty members in the Department of Family and Community Medicine (Jerant, Fenton, Magnan, Agnoli, and Franks).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5058_MOESM1_ESM.docx (26 kb)
ESM 1 (DOCX 26 kb)

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Anthony Jerant
    • 1
    Email author
  • Kevin Fiscella
    • 2
  • Joshua J. Fenton
    • 1
  • Elizabeth M. Magnan
    • 1
  • Alicia Agnoli
    • 1
  • Peter Franks
    • 1
  1. 1.Department of Family and Community Medicine UC Davis School of MedicineSacramentoUSA
  2. 2.Department of Family MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA

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