OBJECTIVE: To compare patient satisfaction of male and female users of Veterans Health Administration (VHA) services.
DESIGN: Cross-sectional study based on secondary analysis of data from VHA’s Survey of Healthcare Experiences of Patients (SHEP).
PATIENTS: National random sample of 107,995 outpatients and 112,817 inpatients in FY2004.
MEASURES: Patient’s ratings of overall quality (OQ) and unique dimensions of satisfaction. Sociodemographic and health-related patient attributes.
ANALYSIS: Bivariate unadjusted analyses of the association between gender and other patient attributes and the outcomes of OQ and dimensions of satisfaction were conducted followed by multivariate analyses for each outcome, adjusting for demographic and health variables.
RESULTS: Significant differences between female and male reporting of satisfaction were found in the unadjusted analyses with males showing greater levels of satisfaction than females (P<.05). These differences disappeared or became smaller for both outpatient and inpatient services, after adjusting for covariates. For 6 of the inpatient dimensions (Transitions, Physical Comfort, Involvement Family and Friends, Courtesy, Coordination, and Access) males had higher satisfaction than females after statistical adjustment.
CONCLUSIONS: After adjustment for patient attributes, female VHA outpatients report similar OQ with VHA services as male patients. The fact that some inpatient dimensions of satisfaction continued to show effects favoring males even after adjustment suggests areas for continued focus in improving health care quality. Covariate adjustment is essential for evaluating satisfaction with health care services. Breaking down overall satisfaction into independent aspects of services is useful. The SHEP survey has provided a useful tool for evaluating and improving satisfaction among its VHA veteran users.
patient satisfaction service quality gender veterans
Crow R, Gage H, Hampson S, et al. The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature. Health Technol Assessment. 2002;32:45–51.Google Scholar
Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in Medicaid managed care. Health Serv Res. 2003;38:789–808.PubMedCentralPubMedCrossRefGoogle Scholar
Zaslavsky AM, Zaborski AB, Shaul DL, Cioffi MJ, Cleary PD. Adjusting performance measures to ensure equitable plan comparisons. Health Care Financing Rev. 2001;22:109–26.Google Scholar
Sargeant A, Kaehler J. Factors of patient satisfaction with medical services: the case of G.P. practices in the U.K. Health Mark Q. 1998;16:55–77.PubMedCrossRefGoogle Scholar
Weisman CS, Henderson JT, Schifrin E, Romans M, Clancy CM. Gender and patient satisfaction in managed care plans: analysis of the 1999 HEDIS/CAHPS 2.0 H Adult Survey. Womens Health Issues. 2001;11:401–15.PubMedCrossRefGoogle Scholar
Rahmqvist M. Patient satisfaction in relation to age, health status and other background factors: a model for comparisons of care visits. Int J Qual Health Care. 2001;13:385–90.PubMedCrossRefGoogle Scholar
Willits FK, Crider DM. Health rating and life satisfaction in the later middle years. J Gerontol. 1988;43:S172–6.PubMedGoogle Scholar
Weisman CS, Rich DE, Rogers J, Crawford KG, Grayson CE, Henderson JT. Gender and patient satisfaction with primary care: tuning in to women in quality measurement. Womens Health Gend Based Med. 2000;9:657–65.CrossRefGoogle Scholar
Foss C. Gender bias in nursing care? Gender related differences in patient satisfaction with the quality of nursing care. Scand J Caring Sci. 2002;16:19–26.PubMedCrossRefGoogle Scholar
Hoff RA, Rosenheck RA, Meterko M, Wilson NJ. Mental illness as a predictor of satisfaction with inpatient care at Veterans Affairs hospitals. Psych Serv. 1999;50:680–5.Google Scholar
Kressin NR, Skinner K, Sullivan L, et al. Patient satisfaction with the Department of Veterans Affairs Health Care: do women differ from men? Mil Med. 1999;164:283–8.PubMedGoogle Scholar
Turpin RS, Darcy LA, Weaver FM, Kruse K. Assessing health care delivery to male versus female veterans. Women Health. 1992;18:81–95.PubMedCrossRefGoogle Scholar
Rothman GH. Needs of female patients in a veterans psychiatric hospital. Soc Work. 1984;29:380–5.PubMedGoogle Scholar
Bean-Mayberry BA, Chang C-CH, McNeil MA, Whittle J, Hayes PM, Scholle SH. Patient satisfaction in women’s clinics versus traditional primary care clinics in the Veterans Health Administration. J Gen Intern Med. 2003;18:175–81.PubMedCentralPubMedCrossRefGoogle Scholar
Cleary PD, Edgman-Levitan S, Roberts M, et al. Patients evaluate their hospital care: a national survey. Health Affairs. 1991;10:254–67.PubMedCrossRefGoogle Scholar
Young GJ, Charns MP, Barbour GL. Quality improvement in the US Veterans Health Administration. International Journal for Quality in Health Care. 1997;9:183–8.PubMedGoogle Scholar
Perlin JP, Kolodner RM, Roswell RH. The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care. Am J Manage Care. 2004;10:828–36.Google Scholar
Jha AK, Perlin JB, Steinman MA, Peabody JW, Ayanian JZ. Quality of ambulatory care for women and men in the Veterans Affairs health care system. J Gen Intern Med. 2005;20:762–5.PubMedCentralPubMedCrossRefGoogle Scholar
Yano EM, Washington DL, Goldzweig C, Caffrey C, Turner C. The organization and delivery of women’s health care in Department of Veterans Affairs medical center. Women’s Health Issues. 2003;13:55–61.PubMedCrossRefGoogle Scholar
Cleary PD, McNiel BJ. Patient satisfaction as an indicator of quality care. Inquiry. 1988;25:25–36.PubMedGoogle Scholar
Hall JA, Dornam MC. Patient sociodemographic characteristics as predictors of satisfaction and medical care: a meta-analyses. Soc Sci Med. 1990;30:811–8.PubMedCrossRefGoogle Scholar
Ren XS, Kazis L, Lee A, Rogers W, Pendergrass S. Health status and satisfaction with health care: a longitudinal study among patients served by the Veterans Health Administration. Am J Med Qual. 2001;16:166–73.PubMedCrossRefGoogle Scholar
Kerr EA, Smith DM, Kaplan SH, Hayward RA. The association between three different measures of health status and satisfaction among patients with diabetes. Med Care Res Rev. 2003;60:158–77.PubMedCrossRefGoogle Scholar
Covinsky KE, Rosenthal GE, Chren MM, et al. The relationship between health status changes and patient satisfaction in older hospitalized medical patient. J Gen Intern Med. 1998;13:223–9.PubMedCentralPubMedCrossRefGoogle Scholar
Young GJ, Meterko M, Desai KR. Patient satisfaction with hospital care: effects of demographic and institutional characteristics. Med Care. 2000;38:325–34.PubMedCrossRefGoogle Scholar