Influence of elective versus emergent hospital admission on patient satisfaction

Abstract

Background: Patient satisfaction is increasingly used as a health care quality metric, although satisfaction has been associated with more intense health care, including hospitalization. Whether the increased hospitalization associated with satisfaction is limited to elective (often discretionary) hospitalization is unknown.

Methods: We conducted a prospective cohort study of adult respondents to the 2000 to 2010 US National Medical Expenditure Panel Survey (N = 50,978), including 2 years of panel data for each subject. Patient sociodemographics, health status, and hospital use were assessed in year 1, with hospital use categorized as elective or emergent hospitalization (based on whether it was preceded by an emergency visit). Year 2 patient satisfaction with health care providers was assessed using 5 items from the Consumer Assessment of Health Plans Survey. We used ordinal logistic regression to estimate adjusted associations between year 1 hospitalization and year 2 patient satisfaction quartile.

Results: Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 office and prescription drug utilization, having ≥ 1 elective hospitalizations in year 1 was associated with higher year 2 satisfaction quartile (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.11-1.32). Emergent hospitalizations in year 1 were not associated with satisfaction quartile in year 2 (adjusted OR, 1.01; 95% CI, 0.91-1.12).

Conclusion: In a nationally representative sample, elective (but not emergent) hospitalizations were associated with subsequently higher overall satisfaction with health care providers, suggesting a nexus between discretionary hospital use and patient satisfaction.

Keywords: Delivery of Health Care; Health Care Systems; Patient Satisfaction; Physician-Patient Relations; Utilization.