Despite complaints that patient-satisfaction surveys may be influenced by factors not associated with the care delivered, the authors of a New England Journal of Medicine opinion piece
argue that appropriately designed and timely administered surveys "provide robust measures of quality" and that efforts to accurately measure patient experiences "should be redoubled."
"Healthcare is, after all, a service, so measures of its quality should include assessment of the extent to which the patient and service providers reach a common understanding of the patient's situation," wrote the authors, who are researchers at Duke University and the University of North Carolina at Chapel Hill. "We have found that patient-reported measures not only are strongly correlated with better outcomes but also largely capture patient evaluation of care-focused communication with nurses and physicians, rather than noncore aspects of patient experience, such as room features and meals."
A concern noted in the opinion piece is that experience measures may reflect a patient's desire for a particular drug, regardless of whether the choice of that drug would actually benefit the patient. But, according to the authors, studies have found that "increased patient engagement leads to lower resource use but greater patient satisfaction."
The key, according to the authors, is that surveys should direct patients to report on their experiences and not on general feelings.
Linking compensation to patient satisfaction received fresh attention last week when the CMS released the list of bonuses and penalties
hospitals have been assessed using clinical and patient-satisfaction measures such as the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS.
Under its new value-based purchasing program, the CMS will marginally reward 1,588 hospitals and slightly penalize 1,426 others. Dr. Ashish Jha, an associate professor of health policy and management at Harvard University, called the purpose of the program "really straightforward and very reasonable" but criticized the incentives as too small to likely achieve the results being sought.
The authors of the NEJM opinion piece cited a 2008 report written by Jha that found a positive relationship between patients' satisfaction with their care and clinical adherence to treatment guidelines.
The opinion piece was co-authored by Dr. Seth Glickman, a University of North Carolina assistant professor of emergency medicine, who noted on his conflict-of-interest form that he is a co-founder, equity holder and board member of Bivarus, a UNC-based company seeking to develop "novel approaches to measuring the patient experience in healthcare." Although he is not receiving any money from the company, a provisional patent application has been submitted for a "patient quality assessment tool."