Methodological Considerations When Studying the Association between Patient‐Reported Care Experiences and Mortality

Abstract

Objective. To illustrate methodological considerations when assessing the relationship between patient care experiences and mortality. Data Source. Medical Expenditure Panel Survey data (2000)(2001)(2002)(2003)(2004)(2005) linked to National Health Interview Survey and National Death Index mortality data through December 31, 2006. Study Design. We estimated Cox proportional hazards models with mortality as the dependent variable and patient experience measures as independent variables and assessed consistency of experiences over time. Data Extraction Methods. We used data from respondents age 18 or older with at least one doctor's office or clinic visit during the year prior to the round 2 interview. We excluded subjects who died in the baseline year. Principal Findings. The association between overall care experiences and mortality was significant for deaths not amenable to medical care and all-cause mortality, but not for amenable deaths. More than half of respondents were in a different care experience quartile over a 1-year period. In the five individual experience questions we analyzed, only time spent with the patient was significantly associated with mortality. Conclusions. Deaths not amenable to medical care and the time-varying and multifaceted nature of patient care experience are important issues to consider when assessing the relationship between care experience and mortality.

The Development of a Pediatric Inpatient Experience of Care Measure: Child HCAHPS®

“…9–18 The preponderance of the evidence shows positive correlations between patient-centeredness and a variety of quality measures, including performance on clinical processes of care and patient adherence to recommended treatment plans, as well as with health outcomes. 9–12,14,16,19–23 In pediatric studies, positive parent report of communication with providers is associated with positive parent perception of discharge preparedness and correlates with a lower readmission likelihood and higher overall quality ratings by parents. 13,15,17 In addition, parents and patients have identified several domains of quality as important to patient- and family-centered care.…”

Should Health Care Providers be Accountable for Patients’ Care Experiences?

“…One recent, widely-publicized study found that patients reporting the best patient-provider communication and overall ratings of care had greater total healthcare and prescription drug expenditures, more inpatient admissions, and higher mortality 17 ; however, methodological challenges of that study may undermine the strength of its findings. 18 Among dozens of studies examined in a recent systematic review, the vast majority found either positive or null associations between patient experiences and best practice clinical processes, lower hospital readmissions, and desirable clinical outcomes. 19 …”

Relationship Between Adolescent Report of Patient-Centered Care and of Quality of Primary Care

“…1 Conceptually, PCC has been hypothesized to improve health-related patient behaviors such as adherence to care, patient activation and self-management, and engagement in shared decision-making. 2,3 Evidence is growing for adults that PCC is associated with achieving better outcomes. 4–10 For instance, PCC is associated with lower readmission rates and greater adherence to treatment plans.…”