Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages

Abstract

OBJECTIVE To examine whether patient satisfaction and perceived quality of medical care was related to stages of activity limitations among older adults. DESIGN Cross-sectional study. SETTING Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011. PARTICIPANTS A population-based sample (n= 42,584) of persons 65 years of age and older living in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physicians, interpersonal skills of primary care physicians, and quality of information provided by primary care physicians. Persons were classified into a stage of activity limitation (0-IV) derived from self-reported difficulty levels performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS Compared to older beneficiaries with no limitations at ADL Stage 0, the adjusted odds ratios (OR) (95% confidence intervals (CI)) for Stage I (mild) to Stage III (severe) for satisfaction with care coordination and quality ranged from OR = 0.85 (95% CI: 0.80-0.92) to OR = 0.79 (95% CI: 0.70-0.89). Compared to ADL Stage 0, satisfaction with access barriers ranged from OR = 0.81 (95% CI: 0.76-0.87) at Stage I (mild) to a minimum of OR = 0.67 (95% CI: 0.59-0.76) at Stage III (severe). Similarly, compared to older beneficiaries at ADL Stage 0, perceived quality of the technical skills of their primary care physician ranged from OR = 0.87 (95% CI: 0.82-0.94) at Stage I (mild) to a minimum of OR = 0.81 (95% CI: 0.72-0.91) at Stage III (severe). CONCLUSIONS Medicare beneficiaries at higher stages of activity limitation although not necessarily the highest stage of activity limitation reported less satisfaction with medical care.

Patient Satisfaction and Prognosis for Functional Improvement and Deterioration, Institutionalization, and Death Among Medicare Beneficiaries Over 2 Years

“…Our conceptual model is consistent with our prior work 11 and represents the hypotheses examined in this study regarding how patient satisfaction with care coordination and quality and access to medical care may relate to activity limitation stage transitions, institutionalization, or death (Figure 1). The objectives of the present study were 1) to describe how socioeconomic characteristics and health-related conditions influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death at 2 years; and 2) to assess whether patient satisfaction with care and access to medical care at baseline were related to activity limitation stage transitions, institutionalization, or death at 2 years.…”

“…5-8 We found that ADL or instrumental activity of daily living (IADL) limitations, by defined stages, 9,10 were associated with dissatisfaction with care coordination and quality and access to medical care. 11 These findings add to a growing body of evidence suggesting that higher disability burden is associated with decreased satisfaction with medical care. To our knowledge, no published research to date has examined whether or not decreased satisfaction with medical care influences transitions across activity limitation stages (functional improvement or deterioration), institutionalization, or death among older adults.…”

“…28,29 In addition, patient satisfaction has been found to be associated with indicators of the type and severity of medical conditions including activity limitation stages, 11 disabling conditions, 5,6 and mortality. 27 Our work provides new critical insight into the association between patient satisfaction and functional stability, improvement, deterioration, institutionalization, and death.…”

“…Details regarding the derivation and application of these indicators of satisfaction are described elsewhere. 19 Consistent with prior work, 20 the scores for the three to five questions under each patient satisfaction dimension were used to calculate a summated score for each respondent. The average summated score corresponding to the upper quartile was considered most satisfied for patient satisfaction dimensions.…”

Surviving the Silver Tsunami: Training a Health Care Workforce to Care for North Carolina's Aging Population

“…This report challenged governments, health systems, academic institutions, insurers, and communities to collaborate to enhance competence in geriatrics, to increase recruitment and retention of health professions focused on caring for older adults, and to explore new models of care. Although progress has been made, gaps remain between the care senior citizens seek and what they receive [5,6]. These problems reflect continued shortfalls in the availability and quality of training for the current and future health care workforce.…”