The influence of psychiatric disorders on patients' ratings of satisfaction with health care.
OBJECTIVE
Patient ratings of satisfaction with health care have been used by patients, insurers, and employers seeking data to compare the quality of health plans and systems of care. Concerns with these ratings include their subjective nature and potential for being influenced by patient characteristics unrelated to the quality of their care. The authors examined the influence of an active psychiatric disorder on patient satisfaction with health care, hypothesizing that patients with psychiatric disorders would be less satisfied with their health care, due to the adverse effects of these conditions on mood and cognition.


METHODS
The authors used linked claims and survey data from the 1991 Medicare Current Beneficiary Survey. Using logistic regressions that controlled for patient sociodemographic and clinical characteristics, the authors examined the influence of an active psychiatric disorder on satisfaction with overall quality of health care and with specific dimensions of quality. The authors also examined the effects of specific types of psychiatric disorders.


RESULTS
Aged and disabled beneficiaries with psychiatric disorders were significantly less likely than those without disorders to be satisfied with the overall quality of health care, follow-up care, and the physician's concern for their overall health. Disabled beneficiaries were also less likely to be satisfied with the health information provided. Further variation was found by type of psychiatric disorder.


CONCLUSIONS
One interpretation of these findings is that Medicare beneficiaries with psychiatric disorders receive lower quality care, a possibility that warrants further investigation. Alternatively, patients with psychiatric disorders may report lower satisfaction despite receiving comparable health care; this interpretation points toward the need for casemix adjustment when comparing satisfaction ratings across health plans and the development of quality measures less susceptible to subjective biases.
Hermann
R C
RC
The Cambridge Hospital and the Department of Psychiatry, Massachusetts 02139, USA. rhermann@warren.med.harvard.edu
Ettner
S L
SL
Dorwart
R A
RA
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003625:Data Collection; D003953:Diagnosis-Related Groups; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000145:classification*; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States