title: Measuring patient expectations: does the instrument affect satisfaction or expectations?
abstract: BACKGROUND
  Fulfillment of patients' expectations may influence health care utilization, affect patient satisfaction, and be used to indicate quality of care. Several different instruments have been used to measure expectations, yet little is known about how different assessment methods affect outcomes.
  
  
  OBJECTIVE
  The object of the study was to determine whether different measurement instruments elicit different numbers and types of expectations and different levels of patient satisfaction.
  
  
  METHODS
  Patients waiting to see their physician were randomly assigned to receive 1 of 2 commonly used instruments assessing expectations or were assigned to a third (control) group that was not asked about expectations. After the visit, patients in all 3 groups were asked about their satisfaction and services they received.
  
  
  METHODS
  The study subjects were 290 male, primary care outpatients in a VA general medicine clinic.
  
  
  METHODS
  A "short" instrument asked about 3 general expectations for tests, referrals, and new medications, while a "long" instrument nested similar questions within a more detailed list. Wording also differed between the 2 instruments. The short instrument asked patients what they wanted; the long instrument asked patients what they thought was necessary for the physician to do. Satisfaction was measured with a visit-specific questionnaire and a more general assessment of physician interpersonal skills.
  
  
  RESULTS
  Patients receiving the long instrument were more likely to express expectations for tests (83% vs. 28%, P <0.001), referrals (40% vs. 18%, P <0.001), and new medications (45% vs. 28%, P <0.001). The groups differed in the number of unmet expectations: 40% of the long instrument group reported at least 1 unmet expectation compared with 19% of the short instrument group (P <0.001). Satisfaction was similar among the 3 groups.
  
  
  CONCLUSIONS
  These different instruments elicit different numbers of expectations but do not affect patient satisfaction.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, North Carolina 27705, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Peck
authors.forename: D A
authors.initials: DA
authors.lastname: Asch
authors.forename: S D
authors.initials: SD
authors.lastname: Goold
authors.forename: D L
authors.initials: DL
authors.lastname: Roter
authors.forename: P A
authors.initials: PA
authors.lastname: Ubel
authors.forename: L M
authors.initials: LM
authors.lastname: McIntyre
authors.forename: K H
authors.initials: KH
authors.lastname: Abbott
authors.forename: J A
authors.initials: JA
authors.lastname: Hoff
authors.forename: C M
authors.initials: CM
authors.lastname: Koropchak
authors.forename: J A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D000554:Ambulatory Care Facilities; D001294:Attitude to Health; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011897:Random Allocation; D018709:Statistics, Nonparametric; D014481:United States; D014728:Veterans