title: Patient satisfaction and use of Veterans Affairs versus non-Veterans Affairs healthcare services by veterans.
abstract: OBJECTIVE
  Chronically ill patients who are not satisfied with their care may change healthcare providers or systems, which could disrupt continuity of care and impede management of their conditions. We examined whether patient satisfaction affected subsequent use of non-Veterans Affairs (VA) services among chronically ill veterans discharged from VA hospitals.
  
  
  METHODS
  The data used in this study came from a multicenter trial of increased access to primary care. We enrolled patients with diabetes, heart failure, and/or chronic obstructive pulmonary disease who were discharged from 1 of 9 VA medical centers. At baseline, we assessed satisfaction using the Patient Satisfaction Questionnaire. VA and non-VA utilization over the subsequent 6 months were assessed using VA and Medicare administrative data, non-VA billing data, and patient interviews. Using multivariable logistic regression analyses, we examined whether baseline patient satisfaction was associated with non-VA inpatient or outpatient utilization during the next 6 months. We conducted the same analysis for Medicare-eligible veterans, a group with better access to non-VA care.
  
  
  RESULTS
  Of 1375 study patients, 174 (13%) used non-VA healthcare. Patients with non-VA utilization were older and lived farther from a VA. The odds of non-VA use decreased by 11% as satisfaction increased (odds ratio 0.89; 95% confidence interval 0.83-0.97; P = 0.005). This relationship was strongest among Medicare-eligible veterans (odds ratio 0.85; 95% confidence interval 0.77-0.93; P = 0.001).
  
  
  CONCLUSIONS
  Dissatisfied veterans discharged from the hospital were more likely to go outside VA for care. Thus, improvements in patient satisfaction may lead to improvements in continuity of care.
authors.affiliation: Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Hines VA Hospital, Hines, Illinois 60141, USA. Kevin.Stroupe@med.va.gov
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
authors.forename: Denise M
authors.initials: DM
authors.lastname: Hynes
authors.forename: Anita
authors.initials: A
authors.lastname: Giobbie-Hurder
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Domenic J
authors.initials: DJ
authors.lastname: Reda
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
mesh_terms: D000367:Age Factors; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D003266:Continuity of Patient Care; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006787:Hospitals, Veterans / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*