Health-related quality of life and patient reports about care outcomes in a multidisciplinary hospital intervention.
BACKGROUND
Patient perceptions of care and health-related quality of life (HRQOL) are important outcomes for hospitalized patients.


OBJECTIVE
This study examined patient experiences with hospital care and HRQOL in individuals hospitalized at a west coast teaching hospital.


METHODS
We assessed patient experiences with care and HRQOL using interviews with 1,207 hospitalized, general medicine patients participating in a multidisciplinary provider team intervention at a large academic medical center. Patient outcome variables included the Picker dimensions of hospital care (Continuity and Transition, Coordination of Care, Emotional Support, Information and Education, Involvement of Family and Friends, Physical Comfort, Respect for Patient Preferences, Overall Impression), the Health Utilities Index Mark 3 (HUI-3), and the SF-12 physical (PCS-12) and mental health (MCS-12) summary scores.


RESULTS
Patients randomized to a multidisciplinary intervention reported higher emotional support (b = 3.32), t(903) = 2.01, p =.044, and physical comfort (b = 3.49), t(863) = 2.25, p = .025, from health care providers than did the control group, but these effects became nonsignificant after adjusting for multiple comparisons. The HUI-3, PCS-12, and MCS-12 summary scores improved significantly from baseline to the 30-day, ts(943, 919, 860) = 4.94, 2.20, and 5.31, ps < .0001, = .03, and < .0001, respectively, and the 4-month follow-ups, ts(871, 919, 943) = 7.25, 8.68, and 8.08, ps < .001, < .001, and < .0001, respectively, but change on these measures did not differ between intervention and control patients. Baseline health was significantly associated with patient evaluations of hospital care, but patient evaluations did not predict future health.


CONCLUSIONS
There were no differences in reports and ratings of hospital care or HRQOL between the control and the intervention groups. Hence, the behavioral changes in hospital staff in the intervention group had no effect on patient-reported outcomes. Mental health at baseline was predictive of patient evaluations of the hospitalization, but evaluations of care were not associated with subsequent HRQOL. Thus, it may be important to adjust patient evaluations of hospital care for case-mix differences in health.
Hays
Ron D
RD
Los Angeles Department of Medicine, Division of General Internal Medicine & Health Services Research, University of California, 90095-1736, USA. drhays@ucla.edu
Eastwood
Jo-Ann
JA
Kotlerman
Jenny
J
Spritzer
Karen L
KL
Ettner
Susan L
SL
Cowan
Marie
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006761:Hospitals / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life