title: Evaluating medication-related services in a hospital setting using the disconfirmation of expectations model of satisfaction.
abstract: BACKGROUND
  Patient satisfaction is considered an important outcome measure of services and associated with behavioral intentions. The appraisal process commonly used in satisfaction models is the disconfirmation of expectations. A patient compares his or her experience to preexisting expectations. The resulting satisfaction from this comparison is dependent on whether the patient's expectations are superior, inferior, or just as expected.
  
  
  OBJECTIVE
  The aims of this study were to (1) determine the relationship between disconfirmation of expectations with medication-related services and patient satisfaction with medical care; and (2) determine if patient satisfaction is related to the likelihood to say good things about the medical care provided at the hospital to family and friends.
  
  
  METHODS
  A cross-sectional, nonexperimental study design was implemented to test the disconfirmation of expectations model. Patients on warfarin therapy and recently discharged from an acute care hospital to their homes were surveyed by mail. The survey asked about how well the hospital services related to medication therapy met patient expectations. Satisfaction with medical care and the likelihood of positive word of mouth regarding the medical care were also measured. Structural equation modeling (SEM) was used to test the model.
  
  
  RESULTS
  The survey response rate was 34% (n=187). Factor analysis of the 7 disconfirmation of expectation items resulted in a 2-factor solution: (1) medication counseling and (2) discharge medication services. The SEM demonstrated that the model was significant; however, the disconfirmation of expectation items did not significantly relate to the 1-item satisfaction measure. Patient satisfaction and the behavioral intentions measures were significantly related. A post hoc analysis using SEM demonstrated that the disconfirmation of expectations factors did significantly relate to a higher-order latent construct. This construct also related to patient satisfaction.
  
  
  CONCLUSIONS
  The disconfirmation of expectations has a role in a postservice experience response expressed by the patient, but not as a direct antecedent to patient satisfaction. Opportunities to improve the model are the use of a multi-item satisfaction measure and the inclusion of patient affect.
authors.affiliation: University of Michigan, Social and Administrative Sciences, College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109, USA. skucukar@umich.edu
authors.forename: Suzan N
authors.initials: SN
authors.lastname: Kucukarslan
authors.forename: Anagha
authors.initials: A
authors.lastname: Nadkarni
mesh_terms: D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D003625:Data Collection; D005163:Factor Analysis, Statistical; D005260:Female; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010351:Patient Discharge / Q000592:standards; D010353:Patient Education as Topic / Q000592:standards; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D014859:Warfarin