Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction.
BACKGROUND
Hospitals use patient satisfaction surveys to assess their quality of care. A key question is whether these data provide valid information about the medically related quality of hospital care. The objective of this study was to determine whether patient satisfaction is associated with adherence to practice guidelines and outcomes for acute myocardial infarction and to identify the key drivers of patient satisfaction.


RESULTS
We examined clinical data on 6467 patients with acute myocardial infarction treated at 25 US hospitals participating in the CRUSADE initiative from 2001 to 2006. Press Ganey patient satisfaction surveys for cardiac admissions were also available from 3562 patients treated at these same 25 centers over this period. Patient satisfaction was positively correlated with 13 of 14 acute myocardial infarction performance measures. After controlling for a hospital's overall guideline adherence score, higher patient satisfaction scores were associated with lower risk-adjusted inpatient mortality (P=0.025). One-quartile changes in both patient satisfaction and guideline adherence scores produced similar changes in predicted survival. For example, a 1-quartile change (75th to 100th) in either the patient satisfaction score or the guideline adherence score yielded the same change in predicted survival (odds ratio, 1.24; 95% CI, 1.02 to 1.49; and odds ratio, 1.24; 95% CI, 1.08 to 1.41, respectively). Satisfaction with nursing care was the most important determinant of overall patient satisfaction (P<0.001).


CONCLUSIONS
Higher patient satisfaction is associated with improved guideline adherence and lower inpatient mortality rates, suggesting that patients are good discriminators of the type of care they receive. Thus, patients' satisfaction with their care provides important incremental information on the quality of acute myocardial infarction care.
Glickman
Seth W
SW
Center for Clinical and Genetic Economics, Duke University, Durham, NC, USA. seth_glickman@med.unc.edu
Boulding
William
W
Manary
Matthew
M
Staelin
Richard
R
Roe
Matthew T
MT
Wolosin
Robert J
RJ
Ohman
E Magnus
EM
Peterson
Eric D
ED
Schulman
Kevin A
KA
D000368:Aged; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology