title: Methodological Considerations When Studying the Association between Patient-Reported Care Experiences and Mortality.
abstract: OBJECTIVE
  To illustrate methodological considerations when assessing the relationship between patient care experiences and mortality.
  
  
  METHODS
  Medical Expenditure Panel Survey data (2000-2005) linked to National Health Interview Survey and National Death Index mortality data through December 31, 2006.
  
  
  METHODS
  We estimated Cox proportional hazards models with mortality as the dependent variable and patient experience measures as independent variables and assessed consistency of experiences over time.
  
  
  METHODS
  We used data from respondents age 18 or older with at least one doctor's office or clinic visit during the year prior to the round 2 interview. We excluded subjects who died in the baseline year.
  
  
  RESULTS
  The association between overall care experiences and mortality was significant for deaths not amenable to medical care and all-cause mortality, but not for amenable deaths. More than half of respondents were in a different care experience quartile over a 1-year period. In the five individual experience questions we analyzed, only time spent with the patient was significantly associated with mortality.
  
  
  CONCLUSIONS
  Deaths not amenable to medical care and the time-varying and multifaceted nature of patient care experience are important issues to consider when assessing the relationship between care experience and mortality.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Biostatistics and the Yale Center for Analytic Studies, Yale School of Public Health, New Haven, CT.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Buta
authors.affiliation: RAND Corporation, Arlington, VA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Anhang Price
authors.affiliation: RAND Corporation, Santa Monica, CA.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.affiliation: Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA.
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000328:Adult; D000367:Age Factors; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009819:Office Visits / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors
keywords: Patient care experiences; mortality; quality of care