Healthcare expenditures and patient satisfaction: cost and quality from the consumer's perspective in the US

A Cross-Sectional Study of Patient Satisfaction Among Immigrants in the Pediatric Outpatient Clinic of Firoozabadi Hospital

Patient satisfaction is important in healthcare as it affects the quality of care and can lower costs in hospitals. This study aimed to measure immigrant satisfaction with outpatient services at Firoozabadi Hospital's pediatric clinic. Data were collected from immigrant patients from January to July 2023. The Patient Satisfaction Questionnaire 18 and the personal information checklist were used in oral interviews with caregivers. The overall satisfaction score was 72.95 out of 90, with a standard deviation of 12.57. Financial issues received the lowest satisfaction scores, while interpersonal manner received the highest ratings. Out of the 241 respondents, 48.6% were completely satisfied, 32.7% were satisfied, 10.6% had no opinion, and 4.4% expressed dissatisfaction. Satisfaction levels were not correlated with income, education, possession of identification documents or health insurance, and length of stay in Iran. Overall, most participants were happy with the outpatient services, but many lacked health insurance. Providing easier access to health insurance for immigrants could help reduce dissatisfaction with expensive medical bills.

The effect of primary care clinician type and care team characteristics on health care costs

OBJECTIVE

To evaluate health care costs as a function of assigned primary care clinician type and care team characteristics.

METHODS

Administrative data were collected for 68 family medicine clinicians (40 physicians and 28 nurse practitioners [NPs]/physician assistant [PAs]), on 11 care teams (variable MD, NP and PA on teams), caring for 77,141 patients. We performed a generalized linear mixed multivariable regression model of standardized per member per month (PMPM) median cost as the outcome, with four practice sites included as random effects.

RESULTS

In bivariate analysis, cost was higher in physicians than NP/PAs, in more complex patients, and associated with emergency department (ED) visit rate. On multivariate analysis, patient complexity, ED visit rate and higher patient experience ratings were independently associated with greater PMPM cost. More time in practice was associated with lower PMPM cost. In the adjusted multivariate model, physicians had 8.3% lower median PMPM costs than NP/PAs (p = 0.046).

CONCLUSIONS

The primary drivers of greater PMPM cost were patient complexity, ED visits and patient satisfaction.

Association of patient-reported experiences with health resource utilization and cost among US adult population, medical expenditure panel survey (MEPS), 2010–13

Objectives

To determine whether optimal patient experiences with healthcare is associated with enhanced and efficient use of healthcare resources and cost.

Design

Retrospective cohort study.

Setting and participants

The study population consisted of pooled participants from the 2010–13 Medical Expenditure Panel Survey cohort of adults ≥18 years with a regular healthcare provider and ≥1 visit to a healthcare provider within the survey year. Using a self-administered questionnaire, individual responses to questions related to healthcare experience were used to develop a weighted average for each of these patient-centered care matrices (ease of access to healthcare, patient–provider communication, shared decision-making and overall patient satisfaction).

Intervention

None.

Outcome measures

The outcomes of interest included (1) emergency room (ER) visits and hospital stay, (2) annual healthcare costs incurred by the respondents.

Results

Overall the study population consisted of 47 969 individuals ≥18 years representing nearly 130 million US non-institutionalized adults. Compared with individuals with a poor report on healthcare experience, participants with positive reports were less likely to utilize the ER and had a lower annual healthcare expenditure. This relationship between patient experience and healthcare expenditure was not demonstrated with shared decision-making and overall patient satisfaction.

Conclusion

Our study findings suggest that there is an association between patient experience with healthcare, health resource utilization and healthcare expenditure. Further studies are needed to assess if interventions focused to enhance patient experiences can improve healthcare efficiency.

Impact of anesthesiologists on parental perioperative satisfaction scores

BACKGROUND

While the focus on patient experience as an important outcome has significantly increased over the past decade, there is paucity of data on predictive factors associated with parental recommendation of a surgical facility to friends and family.

METHODS

Data for this report were obtained from a Hospital Information System and Picker Health validated surveys completed by 538 parents whose children underwent outpatient surgery from July 2014 to March 2016. Bivariate, chi-squared, and multivariate logistic regression analysis were carried out using the Picker Health item "Would you recommend this outpatient surgical facility to your friends and family?" as the primary outcome. Demographic data and 53 Picker Health items were used as potential predictors.

RESULTS

Multivariate logistic regression analysis found the following variables as independent predictors for parental recommendation: quality of perioperative communication by anesthesiologists (odds ratio [95% confidence interval]=0.23 [0.09, 0.58]); provision of information on whom to call for help after discharge (0.22 [0.07, 0.64]); child's perceived baseline health (0.37 [0.15, 0.90]); and ill-informed staff about child's procedure (0.30 [0.21, 0.79]). Variables such as child's pain and child's nausea and vomiting were not predictive for referral pattern.

CONCLUSION

Parental recommendation of a surgical facility to friends and family depends on a number of variables with the quality of perioperative communication with the anesthesiologist being the most predictive item.

Preferred parental method of post-operative tonsillectomy and adenoidectomy follow-up (phone call vs. clinic visit)

INTRODUCTION

Tonsillectomy is the second most common procedure performed in the United States. Over 530,000 tonsillectomies are performed on children under 15 years of age in the United States, accounting for 16% of surgeries in this age group, resulting in missed school for patients of school-age and also resulting in missed work for caregivers. This study compared parent preferences for in-clinic follow-up (CFU) to telephone interview follow-up (TFU) after tonsillectomy.

MATERIALS AND METHODS

One hundred twenty-one parents of children who underwent a tonsillectomy and/or adenoidectomy were recruited to complete a survey about their child's post-operative visit.

RESULTS

Statistical analyses were performed using t-test, Wilcoxon rank-sum, and Fischer's exact tests where appropriate. 60.3% of the surveys were completed as a TFU and the remainder were completed as a CFU. There were no statistical differences in the children's age, the time to follow-up, satisfaction with their follow-up, or the frequency of unresolved symptoms. Of parents receiving TFU, 91.8% disagreed they would have preferred a CFU, with 86.3% strongly disagreeing, and only 5.5% expressing that they would have preferred a CFU. Of the parents with CFU, 47.9% expressed a preference for a TFU. For CFU, 43.9% of parents missed work and 58.1% of their school-age children missed school.

CONCLUSION

Our study results indicate that parents receiving phone follow-up strongly preferred this method to an in-clinic follow-up, and that nearly half of all parents receiving in-clinic follow-up would have preferred a telephone follow-up. In select patients, telephone follow-up after tonsillectomy may increase patient satisfaction and decrease days of missed work and school.

Impact of Inpatient Palliative Care on Treatment Intensity for Patients with Serious Illness

BACKGROUND

Palliative care is associated with decreased treatment intensity and improved quality for individual patients at the end of life, but little is known about how hospital-wide outcomes are affected by the diffusion of palliative care principles.

OBJECTIVE

We examined the relationship between presence of palliative care programs and hospitals' average treatment intensity, as indicated by mean intensive care unit (ICU) length of stay (LOS) and days under Medicare hospice coverage, in the last six months of life among Medicare beneficiaries aged 67 and over with serious chronic illness.

METHODS

We linked hospital-level data from the American Hospital Association Annual Survey, National Palliative Care Registry, and Dartmouth Atlas of Health Care to examine hospital-level treatment intensity for chronically ill Medicare beneficiaries who died in 2010. We used propensity score-adjusted linear regression to estimate the relationship between palliative care programs and hospitals' mean ICU LOS and hospice length of enrollment.

RESULTS

Among 974 hospitals meeting inclusion criteria, we compared 295 hospitals with palliative care programs to 679 hospitals without. Hospitals with palliative care programs were higher volume, more likely to be teaching hospitals, and have oncology services and less likely to be located in rural areas. In propensity score weighted analyses, the mean ICU LOS in hospitals with palliative care was shorter by 0.23 days (standard error [SE] = 0.26), but this was not statistically significant (p = 0.76). In addition, the mean length of hospice enrollment among beneficiaries served by hospitals with palliative care was longer by 0.22 days (SE = 0.61), but also was not statistically significant (p = 0.76).

CONCLUSIONS

Hospital-based palliative care programs alone may not be sufficient to impact ICU LOS or hospice length of enrollment for all chronically ill older adults admitted to hospitals. Future work should measure hospital-wide palliative care outcomes and effects of core palliative knowledge and skills provided by nonpalliative care specialists.

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

Background

Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure.

Objective

The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample.

Methods

Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States.

Results

The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction.

Conclusions

We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

What factors influence follow-up in orthopedic trauma surgery?

BACKGROUND

Among surgical patients, follow-up visits are essential for monitoring post-operative recovery and determining ongoing treatment plans. Non-adherence to clinic follow-up appointments has been associated with poorer outcomes in many different patient populations. We sought to identify factors associated with non-attendance at follow-up appointments for orthopedic trauma patients.

MATERIALS AND METHODS

A retrospective chart review at a level I trauma center identified 2,165 patients who underwent orthopedic trauma surgery from 2008 to 2009. Demographic data including age, sex, race, tobacco use, American Society of Anesthesiologist (ASA) score, insurance status, distance from the hospital, and follow-up time were collected. Injury characteristics including fracture type, anatomic location of the operation, length of hospital stay, living situation and employment status were recorded. Attendance at the first scheduled follow-up visit was recorded. Multivariable log-binomial regression analyses were used with statistical significance maintained at p < 0.05.

RESULTS

Of the 2,165 patients included in the analysis, 1,449 (66.9 %) attended their first scheduled post-operative clinic visit. 33.1 % (717) were not compliant with keeping their first clinic appointment after surgery. Patients who used tobacco, lived more than 100 miles from the clinic site, did not have private insurance, had an ASA score >2, or had a fracture of the hip or pelvis were significantly less likely to follow-up. Age, sex, and race were not significantly associated with failure to follow-up.

DISCUSSION

Follow-up appointments are essential for preventing complications among orthopedic trauma patients. By identifying patients at risk of failure to follow-up, orthopedic surgeons can appropriately design and implement long-term treatment plans specifically targeted for high-risk patients.

Cost of care for subjective tinnitus in relation to patient satisfaction

OBJECTIVE

A consistent management algorithm for subjective tinnitus remains to be elucidated. Chronic tinnitus yields approximately US$2110 in annual health care costs per patient. However, it is unclear whether spending more in the management of tinnitus equates with greater patient satisfaction. Thus, the aim of this study is to correlate patient satisfaction with patient demographics, provider recommendations, and total health care-related expenditures.

STUDY DESIGN

A retrospective chart review and a patient satisfaction questionnaire.

SETTING

All data were collected from a large Midwestern hospital.

SUBJECTS AND METHODS

Patients were included who presented to the tinnitus clinic during the year 2011 and were between the ages of 18 and 89 years. They were excluded with diagnoses of Ménière's disease, pulsatile tinnitus, acoustic neuromas, or autoimmune inner ear diseases. The retrospective data and satisfaction surveys were entered by 3 of the authors. Responses were based on Likert scales.

RESULTS

Of the 692 patients included, 230 completed and returned the satisfaction questionnaire (33.2% response rate), yielding an overall mean of $662.60 charges. The frequency of intervention recommendations per patients ranged from 0 to 13, with a median of 4. Spearman's correlations did not result in significant correlations between patient satisfaction and number of clinic visits (P=.499) or associated charges (P=.453).

CONCLUSION

Given that the variability among provider recommendations, the high overall mean of tinnitus-related charges, and patient satisfaction was not related to costs, further research is needed examining patient preference in the treatment of tinnitus.

Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective

Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes.

The association between health care quality and cost: a systematic review

BACKGROUND

Although there is broad policy consensus that both cost containment and quality improvement are critical, the association between costs and quality is poorly understood.

PURPOSE

To systematically review evidence of the association between health care quality and cost.

DATA SOURCES

Electronic literature search of PubMed, EconLit, and EMBASE databases for U.S.-based studies published between 1990 and 2012.

STUDY SELECTION

Title, abstract, and full-text review to identify relevant studies.

DATA EXTRACTION

Two reviewers independently abstracted data with differences reconciled by consensus. Studies were categorized by level of analysis, type of quality measure, type of cost measure, and method of addressing confounders.

DATA SYNTHESIS

Of 61 included studies, 21 (34%) reported a positive or mixed-positive association (higher cost associated with higher quality); 18 (30%) reported a negative or mixed-negative association; and 22 (36%) reported no difference, an imprecise or indeterminate association, or a mixed association. The associations were of low to moderate clinical significance in many studies. Of 9 studies using instrumental variables analysis to address confounding by unobserved patient health status, 7 (78%) reported a positive association, but other characteristics of these studies may have affected their findings.

LIMITATIONS

Studies used widely heterogeneous methods and measures. The review is limited by the quality of underlying studies.

CONCLUSION

Evidence of the direction of association between health care cost and quality is inconsistent. Most studies have found that the association between cost and quality is small to moderate, regardless of whether the direction is positive or negative. Future studies should focus on what types of spending are most effective in improving quality and what types of spending represent waste.

PRIMARY FUNDING SOURCE

Robert Wood Johnson Foundation.

Absenteeism and short-term disability associated with breast cancer

Few data exist related to the impact of breast cancer on work absenteeism and short-term disability. This retrospective study estimated the extent and costs of breast cancer-associated production loss using a large medical and pharmacy claims database from a US commercially insured population between January 2003 and December 2007. Women aged ≥ 18 years with ≥ 2 breast cancer diagnoses within 90 days were selected. Controls were matched to cases based on index date (first breast cancer diagnosis), age, region, employer, and health insurance type. Outcomes were days absent from work and days with short-term disability. Costs were estimated using daily wage rates. 856 and 2,668 patients were selected for absenteeism and short-term disability, respectively, with a mean age of 49 and 50 years. Average number of absenteeism days was 35 and 21, and short-term disability days were 51 and 5, for cases and controls, respectively, within the post-index year (both P < 0.001). Adjusted incremental costs for absenteeism and short-term disability were $1,911 and $6,157 (P < 0.001), respectively, per breast cancer patient per year. This study suggests that breast cancer is associated with work-related productivity loss within the first year of diagnosis that may be a substantial cost to employers.

Health care and productivity costs associated with diabetic patients with macrovascular comorbid conditions

OBJECTIVE

To examine and quantify from the societal perspective the impact of macrovascular comorbid conditions (MVCCs) on health care and productivity costs in diabetic patients in the U.S.

RESEARCH DESIGN AND METHODS

With use of the pooled Medical Expenditure Panel Survey (MEPS) 2004 and 2006 data, a nationally representative adult sample (aged >or=18 years) was included in the study. Health care cost was measured by the annual health care expenditure. Productivity cost was calculated from the lost productivity from missed work days and additional bed days due to illness/injury based on the 2006 average national hourly wage. Both 2004 and 2006 cost data were adjusted to 2006 dollars. Given the heavily right-skewed distribution of the cost data, the generalized linear model with log-link function and gamma variance was used to identify the relationship between MVCCs and costs after controlling for age, sex, race, ethnicity, education, income, employment status, smoking status, health insurance, diabetes severity, and comorbidities. Negative binomial models were applied to analyze the outcomes of missed work days and bed days. All statistics were adjusted using the proper sampling weight from MEPS.

RESULTS

Compared with diabetic patients without MVCCs (n = 3,320), those with MVCCs (n = 913) had statistically significant higher annual health care costs (5,120 USD, P < 0.001), more missed work days (13.03 days, P < 0.001), and more bed days (7.60 days, P = 0.025) per patient after controlling for differences in sociodemographics, smoking, diabetes severity, and comorbidities. The marginal lost productivity cost was 2,388 USD annually per patient.

CONCLUSIONS

From the U.S. societal perspective, MVCCs in diabetic patients are associated with increased health care and lost productivity costs.