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The relationship between measured performance and satisfaction with care among clinically complex patients
Rachel M Werner1, Virginia W Chang
1Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA. rwerner@mail.med.upenn.edu
Journal of General Internal Medicine
|July 24, 2008
Summary
High performance in recommended care for complex patients correlates with increased satisfaction. This suggests that meeting performance measures for complex patients does not negatively impact unmeasured aspects of their care.
Area of Science:
- Health Services Research
- Quality Improvement
- Patient Outcomes
Background:
- Clinically complex patients often receive recommended care, but the impact of performance goals on their overall care quality and satisfaction is unclear.
- It is unknown if prioritizing performance measures for complex patients detracts from other care aspects, potentially leading to unmet needs.
Purpose of the Study:
- To investigate the association between measured healthcare performance and patient satisfaction in clinically complex populations.
- To determine if adherence to performance metrics impacts overall care experience for complex patients.
Main Methods:
- Observational analysis of 35,927 veterans from the External Peer Review Program (fiscal years 2003-2004).
- Assessed compliance with individual performance measures (e.g., cancer screenings, vaccinations) and overall recommended care, adjusting for clinical complexity.
- Estimated global satisfaction with care based on clinical complexity and performance measure compliance.
Main Results:
- Higher clinical complexity predicted slightly increased overall and individual performance, mediated by visit frequency.
- High measured performance was linked to greater satisfaction among highly complex patients.
- The positive effect of high performance on satisfaction increased with patient complexity.
Conclusions:
- Clinically complex patients demonstrated higher measured performance and satisfaction.
- Achieving high performance in clinically complex patients did not appear to compromise unmeasured aspects of care.
- Compliance with performance measures in complex patients is associated with increased satisfaction, not unmet needs.
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