Is higher patient satisfaction associated with better stroke outcomes?

To evaluate the association between patient satisfaction and cost, outcomes, and clinical performance of stroke care.

An ecological study was conducted on all participating hospitals of the Hospital Consumer Assessment of Healthcare Providers and Systems patient survey that reported stroke outcomes.

Patient satisfaction measures were grouped into global, environmental, communication, pain control, staff responsiveness, care transition, and discharge information categories. Linear regression models compared risk-adjusted 30-day mortality, 30-day readmission, inpatient costs, and clinical performances by patient satisfaction.

Global patient satisfaction was negatively associated with risk-adjusted 30-day mortality (beta coefficient [β] = -0.39; standard error [SE], 0.16; P = .02) and readmission rates (β = -0.30; SE, 0.11; P = .006). Satisfaction with discharge information was positively associated with risk-adjusted 30-day mortality rate (β = 0.70; SE, 0.14; P <.001) and negatively associated with readmission rate (β = -0.37; SE, 0.09; P <.001). Satisfaction with discharge information were positively associated with inpatient management (β = 1.67; SE, 0.43; P <.001) and secondary care performance (β = 1.82; SE, 0.47; P <.001). The average cost among most satisfied hospitals was $6785, 7.3% higher than that among least satisfied hospitals ($6324). Hospitals with the highest environment satisfaction rating had 7% higher costs compared with the least satisfied hospitals.

Global patient satisfaction was positively associated with the quality of stroke care; however, improvements in patient satisfaction were linked to higher stroke care costs. In addition, patient satisfaction with discharge information was linked to worse outcomes. As a result, patient satisfaction should be used with caution as a quality indicator for stroke care.