Patient satisfaction at and after discharge. Effect of a time lag
Introduction
It has been increasingly recognized that patient satisfaction is an important outcome measure for evaluating quality of medical care [1], [2], [3], [4], [5], [6], [7], especially given the tendency of hospital performance indicators to be made publicly accessible in the industrialized countries of the west. Public access to these performance indicators gives patients the possibility to compare hospitals and physicians. It is generally assumed that transparency of these indicators is an incentive for improving the quality of medical care [8], [9], [10], [11].
It is remarkable that consistently high satisfaction ratings of over 90% have been reported over the last 30 years [12], [13], [14]. Different mechanisms influence these ratings. First of all, a number of “social-psychological artifacts” may affect expressions of patient satisfaction. “Social desirability response bias” argues that patients may report greater satisfaction than they actually feel because they believe positive comments are more acceptable. From that perspective it has also been hypothesized that, when responding to questionnaires, people sometimes answer more according to a prevailing social norm than to the factual situation [15]. In addition, “ingratiating response bias” occurs when patients use the satisfaction survey to ingratiate themselves with the medical staff [14], [16]. This can lead to high satisfaction ratings. It is suggested that these response biases occur because of the patients’ dependency on the medical staff for treatment [14].
There are also indications that the time point of administration of a patient satisfaction questionnaire has an influence on satisfaction ratings [3], [17], [18]. However, only a few studies have evaluated whether there is a discrepancy between patient satisfaction immediately after care consultation and at a later time point. These studies show different patterns in patient satisfaction ratings at follow-up. Kinnersly et al. [19] and Savage and Armstrong [20] reported lower levels of patient satisfaction, while the study of Jackson et al. [3] showed an increase in patient satisfaction after a time lag between consulting a physician and follow-up. Different opinions have been reported about possible causes of changes in patient satisfaction over time. It is suggested that, at a later time point, after they have had the opportunity to decide whether the caregiver's advice was “right”, patients are in a better position to determine whether or not they are satisfied [3], [19]. Patients who may have idealized the hospital in their relief and gratitude for the care given may express lower satisfaction when their view becomes more detached after discharge [21]. At a further point in time from the hospital discharge, patients generally have a functional status improvement and are thus less dependent on their hospital care providers and less pressured to give socially desirable answers. This may also result in a more detached judgment [22], and possibly in lower satisfaction rates. On the other hand, this functional status improvement itself can contribute to an increase in patient satisfaction at a later time point [2], [3], [5], [6]. Findings of Kane et al. [6] suggest that patient satisfaction is related to how the patients are feeling at that moment. Because of the functional status improvement, at follow-up patients seem to forget the pain and discomfort of the treatment and the extent of the symptoms that led to their seeking medical care [6].
The present study aimed at investigating whether the assessment of patient satisfaction at different time points resulted in different outcomes among orthopedic patients. This study measured patient satisfaction twice. The first time, the measurement took place at discharge from the orthopedic department of the hospital, the second time after discharge (range 1–12 months). Considering the possible response biases resulting in high satisfaction levels combined with the expectation that, after a time lag, patients are more capable of judging whether they are satisfied with the given care and information, it is our hypothesis that satisfaction ratings of orthopedic patients decrease after discharge.
Section snippets
Sample and data collection
Patient recruitment took place at the Orthopedic Department of the University Medical Center Groningen from January 2002 to February 2003. The sample consisted of 152 orthopedic patients who filled in the questionnaire at discharge from the hospital (T0). Administration of this questionnaire at discharge is a standard procedure at the orthopedic department. After a time lag (range 1–12 months), these patients received the same questionnaire at home, to fill it in for the second time and return
Respondent characteristics
The mean age of the patients is 59, with twice as many women (n = 77) as men (n = 37) in the total population. The mean stay in the hospital was 11.7 days, with men having a longer mean hospitalization than women, respectively, 13.5 and 10.8 days. An overview of disorders in our research population is summarized in Table 1.
Patient satisfaction at discharge and follow-up
A paired samples t-test was used to compare the data of the questionnaires filled in at hospital discharge (T0) with the data of the mailed-in questionnaires (T1). The overall
Discussion and conclusion
In this study we investigated the effect of a time lag on the outcome of the patient satisfaction questionnaire that was self-administered twice by orthopedic patients at different time points. Twice as many women as men participated in the study, although no significant differences between the two groups were found with respect to the outcome variables.
A response rate of 75% was seen the second time the questionnaire was administered. A response rate of 80% has been proposed as a minimum in
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Leren van cijfers. Ziekenhuizen gaan prestaties openbaar maken. (Learning figures. Hospitals make performance records publicly accessible.) (2)
Medisch Contact
Werken aan verbetering. Ziekenhuizen gaan prestaties openbaar maken. (Working towards improvement. Hospitals will be making performance records publicly accessible.) (1)
Medisch Contact
Grenzen aan transparantie. Voorzichtigheid geboden bij openbaarmaking gegevens. (Limits to transparency. Caution recommended when making data public.)
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