Validating a model of patient satisfaction with emergency care

doi:10.1067/mem.2001.119250

Annals of Emergency Medicine

Volume 38, Issue 5, November 2001, Pages 527-532

Presented at the American College of Emergency Physicians Research Forum, Chicago, IL, October 2001.

https://doi.org/10.1067/mem.2001.119250 Get rights and content

Abstract

Study Objective: We sought to validate a previously developed model of emergency department patient satisfaction in a general population using a standard mailed format. The study aims to export the findings of a comprehensive ED quality-of-care study to an easily measured patient population. Methods: A double-sided, single-page survey was mailed to all patients discharged home from 4 teaching hospital EDs during a 1-month period. Determinants of patient satisfaction were analyzed with a previously developed multivariate, ordinal logistic-regression model. Results: The mail survey response rate was 22.9% (2,373/10,381). The survey validates the importance of previously identified determinants of patient satisfaction, including age, help not received when needed, poor explanation of problem, not told about wait time, not told when to resume normal activity, poor explanation of test results, and not told when to return to the ED (P <.01). Greater age predicted higher patient satisfaction, whereas all other variables correlated with lower patient satisfaction. In contrast with prior findings, black race was not a significant predictor of satisfaction in the mail survey population. Low ratings of overall care are strongly correlated with reduced willingness to return (P <.0001). Conclusion: A patient satisfaction model was previously developed from a comprehensive research survey of ED care. We demonstrate the generalizability of this model to a mail survey population and replicate the finding that satisfaction strongly predicts willingness to return. The response rate of this study is typical of commercial patient-satisfaction surveys. The validated model suggests that ED patient satisfaction improvement efforts should focus on a limited number of modifiable and easily measured factors. [Sun BC, Adams JG, Burstin HR. Validating a model of patient satisfaction with emergency care. Ann Emerg Med. November 2001;38:527-532.]

Introduction

The measurement of patient satisfaction has become increasingly prevalent among health providers and purchasers.1, 2, 3 Patient satisfaction describes the subjective experience of patients with health care, and it reflects one aspect of health care quality. Furthermore, patient satisfaction is tightly linked to other outcomes, including malpractice litigation,4, 5 willingness to return,6, 7 and medical compliance.8, 9

A multivariate model of patient satisfaction was recently generated from the 1995 Emergency Department Quality Study (EDQS), which was an exhaustive survey of emergency care.7, 10, 11 From a large pool of candidate predictors, this study identified a limited number of process measures and patient characteristics that are significantly associated with ED patient satisfaction and willingness to return. The EDQS analysis also demonstrated a powerful association between patient satisfaction and willingness to return. This work differs from prior ED satisfaction research because of the focus on specific problems with care, the large sample size (n>2,300), the high response rate, and the use of appropriate statistical methodology for analyzing ratings of overall care.

Although the internal validity of the models was exhaustively tested,⁷ the findings may not be easily exported to other ED settings. The models were based on a 3-part research survey, including a baseline questionnaire, chart review, and telephone interview, which achieved an overall 67% response rate. The survey was restricted to patients with 6 chief complaints, including abdominal pain, asthma, chest pain, hand laceration, head trauma, and vaginal bleeding. The survey included patients who were directly admitted from the ED in addition to those who were discharged home. Finally, this research study required considerable resources and significant costs per enrolled patient.

In contrast, many institutions use mail survey instruments that differ significantly from the EDQS. These surveys focus on patients discharged from the ED regardless of chief complaint, and they typically yield response rates of between 25% and 30% (personal communication, Press, Ganey Associates, Picker Institute, Brigham and Women’s Quality Management Services, 2000). Mail instruments are relatively inexpensive to administer, and they are used for quality improvement efforts rather than research purposes. Mail surveys suffer from potential selection bias, but they are often the only readily available source of information for EDs.

EDs may use self-generated or commercially available patient satisfaction instruments. However, published validation data on these instruments are remarkably scarce.12, 13 To our knowledge, no patient satisfaction instrument has been validated in the ED setting.

This study aims to validate the model of patient satisfaction generated from the EDQS in a mail survey population. Successful validation would allow ED administrators to confidently focus improvement efforts on a few modifiable, easily measured process measures identified by the EDQS.

Section snippets

Materials and methods

This mail survey was conducted at 4 urban teaching hospital EDs affiliated with the same medical school. Institutional review board approval was obtained at each of the participating institutions. The ED directors or their designates served on the study team.

Parameters for sample size calculations included 80% power to detect associations between patient-reported problems and patient satisfaction observed in the EDQS, and type I error was set at 0.05. For the purposes of power calculations,

Results

Surveys were mailed to the 10,381 patients who were discharged home from the participating EDs during the 1-month study period, and 2,373 surveys were returned (22.9% response rate). Demographic data of survey responders are presented in Table 1.

. Characteristics of survey responders (n=2,373).

Question	n	% Total
Age (y)
<30	565	23.8
30–40	482	20.3
41–60	696	29.3
>60	565	23.8
Race
Black	224	9.4
Latin American	180	7.6
White	1,695	71.4
Other	167	7.0
Chief complaint
Abdominal pain	248	10.5
Asthma-bronchitis-emphysema	100	4.2
Chest pain

Discussion

A predictive model of patient satisfaction was previously created from the EDQS, which was a comprehensive 3-part research instrument that focused on patients with 1 of 6 chief complaints. This study validates the EDQS model in the broader setting of all patients who were discharged home from the ED, and it uses an inexpensive and reproducible mail survey methodology. With the exception of black race, the selected variables from the EDQS model were found to be significantly associated with

Acknowledgements

Author contributions: BCS, JGA, and HRB conceived this study and obtained research funding. BCS obtained IRB approval at participating institutions, oversaw data collection, and performed statistical analysis. BCS drafted the manuscript; all authors were substantially involved in manuscript revision. BCS assumes overall responsibility for the results of this study.

We thank Troyen Brennan, MD, JD (Department of Medicine, Brigham and Women’s Hospital); Alasdair Conn, MD (Division of Emergency

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^*: Author contributions are provided at the end of this article.

^**: Funding for the 2000 Harvard Affiliated Emergency Department Patient Satisfaction Survey was provided by the Harvard Risk Management Foundation. This study was supported by an Emergency Medicine Foundation/Society for Academic Emergency Medicine Medical Student Grant and a Harvard Division of Emergency Medicine Grant awarded to Dr. Sun.

^*: Address for reprints: Benjamin C. Sun, MD, MPP, Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115; 617-732-5640, fax 617-264-6848; E-mail [email protected].

View full text

Original ContributionsValidating a model of patient satisfaction with emergency care*,**,*

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Jt Comm J Qual Improv

Ann Emerg Med

Rolling down the runway: the challenges ahead for quality report cards

JAMA

A report card on HMOs

Fortune

Obstetricians’ prior malpractice experience and patients’ satisfaction with care

JAMA

A look at the relationships of parties involved in medical malpractice litigation with a view toward helping the patient

J Leg Med

Patient satisfaction as an indicator of quality care

Inquiry

Satisfaction as a determinant of compliance

Community Dent Oral Epidemiol

Perceived physician humaneness, patient attitude, and satisfaction with the pill as a contraceptive

J Health Soc Behav

Original Contributions
Validating a model of patient satisfaction with emergency care*,**,*