Patient Satisfaction and Prognosis for Functional Improvement and Deterioration, Institutionalization, and Death among Medicare Beneficiaries Over Two Years

Publication date: Available online 30 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Hillary R. Bogner, Heather F. de Vries McClintock, Jibby E. Kurichi, Pui L. Kwong, Dawei Xie, Sean Hennessy, Joel E. Streim, Margaret G. Stineman
ObjectiveTo examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults.DesignA national representative sample with two year follow-up.SettingMedicare Current Beneficiary Survey (MCBS) from calendar years 2001-2008.ParticipantsOur study sample included 23,470 community-dwelling adults aged 65 years and older followed for two years.InterventionsNot applicable.Main Outcome Measure(s)A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activity of daily living (ADL) stage transitions, institutionalization, or death after two years, adjusting for baseline socioeconomics and health-related characteristics.ResultsOut of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2,508 (10.7% weighted) improved, 3,210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2,281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio (RRR) = 0.68, 95% confidence interval (CI): 0.54-0.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR = 0.87, 95% CI: 0.79-0.97), be institutionalized (adjusted RRR = 0.72, 95% CI: 0.56-0.92), or die (adjusted RRR = 0.86, 95% CI: 0.75-0.98).ConclusionsKnowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related healthcare disparities and the impact of ongoing policy changes among Medicare beneficiaries.



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