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Construct Overview of Satisfaction with Care

Please note that this section is an archive and is no longer being updated.

Background

Satisfaction with care is a subjective, user-assessed outcome of health care services. Satisfaction may be viewed as the fulfillment of the health care user's desires or expectations for treatment, but can be more broadly construed as the user's perception of health care quality.¹ Inclusion of the health care user's perspective in assessing overall quality of care can be justified on ethical/humanistic grounds, but may also be viewed as a marketing strategy.² Attention to the patient's experience of health care has become increasingly incorporated into outcomes measurement across health care systems in the United States in recent years.

VA Relevance

The reorganization of the VA health system in the mid-1990s accompanied a number of strategic changes to outcomes management. Along with cost and clinical outcomes, veteran satisfaction is important for VA health care services over the past decade.³ This is consistent with trends in other health systems toward more patient centered outcomes management.

Satisfaction with care may have meaningful implications for clinical outcomes. Several studies in non-VA populations have reported an association between satisfaction with care and treatment compliance,^4-5 although the direction of this relationship is unclear. However, satisfaction does appear to influence veterans' future decisions about the sources of their health care. In a study of chronically ill veterans discharged from VA hospitals, satisfaction with VA care predicted subsequent use of VA rather than non-VA health care services.⁶ Other studies indicated that dissatisfaction with VA care is associated with "dual-use" (i.e., use of both VA and non-VA services) among veteran outpatients.^7-8

Measurement

Despite several decades of research, development of instruments to measure satisfaction with care has been hampered by inconsistent or vague definitions of the construct (for review, see 9-10). Although brief, unidimensional satisfaction measures have been employed frequently, other instruments have been developed to assess satisfaction with multiple aspects of care, such as provider behavior, effectiveness of treatment, and quality of information/education. There is no clear consensus about which aspects of care most influence satisfaction ratings.⁹

The processes by which patients arrive at judgments about their health care experiences are not well understood; previous work suggests that patients do not often use specific expectations to evaluate their satisfaction with services.^2,11 Measures that directly ask respondents to rate their satisfaction with health care have been associated with favorable response biases and low variability,^12-13 limiting their sensitivity to differences across the range of patient experiences. An alternative approach is to ask the respondent to rate the quality of their health care services, particularly with regard to those domains that are believed to influence patient satisfaction. This method has been shown to yield responses with lower means and greater variability than instruments that assess satisfaction per se.¹³ However, the decision to elicit satisfaction ratings, quality evaluations, or both from the respondent is necessarily tied to the purpose for data collection.¹⁴

Satisfaction with care reflects not only the quality of health services but also certain demographic characteristics that appear to influence satisfaction independently of care-related factors (e.g., greater satisfaction is reported by older patients and by patients with better health status).^15-16 These factors may be worthy of assessment as covariates, particularly in clinically or demographically heterogeneous populations. Measurement of patient satisfaction may also be sensitive to conditions that promote socially desirable or acquiescent responding. Possible demand-related factors include self- versus interviewer-administered formatting, item wording, and the privacy and setting of survey administration.

Through literature review, METRIC identified two commonly used self-report instruments for measuring satisfaction with care. These are ranked according to number of citations, as determined by the ISI Web of Knowledge.¹⁷ What follows is a brief summary of each instrument and three applicable references.

Most Frequently Cited Instruments

1. Visit-Specific Satisfaction Questionnaire (VSQ-9)
   [217 Citations]
2. Picker Patient Experience Questionnaire (PPEQ)
   [179 Citations]

1. Donabedian A. The quality of care: How can it be assessed? JAMA 1988; 260(2): 1743-1748. [Abstract]
2. Ross CK, Steward CA, Sinacore JM. The importance of patient preferences in the measurement of health care satisfaction. Med Care 1993; 31(12): 1138-1149. [Abstract]
3. Perlin JB, Kolodner RM, Roswell RH. The Veterans Health Administration: Quality, value, accountability, and information as transforming strategies for patient-centered care. Am J Managed Care 2004; 10(11 Pt 2): 828-836. [Abstract]
4. Hirsh AT, Atchison JW, Berger JJ, Waxenberg LB, Lafayette-Lucey A, Bulcourf BB, et al. Patient satisfaction with treatment for chronic pain: Predictors and relationship to compliance. Clin J Pain 2005; 21(4): 302-310. [Abstract]
5. Sherbourne CD, Hays RD, Ordway L, DiMatteo MR, Kravitz RL. Antecedents of adherence to medical recommendations: Resutls from the Medical Outcomes Study. J Behav Med 1992; 15(5): 447-468. [Abstract]
6. Stroupe KT, Hynes DM, Giobbie-Hurder A, Oddone EZ, Weinberger M, Reda DJ, et al. Patient satisfaction and use of Veterans Affairs versus non-Veterans Affairs healthcare services by veterans. Med Care 2005; 43(5): 453-460. [Abstract]
7. Bean-Mayberry B, Chang CC, McNeil M, Hayes P, Scholle SH. Comprehensive care for women veterans: Indicators of dual use of VA and non-VA providers. J Am Med Womens Assoc 2004; 59(3): 192-197. [Abstract]
8. Borowsky SJ, Cowper DC. Dual use of VA and non-VA primary care. J Gen Int Med 1999; 14(5): 274-280. [Abstract]
9. Avis M, Bond M, Arthur A. Satisfying solutions? A review of some unresolved issues in the measurement of patient satisfaction. J Adv Nurs 1995; 22: 316-322. [Abstract]
10. Sitzia J, Wood N. Patient satisfaction: A review of issues and concepts. Soc Sci Med 1997; 45(12): 1829-1843. [Abstract]
11. Peck BM, Ubel PA, Roter DL, Goold SD, Asch DA, Jeffreys AS, et al. Do unmet expectations for specific tests, referrals, and new medications reduce patients' satisfaction? J Gen Int Med 2004; 19(11): 1080-1087. [Abstract]
12. Minnick A, Young WB, Roberts MJ. 2,000 patient relate their hospital experiences. Nurs Manage 1995; 26(12): 25. [Abstract]
13. Ware JE, Hays RD. Methods for measuring patient satisfaction with specific medical encounters. Med Care 1988; 26(4): 393-402. [Abstract]
14. Hudak PL, Wright JG. The characteristics of patient satisfaction measures. Spine 2000; 25(24): 3167-3177. [Abstract]
15. Hargraves JL, Wilson IB, Zaslavsky A, James C, Walker JD, Rogers G, et al. Adjusting for patient characteristics when analyzing reports from patients about hospital care. Med Care 2001; 39(6): 635-641. [Abstract]
16. Ren XS, Kazis L, Lee A, Rogers W, Pendergrass S. Health status and satisfaction with health care: A longitudinal study among patients served by the Veterans Health Administration. Am J Med Qual 2001; 16(5): 166-173. [Abstract]
17. ISI Web of Knowledge. Accessed August 2005. Available: http://isi01.isiknowledge.com/portal.cgi/wos/.