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DM Smith, VA Ann Arbor HSR&D Center of Excellence; EA Kerr, VA Ann Arbor HSR&D Center of Excellence; SL Krein, VA Ann Arbor HSR&D Center of Excellence; RA Hayward, VA Ann Arbor HSR&D Center of Excellence

Objectives: Studies suggest that health status influences patient satisfaction, but little work has examined the influence of general versus disease specific health status measures on satisfaction. Further, patient-provider interpersonal factors have been shown to influence overall satisfaction, but the relative contribution of health status and interpersonal factors to satisfaction is unknown. Using data from a survey of diabetic veterans, our objectives were to examine 1) the association between health status and patient satisfaction using two different health status measures and 2) the relative contributions of patient-provider communication and health status to patient satisfaction.

Methods: Together with the Office of Quality and Performance, we surveyed 2000 veterans receiving diabetes care across four Veterans Integrated Service Networks in fiscal years 1998 and 1999. Diabetes severity was measured using diabetes-specific components of the Total Illness Burden Index (TIBI). Health status was measured by the Physical Function Index (PFI10) from the Short Form 36. A five-item scale from the Community Assessment Health Plan Survey (CAHPS) measured patient-provider communication (alpha=.92). Using satisfaction with overall quality as the dependent variable, we constructed two separate multiple linear regression models that examined the association between health status (PFI10 or TIBI) and overall satisfaction, controlling for gender, race, income, education, age, number of primary care visits, and out of VA care. Next, we added the patient-provider communication scale as an independent variable to the model examining the influence of the TIBI on satisfaction.

Results: 70% of eligible veterans responded to the survey (n=1314). These veterans reported low levels of physical function (PFI10 mean(SD) = 46.5(30.2), and high levels of diabetes severity (TIBI mean(SD) = 40.5(18.8)). Overall, these patients were moderately satisfied, with 65% percent reporting excellent or very good quality of care. Lower levels of physical functioning were associated with less satisfaction (p < .01), but generic physical health status (the PFI10) explained less than 1% of the variation in satisfaction (model r-squared =.02). In contrast, diabetes-specific severity was more strongly associated with lower levels of satisfaction (p < .001), with the TIBI explaining 4% of satisfaction variation (model r-squared =.05). When we added the communication scale to the model, the variation explained by the TIBI dropped to 1%. Higher communication ratings were positively associated with satisfaction (p< .001), with the communication scale explaining 38% of the variation in satisfaction.

Conclusions: In this VA diabetes population, diabetes specific disease severity explained a greater portion of the variance in satisfaction than did the general health status measure. The effect of diabetes severity was attenuated when a measure of patient-provider communication was added to the model, suggesting that patients with high disease severity may experience greater difficulty in communicating within the current care environment.

Impact: Even in a population with high average disease burden, patients with worse health status are likely to be less satisfied with their care. Nonetheless, health status and patient demographics explain a small amount of variation in satisfaction compared to measures of interpersonal care. This gives support to interventions directed at improving interpersonal care for veterans with poor health status.