Does doctor-patient communication affect patient satisfaction with hospital care? Results of an analysis with a novel instrumental variable.

OBJECTIVE To determine the relationship between physicians' communication behaviors and patients' overall satisfaction with hospital care using a novel instrumental variable to address possible confounding of this association by patient attributes. DATA SOURCES/STUDY SETTING Administrative records and postdischarge survey data were obtained from patients discharged from the General Medicine service at an urban tertiary-care academic hospital between July 1, 1997 and June 30, 2000. Administrative data included comorbidities, demographic data, and payer status. In the discharge survey, patients rated their attending physician on four communication behaviors, other aspects of their hospital stay, and their overall hospital care. STUDY DESIGN The primary outcome was patients' ratings of their overall satisfaction with hospital care, and the primary independent variable was patients' ratings of their physicians' communication behaviors. To remove possible confounding of the association between patient ratings of physician communication and overall satisfaction by other patient-specific attributes, we created an instrumental variable (IV) in a two-stage linear regression. The IV was the mean of the communication ratings given to each physician by the other patients cared for by that physician. PRINCIPLE FINDINGS/CONCLUSIONS: Three thousand one hundred and twenty-three patients were included in the analysis. In the ordinary least squares regression, there was a significant positive relationship between overall satisfaction and overall ratings of attendings' communication behaviors, with an increase in overall satisfaction of 0.58 points on a 5-point scale for each 1-point increase in overall attendings' communication behaviors, p<.001. This relationship was maintained but attenuated in the IV regression, with a coefficient of 0.40, p=.046. Although we find that the relationship between patient communication ratings and overall patient satisfaction may be confounded by patient-level factors, we nevertheless continue to find evidence of a statistically significant and sizable relationship between physicians' communication behaviors and overall patient satisfaction after controlling for such factors.

[1]  P D Cleary,et al.  What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics , 2003, Journal of medical ethics.

[2]  T Chandola,et al.  Patients’ experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care , 2002, Quality & safety in health care.

[3]  J. Benson,et al.  Evaluation of humanistic qualities in the internist. , 1983, Annals of internal medicine.

[4]  B. Bloom.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2002 .

[5]  J. Stock,et al.  Instrumental Variables Regression with Weak Instruments , 1994 .

[6]  J. Jollis,et al.  Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. , 1993, Journal of clinical epidemiology.

[7]  J. Newhouse,et al.  Overview of the special supplement issue. , 2000, Health services research.

[8]  W H Rogers,et al.  Patients' ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study. , 1993, JAMA.

[9]  J. Dale,et al.  Doctor-patient communication and patient satisfaction: a review. , 1998, Family practice.

[10]  E. Vermeire,et al.  Patient adherence to treatment: three decades of research. A comprehensive review , 2001, Journal of clinical pharmacy and therapeutics.

[11]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[12]  P. A. Clark,et al.  Inpatient Heart Failure Treatment From the Patient's Perspective , 2004, Quality management in health care.

[13]  R. Kleinpell,et al.  What influences patients' reports of three aspects of hospital services? , 1997, Medical care.

[14]  R. Deyo,et al.  Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. , 1992, Journal of clinical epidemiology.

[15]  Hidehiko Ichimura,et al.  Identification and estimation of polynomial errors-in-variables models , 1991 .

[16]  K. Elliott,et al.  Hospital patient satisfaction: correlates, dimensionality, and determinants. , 1993, Journal of hospital marketing.

[17]  A. Rademaker,et al.  The cost of efforts to improve quality. , 1999, Medical care.

[18]  J. Newhouse,et al.  Econometrics in outcomes research: the use of instrumental variables. , 1998, Annual review of public health.

[19]  P. Cleary,et al.  Patients evaluate their hospital care: a national survey. , 1991, Health affairs.

[20]  W. Tierney,et al.  Correlates of health care satisfaction in inner-city patients with hypertension and chronic renal insufficiency. , 1995, Social science & medicine.

[21]  N Wood,et al.  Response rate in patient satisfaction research: an analysis of 210 published studies. , 1998, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[22]  H. Rubin.  Patient evaluations of hospital care. A review of the literature. , 1990, Medical care.

[23]  A. Feinstein,et al.  A new instrument for patients’ ratings of physician performance in the hospital setting , 2007, Journal of General Internal Medicine.

[24]  J. Hausman.  Mismeasured Variables in Econometric Analysis: Problems from the Right and Problems from the Left , 2001 .

[25]  M. Stewart.  Effective physician-patient communication and health outcomes: a review. , 1995, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.