Patient satisfaction, preventive services, and emergency room use among African-Americans with type 2 diabetes.
ABSTRACT The aim of this study was to determine the relationship between patient satisfaction and diabetes- related preventive health care and emergency room (ER) use. We studied 542 urban African-Americans with type 2 diabetes aged > or =25 years who were enrolled in a primary carebased intervention trial to improve diabetes control and reduce adverse health events; 73% female, mean age 58 years, 35% had yearly household incomes of <$7500, and all participants had health insurance. All completed a baseline interview-administered questionnaire. Patient satisfaction was measured using a modified version (nine questions) of the Consumer Assessment of Health Plans Survey (CAHPS) and use of diabetes-related preventive health care and ER were assessed by self-report. We then followed participants for 12 months to determine ER use prospectively. In general, participants gave favorable ratings of their care; over 70% reported that they had no problem getting care, over 60% reported the highest ratings on the communication and courtesy domains, and mean ratings (0-10 scale) for personal doctor and overall health care were high (8.8 and 8.4, respectively). Using poisson regression models adjusted for age, education, and self-reported rating of health, several aspects of patient satisfaction were associated with subsequent ER use. Participants who reported that medical staff were usually helpful or that doctors and nurses usually spent enough time were 0.49 and 0.37 times, respectively, less likely to use the ER (all p < 0.05). However, few aspects of patient satisfaction were associated with better preventive services. These data suggest that greater patient satisfaction was associated with lower ER use in urban African-Americans. Whether measures to improve patient satisfaction would reduce ER use requires further prospective study.
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ABSTRACT: Purpose: Emergency department (ED) use for nonemergent conditions is associated with discontinuity of care at a greater cost. The objective of this study was to determine whether the quality of patient-provider communication and access to one's usual source of care (USC) were associated with greater nonemergent ED use. A hurdle model was employed using data from the 2007 to 2009 Medical Expenditure Panel Survey. First, a multivariate logistic regression model was used to identify factors associated with the likelihood of a nonemergent ED visit. Given that one occurrence exists, a second negative binomial model was used to establish whether patient-provider communication or access are related to the frequency of nonemergent ED use. One element of communication, patient-provider language concordance, is associated with fewer nonemergent ED visits (P < .05). Several aspects of access are related to reduced ED use for nonemergent purposes. Patients whose USC is available after hours and those who travel less than an hour to get to their USC use the ED less for nonemergent care (P ≤ .05). Enhancing primary care by expanding interpreter services and access to care after hours may reduce the demand for nonemergent ED services.The Journal of the American Board of Family Medicine 11/2013; 26(6):680-91. · 1.85 Impact Factor
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ABSTRACT: Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs.Medical Care Research and Review 07/2014; · 2.57 Impact Factor